Hierarchically Assembled Nanofiber Scaffolds with Dual Growth Factor Gradients Promote Skin Wound Healing Through Rapid Cell Recruitment

To address current challenges in effectively treating large skin defects caused by trauma in clinical medicine, the fabrication, and evaluation of a novel radially aligned nanofiber scaffold (RAS) with dual growth factor gradients is presented. These aligned nanofibers and the scaffold's spatial design provide many all-around "highways" for cell migration from the edge of the wound to the center area. Besides, the chemotaxis induced by two growth factor gradients further promotes cell migration. Incorporating epidermal growth factor (EGF) aids in the proliferation and differentiation of basal layer cells in the epidermis, augmenting the scaffold's ability to promote epidermal regeneration. Concurrently, the scaffold-bound vascular endothelial growth factor (VEGF) recruits vascular endothelial cells at the wound's center, resulting in angiogenesis and improving blood supply and nutrient delivery, which is critical for granulation tissue regeneration. The RAS+EGF+VEGF group demonstrates superior performance in wound immune regulation, wound closure, hair follicle regeneration, and ECM deposition and remodeling compared to other groups. This study highlights the promising potential of hierarchically assembled nanofiber scaffolds with dual growth factor gradients for wound repair and tissue regeneration applications.

Use of a fractional 1570-nm diode laser scanner for non-ablative face and neck rejuvenation

BACKGROUND

The use of non-ablative fractionated lasers for skin rejuvenation has been proven to be effective in improving skin texture, and has become popular due to minimal wounding, significantly shorter recovery times and decreased adverse effects.

OBJECTIVE

To retrospectively analyze improvement in skin texture in healthy women aged over 18 years with Fitzpatrick skin types II-IV.

METHODS

Participants received three facial and/or neck treatments with the 1570-nm fractional scanning diode laser at 1-month intervals. Three months after the last treatment session two blinded evaluators assessed skin improvement using before and after photos. Pain and patient satisfaction were recorded.

RESULTS

Sixteen women with a mean age of 45.4 ± 4.1 years (range 35-50 years) and skin type II-IV were included in the analysis. All 16 participants received facial treatments and seven (43.8%) also received neck treatments. Three months follow-up evaluation showed that the majority of participants had a visible change in the treated areas. Mean pain score was low and decreased with each treatment session.

CONCLUSION

Skin treatment using fractional scanning 1570-nm diode laser improves skin laxity in women with skin types II-IV. Larger studies are warranted to further clarify the efficacy and safety of this modality.

Helicobacter pylori and oral-gut microbiome: clinical implications

More than half of the world's population are colonized with H. pylori; however, the prevalence varies geographically with the highest incidence in Africa. H. pylori is probably a commensal organism that has been associated with the development of gastritis, ulcers, and gastric cancer. H. pylori alone is most probably not enough for the development of gastric carcinoma, but evidence for its association with the disease is high and has, therefore, been classified by the International Agency for Research on Cancer as a Class 1 carcinogen. Bacteroidetes and Fusobacteria positively coexisted during H. pylori infection along the oral-gut axis. The eradication therapy required to treat H. pylori infection can also have detrimental consequences for the gut microbiota, leading to a decreased alpha diversity. Therefore, therapy regimens integrated with probiotics may abolish the negative effects of antibiotic therapy on the gut microbiota. These eradication therapies combined with probiotics have also higher rates of eradication, when compared to standard treatments, and are associated with reduced side effects, improving the patient's compliance. The eradication therapy not only affects gut microbiome but also affects the oral microbiome with robust predominance of harmful bacteria. However, there have been reports of a protective role of H. pylori in Barrett's esophagus, esophageal adenocarcinoma, eosinophilic esophagitis, IBD, asthma, and even multiple sclerosis. Therefore, eradication therapy should be carefully considered, and test to treat policy should be tailored to specific communities especially in highly endemic areas. Supplementation of probiotics, prebiotics, herbals, and microbial metabolites to reduce the negative effects of eradication therapy should be considered. After failure of many eradication attempts, the benefits of H. pylori eradication should be carefully balanced against the risk of adverse effects especially in the elderly, persons with frailty, and intolerance to antibiotics.

Gut microbiota in relationship to diabetes mellitus and its late complications with a focus on diabetic foot syndrome: A review

Diabetes mellitus is a chronic disease affecting glucose metabolism. The pathophysiological reactions underpinning the disease can lead to the development of late diabetes complications. The gut microbiota plays important roles in weight regulation and the maintenance of a healthy digestive system. Obesity, diabetes mellitus, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy are all associated with a microbial imbalance in the gut. Modern technical equipment and advanced diagnostic procedures, including xmolecular methods, are commonly used to detect both quantitative and qualitative changes in the gut microbiota. This review summarises collective knowledge on the role of the gut microbiota in both types of diabetes mellitus and their late complications, with a particular focus on diabetic foot syndrome.

From consistent subjective assessment of skin sensitivity severity to its accurate objective scoring

BACKGROUND

Sensitive skin (SenS) is a syndrome leading to unpleasant sensations with little visible signs. Grading its severity generally relies on questionnaires or subjective ratings.

MATERIALS AND METHODS

The SenS status of 183 subjects was determined by trained assessors. Answers from a four-item questionnaire were converted into numerical scores, leading to a 0-15 SenS index that was asked twice or thrice. Parameters from hyperspectral images were used as input for a multi-layer perceptron (MLP) neural network to predict the four-item questionnaire score of subjects. The resulting model was used to evaluate the soothing effect of a cosmetic cream applied to one hemiface, comparing it to that of a placebo applied to the other hemiface.

RESULTS

The four-item questionnaire score accurately predicts SenS assessors' classification (92.7%) while providing insight into SenS severity. Most subjects providing repeatable replies are non-SenS, but accepting some variability in answers enables identifying subjects with consistent replies encompassing a majority of SenS subjects. The MLP neural network model predicts the SenS score of subjects with consistent replies from full-face hyperspectral images (R2 Validation set  = 0.969). A similar quality is obtained with hemiface images. Comparing the effect of applying a soothing cosmetic to that of a placebo revealed that subjects with the highest instrumental index (> 5) show significant SenS improvement.

CONCLUSION

A four-item questionnaire enables calculating a SenS index grading its severity. Objective evaluation using hyperspectral images with an MLP neural network accurately predicts SenS severity and its favourable evolution upon the application of a soothing cream.

The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial

The effect of different diet patterns on psoriasis (PSO) and psoriatic arthritis (PSA) is unknown. Τhe aim of our study was to evaluate the effectiveness of a Mediterranean diet (MD) and Ketogenic diet (KD), in patients with PSO and PSA. Twenty-six patients were randomly assigned to start either with MD or KD for a period of 8 weeks. After a 6-week washout interval, the two groups were crossed over to the other type of diet for 8 weeks. At the end of this study, MD and KD resulted in significant reduction in weight (p = 0.002, p < 0.001, respectively), in BMI (p = 0.006, p < 0.001, respectively), in waist circumference (WC) (p = 0.001, p < 0.001, respectively), in total fat mass (p = 0.007, p < 0.001, respectively), and in visceral fat (p = 0.01, p < 0.001, respectively), in comparison with baseline. After KD, patients displayed a significant reduction in the Psoriasis Area and Severity Index (PASI) (p = 0.04), Disease Activity Index of Psoriatic Arthritis (DAPSA) (p = 0.004), interleukin (IL)-6 (p = 0.047), IL-17 (p = 0.042), and IL-23 (p = 0.037), whereas no significant differences were observed in these markers after MD (p > 0.05), compared to baseline. The 22-week MD-KD diet program in patients with PSO and PSA led to beneficial results in markers of inflammation and disease activity, which were mainly attributed to KD.

Skin necrosis after intradermal injection of lyophilized exosome: A case report and a review of the literature

BACKGROUND

Exosomes have gained attention for their potential in skin rejuvenation. Currently, most exosome products are available for topical administration, and the use of subdermal injection as a route of administration has not been approved.

AIMS

The purpose of this case report is to describe a case of skin necrosis that occurred following an intradermal injection of lyophilized exosomes.

MATERIALS AND METHODS

We hereby report a case of a middle-aged man who experienced adverse effects after receiving an intradermal injection of lyophilized exosomes. Multiple injections of an exosome product were administered to treat enlarged facial pores. Shortly after the injection, the patient felt pain and noticed several dark red bumps. Three days after injection, the lesions transformed into palpable, painful, non-blanchable purplish papules and nodules, accompanied by central, tiny crusted erosions. The residual product was injected into the upper arm using an intradermal method. Similar lesions also appeared, and a skin biopsy showed necrotic keratinocytes, leukocytoclastic vasculitis, and eccrine necrosis.

RESULTS

There are few reports available regarding complications, especially those related to intradermal exosomes. These complications include multiple foreign-body granulomatous reactions at the injection sites. In our case, oral prednisolone was administered for a duration of 7 days. After the treatment, the lesions exhibited notable improvement, eventually leaving post-inflammatory hyperpigmentation.

CONCLUSION

Utilizing exosomes through unapproved methods should be avoided due to the possibility of adverse reactions that could cause aesthetic issues.

Psoriatic Arthritis Involving TMJ: A Review on Pathogenesis and Consideration on Eventual Gender Differences

Psoriatic arthritis is defined as chronic inflammatory arthritis associated with psoriasis. The current data regarding gender differences in clinical manifestation and therapeutic outcomes of psoriatic arthritis are limited. Generally, men show a peripheral disease manifestation, while women have an axial distribution of the lesions. If we look at temporomandibular joint (TMJ) involvement, epidemiological data on the involvement of the TMJ are hard to find. Few studies on therapeutic management and the related impact on the quality of life are reported in the literature. Given the morpho-functional peculiarities of the TMJ and the different pain burdens between male and female genders, when manifestation of psoriatic arthritis occurs, clinicians should face it using a multidisciplinary approach for a correct diagnosis and successful treatment. This review aims to examine the diagnostic signs of psoriatic arthritis in the TMJ, the eventual variations of this disease in male and female patients, and the therapeutical strategies. The coordination of different specialties is fundamental to the remission of clinical symptoms and lesion regression.

Clinical effectiveness of finasteride versus hydroxychloroquine in the treatment of frontal fibrosing alopecia: A randomized controlled trial

BACKGROUND

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia with rapid epidemic growth. However, there is no agreement on the best therapeutic approach.

AIMS

To compare the therapeutic effects of finasteride as a first-line systemic treatment of FFA versus hydroxychloroquine as a relatively safe and effective immunosuppressive drug.

METHODS

Thirty-four female FFA patients were randomly assigned to receive either 400 mg/day of hydroxychloroquine or 2.5 mg/day of finasteride for 6 months. Topical treatments in both groups include pimecrolimus, mometasone, and minoxidil. Treatment efficacy was evaluated using the Frontal Fibrosing Alopecia Severity Score (FFASS), photography, and trichoscopy after 3 and 6 months.

RESULTS

Both the finasteride and hydroxychloroquine groups showed significant improvements in FFASS and trichoscopic scores (p < 0.01). However, there was no significant difference between the two groups during the study. Photographic assessment showed that more than 60% of patients in both groups had improved without statistically significant differences between the two groups.

CONCLUSIONS

Both finasteride and hydroxychloroquine are equally effective, safe, and well-tolerable for treating FFA patients.

The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties

Probiotics, known to be live microorganisms, have been shown to improve or restore the gut microbiota, which in turn has been linked to improved health. It is believed that probiotics are the modern equivalent of a panacea, with claims that they may treat or prevent different diseases both in children and adults (e.g., from colic in babies to cardiovascular disease, respiratory infection, and cancer in adults). Ever since the early 2000s, probiotic-based fermented foods have had a resurgence in popularity, mostly due to claims made regarding their health benefits. Fermented foods have been associated with the prevention of irritable bowel syndrome, lactose intolerance, gastroenteritis, and obesity, but also other conditions such as chronic diarrhea, allergies, dermatitis, and bacterial and viral infections, all of which are closely related to an unhealthy lifestyle. Recent and ongoing developments in microbiome/microbiota science have given us new research directions for probiotics. The new types, mechanisms, and applications studied so far, and those currently under study, have a great potential to change scientific understanding of probiotics' nutritional applications and human health care. The expansion of fields related to the study of the microbiome and the involvement of probiotics in its improvement foreshadow an era of significant changes. An expanding range of candidate probiotic species is emerging that can address newly elucidated data-driven microbial niches and host targets. In the probiotic field, new variants of microbiome-modulating interventions are being developed, including prebiotics, symbiotics, postbiotics, microbial consortia, live biotherapeutic products, and genetically modified organisms, with renewed interest in polyphenols, fibers, and fermented foods to ensure human health. This manuscript aims to analyze recent, emerging, and anticipated trends in probiotics (sources, doses, mechanism of action, diseases for which probiotics are administered, side effects, and risks) and create a vision for the development of related areas of influence in the field.

Interaction between the microbiota and the skin barrier in aging skin: a comprehensive review

The interplay between the microbes and the skin barrier holds pivotal significance in skin health and aging. The skin and gut, both of which are critical immune and neuroendocrine system, harbor microbes that are kept in balance. Microbial shifts are seen with aging and may accelerate age-related skin changes. This comprehensive review investigates the intricate connection between microbe dynamics, skin barrier, and the aging process. The gut microbe plays essential roles in the human body, safeguarding the host, modulating metabolism, and shaping immunity. Aging can perturb the gut microbiome which in turn accentuates inflammaging by further promoting senescent cell accumulation and compromising the host's immune response. Skin microbiota diligently upholds the epidermal barrier, adeptly fending off pathogens. The aging skin encompasses alterations in the stratum corneum structure and lipid content, which negatively impact the skin's barrier function with decreased moisture retention and increased vulnerability to infection. Efficacious restoration of the skin barrier and dysbiosis with strategic integration of acidic cleansers, emollients with optimal lipid composition, antioxidants, and judicious photoprotection may be a proactive approach to aging. Furthermore, modulation of the gut-skin axis through probiotics, prebiotics, and postbiotics emerges as a promising avenue to enhance skin health as studies have substantiated their efficacy in enhancing hydration, reducing wrinkles, and fortifying barrier integrity. In summary, the intricate interplay between microbes and skin barrier function is intrinsically woven into the tapestry of aging. Sound understanding of these interactions, coupled with strategic interventions aimed at recalibrating the microbiota and barrier equilibrium, holds the potential to ameliorate skin aging. Further in-depth studies are necessary to better understand skin-aging and develop targeted strategies for successful aging.

Use of the modified meek technique for the coverage of extensive burn wounds

INTRODUCTION

Autologous split thickness skin grafting using meshing technique remains the preferred option for the management of deep dermal and full thickness burns. The limited donor site availability seen in patients with extensive burns, however, restricts use of the mesh grafting technique for skin expansion. Meek micrografting was developed to allow for greater expansion, and, therefore, more reliable treatment of extensive burns. This study aimed to present our outcomes using the Meek micrografting technique and identify risk factors for graft failure.

METHODS

A retrospective review of patients admitted to our large academic hospital who were treated with the Meek micrografting technique from 2013 to 2022 was conducted. Patient demographics, surgical characteristics and outcomes were reported. Regression analyses were performed to identify factors that influence graft take and reoperation rate.

RESULTS

A total of 73 patients with a mean age of 45.7 ± 19.9 years and mean burn size of 60.0 ± 17.8%TBSA, with 45.3 ± 14.9% TBSA being third degree burns, received Meek transplantation. The mean graft take after removal of the pre-folded polyamide gauze at the tenth post-operative day was 75.8 ± 14.7%. Pre-treatment with use of an allograft, longer waiting time between admission and Meek grafting and transplantation over a dermal matrix were identified as positive predictors for graft take, while age was established as a negative predictor.

CONCLUSION

By examining the outcomes of the Meek micrografting technique in extensive burn wounds we identified that preconditioning of the wound bed, through allograft or negative pressure wound therapy application, positively correlates with improved outcomes, including higher graft take. At the same time, older age was seen to negatively correlate with graft take. Overall, Meek transplantation displays a favorable safety profile with promising outcomes. Future prospective studies and clinical trials can optimize the procedure and help establish it as the golden standard for extensive and complex burns.

Bromelain-based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long-term outcomes

In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.

Gender perspective in psoriasis: a scoping review and proposal of strategies for improved clinical practice by European dermatologists

Background

The prevalence of psoriasis is similar between men and women; however, evidence exists of sex- and gender-related differences in disease expression, impact, coping, and needs of patients with psoriasis. These differences are essential and should be considered in clinical practice and research.

Objective

To compile available evidence on sex- and gender-related differences in psoriasis, identify the most critical gaps in clinical practice and research, and use it to propose strategies for improved clinical practice.

Methods

Six European dermatologists selected the topics to consider according to their relevance in the dermatology setting with the support of methodologists. Evidence on sex- and gender-related differences was obtained by a scoping review based on search strategies in Medline and Cochrane Library from inception to October 2021 using the following terms: arthritis, psoriatic, psoriasis, gender, and sex. The panel discussed the results and proposed strategies by consensus.

Results

The scoping review identified broad themes: (1) clinical expression, (2) severity and patient-reported outcomes, (3) psychosocial impact, (4) access to treatments and propensity to treat, (5) comorbidities, and (6) treatment effect. The strategies are based on these broad themes.

Limitations

No risk of bias assessment was done due to the scoping nature of the review.

Conclusion

This review offers insights into gender differences in psoriasis, providing a foundation for improving clinical practice and patient outcomes.

Embolia cutis Medicamentosa (Nicolau syndrome): case series

Introduction

Embolia cutis medicamentosa or Nicolau syndrome is a rare drug reaction associated with the administration of various injectable medications. The pathogenesis of the disease is unknown, though intra and periarterial injection of the drug is a possible cause. The aim of this study was to describe and analyze the clinical characteristics of Nicolau syndrome in patients examined in daily dermatological practice.

Methods

We performed a retrospective chart review, between January 2011 and December 2020, in patients diagnosed with Nicolau syndrome, from the cases of a private dermatology medical office in Târgu Mureș, Romania.

Results

During the 10-year period, 7 patients were diagnosed with Nicolau syndrome. Of these, 4 (57%) patients were males and 3 (43%) were females, The male to female ratio was 1.33. The median age was 64 (interquartile range, IQR, 62-71), with the youngest patient being diagnosed at age 61 and the oldest at age 74. Regarding the drugs classes that caused Nicolau syndrome, these were intravenous antibiotics in 57%, and non-steroidal anti-inflammatory drugs in 43% of cases.

Conclusion

All patients healed in a period of 6 to 8 weeks. No complications occurred. In conclusion, Nicolau syndrome is a rare side effect of injectable drug administration.

Primary Closure Versus Delayed Primary Closure of Class III and IV Surgical Wounds Following Emergency Laparotomy: A Prospective Comparative Study

Introduction Emergency surgery has a high risk of complications due to the detrimental effect of perioperative sepsis and the relative lack of preoperative optimization of patients. Despite advances in critical care for the management of sepsis, its prevention is dependent on various patient and surgeon factors. Surgical site infection continues to be a major determinant of morbidity and mortality following emergency abdominal surgery, especially in contaminated or dirty wounds. This study aims to compare two techniques of abdominal wall closure, primary closure with subcutaneous suction drains and delayed primary closure following negative pressure wound therapy, in terms of incidence of surgical site infection and morbidity. Materials and methods The study was a prospective comparative study including 50 patients with an acute surgical abdomen requiring laparotomy. The patients were randomized into two groups, Group A (n=25) who underwent primary closure, and Group B (n=25) who underwent delayed primary closure. In Group B patients, a vacuum-assisted closure device was applied in the subcutaneous space for five days prior to the closure of the skin. Outcomes were compared in terms of the incidence of superficial and deep surgical site infection, its association with diabetes mellitus, and the total duration of hospital stay. A chi-square test and an unpaired t-test were used for the test of significance. Results A total of 50 patients, comparable in age, were included in the study. The overall incidence of surgical site infection was significantly higher in patients of Group A as compared to Group B (p=0.0046). There was a positive correlation between diabetes mellitus and the occurrence of wound infection in both groups with the odds ratio being 2.67 and 2.38 respectively. The incidence of superficial wound infection was significantly higher in Group A when compared to Group B (52% versus 24%; p=0.04). Deep surgical site infection was higher in patients of Group A (20% versus 8%) but was not statistically significant (p=0.22). The average duration of hospital stay was 41.56 ± 6.96 and 37.86 ± 6.68 days for patients who developed complications from Groups A and B respectively, while it was nearly two and a half times lower in uncomplicated cases of Groups A and B (11.71± 1.70 days and 16.58± 1.06 days respectively). The one-tailed unpaired t-test showed a significant difference in means of hospital stay between patients with and without complications (T: 17.06, critical value: 1.677). Conclusion Delayed primary closure is an effective method of managing contaminated and dirty wounds following emergency laparotomy. Negative pressure wound therapy is one technique for preventing wound bed infection and accelerating wound healing in such cases. By combining the above in emergency surgeries, the incidence of surgical site infection and duration of hospital stay can be significantly reduced.

Up-Regulated Expression of ICAM1, MT1A, PTGS2, LCE3D, PPARD, and GM-CSF2 Following Solar Skincare Protection and Repair Strategies in a 3-Dimensional Reconstructed Human Skin Model

Background

Clinical, optical and histological research confirms that solar skin damage continues to pose a threat to human skin health globally despite widespread sunscreen usage and sun awareness campaigns. Despite this, very few studies examine the critical changes in gene expression and DNA repair activity following recommended topical solar protection and repair strategies to ameliorate the harmful effects of ultraviolet, visible light and near-infrared radiation.

Purpose

To investigate alterations in gene expression following topical solar protection and solar repair strategies.

Methods

Using epidermal keratinocytes and dermal fibroblasts derived from a 3-dimensional reconstructed human skin model, gene expression was assessed via the Genemarkers Standard Skin Panel using 112 genes deploying two analytical techniques: DNA microarray and quantitative real-time PCR exploration. Tissues were inoculated with products then collected after 24 hours following application of solar protection formulations and 16 hours following solar repair formulations (The Essential Six, RATIONALE, Victoria, Australia).

Results

A DNA microarray revealed 67 genes that were significantly up-regulated or down-regulated following the treatment. The quantitative real-time PCR revealed that, in comparison to the control, the genes encoding Intercellular Adhesion Molecule 1 (ICAM1), Metallothionein 1A (MT1A), Prostaglandin-Endoperoxide Synthase 1 (PTGS2), Late Cornified Envelope 3D (LCE3D), Peroxisome Proliferator Activated Receptor (PPARD), and Granulocyte/Macrophage Colony Stimulating Factor 2 (GM-CSF2) have been up-regulated following usage of the solar protection regime, 1.87, 861.16, 4.34, 1.91, 1.06, and 3.6, respectively. ICAM1, MT1A, PTGS2, LCE3D, PPARD, and GM-CSF2 were up-regulated following use of the solar repair regime, 3.78, 2.98, 14.89, 5.09, 2.42, and 13.51, respectively.

Conclusion

This study demonstrates that a specific solar protection and repair regime upregulated genes involved in photoprotection and repair mechanisms in a 3-dimensional (3D) reconstructed human-like skin model.

Itchy Skin: A Challenging Differential Diagnosis Between Mycosis Fungoides and Sézary Syndrome

Primary cutaneous lymphomas represent a diverse spectrum of T-cell and B-cell lymphomas with their primary skin manifestation. Among these, mycosis fungoides (MF) and Sézary syndrome (SS) represent classic forms of cutaneous T-cell lymphomas (CTCLs). This report details the case of a 67-year-old female who presented with longstanding pruritic skin lesions, initially misdiagnosed and managed as eczema. The diagnostic process ultimately revealed the presence of Sézary cells in the peripheral blood smear (PBS). The SS diagnosis was confirmed based on CD4 positivity and CD7 negativity as determined by flow cytometry. The disease was staged as IVA1 (T2N0M1B2). The patient exhibited partial improvement with oral corticosteroid therapy. This report underscores the critical importance of integrating clinical evaluation and blood findings to distinguish between MF and SS. The progression of a circulating clone signals a poor prognosis, requiring surveillance and consideration of targeted therapies to enhance patient outcomes and improve their quality of life. Early detection remains paramount in the management of these rare cutaneous lymphomas, which are associated with unique therapeutic challenges.

Reports of Injection Site Necrosis After 23-Valent Pneumococcal Vaccine Use

This case series uses postmarketing data to evaluate the incidence of injection site necrosis after 23-valent pneumococcal vaccine use in the global market.

A Novel Multi-Component Formulation Reduces Inflammation In Vitro and Clinically Lessens the Symptoms of Chronic Eczematous Skin

Long-term treatments for inflammatory skin diseases like atopic dermatitis or eczema can cause adverse effects. Super Protein Multifunction (SPM) was investigated as a potential treatment for managing skin inflammation by monitoring the expression of pro-inflammatory cytokines induced using LPS and poly(I:C)/TNFα in HaCaT keratinocytes and Hs27 fibroblasts as measured via RT-PCR. SPM solution was also assessed for its effect on cytokine release, measured using ELISA, in a UVB-irradiated 3D human skin model. To evaluate the efficiency of SPM, 20 patients with mild eczematous skin were randomized to receive SPM or vehicle twice a day for three weeks in a double-blind controlled trial. In vitro studies showed SPM inhibited inflammation-induced IL-1β, IL-6, IL-33, IL-1α, TSLP, and TNFα expression or release. In the clinical study, the SPM group showed significant improvements in the IGA, PA, and DLQI scores compared to the vehicle group. Neither group showed significant differences in VAS (pruritus). Histological analysis showed reduced stratum corneum thickness and inflammatory cell infiltration. The results suggest that SPM may reduce inflammation in individuals with chronic eczematous skin.

A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin

In some patients with chronic wounds, the surrounding skin is so injured due to various underlying conditions that negative pressure dressing cannot be applied or cannot function properly. Having faced this problem in our everyday practice, we developed a new skin-sparing technique for vacuum-assisted wound closure, which ensures that the peri-wound skin does not come into contact with the transparent adhesive films.

Methods

For 9 months (April-December 2022), we performed 32 vacuum wound dressings with the newly developed technique using the 3M ActiV.A.C. Therapy Unit and accessories, and Convatec's VARIHESIVE, avoiding skin contact with the adhesive films.

Results

Seven patients with 11 wounds who had sensitive skin or allergy to the conventionally used adhesive films were successfully treated with the new technique. The negative pressure wound dressings remained intact and functioned properly for up to 168 hours without compromising patients' daily activities and therapy.

Conclusion

The novel "no foil-to-skin contact" technique for vacuum-assisted wound closure can successfully be incorporated in the treatment of patients in whom conventional negative pressure dressings are otherwise not applicable.

The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications

BACKGROUND

Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress.

OBJECTIVES AND PROJECT DESCRIPTION

The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth.

FUTURE IMPACT

With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.

Rosacea: The eyes have it

Rosacea is a chronic inflammatory dermatosis typically affecting the facial skin but also the eyes. With its chronic course with fluctuating episodes of flashing, redness, papulopustules, and nodules it poses a severe psychologic burden to the affected individuals. In addition to the facial changes, more than half of the patients have ocular involvement ranging from blepharitis and conjunctival hyperemia to more severe ophthalmic damage, and even blindness. Clinically, the ocular involvement in rosacea includes meibomian gland dysfunction with relapsing hordeola and chalazia, diffuse hyperemic conjunctivitis, photophobia, episcleritis, or kerato-conjunctivitis, and in rare cases, corneal ulcers. These are mainly observed in adult patients but can also occur in children. Depending on the degree of cutaneous or ocular findings, patients with rosacea may present first to the dermatologist or to the ophthalmologist. Both specialists should be aware of the potential oculocutaneous involvement. Any ocular complaints expressed by the patient in the setting of a dermatologist's office should be referred promptly for an ophthalmologic examination. Conversely, signs suggestive of rosacea in the eye should lead the ophthalmologist to consider underlying skin disease. A timely interdisciplinary collaboration is paramount for the earlier diagnosis and treatment, thus preventing permanent eye impairment in this chronic dermatosis.

Nicolau syndrome associated with fluphenazine depot: A case report

Nicolau syndrome is a rare condition characterized by severe pain at the site of injection, leading to ulceration and necrosis of the local tissues. Its presentation is usually acute. Nicolau syndrome is commonly seen in patients after intramuscular, intra-articular, or subcutaneous injections of non-steroidal anti-inflammatory drugs, antiepileptics, antipsychotics, antibiotics, antihistamines, and corticosteroids. Immediate diagnosis and management of this syndrome are of great importance. We herein report a rare presentation of Nicolau syndrome in a 36-year-old married male who suffered from paranoid schizophrenia for the past 3 years. The patient presented with dull pain, mild swelling, and necrotic ulceration over the injection site after receiving intramuscular fluphenazine. The patient underwent wound debridement and was given prophylactic antibiotics. Despite a wide range of therapeutic options for the management of Nicolau syndrome described in the literature, there exist limited guidelines for its management.

Expression in skin biopsies supports genetic evidence linking CAMKK2, P2X7R and P2X4R with HIV-associated sensory neuropathy

HIV-associated sensory neuropathy (HIV-SN) affects 14-38% of HIV+ individuals stable on therapy with no neurotoxic drugs. Polymorphisms in CAMKK2, P2X7R and P2X4R associated with altered risk of HIV-SN in Indonesian and South African patients. The role of CaMKK2 in neuronal repair makes this an attractive candidate, but a direct role for any protein is predicated on expression in affected tissues. Here, we describe expression of CaMKK2, P2X7R and P2X4R proteins in skin biopsies from the lower legs of HIV+ Indonesians with and without HIV-SN, and healthy controls (HC). HIV-SN was diagnosed using the Brief Peripheral Neuropathy Screen. Biopsies were stained to detect protein gene product 9.5 on nerve fibres and CaMKK2, P2X7R or P2X4R, and were examined using 3-colour sequential scanning confocal microscopy. Intraepidermal nerve fibre densities (IENFD) were lower in HIV+ donors than HC and correlated directly with nadir CD4 T-cell counts (r = 0.69, p = 0.004). However, IENFD counts were similar in HIV-SN+ and HIV-SN- donors (p = 0.19) and so did not define neuropathy. CaMKK2+ cells were located close to dermal and epidermal nerve fibres and were rare in HC and HIV-SN- donors, consistent with a role for the protein in nerve damage and/or repair. P2X7R was expressed by cells in blood vessels of HIV-SN- donors, but rarely in HC or HIV-SN+ donors. P2X4R expression by cells in the epidermal basal layer appeared greatest in HIV-SN+ donors. Overall, the differential expression of CaMKK2, P2X7R and P2X4R supports the genetic evidence of a role for these proteins in HIV-SN.

Trichoscopy pattern in alopecia areata: A systematic review and meta-analysis

BACKGROUND

The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining the correct diagnosis of hair loss presentations.

OBJECTIVE

Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns.

METHODS

Thirty-nine studies were eligible for the quantitative analysis. Meta-analysis and subgroup analysis were performed.

RESULTS

Thirty-nine studies (29 cross-sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs.

CONCLUSION

There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.

Animal Models for the Investigation of P2X7 Receptors

The P2X7 receptor is a trimeric ligand-gated cation channel activated by extracellular adenosine 5'-triphosphate. The study of animals has greatly advanced the investigation of P2X7 and helped to establish the numerous physiological and pathophysiological roles of this receptor in human health and disease. Following a short overview of the P2X7 distribution, roles and functional properties, this article discusses how animal models have contributed to the generation of P2X7-specific antibodies and nanobodies (including biologics), recombinant receptors and radioligands to study P2X7 as well as to the pharmacokinetic testing of P2X7 antagonists. This article then outlines how mouse and rat models have been used to study P2X7. These sections include discussions on preclinical disease models, polymorphic P2X7 variants, P2X7 knockout mice (including bone marrow chimeras and conditional knockouts), P2X7 reporter mice, humanized P2X7 mice and P2X7 knockout rats. Finally, this article reviews the limited number of studies involving guinea pigs, rabbits, monkeys (rhesus macaques), dogs, cats, zebrafish, and other fish species (seabream, ayu sweetfish, rainbow trout and Japanese flounder) to study P2X7.

Characteristics and Outcomes of Patients Undergoing Surgical Management of Hidradenitis Suppurativa: An ACS-NSQIP Data Analysis

Objective: Hidradenitis suppurativa (HS) is a painful inflammatory skin disease. Management is largely medical, with surgery reserved for severe refractory cases. In this study, we sought to conduct a retrospective analysis of a multi-institutional surgical database to investigate the surgical management of patients with HS and identify trends in the postoperative outcomes. Approach: The 2011-2019 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to identify patients who underwent surgery for management of HS. Postoperative outcomes were assessed, including surgical and medical complications, length of hospital stay, reoperation, readmission, and nonhome discharge. This article was reported according to the STROBE criteria. Results: We identified 1,030 patients, of which 62% were female and 50% were black. The most common comorbidity was obesity (61%). Surgery was mainly performed by general surgeons (62%) and plastic surgeons (31%). Complications were overall low, with readmission being the most common (7.1%, unplanned 6.0%), followed by reoperation (5.8%). The most common surgical complication was superficial incisional infection (5.1%) and most common medical complication was sepsis (3.8%). Obesity is seen to affect surgical complication rates, with patients with obesity having higher rates of dehiscence (obese: 3.1% and nonobese: 1.0%; p = 0.03) but lower rates of organ space infection (obese: 0.5% and nonobese: 2.0%; p = 0.03) and transfusion (obese: 2.5% and nonobese: 5.2%; p = 0.04). A focus on complications in patients undergoing flap reconstruction (n = 293; 23%), identified higher rates of surgical complications, with superficial incisional infection being the most common (flap reconstruction: 7.5% and incision and drainage, debridement, skin graft: 4.1%; p = 0.04). Innovation: The surgical management of HS is analyzed at the national level, with postoperative complications seen to depend on race and obesity-status. Conclusions: Surgical management for HS is associated with low postoperative complications, making surgery a viable treatment option for this debilitating disease.

Skin Inflammation with a Focus on Wound Healing

Significance: The skin is the crucial first-line barrier against foreign pathogens. Compromise of this barrier presents in the context of inflammatory skin conditions and in chronic wounds. Skin conditions arising from dysfunctional inflammatory pathways severely compromise the quality of life of patients and have a high economic impact on the U.S. health care system. The development of a thorough understanding of the mechanisms that can disrupt skin inflammation is imperative to successfully modulate this inflammation with therapies. Recent Advances: Many advances in the understanding of skin inflammation have occurred during the past decade, including the development of multiple new pharmaceuticals. Mechanical force application has been greatly advanced clinically. Bioscaffolds also promote healing, while reducing scarring. Critical Issues: Various skin inflammatory conditions provide a framework for analysis of our understanding of the phases of successful wound healing. The large burden of chronic wounds on our society continues to focus attention on the chronic inflammatory state induced in many of these skin conditions. Future Directions: Better preclinical models of disease states such as chronic wounds, coupled with enhanced diagnostic abilities of human skin, will allow a better understanding of the mechanism of action. This will lead to improved treatments with biologics and other modalities such as the strategic application of mechanical forces and scaffolds, which ultimately results in better outcomes for our patients.

Familial homozygous hypercholesterolemia with arcus cornea and xanthomas: A rare but serious entity

Familial hypercholesterolemia (FH) is a rare but life-threatening disorder. Skin manifestations can be its only manifestation. We present a case of a fifteen-year-old female child, with multiple eruptive xanthomas, xanthomas anarcus, and a deranged lipid profile consistent with FH. The presence of this manifestation especially in the younger age group should draw attention to hypercholesterolemia. A timely diagnosis is fundamental to prevent serious complications and for early treatment.

Tissue Damage Caused by Diclofenac Intramuscular Injection: The Nicolau Syndrome

Introduction Nicolau syndrome is an extremely rare complication following intramuscular administration of drugs leading to tissue damage and necrosis.

Case Report In this case, the patient received the injection from an untrained quack surgeon (Jarrah) due to an improper intramuscular injection technique. A 45-year-old female complained of pain and blackish discoloration of the skin over the left buttock after receiving an intramuscular diclofenac injection.4 The patient was managed by administering intravenous antibiotics and analgesics, followed by surgical debridement. Flap reconstruction was done after granulation tissue formation.

Conclusion Healthcare should be sought from appropriately trained and licensed professionals. Patients should be well educated on this. Pain, erythema, and discoloration should be recognized as red flags of the Nicolau syndrome so that it can be addressed promptly to avoid complications.

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

Since its approval in Europe a decade ago, NexoBrid^® enzymatic debridement of deep thermal burns has been gaining acceptance as standard practice around the world. The purpose of this study is to report the first experience with NexoBrid^® in the Russian Federation. During 2019-2020, we conducted a post-registration clinical study assessing the safety and treatment results of NexoBrid^® enzymatic debridement. The study involved 15 adult patients suffering from deep thermal burns over an area ≤15% of their total body surface area. Patients were treated with NexoBrid^® within 3 days of injury, followed by spontaneous or surgical wound closure. Complete eschar removal was achieved in twelve patients, 80% eschar removal in two patients, and 70% in one patient. Complete spontaneous epithelialization of wounds was achieved in 12 patients (80%) within 18 ± 1.9 days after the start of treatment. We did not witness pathological scarring during follow-up, and there were no significant safety issues throughout the study. Early use of NexoBrid^® resulted in rapid, effective, and safe eschar removal with good results and sufficient preservation of viable dermis to allow for spontaneous healing in 80% of patients. These results demonstrate the ability to minimize surgical intervention and hopefully lead to better long-term scarring results.

Quantitative phase analysis and hyperspectral imaging for the automatic identification of veins and blood perfusion maps

INTRODUCTION

Medical workers commonly physically identify subcutaneous veins to locate a suitable vesselto implant a catheter for drug administration or blood sample. The general rule of thumb is to locate a big, clean vein that will allow the medication to readily pass within the intended blood vessel. Peripheral problematic venous access happens when a patient's veins are difficult to palpate because of factors like dark skin tone, edema or excess tissue. The ability to see how the vasculature changes to support the therapeutic methods without damaging the surrounding tissue is another challenge.

MATERIALS AND METHODS

Hyperspectral imaging (HI) is a developing technique with several potential uses in medicine. Using its spectroscopic data, veins and arterioles could be noninvasively detected and discriminated. It is frequently important to use quantitative phase analysis for vein localization. To assess hyperspectral image data for the detection of both veins and peripheral arteries, we suggest using an advanced image processing and classification algorithm based on the phase information related to the index of refraction change and associated scattering. We show that this need may be satisfied using quantitative phase imaging of forearm skin tissue at different depths.

RESULTS

To demonstrate the variations in the diffuse reflectance characteristics between skin surface and veins, phase resolved pictures were successfully produced for twelve volunteers using our imaging methodology. We found that the skin surface details are completely apparent at the unique wavelength of 441 nm. The 500-nm wavelength was the most efficient for grouping peripheral arteries and illuminating the blood perfusion maps. Using our HI experimental setup and our phase imaging procedure on the 600 nm and 650 nm visible spectral pictures, we were able to properly describe the vein map. This spectral area may be utilized as a vein locator marker which could approximately reach till 3 mm depth under skin surface.

CONCLUSIONS

Initial findings suggested that our imaging technique would be able to assist medical examiners in safely assessing the veins and arteriole's locations automatically without exposing the skin to infrared radiation. Meanwhile, our pilot research in this work to determine the best spectral wavelengths for localizing veins and mapping blood perfusion using our phase analysis imaging strategy with the HI camera. By substituting the HI camera with a custom conventional RGB camera that only functions at specific wavelengths during the discovering of blood perfusion locations or prior to intravenous catheterization, a distinctive and efficient system for precise identification may be developed to serve in the field of the vascular therapeutic methods.

Modulation of Lymphangiogenesis in Incisional Murine Diabetic Wound Healing Using Negative Pressure Wound Therapy

Objective: Despite the significant function of lymphatics in wound healing, and frequent clinical use of Negative Pressure Wound Therapy (NPWT), the effect of mechanical force application on lymphangiogenesis remains to be elucidated. We utilize a murine incisional wound healing model to assess the mechanisms of lymphangiogenesis following NPWT. Approach: Dorsal incisional skin wounds were created on diabetic mice (genetically obese leptin receptor-deficient mice [db/db]; n = 30) and covered with an occlusive dressing (Control, n = 15) or NPWT (-125 mmHg, continuous, 24 h for 7 days; NPWT, n = 15). The wounds were macroscopically assessed for 28 days. Tissue was harvested on day 10 for analysis. Qualitative functional analysis of lymphatic drainage was performed on day 28 using Evans Blue staining (n = 2). Results: NPWT increased lymphatic vessel density (40 ± 20 vs. 12 ± 6 podoplanin [PDPN]⁺ and 25 ± 9 vs. 14 ± 8 lymphatic vessel endothelial receptor 1 [LYVE-1]⁺) and vessel diameter (28 ± 9 vs. 12 ± 2 μm). Western blotting verified the upregulation of LYVE-1 with NPWT. Leukocyte presence was higher with NPWT (22% ± 3.7% vs. 9.1% ± 4.1% lymphocyte common antigen [CD45]⁺) and the leukocytes were predominately B cells clustered within vessels (8.8% ± 2.5% vs. 18% ± 3.6% B-lymphocyte antigen CD20 [CD20]⁺). Macrophage presence was lower in the NPWT group. Lymphatic drainage was increased in the NPWT group, which exhibited greater Evans Blue positivity. Innovation: The lymphangiogenic effects take place independent of macrophage infiltration, appearing to correlate with B cell presence. Conclusion: NPWT promotes lymphangiogenesis in incisional wounds, significantly increasing the lymph vessel density and diameter. This study highlights the potential of NPWT to stimulate lymphatic drainage and wound healing of surgical incisions.

Outcomes Following Use of Negative-Pressure Wound Therapy Over Autologous Meshed and Non-Meshed Skin Grafts

Negative-pressure wound therapy (NPWT) over split thickness skin grafts can control exudate, decrease infection rates, and improve revascularization. However, no study specifically addresses differences in outcomes between meshed/perforated and non-meshed autologous skin grafts dressed with NPWT. Through retrospective chart review, patients undergoing autologous split thickness skin grafting with a NPWT dressing for any burn injury over a 10-month period were identified. Data on etiology, graft take, meshed/perforated or non-meshed graft, graft size, and seroma/hematoma incidence were collected. Our study included 123 patients who had STSG with NPWT and consisted of 57% males, 57% Caucasian, and an average age of 41. Burn injury etiologies consisted of scald (55%), chemical (25%), flame (15%), and contact (5%). Average 2nd degree TBSA in our cohort was 2.34%, 3rd degree TBSA 4.50%, and total TBSA 5.35%. 66.7% of patients received non-meshed grafts, and these patients had an average graft area of 76.5 cm2. 33.3% of patients received meshed grafts, with an average graft area of 163.5 cm2. Non-meshed burn grafts were significantly smaller than meshed grafts (P = .04). There was 100% graft take and 0% seroma/hematoma formation in all patients. Data was analyzed using an unpaired student's T test and ANOVA testing. There were no statistically significant differences in patient demographics, or burn etiology. There exist many options for dressings after repair of burn injuries, each with its own unique advantages. There were, however, no differences in graft take or incidence of seroma/hematoma formation using a NPWT dressing over autologous meshed grafts vs non-meshed grafts. Our data shows that NPWT use as a bolster dressing is safe and efficacious overlying meshed skin grafts and non-meshed grafts.

The Comparison of Sun Protection Factor 30 Persistence Between Inorganic and Organic Sunscreen in Swimmers: Double-blind Randomized Clinical Trial

BACKGROUND

Long-term sun exposure is one of the risks faced by outdoor swimmers and can cause sunburn. Using sunscreen is one way to prevent sunburn; however, physical activity can trigger sweat, friction, and water washing that can interfere with sunscreen efficacy and decrease its sun protection factor (SPF). Sunscreens are classified into inorganic and organic based on their filter. Organic sunscreen has a better bond to the skin than inorganic sunscreen, which forms a barrier above the skin layer that makes removing it easier. Organic sunscreen lasts longer than inorganic sunscreen when used in physical activities, but it has a limited spectrum, is more photolabile, and is more allergenic.

OBJECTIVE

This study aims to evaluate the persistency of SPF 30 between inorganic and organic sunscreens on the back area after 1.5 hours of swimming.

METHODS

This study is a randomized, split-body, double-blind clinical trial to evaluate the persistency of SPF 30 of the inorganic versus organic sunscreens in swimmers. Randomization was done to allocate the participants into treatment groups. Each participant received inorganic and organic sunscreen treatments applied to the back area. The research participants were swimmers from the Cikini swimming pool and Bina Taruna swimming pool, both in Jakarta, Indonesia.

RESULTS

A total of 22 swimmers were enrolled in this study. The analysis showed no significant difference between the SPF of the two sunscreens before swimming (P=.22). After swimming, the SPF levels of both sunscreens decreased: the inorganic sunscreen decreased from a median of 27 (range 23-47) to 12.3 (range 8-19), and the organic sunscreen decreased from a median of 30 (range 24-47) to 9.9 (range 6-19), which was statistically significant (P<.001). When comparing the SPF of inorganic and organic sunscreens after swimming, there was a statistically significant difference in the decrease in SPF levels between the two groups (P=.02), which indicated a better SPF persistence for inorganic sunscreens when compared to organic sunscreens.

CONCLUSIONS

There was a decrease in the SPF levels of inorganic and organic sunscreens after 1.5 hours of swimming, with better persistence in inorganic sunscreens compared to organic sunscreens.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04618536; https://clinicaltrials.gov/ct2/show/NCT04618536.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/42504.

Surgical Repair of the Acute Burn Wound: Who, When, What Techniques? What Is the Future?

Modern burns surgery is multidisciplinary, multimodal and includes a dermal preservation approach. The management of the surgical wound starts in the pre-hospital environment with stabilization and assessment of the burn injured patient according to protocols of trauma resuscitation with special emphasis in the assessment of the burn depth and surface area. A large burn requires fluid resuscitation and physiological support, including counterbalancing hyper metabolism, fighting infection and starting a long burns intensive care journey. A deep burn may impose the need for surgical debridement and cover through a staged approach of excision of devitalized tissue depending on its extension and patient circumstances. These methodologies warrant patients survivability and require professionals integrated in a multidisciplinary team sharing decisions and directing management. Burns Multimodality involves multiple techniques used according to patient's needs, wound environment, operators experience and available resources. Traditional practices used together with new techniques may reduce morbidity and operative time but also challenge stablished practice. The concept of using the best teams with the best techniques combines with the need for selective and judicious surgery that preserves tissue architecture and spares as much as possible dermal component, therefore reducing the possibility of functional impairment and cosmetic embarrassment caused by pathological scars. Who is best placed to perform these tasks, the appropriate or best timing of surgery and the different practices used to achieve best results will be discussed, together with a reflection on what the future holds for these fundamental steps in the management of the burn injured patient turning into a functional burn survivor.

Negative-Pressure Wound Therapy: What We Know and What We Need to Know

Negative-pressure wound therapy (NPWT) promotes wound healing by applying negative pressure to the wound surface. A quarter of a century after its introduction, NPWT has been used in various clinical conditions, although molecular biological evidence is insufficient due to delay in basic research. Here, we have summarized the history of NPWT, its mechanism of action, what is currently known about it, and what is expected to be known in the future. Particularly, attention has shifted from the four main mechanisms of NPWT to the accompanying secondary effects, such as effects on various cells, bacteria, and surgical wounds. This chapter will help the reader to understand the current status and shortcomings of NPWT-related research, which could aid in the development of basic research and, eventually, clinical use with stronger scientific evidence.

Novel cell culture system for monitoring cells during continuous and variable negative-pressure wound therapy

BACKGROUND

Although the clinical efficacy of negative-pressure wound therapy (NPWT) is well known, many of its molecular biological mechanisms remain unresolved, mainly due to the difficulty and paucity of relevant in vitro studies. We attempted to develop an in vitro cell culture system capable of real-time monitoring of cells during NPWT treatment.

MATERIALS AND METHODS

A novel negative-pressure cell culture system was developed by combining an inverted microscope, a stage-top incubator, a sealed metal chamber for cell culture, and an NPWT treatment device. Human keratinocytes, PSVK-1, were divided into ambient pressure (AP), continuous negative-pressure (NPc), and intermittent negative-pressure (NPi) groups and cultured for 24 h with scratch assay using our real-time monitoring system and device. Pressure inside the device, medium evaporation rate, and the residual wound area were compared across the groups.

RESULTS

Pressure in the device was maintained at almost the same value as set in all groups. Medium evaporation rate was significantly higher in the NPi group than in the other two groups; however, it had negligible effect on cell culture. Residual wound area after 9 h evaluated by the scratch assay was significantly smaller in the NPc and NPi groups than in the AP group.

CONCLUSION

We developed a negative-pressure cell culture device that enables negative-pressure cell culture under conditions similar to those used in clinical practice and is able to monitor cells under NPWT. Further experiments using this device would provide high-quality molecular biological evidence for NPWT.

Comparison of Sun Protection Factor (SPF) 30 Persistence Between Inorganic and Organic Sunscreen in Swimmers: Protocol for a Multicenter, Randomized, Noninferiority, Split-Body, Double-Blind Clinical Trial

BACKGROUND

Outdoor swimming athletes are often exposed to undesirable environmental conditions such as long-term sun exposure. The risk of sunburn can still occur in this population due to the loss of sunscreen and an increase in the sensitivity of the skin to ultraviolet rays, particularly ultraviolet B, in wet conditions. Some previous trials showed that organic sunscreens had a longer shelf-life than inorganic sunscreens after exercise due to their characteristics to bind better with the skin layer. Meanwhile, inorganic sunscreens tend to form layers on the skin's surface so that they can be more easily removed. To our knowledge, no studies evaluate sunscreens' resistance, either inorganic or organic, after exercising in Indonesia.

OBJECTIVE

This study aims to evaluate the persistence of inorganic versus organic sunscreens used by swimmers. The primary objective is to assess whether the inorganic sunscreen is as good as the organic sunscreen in the field of the persistence of sunscreens after swimming for 1.5 hours.

METHODS

This study is a randomized, split-body, double-blind, noninferiority, and multicenter clinical trial in Cikini, Jakarta, Indonesia. An estimated 22 athletes in each group, who aged 18-40 years and practice in the morning or afternoon, will be randomized using a computer-generated randomization method. We calculated the sample size using the difference in the average decrease in sun protection factor (SPF) levels that is considered significant based on the clinical judgment set by the researchers, which was 5. Neither the research subjects nor the researchers are aware of the type of sunscreen that will be applied. The hypothesis will be tested using paired-sample t test or Wilcoxon to assess the difference of SPF levels in each group between organic and inorganic sunscreens with SPSS (version 20.0; IBM Corp).

RESULTS

This study has been approved by the Ethical Committee Faculty of Medicine Universitas Indonesia and is funded by the International Publication Grant from Universitas Indonesia. The enrollment process was completed in December 2020.

CONCLUSIONS

This study will test all procedures in preparation for conducting the main study, including several potential obstacles and challenges from the perspective of participating physicians and eligible swimmers. The study results will be disseminated through publications in a peer-reviewed journal with Open Access format. This study will provide information about SPF 30 persistence in sunscreens and the best type of sunscreen to be used while swimming, particularly for athletes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04618536; https://clinicaltrials.gov/ct2/show/NCT04618536?term=NCT04618536.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/42504.

Designing a Band for Vehicles' Drivers Induced by Ultraviolet and Infrared Radiations

Background

Solar radiations that reach the Earth can be divided into ultraviolet, visible light, and infrared. Overexposure to these radiations can facilitate adverse skin diseases such as sunburn, skin cancer, and photoaging. People who drive vehicles for an extended period are likely to develop skin cancer in the exposed body area.

Method

This research proposes a wearable protective device around the upper arm to measure the transmitted radiation through the front and the side windows. A novel skin type classification algorithm using a color sensor was created to provide an accurate skin type identification. Also, the device was programmed to calculate the time before sunburn occurrence based on the ultraviolet index, sunscreen's sun protection factor, and skin type.

Results

The prototype was tested inside a Toyota Camry model 2001 vehicle with an accuracy of 97%. The front window had transmitted more infrared radiation compared to the side window. The highest recorded value was 76.76 mW/cm². On the other hand, the side window had transmitted more ultraviolet compared to the front window as it lacks the protective polyvinyl butyral layer that the front window has. The highest recorded ultraviolet index was 3.5.

Conclusion

These results highlight the importance of wearing the designed solar band and using appropriate UV and IR protection while driving a vehicle to prevent skin diseases from occurring.

Dynamic Optical Coherence Tomography: A Non-Invasive Imaging Tool for the Distinction of Nevi and Melanomas

Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability to distinguish melanocytic lesions based on its focus on microvascularization. To determine if an addition to the gold standard of a clinical-dermoscopic examination improves the diagnosis of unclear lesions, further studies, including a larger sample of dysplastic nevi and artificial intelligence, should be conducted.

Autologous whole blood clot and negative-pressure wound therapy in South Africa: A comparison of the cost and social considerations

BACKGROUND

Advanced wound treatment modalities enhance healing of hard-to-heal wounds, decrease the risk of amputations, and improve the quality of life of patients. Modalities have different rates of efficacy and incur different social and financial costs to the individual and the healthcare system. Two such modalities, the autologous whole blood clot (WBC) and negative-pressure wound therapy (NPWT), were compared in the South African (SA) context. The comparison was conducted on hard-to-heal wounds, with a specific focus on diabetic foot ulcers (DFUs).

OBJECTIVES

To compare the social considerations and financial costs of using autologous WBC v. NPWT in the treatment of DFUs in SA.

METHODS

Data were obtained based on current supply costs from SA suppliers for the two modalities, the standard of care for both modalities, the number of applications required for each, and social considerations provided by SA wound management clinicians. Wound healing rates were obtained from the published literature. This information was used to calculate costs of two scenarios (scenario 1: low exudate v. scenario 2: high exudate), which were compared over two treatment durations (4 and 12 weeks) for each treatment modality. Calculations included weekly cost of supplies, total cost saved by a patient with a DFU managed with either of the wound therapies, and the difference in total cost saved between the two modalities. Key social considerations were assessed qualitatively from discussions with SA clinicians experienced in both autologous WBC and NPWT, and from published research.

RESULTS

The cost of supplies per week was ZAR3 250 for autologous WBC and ZAR4 804 for NPWT in scenario 1, and ZAR3 332 and ZAR6 612 in scenario 2. With healing rates over 4 weeks' treatment duration of 19% for autologous WBC and 10% for NPWT, autologous WBC saved ZAR17 719.93, or 9% more than using NPWT, in scenario 1 and ZAR18 381.47, or 10% more, in scenario 2. At 12 weeks' treatment duration, healing rates for autologous WBC and NPWT were 75% and 43%, respectively. In scenario 1, results indicated a 43% cost difference between the two modalities. Autologous WBC had a total cost saving of ZAR61 874.40 compared with NPWT over a period of 12 weeks. In scenario 2, results indicated a 46% cost difference between the two modalities. Autologous WBC had a total cost saving of ZAR70 454.68 compared with NPWT over a period of 12 weeks. One of the identified social considerations is that NPWT needs a reliable supply of electricity to recharge the pump, while autologous WBC does not.

CONCLUSION

Both modalities are safe and effective in treating hard-to-heal wounds of the lower extremities. Autologous WBC consistently demonstrated better outcomes than NPWT in terms of both healing rate and cost-effectiveness, as well as having some advantages in terms of social considerations in SA.

The Association between Neoadjuvant Radio-Chemotherapy and Prolonged Healing of Anastomotic Leakage after Esophageal Resection Treated with EndoVAC Therapy

(1) Background: Endoscopic vacuum therapy (EVT) has become the mainstay in the treatment of early anastomotic leakage (AL) after esophageal resection. The effect of nRCT on the efficacy of EVT is currently unknown. (2) Methods: Data of 427 consecutive patients undergoing minimally invasive esophagectomy between 2013 and 2022 were analyzed. A total of 26 patients received EVT for AL after esophagectomy between 2010 and 2021. We compared a cohort of 13 patients after treatment with EVT for anastomotic leakage after neoadjuvant radiochemotherapy (nRCT) with a control group of 13 patients after neoadjuvant chemotherapy (nCT) using inverse propensity score weighting to adjust for baseline characteristics between the groups. EVT therapy was assessed regarding patient survival, treatment failure as defined by a change in treatment to stent/operation, duration of treatment, and secondary complications. Statistical analysis was performed using linear regression analysis. (3) Results: Time to EVT after initial tumor resection did not vary between the groups. The duration of EVT was longer in patients after nRCT (14.69 days vs. 20.85 days, p = 0.002) with significantly more interventions (4.38 vs. 6.85, p = 0.001). The success rate of EVT did not differ between the two groups (nCT n = 8 (61.54%) vs. nCT n = 5 (38.46%), p = 0.628). The rate of operative revision did not vary between the groups. Importantly, no mortality was reported within 30 days and 90 days in both groups. (4) Conclusions: EVT is a valuable tool for the management of AL after esophageal resection in patients after nRCT. While the success rates were comparable, EVT was associated with a significantly longer treatment duration. Anastomotic leakages after nRCT often require prolonged and multimodal treatment strategies while innovative strategies such as prophylactic endoVAC placement or use of a VAC-Stent may be considered.

Fishing for the Microbiome of Tropical Tuna

Although tunas represent a significant part of the global fish economy and a major nutritional resource worldwide, their microbiome still remains poorly documented. Here, we conducted an analysis of the taxonomic composition of the bacterial communities inhabiting the gut, skin, and liver of two most consumed tropical tuna species (skipjack and yellowfin), from individuals caught in the Atlantic and Indian oceans. We hypothesized that each organ harbors a specific microbial assemblage whose composition might vary according to different biotic (sex, species) and/or abiotic (environmental) factors. Our results revealed that the composition of the tuna microbiome was totally independent of fish sex, regardless of the species and ocean considered. Instead, the main determinants of observed diversity were (i) tuna species for the gut and (ii) sampling site for the skin mucus layer and (iii) a combination of both parameters for the liver. Interestingly, 4.5% of all amplicon sequence variants (ASV) were shared by the three organs, highlighting the presence of a core-microbiota whose most abundant representatives belonged to the genera Mycoplasma, Cutibacterium, and Photobacterium. Our study also revealed the presence of a unique and diversified bacterial assemblage within the tuna liver, comprising a substantial proportion of potential histamine-producing bacteria, well known for their pathogenicity and their contribution to fish poisoning cases. These results indicate that this organ is an unexplored microbial niche whose role in the health of both the host and consumers remains to be elucidated.