Evaluation of reconstructed auricles by convolutional neural networks.

The difficulty in determining which structures are crucial to ensure a natural-looking ear has been plaguing surgeons for many years. This preliminary study explores the feasibility of training convolutional neural network (CNN) models to evaluate a reconstructed auricle as accurate as a human would. By visualizing the attention of trained models, the criteria for the design of a natural-looking auricle can be established. A total of 400 pictures were evaluated by 20 volunteers, and 20 labeled datasets were generated, which were then used to train ResNet models that had been pre-trained on ImageNet. The saliency maps and occlusion maps of each trained model were calculated to capture the attention of models. The average accuracy of the 20 models was 0.8245 ± 0.0356 (>0.80), and the evaluation results of the trained model and the medical student showed a significant correlation (P < 0.05). For the attention visualization of auricles labeled as normal, distribution of the highlighted portions corresponded to a linear contour of the helix, the inferior crura of the antihelix, and the contour of the concha. A CNN can provide an evaluation of a reconstructed auricle in a manner similar to that of a medical student. Saliency maps generated by the CNN demonstrate the subjective view, which was consistent with professional opinion.

Comparison of Two Surgical Epilation Procedures Based on the Nagata Method in All Degrees of Low Hairline Microtia.

Background: Various methods exist to manage unwanted hair in low hairline microtia. We present our 10-year experience that compares the two procedures toward all degrees of low hairline microtia. Methods: The tongue-shaped split-thickness skin graft procedure (modified Chen's procedure) and the modified Nagata procedure were used for ear reconstruction in 42 microtia patients with three degrees of low hairlines from 2010 to 2020. Hair follicles in the low hairline area were removed free-hand, and the removed area was replaced with extended temporoparietal fascia (TPF) flap during the ear elevation. The satisfaction score and the clearance percentages of the hair were used as outcome measures. Results: There was no significant difference in satisfaction scores and the hair clearance percentages of hair between two procedures (p > 0.05) and among three degrees of low hairline (p > 0.05), respectively. Although the complication rate showed no significant difference, the major types of complication in modified Chen's procedure was fluid accumulation (9.52%), whereas in modified Nagata procedure was hypertrophic scar (4.76%). Conclusion: Patients with low hairlines can be treated using two different microtia reconstruction techniques to limit hair growth on the new ear. The rib graft construct is covered by a TPF flap, which is then grafted with an ultrathin skin graft and shows benefit in this review of our 10-year experience. Clinical Trial Registration Information Provided: Registration no. and date registered: ChiCTR2000030214.

TGF-ß-activated kinase-1: a potential prognostic marker for clear cell renal cell carcinoma.

BACKGROUND: TGF-ß-activated kinase-1 (TAK1) has been found to be over-expressed in a variety of solid malignancies and related to tumor growth. The aim of this study was to evaluate the expression level of TAK1 in clear cell renal cell carcinoma (ccRCC) and assess its value as a novel prognostic marker. METHODS: TAK1 mRNA was assessed in 51 paired ccRCC tissues and adjacent normal tissues (ADTs) by real-time PCR. Tissue TAK1 protein was also assessed in 91 ADTs and 177 samples of ccRCC immunohistochemically for evaluation of relationships with clinical characteristics. RESULTS: RT-PCR showed that TAK1 RNA level was significantly higher in ccRCC tissues than in the paired ADTs and immunohistochemistry confirmed higher expression of TAK1 protein in ccRCC samples compared with ADTs. TAK1 protein expression in 177 ccRCC samples was significantly correlated with T stage, N classification, metastasis, recurrence and Fuhrman grade, but not age and gender. Patients with low TAK1 levels had a better survival outcome. TAK1 expression and N stage were independent prognosis factors for the overall survival of ccRCC patients. CONCLUSIONS: Overexpression of TAK1 predicts a poor prognosis in patients with ccRCC, so that TAK1 may serve as a novel prognostic marker.

Development of neonatal mouse and fetal human testicular tissue as ectopic grafts in immunodeficient mice.

AIM: To investigate the stepwise development and germ cell gene expression in allografted neonatal mouse testes and the differentiation of immature human testicular cells in xenografted human testes. METHODS: Immunodeficient nude mice were used as hosts for allografting of neonatal mouse testes and xenografting of human fetal testicular tissues. Stepwise development and stage-specific gene expression of germ cells in allografts were systematically evaluated and parallel compared with those in intact mice by periodically monitoring the graft status with measurement of graft weight, histological analysis and determination of five stage-specific genes. Human testicular tissues from 20 and 26 weeks fetuses were used for the xenografting study. Histological analysis of xenografts was performed 116 and 135 d after the grafting procedure. RESULTS: In the allografting study, progressive increase in tissue volume and weight as well as in tubule diameter in grafts was observed; the appearance time of various germ cells in seminiferous tubules, including spermatogonia, spermatocytes, round and elongate spermatids and sperm, was comparable with that in intact donors; the initiation of gene transcription in grafts showed a similar trend as in normal mice. Graft weight ceased to increase after 7-8 weeks and degradation of grafts was observed after 5 weeks with progressive damage to seminiferous epithelium. In the xenografting study using immature human testicular tissues, graft survival and development was indicated by increasing graft weight, Sertoli cells differentiation into advanced stage, germ cells migration and location to the basal lamina and formation of a niche-like structure. CONCLUSION: The developmental course and gene expression pattern of germ cells in allografts were similar to those in intact mice. The best time point for retrieval of mouse sperm from grafts was 5-7 weeks after grafting procedure. An accelerated development of immature human testicular cells could be achieved by ectopic xenografting of human testes.