The recombinant adenovirus Toll like receptor 4 (TLR4) shRNA vector (pGSadeno-TLR4) was constructed and transfected into human aortic vascular smooth muscle cells (HA-VSMC).After HA-VSMC were treated with palmitate or different signaling pathway inhibitors,the mRNA and protein levels of interleukin-6 (IL-6)and NF-κB activity were tested with real-time PCR and ELISA,respectively.The results showed that palmitate increased mRNA and protein levels of IL-6 in HA-VSMC in a dose-dependent manner.The expression of IL-6 mRNA reached peak after treatment with 400 μmol/L of palmitate for 6 h,being 10.43 fold of control (P＜0.01).Treatment with 400 pmol/L of palmitate for 24 h maximally upregulated the protein level of IL-6,which was 2.18 fold of control (P＜0.01).NF-κB inhibitor parthenolide markedly inhibited palmitate-stimulated increased in IL-6 mRNA level by 65％ and protein level by 59％ (both P＜0.01).Protein kinase C (PKC) inhibitor chlerythrine suppressed palmitateinduced IL-6 mRNA expression by 24％ and IL-6 protein level by 28％.By contrast,extracellular signal-regulated protein kinase inhibitor PD98059 and phosphatidylinositol 3-kinase inhibitor wortmannin had no effect on the induction of IL-6 by palmitate.Blockade of TLR4 with pGSadeno-TLR4 significantly suppressed palmitate-induced IL-6 mRNA expression by 72％ and IL-6 protein expression by 75％ (both P＜0.01),along with decrease of NF-κB p65 activity decreased by 62％.These results suggest that TLR4/NF-κB and PKC pathways mediate palmitate-induced IL-6 expression in HA-VSMC.

Objective: To sum up the repair techniques of secondary alar deformity after the first phase reconstruction of alar defect. Methods: From January 2010 to December 2017, 17 patients with secondary alar deformity were included. Secondary alar deformities after the first stage reconstruction of alar defect included the abnormalities of alar groove line, absence of alar-cheek groove and the notch of alar rim. Z-plasty, V-Y advanced flaps, local skin flap and other technologies were introduced to repair details. Results: Infection was found in one case of the reconstruction of the alar-cheek groove and the wound was healed by treatment. There was no necrosis occurred in other flap. The shape of the alar was satisfactory and the anterior nostril was not narrow. Patients were followed up for 1 month to 1 year. The average follow-up time was 5 months. No recurrence of nasal alar tumor was found. The patients were satisfied with the appearance. Conclusions The symmetrical and satisfactory nasal shape can be obtained with local flaps such as Z-plasty, V-Y advancement of flaps for secondary alar deformities.

Objective:To discuss the application of free double-layered auriclar composite tissue flap (auriclar cartilage and the skin) in repairing the full-thickness nasal alar defects.Methods:The clinical data of the patients with unilateral full-thickness nasal alar defects who were admitted to the Department of Plastic Surgery of Sichuan Provincial People’s Hospital from June 2016 to December 2019 were analyzed. The free double-layered auricular composite grafts were harvested from the unilateral nasal cavity as the nasal lining and covered with pedicled skin flap. The survival of free double-layered auricular composite grafts and pedicled skin flap as well as the appearance of the reconstructed nasal alar were observed.Results:A total of 12 patients with unilateral full-thickness alar defect were included, including 4 females and 8 males, aged from 6 to 53 years old, with an average of 35.3 years old. The areas of the defects were 0.7 cm × 1.0 cm-2.0 cm × 2.6 cm, and the areas of double-layered auricular composite grafts(skin) were 0.8 cm × 1.0 cm-2.1 cm × 2.7 cm. All the 12 patients healed primarily. No necrosis or infection occurred in the double auricle composite tissue flap and pedicled skin flap. After the completion of the whole treatment, the reconstructed nasal alar with similar shape and function to the normal nasal alar was obtained. After the last operation, the patients were followed up for 3 months to 32 months, with an average of 15 months.Conclusions:The free double-layered auricular composite grafts breaks the area limitation of free transplantation of full-layer auricle composite tissue flap. The combined grafting with pedicled flap shortens the treatment duration with skin flap alone, and it is easier to obtain vivid nasal alar.

Objective: To study the effect of individualized treatment of prominent ears using mattress suture combined tubed cartilage method. Methods: A total of 21 patients (28 ears) with prominent ear deformity were retrospectively analyzed from January 2013 to December 2015. Horizontal mattress suture and tubed cartilage were used to correct the deformed ears. The patients were followed up for 6 months to 1 year (mean: 9 months). Results: Hematoma occurred in 3 cases after operation, but the wounds were healed after removal of hematoma. No infection, flap necrosis, cartilage absorption or deformation, or other complications occurred. 28 ears were corrected. The shape of the antihelix was smooth and the auriculocephalic angle and scapha-conchal angle were significantly reduced, compared with preoperative. No obvious scar hypertrophy was left on incision. Conclusions The method of horizontal mattress suture combined with tubed cartilage is simple to use for prominent ear, result in satisfactory and stable outcomes.

Objective:To investigate the clinical application and effect of orbicularis oculi muscle shaping in lower blepharoplasty.Methods:A retrospective analysis was performed on the clinical data of 32 cases of flabby blepharoplasty patients admitted to the Orthopedic Surgery Clinic of Sichuan people＇s Hospital from October 2018 to September 2019. At the same time of transcutaneous blepharoplasty, 32 patients were treated with orbicularis oculi muscle shaping to remove the relaxed orbicularis oculi muscle, to reconstruct the annular strength and shape of the orbicularis oculi muscle, to strengthen the supporting structure of the lower eyelid, to reset the relationship between the external canthus orbicularis muscle and the skin, and then to reconstruct the soft tissue filling degree of the lower eyelid margin. The safety, efficacy and stability of the operation were evaluated by Barton grading, postoperative complications and scoring before and after operation and satisfactory analysis based on patients＇ satisfaction scale after operation.Results:All the patients were free of postoperative infection and healed at stage I. There were 2 cases of ecchymosis, 3 cases of ocular foreign body sensation, and no cases of infection, lower eyelid retraction, lower eyelid ectropion, or retrobulbous hematoma. The mean Barton score of all patients before surgery was 1.88±0.49, and the mean Barton score after surgery was 0.53±0.51. The t-test showed that the difference was statistically significant ( t=15.75, P<0.05), and the postoperative lacrimal groove deformity was improved. According to the score of satisfaction scale, 7 people were basically satisfied (21.88%) and 25 people were very satisfied (78.12%). Conclusions:Forming in the orbicularis oculi muscle relaxation eyelid bag type of prosthesis, in addition to the part of the orbicularis oculi muscle relaxation, deformation, and widely shed canthus outside skin and orbicularis connection, make the next eyelid edge to reproduce the full shape, obviously the bulging under the eyelid relaxation, the shape of the degree of repair, lateral canthus wrinkles tail department have also improven, restoring the full eyelid platform. The operation has strong pertinence, simple procedures, less complications and better long-term effect.

Objective:To explore an optimal surgical approach for different types of labia minora hypertrophy and to design a better personalized surgical treatment plan for patients.Methods:From October 2017 to October 2020, 71 patients with labia minora hypertrophy were treated in the plastic surgery department of Sichuan Provincial People＇s Hospital, aged 18-38 years, with an average of 26 years. According to the type and degree of hypertrophy, the appropriate surgical method was selected. The wound healing and complications were observed after operation, and the shape of labia minora was followed up.Results:Among the 71 patients, 1 patient had postoperative hematoma and no flap necrosis after active treatment. 1 patient had poor healing of distal labia minora incision and improved after dressing change. The other patients had good blood supply of labia minora, no necrosis, no postoperative infection, hematoma and other complications. The patients were followed up for 1-6 months. The appearance of labia minora was natural, bilateral symmetry, and the incision scar was hidden. The improvement was significant compared with that before operation. The patients were satisfied with the shape and function.Conclusions:According to the degree of hypertrophy of the labia minora, the specific shape and the psychological expectation of patients, we can choose the appropriate operation method, which can achieve the aesthetic standard of symmetry and beautiful shape of the labia minora, and meet the normal physiological function and aesthetic requirements of patients.

Objective:The mechanical properties of costal cartilage of different genders and layers were tested, and the differences in mechanical properties of costal cartilage of different genders and layers were discussed. The theoretical basis was provided for the clinical use of costal cartilage of different layers in different situations, and the long-term effect after cartilage implantation could be predicted.Methods:According to the inclusion criteria, from June 2018 to December 2019, patients who receive dauricle reconstruction with costal cartilage or supporting treatment with costal cartilage were collected from the Inpatient and Outpatient Department of Plastic Surgery of Sichuan Provincial People’s Hospital. The remaining central and marginal layers of the seventh costal cartilage were made into different sizes of cartilage blocks. The tensile strength test and compression test (including creep test and stress relaxation test) were carried out respectively. The counting data were described by the number of cases, and Fisher exact test was used to analyze the differences between groups; the measurement data were expressed by mean ± standard deviation, and the comparison between groups was analyzed witht-test.Results:A total of 28 patients, including 16 males, aged 12-24 years old and 12 females, aged 12-18 years old, were collected. In the tensile strength test, the tensile fracture rate of the central layer of costal cartilage in male was 87.5% (14 / 16) and that of marginal layer was 0, the difference was statistically significant ( P< 0.001). The tensile fracture rate of central layer of costal cartilage in female was 83.3% (10 / 12), and that of marginal layer was 0, the difference was statistically significant ( P< 0.001). In the creep test, there was no significant difference between the central layer and the marginal layer between 0.5 min and 2 min in men ( t=-1.439, P= 0.171), and there was no significant difference between the central layer and the marginal layer in women ( t=-0.731, P=0.480). In the stress relaxation test, there was no significant difference between the central layer of costal cartilage and the marginal layer in male ( t=-2.053, P=0.058); in female, the stress relaxation in the central layer of costal cartilage was (0.006 ± 0.003)%, and that in the marginal layer was (0.011 ± 0.004)%, which was significantly higher than that in the central layer ( t=-3.342, P=0.007). Conclusions:The central layer of the costal cartilage in young people is worse than the marginal layer in tensile strength, and the calcification obviously weakens the tensile strength of the costal cartilage. Clinically, considering the calcification of the cartilage, the appropriate layer should be selected according to different parts and uses.

Objective:To discuss the application of free two-layered auriclar composite tissue flap (consisted of auriclar cartilage and the anterior skin) in repairing the full-thickness nasal alar defects.Methods:To analyze the clinical data of patients with unilateral full-thickness nasal alar defect admitted to the plastic surgery department of Sichuan Provincial People's Hospital from June 2016 to December 2019. One side of the concha was excised from the nasal cavity with free two-layered auricular composite grafts as the nasal lining and covered with pedicled skin flap. The survival of free two-layered auricular composite grafts, pedicled skin flap and nasal alar reconstruction were observed.Results:A total of 12 patients with unilateral full-thickness alar defect were included, including 4 females and 8 males, aged from 6 to 53 years, with an average of 35.3 years. The area of lining defect was 0.7 cm × 1.0 cm~2.0 cm × 2.6 cm, and the area of two-layered auricular composite grafts(skin) was 0.8 cm × 1.0 cm~2.1 cm × 2.7 cm. All the 12 patients healed in the first stage. No necrosis or infection occurred in the double auricle composite tissue flap and pedicled skin flap. After the completion of the whole treatment cycle, the reconstructed nasal alar with similar shape and function to the normal nasal alar was obtained. After the last operation, the patients were followed up for 3 months to 32 months, with an average of 12 months.Conclusions:The two-layered auricular composite grafts breaks through the area limitation of free transplantation of full-layer auricle composite tissue flap; the combined transplantation with pedicled flap shortens the treatment cycle of skin flap alone, and it is easier to obtain realistic nasal alar.

Objective:To discuss the application of free double-layered auriclar composite tissue flap (auriclar cartilage and the skin) in repairing the full-thickness nasal alar defects.Methods:The clinical data of the patients with unilateral full-thickness nasal alar defects who were admitted to the Department of Plastic Surgery of Sichuan Provincial People’s Hospital from June 2016 to December 2019 were analyzed. The free double-layered auricular composite grafts were harvested from the unilateral nasal cavity as the nasal lining and covered with pedicled skin flap. The survival of free double-layered auricular composite grafts and pedicled skin flap as well as the appearance of the reconstructed nasal alar were observed.Results:A total of 12 patients with unilateral full-thickness alar defect were included, including 4 females and 8 males, aged from 6 to 53 years old, with an average of 35.3 years old. The areas of the defects were 0.7 cm × 1.0 cm-2.0 cm × 2.6 cm, and the areas of double-layered auricular composite grafts(skin) were 0.8 cm × 1.0 cm-2.1 cm × 2.7 cm. All the 12 patients healed primarily. No necrosis or infection occurred in the double auricle composite tissue flap and pedicled skin flap. After the completion of the whole treatment, the reconstructed nasal alar with similar shape and function to the normal nasal alar was obtained. After the last operation, the patients were followed up for 3 months to 32 months, with an average of 15 months.Conclusions:The free double-layered auricular composite grafts breaks the area limitation of free transplantation of full-layer auricle composite tissue flap. The combined grafting with pedicled flap shortens the treatment duration with skin flap alone, and it is easier to obtain vivid nasal alar.

Objective:The mechanical properties of costal cartilage of different genders and layers were tested, and the differences in mechanical properties of costal cartilage of different genders and layers were discussed. The theoretical basis was provided for the clinical use of costal cartilage of different layers in different situations, and the long-term effect after cartilage implantation could be predicted.Methods:According to the inclusion criteria, from June 2018 to December 2019, patients who receive dauricle reconstruction with costal cartilage or supporting treatment with costal cartilage were collected from the Inpatient and Outpatient Department of Plastic Surgery of Sichuan Provincial People’s Hospital. The remaining central and marginal layers of the seventh costal cartilage were made into different sizes of cartilage blocks. The tensile strength test and compression test (including creep test and stress relaxation test) were carried out respectively. The counting data were described by the number of cases, and Fisher exact test was used to analyze the differences between groups; the measurement data were expressed by mean ± standard deviation, and the comparison between groups was analyzed witht-test.Results:A total of 28 patients, including 16 males, aged 12-24 years old and 12 females, aged 12-18 years old, were collected. In the tensile strength test, the tensile fracture rate of the central layer of costal cartilage in male was 87.5% (14 / 16) and that of marginal layer was 0, the difference was statistically significant ( P< 0.001). The tensile fracture rate of central layer of costal cartilage in female was 83.3% (10 / 12), and that of marginal layer was 0, the difference was statistically significant ( P< 0.001). In the creep test, there was no significant difference between the central layer and the marginal layer between 0.5 min and 2 min in men ( t=-1.439, P= 0.171), and there was no significant difference between the central layer and the marginal layer in women ( t=-0.731, P=0.480). In the stress relaxation test, there was no significant difference between the central layer of costal cartilage and the marginal layer in male ( t=-2.053, P=0.058); in female, the stress relaxation in the central layer of costal cartilage was (0.006 ± 0.003)%, and that in the marginal layer was (0.011 ± 0.004)%, which was significantly higher than that in the central layer ( t=-3.342, P=0.007). Conclusions:The central layer of the costal cartilage in young people is worse than the marginal layer in tensile strength, and the calcification obviously weakens the tensile strength of the costal cartilage. Clinically, considering the calcification of the cartilage, the appropriate layer should be selected according to different parts and uses.