Evaluating the Satisfaction of Patients Undergoing Hair Transplantation Surgery Using the FACE-Q Scales

BACKGROUND

It is necessary to evaluate a successful cosmetic procedure from the patients' perspective. FACE-Q is a patient-reported outcome scale for patients undergoing cosmetic procedures. However, currently there are no FACE-Q scales used in the field of hair transplant surgery. This article aims to apply FACE-Q scales to evaluate the satisfaction of patients undergoing hair transplantation surgery.

METHODS

FACE-Q scales were modified to contain both preoperative and 6-month postoperative self-assessment, including baseline preoperative information of patients (such as age, family history of alopecia, Hamilton' alopecia grade),preoperative self-assessment (satisfaction with appearance, the preoperative visual age, expected visual age) and postoperative self-assessment (satisfaction with appearance, postoperative visual age, satisfaction with decision, psychological well-being and social function). Besides, early life impact and recovery early symptoms were also re-evaluated.

RESULTS

The mean difference between the 6-month satisfaction with appearance and baseline scores showed a significant increase of 29.62 (baseline, 46.97; 6-month, 76.59; P < 0.001) and patients perceived they appeared 5.81 years younger after surgery (P < 0.001). Postoperative satisfaction with appearance has no significant relevance with gender (P = 0.460), age (P = 0.529), marriage (P = 0.811) or family history of alopecia (P = 0.641). However, income (P = 0.003), educational level (P = 0.003), the purpose of hair transplantation (P = 0.018) and early life impact (P = 0.002) were shown to have a significant impact on satisfaction with appearance.

CONCLUSIONS

The FACE-Q scales are a valid and reliable patient-reported outcome tool for patients undergoing hair transplantation and can be widely used to evaluate the satisfaction of patients undergoing such surgery.

LEVEL OF EVIDENCE IV

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 .

Types of hairline recession in androgenetic alopecia and perceptions of aging in Asian males

BACKGROUND

Cranial hair loss is one of the characteristics of age. Hairline recession has been confirmed adversely to affect the perceptions of age in Western males. However, comparatively little is known about the effect of frontal recession on the perceived facial age (PFA) of East Asian males. Moreover, specific roles of different types of hairline recession in PFA of different age groups still remain a mystery.

OBJECTIVE

To investigate and quantify the effect of different types of hairline recession on PFA in East Asian young males of different age groups.

METHODS

Thirty non-bald males were selected and divided equally into three groups (20s, 30s, and 40s). With the aid of modern software, the frontoparietal area of facial images from 30 experimenters was modified into three basic types of hair loss (M₂ , C₂ , and U₂ ) according to the basic and specific classification of androgenic alopecia. In a web-based survey, approximately 900 naive participants were asked to estimate the PFA of males from their original and modified facial images.

RESULTS

Perceived facial age increased to 1.58 ± 0.79, 4.19 ± 1.27, and 5.90 ± 1.00 years when the original facial images were modified to have hair loss types M₂ , C₂ , or U₂ , respectively. In addition, the PFA of males with hair loss type C₂ or U₂ appeared significantly older than the original facial images in the 30s group.

CONCLUSION

Different types of hairline recession can increase the PFA to different degrees in East Asian males of different age groups.

Research on complex air leakage method to prevent coal spontaneous combustion in longwall goaf

Spontaneous combustion of coal is one of the major hazards threatening production safety during longwall mining. Mining-induced voids, which provide passages for air leakage, are the key factor triggering spontaneous combustion of coal in longwall goafs. In this study, a comprehensive method, which combined pressure balance, grouting injection, and filling fissures, was proposed to prevent spontaneous combustion of coal in longwall goafs with complex air leakage. Field engineering practice was carried out in Sitai Coal Mine in China. The results demonstrated that with the application of the proposed method, in the working face, the concentration of CO was decreased from 31ppm to 0 and the air leakage quantity was decreased from 261 to below 80 m³min^-1. The gas samples analysis from the gob areas also indicated that concentrations of O₂ and CO were successively decreased, indicating that the risk of spontaneous combustion of coal in goafs was eliminated. The above mentioned analysis indicates that, the method proposed in this study is useful and efficient. Successful application of this technology could provide reference for the treatment of other coal mines.

Dynamic Nestin expression during hair follicle maturation and the normal hair cycle

Nestin, a type-VI intermediate filament protein, serves as a marker for neural stem cells, and is also known to be expressed in follicle stem cells. Hair follicles go through repeated cycles of anagen (growth), catagen (regression) and telogen (quiescence) throughout the life of mammals following morphogenesis. In the present study it was demonstrated that in mice, the maturation of hair follicles includes the period between morphogenesis and the first anagen (4 weeks of age). Skin samples from Nestin‑green fluorescent protein (GFP)+ mice at different hair follicle stages were collected, and immunostaining for Nestin and Ki67 was performed. It was identified that during morphogenesis, Nestin‑GFP expression was rarely detected and it gradually increased during maturation (0‑4 weeks) in hair follicle dermal cells. In mature hair follicle dermal cells, Nestin and the proliferation marker Ki67 were highly expressed in anagen, while during telogen, they were markedly decreased. Additionally, lineage tracing data demonstrated that peri‑follicular Nestin+ cells during morphogenesis differentiated into cluster of differentiation 31+ cells.

Hydrogen bonds autonomously powered gelatin methacrylate hydrogels with super-elasticity, self-heal and underwater self-adhesion for sutureless skin and stomach surgery and E-skin

Interface-interaction induced self-healing and self-adhesive are a gem-like attribute inspired by our Mother Nature. Biocompatible gelatin methacrylate (GelMA) hydrogels exhibit tunable mechanical properties which are favorable in biomedical applications. However, it is difficult to integrate high stiffness, super-elasticity, large deformability and self-healing property together. Here, we report a GelMA-based double-network (DN) hydrogel with above properties by utilizing tannic acid (TA) as a multi-functional H-bond provider. We first investigated the morphological and mechanical properties' changes of GelMA over different TA's concentrations and treating times. In comparison to pristine GelMA hydrogel (10% w/v), the GelMA-TA hydrogels presented significant increase in ultimate stress (4.3-fold), compressive modulus (2.5-fold), and especially in elongation (6-fold). Adhesion properties of GelMA-TA can be tuned by TA and have been proven to be water-resistant. To test gels' feasibility in vivo, we applied GelMA-TA gels to close skin wound and gastric incision without suture. The results indicated the gels had the capabilities of promoting wound healing with superior tissue restoration and minimal tissue adhesion. Furthermore, integrated with carbon nanotubes, the GelMA-TA-carbon nanotube gel was an alternative self-healing electric skin with strain-sensitive conductivity. This work demonstrated a strategy to yield mechanically strong hydrogel adhesives for innovative biomedical applications.

Bottom-up Nanoencapsulation from Single Cells to Tunable and Scalable Cellular Spheroids for Hair Follicle Regeneration

Cell surface engineering technology advances cell therapeutics and tissue engineering by accurate micro/nanoscale control in cell-biomaterial ensembles and cell spheroids formation. By tailoring cell surface, microgels can encapsulate cells for versatile uses. However, microgels are coated in a thick layer to house multiple cells together but not a single cell based. Besides, excessive deposition on cell surface is detrimental to cellular functions. Herein, layer-by-layer (LbL) self-assembly to encapsulate single cell using nanogel is reported, owing to its security and tunable thickness at nanoscale, and further forms cell spheroids by physical cross-linking on nanogel-coated cells for delivery. A hair follicle (HF) regeneration model where the dermal papilla cells (DPCs) are given a 3D installation to maintain its ability of HF induction during in vitro culture is studied. Dermal papilla (DP) spheroids are optimized and that LbL-DPCs aggregation is akin to primary DP is demonstrated. The markers ALP, Versican, and NCAM are examined to investigate that high-passaged (P8) DP spheroids can restore the hair induction potential, which are lost in 2D culture. New HFs are regenerated successfully by implantation of DP spheroids in vivo.

Nanoparticles based on lipidyl-β-cyclodextrins: synthesis, characterization, and experimental and computational biophysical studies for encapsulation of atazanavir

After showing tensioactive properties of the compounds, the formation, stability and morphology of nanoparticles were demonstrated.

[Analysis of risk factors and outcomes for delayed gastric emptying following pancreaticoduodenectomy: a single center experience of 492 cases]

Objective: To evaluate risk factors for delayed gastric emptying(DGE)following pancreaticoduodenectomy(PD). Methods: There were 492 consecutive patients who underwent PD in Pancreas Center, the First Affiliated Hospital with Nanjing Medical University between January 2012 and December 2014 were identified from a prospective database.There were 315 male and 177 female patients with a median age of 60.5 years.Univariate and multivariate analyses were performed to investigate the independent risk factors for clinically relevant DGE(CR-DGE). Results: The overall incidence of DGE was 29.5%, with Grade B and C occurring at 4.3% and 5.9%, respectively.In multivariate analysis, pancreatic duct diameter less than 3 mm(OR=1.888, P=0.042), pylorus-preserving pancreaticoduodenectomy(OR=2.627, P=0.005) and clinically relevant postoperative pancreatic fistula(OR=2.740, P=0.007) were independently associated with CR-DGE.Other main complications such as postoperative pancreatic fistula, pyoperitoneum, intraabdominal infection were also associated with the severity of DGE(χ(2)=21.360, 14.422, 14.378; P=0.011, 0.002, 0.002). DGE patients had a significantly prolonged postoperative length of stay(31(24-41)d vs. 13(11-17)d) and increased medical cost((122 367.5±66 068.3)yuan vs. (78 200.7±27 043.9)yuan)(both P<0.01). Conclusions: Small pancreatic duct, underwent pylorus-preserving pancreaticoduodenectomy and suffered postoperative pancreatic fistula might indicate a high risk of CR-DGE.

Exogenous growth factors enhance the expression of cola1, cola3, and Elastin in fibroblasts via activating MAPK signaling pathway

Exogenous growth factors could accelerate the process of wound healing. However, the underlying mechanisms have not been clearly clarified. The aim of the present study was to investigate the effect of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) on the expression of type I collagen (cola1), type III collagen (cola3), and Elastin in fibroblasts, which are widely expressed in fibroblasts and promote the function of fibroblasts. We measured the levels of cola1 and cola3 in human fibroblast cells cultured in medium containing EGF or bFGF at concentrations ranging from 0.1 to 1000 μg/L by Western blotting and RT-PCR assays, and found that EGF or bFGF enhanced the expression of cola1 and cola3 in a concentration-dependent manner. We further discovered that after stimulation with EGF or bFGF in human fibroblast cells, mitogen-activated protein kinases (MAPK) family members were generally activated, whose expression trend was consistent with that of cola1, cola3, and Elastin. In summary, in this study, we uncovered that exogenous growth factors enhance the expression of cola1, cola3, and Elastin, which is probably regulated via activating MAPK signaling pathway.

Unlocking the vital role of host cells in hair follicle reconstruction by semi-permeable capsules

Organ regeneration is becoming a promising choice for many patients; however, many details about the mechanisms underlying organ regeneration remain unknown. As regenerative organs, hair follicles offer a good model to study the mechanisms associated with regenerative medicine. The relevant studies have mainly focused on donor cells, and there are no systematic studies involving the effect of host factors on hair follicle reconstruction. Thus, we intend to explore the effect of host cells on hair follicle reconstruction. Epidermal and dermal cells from red fluorescent protein (RFP) transgenic newborn mice were injected into green fluorescent protein (GFP) transgenic mice. In addition, we wrapped the mixed dermal and epidermal cells from GFP transgenic and RFP transgenic mice by the Cell-in-a-Box kit to form "capsules," so that the cells within would be isolated from host cells. These capsules were cultured in vitro and transplanted in vivo. Fully developed reconstructed hair follicles were observed after the injection of mixed cells. These reconstructed follicles mainly consisted of donor cells, as well as a small number of host cells. The encapsulated cells gradually aggregated into cell spheres in vitro without apparent differentiation towards hair follicles. With respect to the transplanted capsules, concentric circle structures were observed, but no hair follicles or hair shafts formed. When the concentric circle structures were transplanted in vivo, mature hair follicles were observed 30 days later. Host cells were found in the reconstructed hair follicles. Thus, we conclude that host cells participate in the process of hair follicle reconstruction, and they play a vital role in the process, especially for the maturation of reconstructed hair follicles. Furthermore, we established a special hair follicle reconstruction system with the help of capsules: transplant cells were isolated from host, but other factors from host could exchange with cells inside.

Na+ influx via Orai1 inhibits intracellular ATP-induced mTORC2 signaling to disrupt CD4 T cell gene expression and differentiation

T cell effector functions require sustained calcium influx. However, the signaling and phenotypic consequences of non-specific sodium permeation via calcium channels remain unknown. α-SNAP is a crucial component of Orai1 channels, and its depletion disrupts the functional assembly of Orai1 multimers. Here we show that α-SNAP hypomorph, hydrocephalus with hopping gait, Napa^hyh/hyh mice harbor significant defects in CD4 T cell gene expression and Foxp3 regulatory T cell (Treg) differentiation. Mechanistically, TCR stimulation induced rapid sodium influx in Napa^hyh/hyh CD4 T cells, which reduced intracellular ATP, [ATP]_i. Depletion of [ATP]_i inhibited mTORC2 dependent NFκB activation in Napa^hyh/hyh cells but ablation of Orai1 restored it. Remarkably, TCR stimulation in the presence of monensin phenocopied the defects in Napa^hyh/hyh signaling and Treg differentiation, but not IL-2 expression. Thus, non-specific sodium influx via bonafide calcium channels disrupts unexpected signaling nodes and may provide mechanistic insights into some divergent phenotypes associated with Orai1 function.

DOI:http://dx.doi.org/10.7554/eLife.25155.001

[Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament]

Objective: To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach. Methods: From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct. Results: The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days. Conclusion: The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD.

As a carrier-transporter for hair follicle reconstitution, platelet-rich plasma promotes proliferation and induction of mouse dermal papilla cells

Morphogenesis of hair follicles during development and in hair reconstitution assays involves complex interactions between epithelial cells and dermal papilla cells (DPCs). DPCs may be a source of cells for hair regeneration in alopecia patients. Reconstitution of engineered hair follicles requires in vitro culture of trichogenic cells, a three-dimensional scaffolds, and biomolecular signals. However, DPCs tend to lose their biological activity when cultured as trichogenic cells, and scaffolds currently used for hair follicle regeneration lack biological efficiency and biocompatibility. Platelet-rich plasma (PRP) gel forms a three-dimensional scaffold that can release endogenous growth factors, is mitogenic for a variety of cell types and is used in model tissue repair and regeneration systems. We found that 5% activated PRP significantly enhanced cell proliferation and hair-inductive capability of mouse and human DPCs in vitro and promoted mouse hair follicle formation in vivo. PRP also formed a three-dimensional gel after activation. We used PRP gel as a scaffold to form many de novo hair follicles on a plane surface, showing it to be candidate bioactive scaffold capable of releasing endogenous growth factors for cell-based hair follicle regeneration.