1.Effect and Mechanism of Schisandrae Chinensis Fructus Lignans on Behavior of Schizophrenic Mice
Jiaqi LI ; Xi CHEN ; Siwei WANG ; Qi WANG ; Yiting LIU ; Ziyan GUO ; Zilong LUN ; Chengyi ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):65-71
ObjectiveTo investigate the effects of Schisandrae Chinensis Fructus lignans on schizophrenia induced by dizocilpine maleate (MK-801) in mice and to clarify its mechanism. MethodsMale mice of 4-6 weeks old were randomized into blank, model, positive drug, and low-, medium-, and high-dose (40, 80, 160 mg·kg-1, respectively) Schisandrae Chinensis Fructus lignans groups. The blank group was administrated with distilled water, and the other groups were injected with 0.5 mg·kg-1 MK-801 to induce schizophrenia symptoms. Meanwhile, risperidone was injected at 0.2 mg·kg-1 in the positive drug group, and mice in the intervention groups were injected with corresponding drugs for 14 consecutive days. The behavioral changes of mice were observed by autonomous activity test, open field test, forced swimming test, and water maze test. The levels of dopamine (DA) and 5-hydroxytryptamine (5-HT) in the brain and tumor necrosis factor-α (TNF-α) and nuclear factor-κB (NF-κB) in peripheral blood were quantified by enzyme-linked immunosorbent assay (ELISA). The changes in the prefrontal lobe of mice were observed by hematoxylin-eosin staining, and the changes of the hippocampal tissue were observed by Nissl staining. The protein levels of silencing information regulatory factor 1 (SIRT1) and forkhead box protein O3a (FoxO3a) in the hippocampus of mice were determined by Western blot. ResultsCompared with the model group, low, medium, and high doses of Schisandrae Chinensis Fructus lignans reduced the total number of autonomous activities, total distance in the open field test, immobile time in the forced swimming test, and levels of TNF-α and NF-κB in peripheral blood (P<0.05), while increasing the number of platform crossings in the water maze test and DA and 5-HT levels in the brain tissue (P<0.05). Compared with the model group, risperidone and low, medium, and high doses of Schisandrae Chinensis Fructus lignans improve the neural cell morphology in the CA1 region, with full cells in neatly dense arrangement and exhibiting clear membrane boundary. Schisandrae Chinensis Fructus lignans inhibited the expression of SIRT 1 and FoxO3a in the hippocampus (P<0.05). ConclusionTo sum up, Schisandrae Chinensis Fructus lignans may improve the behavior of schizophrenic mice by activating the SIRT1/FoxO3a signaling pathway to exert neuroprotective effects.
2.Hepatitis C virus infection status among drug users in Baoshan District
CHEN Jianshuang ; ZHU Liming ; LE Boxin ; WANG Chengyi ; LIU Xiaofeng ; HE Fan
Journal of Preventive Medicine 2025;37(2):168-172
Objective:
To investigate the prevalence and influencing factors of hepatitis C virus (HCV) infection among drug users in Baoshan District, Shanghai Municipality, so as to provide insights into strengthening HCV intervention among drug users.
Methods:
Drug users under community management in Baoshan District from 2017 to 2023 were recruited. Demographic information, drug use behaviors, sexual behaviors and receipt of intervention service were collected through questionnaire surveys. Blood samples were collected for HCV antibody testing, and the prevalence of anti-HCV antibody was analyzed. Factors affecting the prevalence of anti-HCV antibody among drug users were analyzed using a multivariable logistic regression model.
Results:
A total of 2 801 drug users were surveyed, including 2 233 males (79.72%) and 568 females (20.28%). The majority of drug users were aged 40 to <60 years (1 663 drug users, 59.37%). The prevalence of anti-HCV antibody was 28.35%, showing an overall upward trend from 2017 to 2023 (P<0.05). Multivariable logistic regression analysis showed that females (OR=1.468, 95%CI: 1.169-1.844), 40 years and over (40 to <50 years, OR=2.441, 95%CI: 1.838-3.242; 50 to <60 years, OR=2.377, 95%CI: 1.787-3.161; 60 to 97 years, OR=1.637, 95%CI: 1.163-2.304), using traditional drugs (OR=2.488, 95%CI: 1.967-3.147) or mixed drugs (OR=2.950, 95%CI: 1.974-4.409), having injected drugs (not share needles, OR=3.649, 95%CI: 2.849-4.673; share needles, OR=3.532, 95%CI: 1.851-6.738) and never using condoms during sexual contacts with spouses/cohabitants in the past year (OR=1.975, 95%CI: 1.354-2.879) were associated with a higher prevalence of anti-HCV antibody; the educational level of high school/technical secondary school (OR=0.483, 95%CI: 0.280-0.835) or college and above (OR=0.280, 95%CI: 0.129-0.608) was associated with a lower prevalence of anti-HCV antibody.
Conclusions
The prevalence of anti-HCV antibody among drug users in Baoshan District showed an upward trend from 2017 to 2023. Gender, age, educational level, type of drugs, history of drug injection and never using condoms during sexual contacts with spouses/cohabitants were influencing factors for prevalence of anti-HCV antibody among drug users.
3.Clinical observation of Zishen Ningxin capsule combined with telmisartan in the treatment of perimenopausal hypertension
Bei WANG ; Mingmin DU ; Chengyi WANG ; Da FU ; Jing ZHANG ; Qiang WANG
Chinese Journal of Pharmacoepidemiology 2024;33(1):52-59
Objective To observe the efficacy of Zishen Ningxin capsule combined with telmisartan in the treatment of perimenopausal hypertension,and its influence on the patients'blood pressure,biochemical indexes and TCM symptom scores.Methods 300 patients with perimenopausal hypertension were randomly divided into control group and observation group with 150 patients in each group.The control group was given telmisartan treatment,and the observation group was given Zishen Ningxin capsule on the basis of the control group.The treatment course of both groups was 8 weeks.The dynamic blood pressure and coefficient of variation of blood pressure at 24 h before and after treatment were observed and compared between two groups(24 h systolic blood pressure and coefficient of variation,24 h diastolic blood pressure and its coefficient of variation),sex hormone levels(serum estradiol,follicle stimulating hormone,testosterone,progesterone),blood lipid levels(triacylglycerol,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol),renin and hypersensitive C-reactive protein levels,as well as the changes of TCM symptom score were evaluated for the efficacy of the two groups.Results After treatment,the 24 h systolic blood pressure and its coefficient of variation,24 h diastolic blood pressure and its coefficient of variation,the levels of sex hormones,blood lipids,renin and hypersensitive C-reactive protein,as well as TCM symptom scores in two groups were significantly improved(P<0.05),and all indexes in the observation group were better than those in the control group(P<0.05).The total effective rate of observation group was significantly higher than that of control group(P<0.05).There was no significant difference of the incidence of adverse reactions in the two groups(P>0.05).Conclusion Zishen Ningxin capsule combined with telmisartan has significant clinical efficacy in the treatment of perimenopausal hypertension,which can effectively reduce blood pressure,relieve symptoms,improve the levels of sex hormones,blood lipids,renin and hypersensitive C-reactive protein.
4.Zhuangtongyin Modulates Ferroptosis via the Nrf2-SCL7A11/xCT-Gpx4 Pathway to Im-prove Cerebral Ischemia-reperfusion Injury
Chengyi WANG ; Yuefang CAI ; Zhenqiu NING ; Minzhen DENG ; Jingbo SUN ; Kim Sookja CHUNG ; Yan LI ; Xiao CHENG
Journal of Sun Yat-sen University(Medical Sciences) 2024;45(4):539-548
[Objective]To investigate the protective effect of Zhuangtongyin on the Middle Cerebral Artery Occlusion(MCAO)model by modulating ferroptosis through the Nrf2-SCL7A11/xCT-Gpx4 pathway and its underlying mechanism.[Methods]C57BL/6J mice were randomly divided into Sham operation group(Sham),model group(MCAO),low-dose Zhuangtongyin group(ZTY-L),high-dose Zhuangtongyin group(ZTY-H),with 5 mice in each group.The MCAO group was modelled by silica gel embolization,the middle cerebral artery of mice was embolized for 1h,then the silica gel was pulled out and reperfusion was performed after 72 h;and the other operations in the Sham group were the same as those in the MCAO group except that the thread plug was not inserted.The neural function of mice was evaluated by Zea-Longa method.TTC staining was used to evaluate the volume of cerebral infarction.The level of brain injury was evaluated by HE staining and Nissl staining.Prussian blue staining and the expression of iron transport-related carrier receptors TfR1 and DMT1 on mRNA level was detected by qPCR to evaluate the iron ion deposition level in mice brain.The expression of lipid peroxidation-related gene ACSL4 on mRNA level was detected by qPCR,and the content of 4-HNE was detected by ELISA kit to evaluate the lipid peroxidation level of mice brain.The expressions of ferroptosis marker PTGS2 mRNA level was detected by qPCR.The expressions of Nrf2,SCL7A11/xCT,Gpx4 in mice brain tissue were detected by Western-blot and immunofluorescence.[Results]Zhuangtongyin improved the nerve function of mice after MCAO(P<0.05)and the cerebral infarction volume of mice(P<0.05)and alleviate the pathological injury of cerebral cortex cells after MCAO operation.Zhuangtongyin attenuated the accumulation of trivalent iron ions in the brain tissue of mice following MCAO.Additionally,Zhuangtongyin downregulated the expression of TfR1 and DMT1 mRNA(P<0.001),a transporter associated with cellular iron ion uptake,in the brains of post-MCAO mice.Furthermore,Zhuangtongyin reduced levels of lipid peroxidation product 4-HNE(P<0.001)and suppressed ACSL4 mRNA expression in brain tissue post-MCAO(P<0.001).Besides,Zhuangtongyin downregulated the expression of PTGS2 mRNA(P<0.001),in the brains of post-MCAO mice.Zhuangtongyin increased the expression of nrf2 into the nucleus(P<0.001),and increased the expression of xCT and Gpx4 in neurons after MCAO(P<0.001).[Conclusion]Zhuangtongyin can enhance the nerve function and reduce cerebral infarction volume in MCAO/R mice,alleviate the pathological damage of cerebral cortex cells,and modulate the expression of key signaling molecules in the Nrf2-SCL7A11/xCT-Gpx4 pathway.Therefore,it is suggested that the mechanism by which Zhuangtongyin improves MCAO/R injury in mice may involve regulating ferroptosis through the Nrf2-SCL7A11/xCT-GPX4 pathway.
5.Prokaryotic Expression,Purification and Polyclonal Antibody Preparation of Hemolysin Co-Regulatory Protein(Hcp)from Vibrio Cholerae
Yuanfeng CAI ; Chengyi JIA ; Guangli WANG
Journal of Modern Laboratory Medicine 2024;39(5):189-192,204
Objective To explore prokaryotic expression,purification of hemolysin coregulatory protein(Hcp)of Vibrio cholerae,and preparation of its polyclonal antibodies.Methods PCR was used to amplify Vibrio cholerae Hcp gene and clone it into pET28a vector to construct recombinant expression vector.The recombinant vector pET28a-hcp was transformed into E.coil BL21(DE3)for expression condition optimization and expression form identification.The soluble Hcp protein was purified by Ni-NTA column.The purified Hcp protein was used to immunize BALB/c mice to prepare polyclonal antibodies.The antibody titer was detected by indirect enzyme-linked immunosorbent assay(ELISA)to evaluate its immunogenicity.Western blot was used to analyze the specific recognition of antibodies to Hcp protein in Vibrio cholerae.Results The enzyme fragment digested by recombinant vector pET28a-hcp was consistent with the expected,the sequencing results were consistent with the Hcp gene sequence in the GenBank database,and the pET28a-hcp recombinant plasmid was successfully constructed.The recombinant plasmid was induced by isopropyl-β-D-thiogalactopyranoside(IPTG)to express the target protein with a relative molecular weight of 28 kD.The pure Hcp protein was obtained after purification by Ni-NTA column,and then Hcp polyclonal antibody(anti-Hcp)with a titer of 1∶512 000 could be obtained from immunized mice.Western blot results showed that anti-Hcp had specificity in recognizing Hcp protein in Vibrio cholerae.Conclusion The soluble expression of Hcp protein is successfully obtained,and high-titer polyclonal antibodies against Hcp are obtained after immunization of mice,which may lay a foundation for subsequent studies on the role of Hcp protein in the pathogenesis of T6SS in non-O1/non-O139 V.cholerae.
6.Comparative study of trastuzumab modification analysis using mono/multi-epitope affinity technology with LC-QTOF-MS.
Chengyi ZUO ; Jingwei ZHOU ; Sumin BIAN ; Qing ZHANG ; Yutian LEI ; Yuan SHEN ; Zhiwei CHEN ; Peijun YE ; Leying SHI ; Mao MU ; Jia-Huan QU ; Zhengjin JIANG ; Qiqin WANG
Journal of Pharmaceutical Analysis 2024;14(11):101015-101015
Dynamic tracking analysis of monoclonal antibodies (mAbs) biotransformation in vivo is crucial, as certain modifications could inactivate the protein and reduce drug efficacy. However, a particular challenge (i.e. immune recognition deficiencies) in biotransformation studies may arise when modifications occur at the paratope recognized by the antigen. To address this limitation, a multi-epitope affinity technology utilizing the metal organic framework (MOF)@Au@peptide@aptamer composite material was proposed and developed by simultaneously immobilizing complementarity determining region (CDR) mimotope peptide (HH24) and non-CDR mimotope aptamer (CH1S-6T) onto the surface of MOF@Au nanocomposite. Comparative studies demonstrated that MOF@Au@peptide@aptamer exhibited significantly enhanced enrichment capabilities for trastuzumab variants in comparison to mono-epitope affinity technology. Moreover, the higher deamidation ratio for LC-Asn-30 and isomerization ratio for HC-Asn-55 can only be monitored by the novel bioanalytical platform based on MOF@Au@peptide@aptamer and liquid chromatography-quadrupole time of flight-mass spectrometry (LC-QTOF-MS). Therefore, multi-epitope affinity technology could effectively overcome the biases of traditional affinity materials for key sites modification analysis of mAb. Particularly, the novel bioanalytical platform can be successfully used for the tracking analysis of trastuzumab modifications in different biological fluids. Compared to the spiked phosphate buffer (PB) model, faster modification trends were monitored in the spiked serum and patients' sera due to the catalytic effect of plasma proteins and relevant proteases. Differences in peptide modification levels of trastuzumab in patients' sera were also monitored. In summary, the novel bioanalytical platform based on the multi-epitope affinity technology holds great potentials for in vivo biotransformation analysis of mAb, contributing to improved understanding and paving the way for future research and clinical applications.
7.Inhibition of CD36 and Nogo-B expression inhibited the proliferation and migration of triple negative breast cancer cells.
Chengyi WANG ; Jihong HAN ; Yuanli CHEN
Chinese Journal of Biotechnology 2023;39(10):4168-4188
Cluster of differentiation 36 (CD36) is a membrane glycoprotein receptor capable of binding and transporting fatty acid. Nogo-B regulates the metabolism of fatty acids in the liver and affects the development of liver cancer. To date, it remains unclear whether the interaction between CD36 and Nogo-B affects the proliferation and migration of breast cancer cells. In the current study, we aimed to determine whether the interference of CD36 and Nogo-B affects the proliferation and migration of triple-negative breast cancer (TNBC) cells. The results showed that inhibition of CD36 or Nogo-B alone can inhibit the proliferation and migration of TNBC cells, and the inhibitory effect was more pronounced when CD36 and Nogo-B were inhibited simultaneously. Meanwhile, it was found that inhibition of CD36 and Nogo-B expression can inhibit the expression of Vimentin, B-cell lympoma-2 (BCL2) and proliferating cell nuclear antigen (PCNA). In vivo, knockdown of CD36 or Nogo-B in E0771 cells reduced its tumorigenic ability, which was further enhanced by knockdown of CD36 and Nogo-B simultaneously. Mechanistically, inhibition of CD36 and Nogo-B expression can decrease fatty acid binding protein 4 (FABP4) and fatty acid transport protein 4 (FATP4) expression. Moreover, overexpression of CD36 and Nogo-B-induced cell proliferation was attenuated by FABP4 siRNA, indicating that inhibition of CD36 and Nogo-B expression could inhibit the absorption and transport of fatty acids, thereby inhibiting the proliferation and migration of TNBC. Furthermore, inhibition of CD36 and Nogo-B expression activated the P53-P21-Rb signaling pathway which contributed to the CD36 and Nogo-B-inhibited proliferation and migration of TNBC. Taken together, the results suggest that inhibition of CD36 and Nogo-B can reduce the proliferation and migration of TNBC, which provides new targets for the development of drugs against TNBC.
Humans
;
Triple Negative Breast Neoplasms/metabolism*
;
Cell Movement
;
Cell Proliferation
;
Cell Line, Tumor
;
Fatty Acids
8.Anti-tumor Effect and Mechanism of Effective Components in Hedysari Radix: A Review
Miaoting JIA ; Chengyi LI ; Zhengze QIANG ; Mingwei WANG ; Xiaoli FENG ; Xiaocheng WEI ; Ruijuan ZHOU ; Guangmao ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(21):213-219
Malignant tumors are one of the main causes of human death worldwide and pose a serious threat to human health. The current treatment methods are mainly the combination of chemotherapeutics, surgery, radiotherapy, or hormone therapy. The treatment process has limitations such as multidrug resistance, non-selective targeting of cancer cells, and drug toxicity. With the development and application of traditional Chinese medicine (TCM), Chinese medicine has the characteristics of multi-angle and multi-mechanism coordination and slight toxic and side effects. It can effectively inhibit tumor proliferation, differentiation, and metastasis, and avoid drug resistance, serving as the focus of current tumor treatment research. Hedysari Radix, one of the genuine medicinal materials in Gansu province, is a tonic Chinese medicine with a wide range of pharmacological effects such as anti-inflammation, immune regulation, anti-oxidation, prevention and treatment of diabetic complications. In the majority of the ancient works on herbs of the past dynasties, Hedysari Radix was included under the item of Astragali Radix and used as Astragali Radix. Hedysari Radix is superior to Astragali Radix in enhancing immunity, scavenging free radicals, and resisting liver fibrosis. Studies have found that the effective components of Hedysari Radix have a prominent anti-tumor effect and a significant inhibitory effect on various malignant tumors such as liver cancer, bladder cancer, gastric cancer, breast cancer, and colorectal cancer. They can also combine with clinical anti-cancer drugs to reduce the toxic and side effects of chemotherapy drugs and improve the tolerance of patients during chemotherapy. On the basis of current research, this study summarized the mechanism of Hedysari Radix active components in inducing cell apoptosis, blocking cell cycle, inhibiting tumor cell proliferation, migration, and invasion, regulating micro mRNA (miRNA), inducing cell autophagy, enhancing immune regulation, as well as reducing toxicity and enhancing efficiency and sensitization with clinical chemotherapeutics, and systematically explained the anti-tumor mechanism of Hedysari Radix active components, aiming to provide a basic reference for the further exploration of the anti-tumor mechanism of Hedysari Radix and the further development and utilization of its effective components.
9.Effects of TRIB3 activation of Wnt/β-catenin signaling pathway on growth and proliferation of laryngeal carcinoma TU686 cells in vitro and peripheral immunosuppressive molecule expression in transplanted mice
Zhongqiang CHENG ; Chengyi JIANG ; Wei WANG ; Hualong QIANG ; Xiaodong ZHAN ; Runsheng YUAN
Chinese Journal of Immunology 2023;39(12):2595-2600
Objective:To investigate the effects of TRIB3 activation of Wnt/β-catenin signaling pathway on the growth and pro-liferation of laryngeal carcinoma TU686 cells in vitro and expression of peripheral immunosuppressive molecules in transplanted mice.Methods:Protein and RNA expressions of TRIB3 were detected in vitro cells(human immortalized epidermal cell line HaCat and laryngeal carcinoma cell line TU686)and tissues(laryngeal carcinoma and adjacent tissues),respectively.Laryngeal carcinoma TU686 cells were cultured in vitro and divided into negative control group(NC group)and TRIB3 knockdown group(sh-TRIB3 group),total protein and RNA of cells were extracted to verify the expression level of TRIB3 in two groups.After successful verifica-tion,proliferation ability of TU686 cells was detected by CCK-8,colony cloning and flow cytometry.Protein expression levels of Wnt,Cyclin-D1,C-myc,β-catenin and p-β-catenin in two groups were detected by Western blot.Correlation analysis verified the correla-tion between TRIB3 and Wnt,Cyclin-D1,C-myc,β-catenin,p-β-catenin protein expressions.TRIB3-low expressing nude mouse transplanted tumor model(TRIB3 sgRNA group)was constructed by knockdown the TRIB3 core plasmid,and a parallel control group(Control sgRNA group)was set up,tumor growth volume and weight were observed,and serum immunosuppressive molecules expres-sions was determined by ELISA.Results:Compared with HaCat cells and normal paracarcinoma tissues,TRIB3 was highly expressed in TU686 cells and laryngeal carcinoma tissues.Compared with negative control group,proliferation ability of TU686 cells was signifi-cantly inhibited after TRIB3 knockdown,and cell growth was blocked in G1/S phase.Expressions of Wnt,Cyclin-D1,C-myc andβ-catenin protein in Wnt/β-catenin signaling pathway were decreased significantly,while expression of p-β-catenin was increased significantly.TRIB3 was significantly correlated with protein expression levels of Wnt,Cyclin-D1,β-catenin and p-β-catenin.The in vivo results showed that compared with Control sgRNA group,tumor growth volume and weight of mice in TRIB3 sgRNA group were significantly decreased,and expressions of serum immunosuppressive molecules IL-4,IL-6,IL-10,TGF-β and PGE2 were signifi-cantly decreased.Conclusion:TRIB3 is highly expressed in TU686 cells,and TRIB3 can inhibit growth and proliferation of TU686 cells and transplanted tumors by activating Wnt/β-catenin-related signaling pathways,and reverse tumor immunosuppressive microen-vironment,suggesting that TRIB3 may be an effective target for laryngeal cancer.
10.Evaluating the symmetry of soft and hard tissues of patients with unilateral old zygomatic fracture after open reduction and internal fixation assisted by digital surgery
Chengyi WANG ; Bimeng JIE ; Shuo CHEN ; Jingang AN ; Yi ZHANG ; Yang HE
Chinese Journal of Plastic Surgery 2023;39(5):520-528
Objective:To evaluate the postoperative symmetry of soft and hard tissues in patients with unilateral old zygomatic fractures.Methods:A retrospective analysis of patients who underwent computer-assisted open reduction and internal fixation for unilateral old zygomatic complex fractures. The spiral CT data of the patient before and 1 year after operation was imported into ProPlan CMF 3.0 software to segment the skin and bone STL models. Eleven sets of soft tissue landmarks and 10 sets of hard tissue landmarks in the middle of the face were marked, with a coordinated system for measurement established. The asymmetry index (AI) between each mark point was calculated. The data were expressed by Mean±SD. Paired t-test was used to compare whether there was a statistical difference in the AI of each landmark before and after operation. P<0.05 was considered the difference to be statistically significant. At the same time, the study subjects were selected from the Chinese craniomaxillofacial three-dimensional morphological database. Microsoft Excel 2017 software was used to draw the AI baseline data map of common people. The patients’ soft and hard tissue landmarks AI (before and 1 year after surgery) were included in the AI baseline map of common people, and the patient’s soft and hard tissue symmetry was evaluated. Results:A total of 30 patients were included in the study, including 17 males and 13 females, age range from 18 to 55 years old, with an average age of 25.2 years. The preoperative hard tissue AI was 4.5±4.1, and the hard tissue AI was 2.0±1.7 one year after surgery, and the difference in the AI of each hard tissue landmark before and 1 year after operation was statistically significant( P<0.01 or <0.05). The preoperative soft tissue AI was 4.5±4.0, and the soft tissue AI was 2.3±1.9 one year after surgery, and the difference in the AI of each soft tissue landmark before and 1 year after operation was statistically significant( P<0.01 or <0.05). 50 common people were selected from the total database, including 25 men and 25 women, aged from 18 to 57 years old, with an average of 23.8 years old. The hard tissue landmark AI was 2.1±2.0, and the soft tissue landmark AI was 2.0±1.9. The hard tissue landmarks AI of patients 1 year after operation were all within the symmetrical baseline value, with good symmetry. The AI values of some soft tissue landmarks were higher than the symmetrical baseline value, indicating poor symmetry. Conclusion:The three-dimensional symmetry of the soft and hard tissues of patients with unilateral old zygomatic complex fractures after surgery was significantly improved compared with that before surgery. Compared with the normal range of the database, the postoperative hard tissue has better symmetry, but the postoperative soft tissue has poor symmetry.


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