Purpose: Cavernous nerve injury induced erectile dysfunction (ED) is a refractory complication with high incidence in person under radical prostatectomy. Studies have shown that relaxin-2 (RLX-2) plays a vital role of endothelial protection, vasodilation, anti-fibrosis and neuroprotection in a variety of diseases. However, whether penile cavernous erection can benefit from RLX-2 remains unknown. The purpose of the experiment was to explore the effects of RLX-2 on ED in the rat suffering with bilateral cavernous nerve injury (BCNI). Materials and Methods: The rats were divided into three groups: Sham group was underwent sham operation, BCNI+RLX group or BCNI group was underwent bilateral cavernous nerve crush and then randomly treated with RLX-2 (0.4 mg/kg/d) or saline by continuous administration using a subcutaneously implanted micro pump for 4 weeks respectively. Then, erectile function was evaluated by electrical stimulation of cavernous nerves. Cavernous nerves and penile tissues and were collected for histological evaluation. Results: Erectile function of rats with BCNI was partially improved after RLX-2 treatment. The BCNI group had lower expression of relaxin family peptide receptor (RXFP) 1, p-AKT/AKT, p-eNOS/eNOS ratios than sham operation rats, but RLX-2 could partially reversed these changes. Histologically, the BCNI+RLX group had a significant effect on preservation of neurofilament, neuronal glial antigen 2 of penile tissue and nNOS of cavernous nerves when compared with BCNI group. RLX-2 could inhibited the lever of BCNI induced corporal fibrosis and apoptosis via regulating TGFβ1-Smad2/3-CTGF pathway and the expression of Bax/Bcl-2 ratio, caspase3. Conclusions RLX-2 could improve erectile function of BCNI rats by protecting cavernous nerve and endothelial function and suppressing corporal fibrosis and apoptosis via RXFP1 and AKT/eNOS pathway. Our findings may provide a promising treatment for refractory BCNI induced ED.

Objective:To compare the pros and cons of harvesting ear cartilage through anterior and posterior auricular approaches during rhinoplasty.Methods:From January 2017 to December 2018, 63 patients with otochondral rhinoplasty in our hospital were enrolled in this study, 60 were female and 3 were male; the average age was 31.6 years (range, 18 to 43) . They were randomly divided into anterior auricular approach group with 32 cases (64 sides) and posterior auricular approach group with 31 cases (62 sides). Surgical duration, complications and postoperative scar of the two methods were analyzed.Results:The average time for harvesting the ear cartilage through posterior auricular approach and anterior auricular approach was (20.8±1.7) min and (12.6±1.1) min, respectively ( P<0.01). The overall complication rate was 15.6% for posterior auricular approach group and 4.8% for anterior auricular approach group. The wound healed well in both groups, and there was no significant difference in postoperative scar between the two groups during an average 13 months follow-up period. Conclusions:While both the anterior and the posterior auricular approaches present with similar inconspicuous scarring, the use of anterior auricular approach alone to harvest ear cartilage during rhinoplasty provides both the surgeons and the patients with easier access, shorter surgical duration, and fewer complications. Hence, we believe that the anterior auricular approach possesses greater advantages than the posterior auricular approach.

Objective:To explore the classification and treatment strategies of developmental breast asymmetry (DBA).Methods:A retrospective study was conducted in adult female patients with developmental breast asymmetry deformity who underwent surgery between January 2005 to June 2019 in the Plastic Surgery Department of Peking Union Medical College Hospital. According to different clinical manifestations, DBA was divided into three types which adopted to different surgical strategies. Postoperative complications and patient satisfaction were evaluated.Results:A total of 203 patients were included in the study; 42.36% (86 cases) were type Ⅰ, 31.03% (63 cases) were type Ⅱ and 26.60% (54 cases) were type Ⅲ. The number of follow-up patients accounted for 79.3% (161/203). The mean follow-up time was 9 months. There were one case of poor healing of the axillary incision in latissimus dorsi muscle flap, two cases of seroma, five cases of Baker grade Ⅰ capsule contracture, two cases of Baker grade Ⅱ capsule contracture and one cases of small nodules in autologous fat breast augmentation. With regard to patient satisfaction, 80.1% (129 cases) felt satisfied with the aesthetic results, 15% (24 cases) felt good, 3.7%. (6 cases) felt average and 1.2% (2 cases) felt unsatisfied.Conclusions:This study shows that the clinical manifestations of DBA are varied, and our classification method is an effective and useful tool to guide the surgical treatment. Individualized surgical design is essential for aesthetical results.

The TEA domain (TEAD) family proteins (TEAD1‒4) are essential transcription factors that control cell differentiation and organ size in the Hippo pathway. Although the sequences and structures of TEAD family proteins are highly conserved, each TEAD isoform has unique physiological and pathological functions. Therefore, the development and discovery of subtype selective inhibitors for TEAD protein will provide important chemical probes for the TEAD-related function studies in development and diseases. Here, we identified a novel TEAD1/3 covalent inhibitor (DC-TEADin1072) with biochemical IC

Objective:To investigate the effect of mechano-growth factor（MGF）on osteoclast activity and its mechanism.Methods:The RAW264.7 precursor osteoclast cell line was cultured with 25 ng/ml macrophage-colony stimulating factor（M-CSF）and 30 ng/ml receptor activator of NF-κB ligand（RANKL），and identified by tartrate resistant acid phosphatase（TRAP）staining after 7 days of culture. Western blot anslysis was used to determine the effect of 45 ng/ml MGF on the phosphoinositide-3-kinase/protein kinase B（PI3K/AKT）signaling pathway in separated osteoclasts，including levels of AKT，phosphorylation（p）-AKT，lactation mammalian target of rapamycin（mTOR），p-mTOR and TRAP at 0，4，8 and 12 hours. Real-time fluorescence quantitative PCR was used to expressions of TRAP in osteoclasts at 0，4，8 and 12 hours. The PI3K/Akt phosphorylation inhibitor LY294002（20 μmol/L）combined with MGF（45 ng/ml）was used to act on osteoclasts，and expression levels of Akt，p-Akt，mTOR，p-mTOR and TRAP were detected by Western blot at 0，4，8 and 12 hours.Results:After culturing RAW264.7 cells with M-CSF and RANKL for 7 days，a large number of osteoclasts with positive TRAP staining can be obtained. Western blot analysis showed expression levels of Akt and mTOR did not change significantly over time（ P>0.05），expression levels of p-Akt and p-mTOR increased continuously from（2.18±0.34）pg/ml and（0.83±0.10）pg/ml at 0 hour to（3.86±0.36）pg/ml and（1.56±0.19）pg/ml at 12 hours（ P<0.05），and expression level of TRAP decreased significantly over time，from（5.66±0.47）pg/ml at 0 hour to（3.76±0.38）pg/ml at 12 hours（ P<0.05）. Real-time fluorescence quantitative PCR analysis of expression of TRAP in osteoclasts showed that MGF inhibited the expression of TRAP in osteoclasts，which decreased from 1.02±0.06 at 0 hour to 0.53±0.11 at 12 hours（ P<0.05）. After acting LY294002 combined with MGF on osteoclasts，Western blot analysis showed expression levels of Akt and mTOR did not change significantly over time（ P>0.05），expression levels of p-AKT and p-mTOR decreased significantly from（3.28±0.18）pg/ml and（3.29±0.22）pg/ml at 0 hour to（2.06±0.34）pg/ml and（2.04±0.20）pg/ml at 12 hours（ P<0.05），and expression level of TRAP had no significant difference over time（ P>0.05）. Conclusions:MGF inhibits osteoclast activity by inhibiting the expression of TRAP in osteoclasts through PI3K/Akt signaling pathway. LY294002 inhibits the expression of PI3K/Akt signaling pathway in osteoclasts，further verifying the mechanism of MGF inhibiting osteoclast activity，and this finding puts forward new ideas for clinical prevention and treatment of osteoporosis.

Objective To investigate the effect of medial collateral ligament (MCL) repair and coronoid process fracture fixation on stability of the Terrible Triad of the elbow. Methods CT and MRI scan images of elbow joints from one healthy 28-year-old male volunteer were used to establish three elbow models. Model A: normal model. Model B: repair of coronoid process fractures, without MCL repair. Model C: repair of MCL, without repair of ulnar coronoid processes. Longitudinal loads were applied on the three models to analyze the displacement and stress distributions of the elbow joint under different working conditions and compare the stability of the elbow joint. Results The displacement and stress distributions of the three models were similar. The maximum displacement and maximum stress of the articular surface were located at the ulna pulley notch, while the minimum displacement was located at the coronoid process and its medial side. The minimum stress was located at the lower lateral side of the coronoid process. There were no statistical differences in the maximum displacement and stress among the three models (P>0.05). Conclusions When the lateral column is stable, the effect of repairing the MCL and fixing the fracture block of ulnar coronoid process is similar.

Objective:The purpose of this study was to observe the anatomical features in the area of forehead and further to discuss precautions of forehead autologous fat injection.Methods:A total of 12 fresh adult cadaveric specimens (6 males and 6 females, 47.5±11.7 years old) were studied during January 2018 to December 2018. Combined with routine anatomy and microanatomy, forehead tissues were dissected to observe important structures and their surroundings. The important blood vessels and tissues thickness were measured by electronic vernier caliper.Results:The forehead is composed of skin, subcutaneous adipose tissue, superficial musculoaponeurotic system(SMAS), loose connective tissue and periosteum. There are three superficial fat compartments. The width and length of superficial central forehead compartments is(2.17±0.27) cm and(4.16±0.38) cm. The width and length of left superficial lateral forehead compartments is(2.09±0.31) cm and(3.65±0.39) cm and right superficial lateral forehead compartments is(2.14±0.29) cm and(3.18±0.55) cm. The three deep fat compartments shape is similar to superficial fat compartments. It is an avascular layer.Retro-orbicularis oculi fat lies deep to the supraorbital area with the thickness is (2.58±0.03) mm and the length is (2.55±0.05) mm. The blood supply of forehead is provided by the supratrochlear artery, the superaorbital artery and the superficial temporal artery with internal diameters of (1.01±0.16) mm, (0.85±0.12) mm and (1.35±0.15) mm, respectively.Conclusions:Forehead autologous fat transfer should be injected into the avascular forehead deep fat compartments. Avoiding injected into superficial fat compartments to avoid unnatural mask face. Because there are potential channels in the superficial central fat compartments and the area of the upper eyelid, it should be avoided to form periorbital migratory fat granuloma caused by postoperative acupressure.

Objective:The purpose of this study was to observe the anatomical features in the area of forehead and further to discuss precautions of forehead autologous fat injection.Methods:A total of 12 fresh adult cadaveric specimens (6 males and 6 females, 47.5±11.7 years old) were studied during January 2018 to December 2018. Combined with routine anatomy and microanatomy, forehead tissues were dissected to observe important structures and their surroundings. The important blood vessels and tissues thickness were measured by electronic vernier caliper.Results:The forehead is composed of skin, subcutaneous adipose tissue, superficial musculoaponeurotic system(SMAS), loose connective tissue and periosteum. There are three superficial fat compartments. The width and length of superficial central forehead compartments is(2.17±0.27) cm and(4.16±0.38) cm. The width and length of left superficial lateral forehead compartments is(2.09±0.31) cm and(3.65±0.39) cm and right superficial lateral forehead compartments is(2.14±0.29) cm and(3.18±0.55) cm. The three deep fat compartments shape is similar to superficial fat compartments. It is an avascular layer.Retro-orbicularis oculi fat lies deep to the supraorbital area with the thickness is (2.58±0.03) mm and the length is (2.55±0.05) mm. The blood supply of forehead is provided by the supratrochlear artery, the superaorbital artery and the superficial temporal artery with internal diameters of (1.01±0.16) mm, (0.85±0.12) mm and (1.35±0.15) mm, respectively.Conclusions:Forehead autologous fat transfer should be injected into the avascular forehead deep fat compartments. Avoiding injected into superficial fat compartments to avoid unnatural mask face. Because there are potential channels in the superficial central fat compartments and the area of the upper eyelid, it should be avoided to form periorbital migratory fat granuloma caused by postoperative acupressure.

Objective To evaluate ilioischial plating via the modified Stoppa approach for acetabular fractures involving the posterior column.Methods A retrospective analysis was conducted of the 12 patients who had been treated for acetabular fractures involving the posterior column from January 2017 to June 2018 by ilioischial plating via the modified Stoppa approach at Department of Orthopaedics,The Second Affiliated Hospital to Mongolia Medical University.They were 7 males and 5 females,aged from 35 to 62 years (average,43.3 years).According to the Letournel-Judet classification,there were 5 transverse fractures,4 anterior column plus posterior hemitransverse fractures and 3 both column fractures.Ilioischial plating was conducted for all the patients via the modified Stoppa approach.The Matta criteria were used to evaluate the fracture reduction.The operative time,intraoperative bleeding volume,postoperative fracture reduction and complications like traumatic arthritis and deep venous thrombosis were recorded.Merle d'Aubigné and Postel scoring was used to evaluate hip function during follow-up.Results The operative time for this group averaged 130 min (from 90 to 170 min) and the intraoperative blood loss 550 mL (from 400 to 700 mL).No major intraoperative bleeding occurred.All the 12 patients were followed up for 6 to 16 months (average,8 months).The Matta evaluation for reduction quality yielded 10 excellent and 2 good cases.Their fractures healed after 8 to 10 weeks (average,8.7 weeks).At the last follow-up,the affected hips scored 12 to 18 points (average,16 points),giving 6 excellent,4 good and 2 fair cases.Follow-ups revealed no fracture re-displacement,nerve injury,deep vein thrombosis,ectopic ossification or other complications.Conclusion In the operative treatment of complex acetabular fractures involving the posterior column,ilioischial plating via the modified Stoppa approach displays advantages of easy reduction,easy maintenance of the reduction,limited complications and fine therapeutic effects.

Objective: To observe the anatomical layers and important vascular structures in the main periorbital regions of the human body, and to provide some anatomical basis for clinical periorbital fat injection. Methods: During January 2018 to December 2018, 12 (24 sides) cadavers (6 males and 6 females, 47.5±11.7 years old) were selected. Their orbital tissues were dissected routinely and microdissected. The important blood vessels and tissues around the orbit were measured by electronic vernier caliper. The related matters needing attention in fat injection filling were analyzed according to references. Results: The main structural areas around the orbit included eyelid, eyebrow and lacrimal groove deformities. The thickness of eyelid skin was (0.09±0.03) mm. The thickness of eyebrow skin was (3.45±0.38) mm. Vascular (diameter ranged from 1 mm to 3 mm) distribution was abundant in this area. The inner diameter of dorsal nasal artery, supraorbital artery and trochlear artery were (0.73±0.42) mm, (0.88±0.37) mm and (0.71±0.51) mm respectively. Facial artery, maxillary artery and superficial temporal artery with internal diameters of (2.96±0.88) mm, (1.92±0.33) mm and (1.35±0.15) mm, respectively. Conclusions The entrance of upper eyelid injection is usually in the eyebrow tail or middle eyebrow, and fat is injected into the deep surface of orbicularis oculi muscle. The injection range is limited to the medial 2/3 of upper eyelid, the medial 1/3 of lower eyebrow and the lateral part of eyebrow. It is suggested that single layer microinjection of fat (0.5 ml to 1.5 ml) could be used. Lower eyelid fat transplantation is mainly used to correct deformities at the eyelid-cheek junction. The aim is to reduce the V-shaped deformity at the eyelid-cheek junction by increasing the fullness. Injection can be made by blunt needle into the inner, outer and middle part of the deformity. Fat can be injected into SOOF layer or periosteum in the palpebral and cheek sulcus area. The injection volume is 0.5-1.0 ml.