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Zhang Y, Li X, Yu Q, Lv X, Li C, Wang L, Liu Y, Wang Q, Yang Z, Fu X, Xiao R. Using network pharmacology to discover potential drugs for hypertrophic scars. Br J Dermatol 2024; 191:592-604. [PMID: 38820210 DOI: 10.1093/bjd/ljae234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Hypertrophic scarring is a disease of abnormal skin fibrosis caused by excessive fibroblast proliferation. Existing drugs have not achieved satisfactory therapeutic effects. OBJECTIVES To explore the molecular pathogenesis of hypertrophic scars and screen effective drugs for their treatment. METHODS Existing human hypertrophic scar RNA sequencing data were utilized to search for hypertrophic scar-related gene modules and key genes through weighted gene co-expression network analysis (WGCNA). Candidate compounds were screened in a compound library. Potential drugs were screened by molecular docking and verified in human hypertrophic scar fibroblasts and a mouse mechanical force hypertrophic scar model. RESULTS WGCNA showed that hypertrophic scar-associated gene modules influence focal adhesion, the transforming growth factor (TGF)-β signalling pathway and other biologic pathways. Integrin β1 (ITGB1) is the hub protein. Among the candidate compounds obtained by computer virtual screening and molecular docking, crizotinib, sorafenib and SU11274 can inhibit the proliferation and migration of human hypertrophic scar fibroblasts and profibrotic gene expression. Crizotinib had the best effect on hypertrophic scar attenuation in mouse models. At the same time, mouse ITGB1 small interfering RNA can also inhibit mouse scar hyperplasia. CONCLUSIONS ITGB1 and TGF-β signalling pathways are important for hypertrophic scar formation. Crizotinib could be a potential treatment drug for hypertrophic scars.
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Affiliation(s)
- Yi Zhang
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiu Li
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Qian Yu
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Xiaoyan Lv
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Chen Li
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Lianzhao Wang
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Yue Liu
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Qian Wang
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Zhigang Yang
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xin Fu
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Ran Xiao
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
- Key Laboratory of External Tissue and Organ Regeneration, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
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Borowiec BM, Dyszkiewicz-Konwińska M, Bukowska D, Nowicki M, Budna-Tukan J. Small Extracellular Vesicles and Oral Mucosa: The Power Couple in Regenerative Therapies? Cells 2024; 13:1514. [PMID: 39329698 PMCID: PMC11429515 DOI: 10.3390/cells13181514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Although ongoing debates persist over the scope of phenomena classified as regenerative processes, the most up-to-date definition of regeneration is the replacement or restoration of damaged or missing cells, tissues, organs, or body parts to full functionality. Despite extensive research on this topic, new methods in regenerative medicine are continually sought, and existing ones are being improved. Small extracellular vesicles (sEVs) have gained attention for their regenerative potential, as evidenced by existing studies conducted by independent research groups. Of particular interest are sEVs derived from the oral mucosa, a tissue renowned for its rapid regeneration and minimal scarring. While the individual regenerative potential of both sEVs and the oral mucosa is somewhat understood, the combined potential of sEVs derived from the oral mucosa has not been sufficiently explored and highlighted in the existing literature. Serving as a broad compendium, it aims to provide scientists with essential and detailed information on this subject, including the nature of the materials employed, isolation and analysis methodologies, and clinical applications. The content of this survey aims to facilitate the comparison of diverse methods for working with sEVs derived from the oral mucosa, aiding in the planning of research endeavors and identifying potential research gaps.
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Affiliation(s)
- Blanka Maria Borowiec
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznan, Poland (M.N.)
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | | | - Dorota Bukowska
- Department of Diagnostics and Clinical Sciences, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland;
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznan, Poland (M.N.)
| | - Joanna Budna-Tukan
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781 Poznan, Poland (M.N.)
- Department of Anatomy and Histology, Collegium Medicum, University of Zielona Gora, 65-046 Zielona Gora, Poland
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Zhao F, Wang L, Zhang Y, Tang S, Ji P, Xiang X, Pang X. MiR-494-3p regulates skin fibroblast activities by mediating fibromodulin production. J Cell Physiol 2024:e31404. [PMID: 39129212 DOI: 10.1002/jcp.31404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/04/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024]
Abstract
Skin wound healing is a well-coordinated process in which various cells and factors participate, during which fibroblast exhibits a critical role by exerting its multiple activities, including proliferation, migration, invasion, and differentiation. Previous studies have identified that fibromodulin (FMOD) could enhance dermal wound healing by promoting skin fibroblast activities, but little is known about its upstream regulator. We occasionally found that FMOD expression was downregulated in skin fibroblast by transforming growth factor-β1 treatment. It was hypothesized that microRNAs (miRNA) in skin fibroblast could downregulate FMOD production and blocking them would increase FMOD expression, as well as promote skin wound healing. Here, by utilizing combined analysis of miRNA microarray from the Gene Expression Omnibus database and miRNA targets prediction, we successfully identified a miRNA, termed miR-494-3p, could regulate FMOD production in human skin fibroblast (BJ fibroblast). The functional analysis revealed that miR-494-3p mimics could inhibit BJ fibroblast migration and invasion but not proliferation and differentiation, while miR-494-3p inhibition markedly promotes migration, invasion, and differentiation of BJ fibroblast. Moreover, we established FMOD overexpression (OE) and knockout BJ fibroblast. We found that FMOD OE could rescue the inhibitory effects of miR-494-3p mimics on the migration and invasion of BJ fibroblast. In contrast, the miR-494-3p inhibitor transfection could not enhance migration, invasion, and differentiation of FMOD KO BJ fibroblast. Together, our results suggest that miR-494-3p may be a potential target for skin wound management via regulating FMOD production.
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Affiliation(s)
- Feng Zhao
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Linshu Wang
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin Zhang
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Siqi Tang
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Ji
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Xuerong Xiang
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxiao Pang
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Stomatological Hospital of Chongqing Medical University, Chongqing, China
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Yang Z, Yang Z, Zuo Z. Early intervention of carbon dioxide fractional laser in hypertrophic scar through TGFβ-1/ Smad3 signaling pathway. Lasers Med Sci 2024; 39:78. [PMID: 38388742 DOI: 10.1007/s10103-024-04026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Hypertrophic scars are usually the result of surgical trauma or burn,and more common in individuals with a darker skin color. They appear as red and raised lesions around the wound that continually expand over a period of weeks or months, causing itching, pain, burning sensation and discomfort. Severe scarring affects interpersonal and social relationships, and decreases the quality of life of the patients.The aim of this study was to evaluate the effect of carbon dioxide fractional laser as an early intervention against hypertrophic scars using a rabbit ear scar model, and explore the role of the TGFβ-1/ Smad3 signaling pathway in scar hyperplasia. Four wounds were made into each ear of rabbits, and divided into the untreated control and three laser-treatment groups. The experimental groups received laser intervention once, twice and thrice respectively. laser treatment significantly inhibited the formation of hypertrophic scars, and maximum benefits were seen in the wounds that received three laser treatments. Immunohistochemical staining showed that the in situ expression of TGFβ-1 and Smad3 in the scars decreased by varying degrees after laser intervention, and was most obvious after three laser interventions. Furthermore, the expression levels were the lowest at the end of 6 months after modeling. Therefore, we can assume that early intervention with carbon dioxide fractional laser can prevent formation of hypertrophic scars by regulating the TGF-β1/Smad3 pathway.
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Affiliation(s)
- Zizheng Yang
- Department of Plastic and Cosmetic Burns, Anhui No.2 Provincial People's Hospital, Anhui Medical University, Hefei, China
| | - Zhiguo Yang
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zongbao Zuo
- Department of Plastic and Cosmetic Burns, Anhui No.2 Provincial People's Hospital, Anhui Medical University, Hefei, China.
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Zhao Y, Ran B, Lee D, Liao J. Photo-Controllable Smart Hydrogels for Biomedical Application: A Review. SMALL METHODS 2024; 8:e2301095. [PMID: 37884456 DOI: 10.1002/smtd.202301095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/28/2023] [Indexed: 10/28/2023]
Abstract
Nowadays, smart hydrogels are being widely studied by researchers because of their advantages such as simple preparation, stable performance, response to external stimuli, and easy control of response behavior. Photo-controllable smart hydrogels (PCHs) are a class of responsive hydrogels whose physical and chemical properties can be changed when stimulated by light at specific wavelengths. Since the light source is safe, clean, simple to operate, and easy to control, PCHs have broad application prospects in the biomedical field. Therefore, this review timely summarizes the latest progress in the PCHs field, with an emphasis on the design principles of typical PCHs and their multiple biomedical applications in tissue regeneration, tumor therapy, antibacterial therapy, diseases diagnosis and monitoring, etc. Meanwhile, the challenges and perspectives of widespread practical implementation of PCHs are presented in biomedical applications. This study hopes that PCHs will flourish in the biomedical field and this review will provide useful information for interested researchers.
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Affiliation(s)
- Yiwen Zhao
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Bei Ran
- Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Dashiell Lee
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Jinfeng Liao
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
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Bueno A, Nevado-Sanchez E, Pardo-Hernández R, de la Fuente-Anuncibay R, González-Bernal JJ. Treatment and Improvement of Healing after Surgical Intervention. Healthcare (Basel) 2023; 11:2213. [PMID: 37570454 PMCID: PMC10418496 DOI: 10.3390/healthcare11152213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The development of abnormal scars has a great impact on people's well-being, and improving scarring outcomes after surgery is a field that currently lacks consensus. This review aims to identify newly researched approaches to improving the quality of surgical scars. A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted between 13 May 2023 and 17 May 2023, in accordance with the recommendations of the PRISMA Statement. Study selection and analysis of methodological quality were performed in parts, independently and blindly, based on eligibility criteria. The 21 prospective, comparative, and randomized studies reviewed included 1057 subjects and studied approaches such as topical applications of creams with herbal extracts and silicone gels, growth factors, negative pressure dressings, oligonucleotides, intralesional injection of compounds such as botulinum toxin, skin closure techniques such as suturing and tissue adhesive, and laser treatments. There are recent research techniques that generate good results and are really promising to improve the results of surgical scars; however, the available evidence is extremely limited in some cases, and it is necessary to deepen its analysis to obtain reliable action protocols in each type of surgery.
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Affiliation(s)
- Andrea Bueno
- Health Center of Las Huelgas, 09001 Burgos, Spain;
| | - Endika Nevado-Sanchez
- Reconstructive and Aesthetic Plastic Surgery Service, University Hospital of Burgos, 09006 Burgos, Spain
- Propios Nevado Clinic, 09004 Burgos, Spain
| | - Rocío Pardo-Hernández
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (R.d.l.F.-A.); (J.J.G.-B.)
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Amici JM, Cogrel O, Jourdan M, Raimbault C, Canchy L, Kerob D, Madfes DC, Tian Y, Araviiskaia E. Expert recommendations on supportive skin care for non-surgical and surgical procedures. J Eur Acad Dermatol Venereol 2023; 37 Suppl 3:16-33. [PMID: 36635618 DOI: 10.1111/jdv.18855] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
A thorough knowledge of non-surgical procedures (laser, peelings, injections, threads) and surgical procedures (combined surgeries and skin grafts), including contraindications and potential risks and side effects, (e.g. infection, hypopigmentation, hyperpigmentation, and scarring) is essential to be able to reduce their incidence and ensure the patient receives the most benefit from the procedure. Individuals with darker skin and of high Fitzpatrick phototype are at higher risk of dyschromias, notably melasma and post-inflammatory hyperpigmentation, which may be treated using aesthetic procedures but may also arise as a complication of some procedures. A group of experts in cosmetic surgery and dermatology reviewed the published literature and discussed recommendations for optimizing outcomes with practical advice on supportive skincare before, during and after non-surgical or surgical procedures. A broad-spectrum sunscreen with a high sun protection factor against UVB and high protection against UVA, especially long UVA, is essential for all treatment modalities for the prevention and potential improvement of pigmentation disorders. Supportive skin care management to prepare, cleanse and protect the skin and post-procedure skin care with healing and anti-inflammatory ingredients are recommended to speed up regeneration and wound healing whilst minimizing scarring and downtime. Additionally, adjunctive skin care to procedures with antioxidant, anti-ageing and lightening properties may enhance skin benefits.
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Affiliation(s)
- Jean-Michel Amici
- Dermatology Department, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France
| | - Olivier Cogrel
- Mohs Surgery and Laser Unit, Dermatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Marie Jourdan
- Centre Laser International de la Peau-Paris (CLIPP), Paris, France
| | | | - Ludivine Canchy
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | - Delphine Kerob
- Laboratoire Dermatologique La Roche-Posay, Levallois-Perret, France
| | | | - Yan Tian
- Dermatology Department, Air Force Medical Center, PLA, Beijing, China
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Ren Z, Cui S, Lyu S, Wang J, Zhou L, Jia Y, He Q, Lang R. Establishment of rat allogenic vein replacement model and pathological characteristics of the replaced vessels. Front Surg 2022; 9:984959. [PMID: 36157414 PMCID: PMC9500297 DOI: 10.3389/fsurg.2022.984959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWith the advancement of vascular anastomosis techniques in recent years, radical surgery for tumors combined with venous vascular resection and reconstruction has been widely used. This study intends to establish two different rat vein replacement models, and further analyze the pathological changes of blood vessels after replacement.MethodsBrown-Norway (BN) rats were selected as donors and recipients, randomly divided into control group, cuff group (1-week group, 2-week group, and 4-week group), and suture group (1-week group, 2-week group, and 4-week group), with 6 rats in each group. The perioperative conditions, inner diameter, flow velocity and histopathological changes of the replaced vessels at different time points were analyzed.ResultsBoth cuff group and suture group can safely establish the rat vein replacement model. From the surgical operation, the operation time and venous cross-clamp time in the cuff group were shorter than those in the suture group (P < 0.05). At 2 and 4 weeks after operation, the diameter of suture group was wider than that of cuff group, and the flow rate was faster (P < 0.05). With prolonged postoperative survival, the wall of the replaced vessels underwent infiltration of CD4+ and CD8+ lymphocytes and high TGF-β1 gene expression. This leads to the proliferation of blood vessels and intimal layer. The results of vascular pathological staining showed that the infiltration degree of CD4+ lymphocytes at 2 weeks after operation and CD8+ lymphocytes at 4 weeks after operation in the suture group was lighter than that in the cuff group (P < 0.05). Meanwhile, TGF-β1 gene content at 4 weeks after operation in suture group was significantly lower than that in cuff group (P < 0.05).ConclusionCompared with cuff method, suture method is more suitable for the study of long-term pathological changes after vein replacement in rats. The main pathological changes in the long term after venous replacement in syngeneic background may be vascular fibrosis caused by inflammatory cell infiltration.
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Affiliation(s)
| | | | | | | | | | | | - Qiang He
- Correspondence: Ren Lang Qiang He
| | - Ren Lang
- Correspondence: Ren Lang Qiang He
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Kim YH, Kim HK, Choi JW, Kim YC. Photobiomodulation therapy with an 830-nm light-emitting diode for the prevention of thyroidectomy scars: a randomized, double-blind, sham device-controlled clinical trial. Lasers Med Sci 2022; 37:3583-3590. [PMID: 36045183 DOI: 10.1007/s10103-022-03637-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
This randomized, double-blind, and sham device-controlled trial aimed to evaluate the efficacy and safety of home-based photobiomodulation therapy using an 830-nm light-emitting diode (LED)-based device for the prevention of and pain relief from thyroidectomy scars. Participants were randomized to receive photobiomodulation therapy using an LED device or a sham device without an LED from 1 week postoperatively for 4 weeks. Scars were assessed using satisfaction scores, the numeric rating scale (NRS) score for pain, Global Assessment Scale (GAS), and Vancouver Scar Scale (VSS) scores. The scars were also assessed using a three-dimensional (3D) skin imaging device to detect color, height, pigmentation, and vascularity. Assessments were performed at the 1-, 3-, and 6-month follow-ups. Forty-three patients completed this trial with 21 patients in the treatment group and 22 patients in the control group. The treatment group showed significantly higher patient satisfaction and GAS scores and lower NRS and VSS scores than the control group at 6 months. Improvements in color variation, height, pigmentation, and vascularity at 6 months were greater in the treatment group than in the control group, although the differences were not significant. In conclusion, early application of 830-nm LED-based photobiomodulation treatment significantly prevents hypertrophic scar formation and reduces postoperative pain without noticeable adverse effects.
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Affiliation(s)
- Yul Hee Kim
- Department of Dermatology, School of Medicine, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea.,Department of Medical Sciences, Graduate School of Ajou University, Suwon, Korea
| | - Hyeung Kyoo Kim
- Department of Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jee Woong Choi
- Department of Dermatology, School of Medicine, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - You Chan Kim
- Department of Dermatology, School of Medicine, Ajou University, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
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Therapeutic targeting of mechanical stretch-induced FAK/ERK signaling by fisetin in hypertrophic scars. Eur J Pharmacol 2022; 932:175228. [PMID: 36007606 DOI: 10.1016/j.ejphar.2022.175228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
Abstract
Hypertrophic scarring is a complex fibrotic disease with few treatment options. Mechanical stress has been proven to be crucial for hypertrophic scar (HS) formation. Here, we showed that the flavonoid small molecule fisetin, could dramatically ameliorate HS formation in a mechanical stretch-induced mouse model. In addition, in vitro and in vivo studies demonstrated that fisetin inhibited the stretch-induced profibrotic effects by suppressing the proliferation, activation, and collagen production of fibroblasts. Mechanistically, we revealed that fisetin obviously downregulated mechanical stretch-induced the phosphorylation of FAK and ERK, and reduced nuclear localization of ERK. This bioactivity of fisetin may result from its selective binding to the catalytic region of FAK, which was suggested by the molecular docking study and kinase binding assay. Taken together, these findings suggest that fisetin is a promising agent for the treatment of hypertrophic scars and other excessive fibrotic diseases.
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Intra-Lesional Injection of Triamcinolone to Palatoplasty Scar to Aid Reversal of Transverse Maxillary Relapse after Orthognathic Surgery. J Craniofac Surg 2021; 33:e416-e418. [PMID: 34753867 DOI: 10.1097/scs.0000000000008347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT A 32-year-old female with a repaired right unilateral cleft lip and palate underwent several surgical and orthodontic procedures during the rehabilitation process of her condition. Nine years after this extensive treatment she underwent transverse relapse of her maxilla and requested a consultation for its correction as she felt her speech and chewing were negatively affected. She presented with a transverse maxillary arch collapse on the cleft side with significant palatal scarring secondary to multiple palate procedures. A course of maxillary expansion and dental alignment with fixed orthodontic appliances was carried out. In addition, she had 2 triamcinolone injections 7 months apart while undergoing orthodontic treatment and one 10 months after completion to soften the scarred palatal tissues. The maxillary arch was successfully expanded and aligned. She was retained with a removable chrome cobalt palatal frame to be used full-time and assure stability of the correction. She has been followed for 4 years with no clinical evidence of relapse. Triamcinolone injection into significant palatal scarring in cleft palate patients with a decreased transverse maxillary dimension can be considered an adjunct procedure in conjunction with orthodontic treatment.
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Li YY, Liu SY, Guo DY, Yuan FL. Comments on "Early Intervention with Autologous Fat Grafting to Reduce Hypertrophic Scar Formation: A Preliminary Study". Aesthetic Plast Surg 2021; 46:2091-2092. [PMID: 34668035 DOI: 10.1007/s00266-021-02606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
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Lyu SC, Wang J, Xu WL, Wang HX, Pan F, Jiang T, He Q, Lang R. Therapeutic Effect of Combining Anisodamine With Neostigmine on Local Scar Formation Following Roux-en-Y Choledochojejunostomy in a Novel Rat Model. Front Pharmacol 2021; 12:700050. [PMID: 34658849 PMCID: PMC8511430 DOI: 10.3389/fphar.2021.700050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The present study aimed to explore the potential effect of combining anisodamine with neostigmine on local scar formation following Roux-en-Y choledochojejunostomy (RCJS) in a novel rat model. Methods: The biliary obstruction model of Sprague Dawley (SD) rats was established in advance, and 54 rats were divided into nine groups randomly (sham operation group, anisodamine group, neostigmine group, combination group, and control group). Anisodamine (25 mg/kg) and neostigmine (50 μg/kg) were injected to the abdominal cavity separately or simultaneously for 1 week since the first day after surgery according to their allocated intervention, while the same amount of saline (0.5 ml) was injected intraperitoneally in the control group. Indexes including body weight, the diameter of the common bile duct, liver function, inflammatory indexes, and the condition of scar formation in different groups at certain time were evaluated in our study. Results: Recovery of liver function (ALT, AST, TB, DB, and GGT) and systematic inflammation indexes (CRP, TNF-α, and IL-1β) in the combination group was prior to that in the control group (p < 0.05), while no statistical difference in the serum level of IL-10 was observed among groups. Rats in the combination group represented a wider anastomotic diameter and lower expression of α-SMA and TGF-β1 at anastomotic stoma compared to the control group (p < 0.05). Histopathological staining showed slighter proliferation of collagen and smooth muscle fibers in rats’ bile duct wall and less local scar formation at anastomotic stoma compared to the control group. Conclusion: The combination of anisodamine and neostigmine can alleviate local and systemic inflammatory response, promote the recovery of liver function, and reduce scar formation in rats after the RCJS procedure.
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Affiliation(s)
- Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen-Li Xu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Han-Xuan Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Pan
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Early Intervention with Autologous Fat Grafting to Reduce Hypertrophic Scar Formation: A Prelimilary Study. Aesthetic Plast Surg 2021; 45:2409-2416. [PMID: 33885941 DOI: 10.1007/s00266-021-02277-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/28/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Once an early-stage immature scar develops into a hypertrophic scar, it is difficult to achieve satisfactory improvement with existing treatments. Therefore, the prevention of hypertrophic scar formation should be given priority. Fat grafting was previously proven to be an effective treatment for mature scars, but it has not been used in the early-stages of (less than three months) scar formation. OBJECTIVES We present our experience with the use of combined grafting of macro fat and emulsified fat for prevention of hypertrophic scar formation in patients. METHODS Thirty-five patients who received fat grafting for facial scar repair were included as a treatment group and another 35 patients without particular interventions were classified as the control group. Patients in both groups were followed up every three months during one year, and the Vancouver Scar Scale (VSS) was used for evaluation of the clinical outcomes at baseline (within one to three months after trauma, burn or surgery) and after 12 months of follow-up. RESULTS All patients in the treatment group achieved a marked improvement after their first fat grafting procedure. Thirteen patients (37.1%) underwent the second procedure and seven (20%) underwent the third procedure. Statistical analysis of average VSS score also showed significant differences between the treatment and control groups. CONCLUSION The results of this retrospective study suggest that treatment of immature scars with combined grafting of macro fat and emulsified fat can successfully prevent the formation of hypertrophic scars. LEVEL OF EVIDENCE III 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 .
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Kurtti A, Nguyen JK, Weedon J, Mamalis A, Lai Y, Masub N, Geisler A, Siegel DM, Jagdeo JR. Light emitting diode-red light for reduction of post-surgical scarring: Results from a dose-ranging, split-face, randomized controlled trial. JOURNAL OF BIOPHOTONICS 2021; 14:e202100073. [PMID: 33788987 PMCID: PMC8919713 DOI: 10.1002/jbio.202100073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Scarring has significant esthetic and functional consequences for patients. A need exists for anti-scarring therapeutics. Light emitting diode-red light (LED-RL) has been shown to modulate skin fibrosis. The aim of this study is to evaluate the safety and efficacy of LED-RL to reduce post-operative scarring. Cutaneous Understanding of Red-light Efficacy on Scarring was a randomized, mock-controlled, single-blind, dose-ranging, split-face phase II clinical trial. Starting 1 week post-surgery, patients received LED-RL irradiation and temperature-controlled mock therapy to incision sites at fluences of 160, 320 or 480 J/cm2 , triweekly for 3 weeks. Efficacy was assessed at 1, 3 and 6-12 months. The primary endpoint was difference in scar pliability between LED-RL-treated and control sites. Secondary outcomes included Patient and Observer Scar Assessment Scale, collagen and water concentration, and adverse events. There were no significant differences in scar pliability between treated and control scars. At certain fluences, treated scars showed greater improvements in observer rating and scar pliability, reflected by greater reductions in induration, from baseline to 6 months compared to control scars. Treatment-site adverse events included blistering (n = 2) and swelling (n = 1), which were mild and resolved without sequelae. LED-RL phototherapy is safe in the early postoperative period and may reduce scarring.
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Affiliation(s)
- Alana Kurtti
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
| | - Julie K. Nguyen
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Jeremy Weedon
- Office of the SVP for Research, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Andrew Mamalis
- Department of Dermatology, The Permanente Medical Group, Modesto, CA
| | - Yi Lai
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Natasha Masub
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Amaris Geisler
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Daniel M. Siegel
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Jared R. Jagdeo
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
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Comparison of Nd: YAG Laser and Combined Intense Pulsed Light and Radiofrequency in the Treatment of Hypertrophic Scars: A Prospective Clinico-Histopathological Study. Ann Plast Surg 2021; 84:518-524. [PMID: 31800559 DOI: 10.1097/sap.0000000000002086] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hypertrophic scars are fibroproliferative disorders, seen after burn, trauma, and/or surgery. We aimed to compare the clinical and histopathological results of 1064-nm Nd:YAG laser and combined intense pulsed light and radiofrequency in the treatment of hypertrophic scars. METHODS Fifty patients with hypertrophic scars were included in this prospective, randomized study. Twenty-five patients were treated with Nd:YAG laser and 25 patients with combined intense pulsed light and radiofrequency (E-light). The scars were evaluated at baseline, during and at 3 months after the final treatment session using the Vancouver scar scale. Biopsy specimens from scars were obtained before, during, and 3 months after the final treatment session and were stained with hematoxylin and eosin stain, Masson's trichrome stain, and immunostaining procedures for collagen I, collagen III, and TGF-β1. RESULTS Significant improvements in the total Vancouver scar scale scores before and after the treatment in both groups (P < 0.001); however, a significant difference between both groups (P < 0.001), regarding the E-light, which showed better response than Nd:YAG laser. Hematoxylin and eosin and Masson's trichrome staining showed arrangement and thinning of collagen bundles and reduction in collagen density by in both groups, but the collagen bundles thinning and parallelism were more obvious in the E-light group. Significant decrease in the concentration of collagen I, collagen III, and TGF-β1 in the E-light group as compared with the laser group (P = 0.005, P = 0.003 and P < 0.001, respectively). CONCLUSIONS Both modalities were successful in the treatment of hypertrophic scars; however, a significant improvement in the clinical and histopathological findings was detected with the E-light method.
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Byun HJ, Park JH, Lee JH. Combination Treatment of Intra/Perilesional Botulinum Toxin-A Injection and Ablative Fractional Laser for Better Clinical Outcomes of Hypertrophic Fibrotic Thyroidectomy Scars Following Fractional Ablative Laser Resurfacing. Ann Dermatol 2021; 33:170-177. [PMID: 33935459 PMCID: PMC8082008 DOI: 10.5021/ad.2021.33.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent reports have shown that intralesional botulinum toxin type-A (BTX-A) works on scar cosmesis. OBJECTIVE To evaluate the clinical efficacy of combination treatment of laser and BTX-A injection and compare the effects of conventional intralesional injection and intra- and perilesional BTX-A injection on fibrotic thyroidectomy scars. METHODS Patients with fibrotic thyroidectomy scars showing insufficient responses to previous ablative fractional laser (AFL) treatment were enrolled. Combination treatment with AFL and BTX-A injection was performed. Patients who received intra/perilesional BTX-A injections were classified into group A. Group B was patients in whom the injection was performed only intralesionally. The improvement was assessed based on the Vancouver Scar Scale (VSS). RESULTS A total of 24 patients was included. Statistically significant improvement in pliability and total VSS score after the combination treatment were observed in overall patient group. Subgroup analysis demonstrated that pliability, height, and total VSS improved significantly in group A. In group B, only pliability significantly improved. CONCLUSION BTX-A injection combined with AFL can provide better relief for the previously treated fibrotic thyroidectomy scars. Injection of BTX-A not only into the scar itself, but also into perilesional muscles that can exert tension on the scar site may provide additional benefit in flattening scar height.
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Affiliation(s)
- Hyun Jeong Byun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medical Device Management & Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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A pulsatile release platform based on photo-induced imine-crosslinking hydrogel promotes scarless wound healing. Nat Commun 2021; 12:1670. [PMID: 33723267 PMCID: PMC7960722 DOI: 10.1038/s41467-021-21964-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
Effective healing of skin wounds is essential for our survival. Although skin has strong regenerative potential, dysfunctional and disfiguring scars can result from aberrant wound repair. Skin scarring involves excessive deposition and misalignment of ECM (extracellular matrix), increased cellularity, and chronic inflammation. Transforming growth factor-β (TGFβ) signaling exerts pleiotropic effects on wound healing by regulating cell proliferation, migration, ECM production, and the immune response. Although blocking TGFβ signaling can reduce tissue fibrosis and scarring, systemic inhibition of TGFβ can lead to significant side effects and inhibit wound re-epithelization. In this study, we develop a wound dressing material based on an integrated photo-crosslinking strategy and a microcapsule platform with pulsatile release of TGF-β inhibitor to achieve spatiotemporal specificity for skin wounds. The material enhances skin wound closure while effectively suppressing scar formation in murine skin wounds and large animal preclinical models. Our study presents a strategy for scarless wound repair. Dysfunctional and disfiguring scars can result from aberrant wound repair. Here, the authors develop a wound dressing material based on an integrated photo-crosslinking strategy and a microcapsule platform with pulsatile release of TGF-β inhibitor to achieve spatiotemporal specificity for scarless wound repair.
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Hong EM, Pham TT, Seo S, Moy WJ, Borden P, Hansen K, Kim S, Mo JH, Wong BJF. Electrochemical Therapy of In Vivo Rabbit Cutaneous Tissue. Laryngoscope 2021; 131:E2196-E2203. [PMID: 33666252 DOI: 10.1002/lary.29461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2021] [Accepted: 02/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the acid-base and histological changes in in vivo rabbit cutaneous tissue after electrochemical therapy. STUDY DESIGN In vivo rabbit tissue study. METHODS The shaved skin on the backs of female Oryctolagus cuniculi were assigned to treatments with or without tumescence with normal saline. Two platinum-needle electrodes were inserted into each treatment area and connected to a direct current (DC) power supply. Voltage (3-5 V) was varied and applied for 5 minutes. The wound-healing process was monitored via digital photography and ultrasonography until euthanasia at day 29. Treatment areas were biopsied, and specimens were sectioned through a sagittal midline across both electrode insertion sites. Samples were then evaluated utilizing light microscopy (hematoxylin and eosin, Masson's Trichrome, and Picrosirius red). RESULTS Treatment sites developed mild inflammation that dissipated at lower voltages or became scabs at higher voltages. Ultrasonography demonstrated acoustic shadowing with spatial spread that increased with increasing voltage application. The 4- and 5-V sites treated with saline had localized areas of increased tissue density at day 29. Although specimens treated with 3 V did not look significantly different from control tissue, 4- and 5-V samples with and without saline tumescence had finer, less-organized collagen fibers and increased presence of fibrocytes and inflammatory infiltrates. CONCLUSIONS Electrochemical therapy caused localized injury to in vivo rabbit cutaneous tissue, prompting regenerative wound repair. With future development, this technology may offer precise, low-cost rejuvenation to restore the functionality and appearance of dermal scars and keloids. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2196-E2203, 2021.
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Affiliation(s)
- Ellen M Hong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Tiffany T Pham
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Soohong Seo
- Department of Dermatology, Korea University Anam Hospital, Seoul, South Korea
| | - Wesley J Moy
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Pamela Borden
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Kyle Hansen
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A
| | - Sehwan Kim
- Department of Biomedical Engineering, School of Medicine, Dankook University, Cheonan, Republic of Korea.,Beckman Laser Institute Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea
| | - Ji-Hun Mo
- Beckman Laser Institute Korea, Dankook University, Cheonan-si, Chungnam, Republic of Korea.,Department of Otorhinolaryngology, School of Medicine, Dankook University, Chenoan, Republic of Korea
| | - Brian J F Wong
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California-Irvine, Irvine, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, School of Medicine, Orange, California, U.S.A
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Surakunprapha P, Winaikosol K, Chowchuen B, Jenwitheesuk K, Jenwitheesuk K. Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study. J Wound Care 2021; 29:S36-S42. [PMID: 32279615 DOI: 10.12968/jowc.2020.29.sup4.s36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. METHOD After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. RESULTS Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (-0.391, p=0.025; -0.435, p=0.013, respectively), and pigmentation scores at three and six months (-0.391, p=0.019; -0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (-0.6609, p=0.000; -0.348, p=0.046, respectively). CONCLUSION Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.
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Affiliation(s)
- Palakorn Surakunprapha
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Kengkart Winaikosol
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Bowornsilp Chowchuen
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Kriangsak Jenwitheesuk
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Kamonwan Jenwitheesuk
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
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Lyu SC, Wang J, Zhou L, Zhu JQ, Pan F, Jiang T, Lang R, He Q. Mechanism of scar formation following Roux-en-Y choledochojejunostomy in a novel rat model of obstructive jaundice. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:456. [PMID: 33850853 PMCID: PMC8039641 DOI: 10.21037/atm-20-5135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The present study aimed to analyze the scar formation mechanism following Roux-en-Y choledochojejunostomy (CJS) in a novel rat model of obstructive jaundice. Methods The biliary obstruction model of Sprague-Dawley (SD) rats was established in advance, and 24 rats were randomly divided into 4 groups (control group, 1-day ligation group, 3-day ligation group, and 5-day ligation group). Changes in postoperative weight, common bile duct diameter, and laboratory indexes were analyzed to determine the best operation time. Roux-en-Y CJS in rats was studied based on the model, and the rats were randomly divided into 4 groups [control group, 3-day choledochojejunostomy (CJS) group, 7-day CJS group, and 30-day CJS group]. The same indexes were analyzed, and the characteristics of scar formation were evaluated by histopathology and polymerase chain reaction examination. Results The third day after common bile duct ligation is the best time for a Roux-en-Y CJS. The common bile duct diameter expands to 4.2 mm on average, and these physiological characteristics are consistent with current standard clinical findings. After completing CJS, the rats’ weight returned to normal levels, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB), and C-reactive protein (CRP) indexes gradually decreased (P<0.05). Anastomotic stoma diameter tended to narrow with time and was significantly narrower on day 30 than preoperation. After CJS, the expression of α-smooth muscle actin (α-SMA) peaked in the early stage and was still higher than that of the control group in the bile duct wall 1 month postoperatively (P<0.05). Transforming growth factor-β1 (TGF-β1) expression gradually increased and was higher than that of the control group at each stage postoperatively (P<0.05). Conclusions The rat Roux-en-Y CJS model is more in line with our surgical model, and the clinical condition has potential applicability for the study of CJS scar formation. Scar formation following CJS in rats is characterized by the activation of fibroblasts caused by early inflammatory stimulation, which leads to the proliferation of collagen and smooth muscle fibers, resulting in scars.
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Affiliation(s)
- Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lin Zhou
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ji-Qiao Zhu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Pan
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Modified Buried Vertical Mattress Suture Versus Buried Intradermal Suture: A Prospective Split-Scar Study. Dermatol Surg 2021; 47:e75-e80. [PMID: 32796329 DOI: 10.1097/dss.0000000000002642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The modified buried vertical mattress suture (MBVMS) is believed to provide excellent outcomes by relieving the tension on wound edges. However, clinical data on the topic remain sparse and inadequate. OBJECTIVE To compare the cosmetic results of the MBVMS and the buried intradermal suture (BIS) in chest wounds using a split-scar model. MATERIALS AND METHODS Twenty patients participated in the study. One randomly selected half of each chest wound was closed with the MBVMS; the other half was closed with the BIS. Immediately, postoperatively, the maximum degree of wound eversion was obtained. After 3 months, the wound complication rates were recorded, and the aesthetic appearance of each scar was evaluated by the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), the visual analog scale (VAS), and scar width. RESULTS The MBVMS yielded a greater mean postoperative eversion height and width (p < .05); lower POSAS, VSS, and VAS scores (p < .05); and a narrower scar width (p < .05) than did the BIS. CONCLUSION Compared with the BIS, the MBVMS provided significantly increased wound eversion immediately, postoperatively, and improved aesthetic outcomes at the end of the 3-month follow-up period.
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1550-nm Nonablative Fractional Laser Versus 10,600-nm Ablative Fractional Laser in the Treatment of Surgical and Traumatic Scars: A Comparison Study on Efficacy and Treatment Regimen. Dermatol Surg 2020; 46:780-788. [PMID: 31567609 DOI: 10.1097/dss.0000000000002152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The appearance and symptoms of scars can cause significant distress to patients. OBJECTIVE To assess and compare efficacy of the 1,500-nm nonablative fractional laser (NAFL) and 10,600-nm ablative fractional laser (AFL) in reducing symptoms and improving the appearance of traumatic or surgical scars. MATERIALS AND METHODS Single-center prospective, randomized, blinded, split-scar study was conducted on 100 patients with a scar obtained through trauma or surgery. Three treatments of NAFL or AFL were administered to each half of the scar at 4-week intervals. Scars were self-rated by the patient using the Patient and Observer Scar Assessment Scale and a satisfaction score and objectively evaluated by blinded dermatologists using the Manchester Scar Scale and visual analog scale. RESULTS Blinded observers found no statistically significant difference in scar appearance. Patient rating showed improvement of scar appearance (p < .0001). Pain was worse after treatment with AFL (p = .0492). Overall, there was no statistically significant evidence of one laser being superior or inferior to the other for patient and blinded observer scores (p = .3173 and p = .2513, respectively). CONCLUSION Scar treatment with AFL or NAFL is associated with high patient satisfaction. Objective evaluation of scars did not identify improvement in scar appearance.
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Owji N, Khalili MR, Khademi B, Shirvani M, Sadati MS. Comparison of the Effectiveness of Onion Extract, Topical Steroid, and Petrolatum Emollient in Cosmetic Appearance of Upper Blepharoplasty Scar. J Curr Ophthalmol 2020; 32:408-413. [PMID: 33553845 PMCID: PMC7861112 DOI: 10.4103/joco.joco_39_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the effectiveness of onion extract, topical steroid, and petrolatum emollient in the prevention of scars in cases who underwent bilateral upper eyelid blepharoplasty. Methods A prospective, interventional, comparative, double-blinded case series was designed on cases who underwent upper lid blepharoplasty. After suture removal (1 week following the surgery), the eyelids of participants were randomly allocated into the three groups: The first group used onion extract on the right eyelids (n = 18), and the second group used topical steroid on the right eyelids (n = 19). In the third group, the control group, petrolatum emollient was used on the left eyelids (n = 37) of the first and second group's cases. They used drugs for 2 months and were evaluated by the Manchester Scar Scale (MSS) objectively by two graders who were blinded to the type of medication. MSS evaluates five different characteristics of the scar in addition to the Visual Analog Scale (VAS). These characteristics include color, distortion, contour, texture, and transparency. VAS scores the overall scar appearance which ranged among 0-10. The sum of the scores for the five different parameters, and VAS was calculated, analyzed, and compared among the groups. Results A total of 37 cases (74 eyelids) who underwent bilateral upper blepharoplasty were included. The mean ± standard deviation (SD) of age was 51.94 ± 9.26 years, 49.40 ± 9.37 years, and 47.00 ± 9.06 years in the onion extract, topical steroid, and petrolatum emollient groups, respectively (P = 0.275). There were no statistically significant differences in the mean ± SD of the sum of the MSS scores among the three groups (P = 0.924) or between the onion extract and topical steroid groups (P = 0.951). Furthermore, the color, distortion, contour, texture, transparency, and VAS scores were not statistically significantly different among the three groups or between the onion extract and topical steroid groups (P > 0.05). Conclusion There were no significant differences among these three groups of drugs regarding the appearance of the upper blepharoplasty scar.
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Affiliation(s)
- Naser Owji
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Khalili
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Khademi
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shirvani
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sadat Sadati
- Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
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Ismail SA, Mohammed NHK, Sotohy M, Abou-Taleb DAE. Botulinum toxin type A versus 5-Fluorouracil in treatment of keloid. Arch Dermatol Res 2020; 313:549-556. [PMID: 32892246 DOI: 10.1007/s00403-020-02132-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/05/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
Most therapeutic approaches for keloids remain clinically unsatisfactory. In the last years, intralesional botulinum toxin-A (IL BTX-A) was proposed for treatment of keloids. Our aim of the study was to compare the clinical efficacy of IL BTX-A and IL 5-Fluorouracil (IL 5-FU) in treatment of keloids. A total of 50 patients with keloids were included in the study, 22 patients (with 26 keloids) were treated with IL BTX-A monthly for up to 6 months and other 22 patients (with 27 keloids) were treated with IL 5-FU weekly for up to 6 weeks, while the remaining 6 patients, each having multiple keloids, were treated with both IL BTX-A for some lesions (8 keloids) and IL 5-FU for their remaining lesions (8 keloids). The clinical improvement was assessed according to flattening of the lesions. Side effects were recorded. A significantly better therapeutic response of keloids was detected after IL BTX-A than IL 5-FU (P = 0.041). IL BTX-A achieved excellent and good flattening of the lesions (58.8% and 20.6%) compared to (31.4% and 17.1%) after IL 5-FU, respectively. In BTX-A treated group, there was no statistically significant difference between the clinical response in small lesions compared to medium and large ones (P = 0.476). While in 5-FU treated group, small and medium lesions showed significantly better response than larger ones (P = 0.009). IL BTX-A caused fewer side effects than IL 5-FU, less pain, itching, no hyperpigmentation and less recurrence. Both IL BTX-A and IL 5-FU showed positive results in treatment of keloids. However, IL BTX-A showed higher clinical efficacy even in large size keloids with less side effects.
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Affiliation(s)
- Sahar A Ismail
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Doaa A E Abou-Taleb
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Elshahed AR, Elmanzalawy KS, Shehata H, ElSaie ML. Effect of botulinum toxin type A for treating hypertrophic scars: A split‐scar, double‐blind randomized controlled trial. J Cosmet Dermatol 2020; 19:2252-2258. [PMID: 32668499 DOI: 10.1111/jocd.13627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Ahmad R. Elshahed
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Al Azhar University Cairo Egypt
| | - Khaled S. Elmanzalawy
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Al Azhar University Cairo Egypt
| | - Hany Shehata
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Mohamed L. ElSaie
- Department of Dermatology and Venereology National Research Centre Giza Egypt
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Dunn J, Liu Y, Banov F, Denison S, Banov D. A topical naltrexone formulation for surgical wound healing: A case report. J Cosmet Dermatol 2020; 20:838-841. [PMID: 32652808 DOI: 10.1111/jocd.13604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In current guidelines, there is no specific therapeutic recommendation for promoting surgical wound healing. Proper postsurgical wound care regimen can speed up wound healing and prevent abnormal scarring. AIMS The purpose of this case study was to evaluate the effectiveness of a compounded topical formulation containing naltrexone in managing surgical wound in a patient after Mohs micrographic surgery (MMS). PATIENTS/METHODS A patient started to apply the topical naltrexone formulation two days after the MMS on his hand. Images of the wound and a Patient Scar Assessment Questionnaire (PSAQ) were used to evaluate the clinical outcomes. RESULTS The wound completely healed, and the hand function was fully recovered following application of the formulation for 2 weeks. No abnormal scarring was formed, and the scar was only slightly noticeable after 2 months. CONCLUSION This case study demonstrated the effectiveness of the topical naltrexone formulation in surgical wound management.
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Affiliation(s)
- Jack Dunn
- Jasper Drug Store, Jasper, Georgia, USA
| | - Yi Liu
- Research and Development Department, Professional Compounding Center of America (PCCA), Houston, Texas, USA
| | - Fabiana Banov
- Formulations, Professional Compounding Center of America (PCCA), Houston, Texas, USA
| | - Sebastian Denison
- Clinical Services, Professional Compounding Center of America (PCCA), Houston, Texas, USA
| | - Daniel Banov
- Research and Development Department, Professional Compounding Center of America (PCCA), Houston, Texas, USA
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Ma J, Yan X, Lin Y, Tan Q. Hepatocyte Growth Factor Secreted from Human Adipose-Derived Stem Cells Inhibits Fibrosis in Hypertrophic Scar Fibroblasts. Curr Mol Med 2020; 20:558-571. [PMID: 31903876 DOI: 10.2174/1566524020666200106095745] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/22/2022]
Abstract
AIMS To study the effect of Adipose-derived stem cells (ADSCs) on fibrosis of hypertrophic scar-derived fibroblasts (HSFs) and its concrete mechanism. BACKGROUND ADSCs have been reported to reduce collagen production and fibroblast proliferation in co-culture experiments. Conditioned medium from adipose-derived stem cells (ADSCs-CM) has successfully inhibited fibrosis by decreasing the expression of collagen type І (Col1) and α-smooth muscle actin (α-SMA) in rabbit ear scar models. Hepatocyte growth factor (HGF), the primary growth factor in ADSCs-CM, has been shown to reverse fibrosis in various fibrotic diseases. OBJECTIVE To test the hypothesis that ADSCs inhibit fibrosis of HSFs through the secretion of HGF. METHODS HSFs were treated with DMEM containing 0%, 10%, 50% and 100% concentration of ADSCs-CM. The effect of ADSCs-CM on the viability was determined by cell viability assay, and the collagen production in HSFs was examined by Sirius red staining. Expression and secretion of fibrosis and degradation proteins were detected separately. After measuring the concentration of HGF in ADSCs-CM, the same number of HSFs were treated with 50% ADSCs-CM or HGF. HGF activity in ADSCs-CM was neutralized with a goat anti-human HGF antibody. RESULTS The results demonstrated that ADSCs-CM dose-dependently decreased cell viability, expression of fibrosis molecules, and tissue inhibitor of metalloproteinases-1 (TIMP-1), and significantly increased matrix metalloproteinase-1 (MMP-1) expression in HSFs. Collagen production and the ratio of collagen type І and type III (Col1/Col3) were also suppressed by ADSCs-CM in a dose-dependent manner. When HSFs were cultured with either 50% ADSCs-CM or HGF (1 ng/ml), a similar trend was observed in gene expression and protein secretion. Adding an HGF antibody to both groups returned protein expression and secretion to basal levels but did not significantly affect the fibrosis factors in the control group. CONCLUSION Our findings revealed that adipose-derived stem cell-secreted HGF effectively inhibits fibrosis-related factors and regulates extracellular matrix (ECM) remodeling in hypertrophic scar fibroblasts.
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Affiliation(s)
- Ji Ma
- 1Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210008, China
| | - Xin Yan
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Yue Lin
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Qian Tan
- 1Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210008, China
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Hsieh JC, Joshi CJ, Wan R, Galiano RD. The Northwestern Abdominoplasty Scar Model: A Tool for High-Throughput Assessment of Scar Therapeutics. Adv Wound Care (New Rochelle) 2020; 9:396-404. [PMID: 32320363 DOI: 10.1089/wound.2018.0900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Significance: Scar management is an important concern in plastic surgery. Scar models that best mimic in vivo human scarring are essential for understanding scar development and progression, assessing the efficacy of therapeutics, and providing reliable and valid research outcomes. Recent Advances: In 2016, Lanier et al. proposed a new in vivo patient model, the Northwestern Abdominoplasty Scar Model, that overcomes the prior limitations of both animal and human models, with greater representativeness of the human scarring process, expedited recruitment, smaller sample requirements, and greater flexibility in the types and number of interventions that can be studied simultaneously. Critical Issues: Existing animal models suffer from limitations that impede generalization to human scars. Human scar studies are difficult to conduct and rarely used due to recruitment difficulties, ethical concerns regarding purposeful wounding, and inherent variability based on location, type of scar, and the heterogeneity of the host response between humans. Although overcoming many of these hurdles, the Northwestern Abdominoplasty Scar Model still has a few limitations. In addition, there remains a need for further study of and comparison between the Northwestern Abdominoplasty Scar Model and existing human and animal models, to inspire more widespread acceptance of a standardized human scar model. Future Directions: The Northwestern Abdominoplasty Scar Model is a critical stepping stone toward better human scar models. This model hopefully will inspire other in vivo patient models utilizing elective surgery to overcome recruitment and ethical concerns.
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Affiliation(s)
- Ji-Cheng Hsieh
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chitang J. Joshi
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rou Wan
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert D. Galiano
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Li Z, Li S, Li K, Jiang X, Zhang J, Liu H. A highly simulated scar model developed by grafting human thin split-thickness skin on back of nude mouse: The remodeling process, histological characteristics of scars. Biochem Biophys Res Commun 2020; 526:744-750. [PMID: 32265030 DOI: 10.1016/j.bbrc.2020.03.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022]
Abstract
A predictive scar animal model is needed in order to study the mechanism and assess the therapies before its use in humans. However, due to the differences in wound healing patterns and regeneration ability, none of the existing models can fully simulate the characteristics of human scar. The aim of this study was to build a model that recapitulated the developing process and outcomes of human hypertrophic scar (HS). Nude mice were grafted with thin split-thickness human skins. The dynamic changes and final outcomes of the grafts were investigated. The results showed that human skin grafts survived and underwent progressive scarring remodeling in morphology and histology. Scar related markers (α-SMA, CD34, Collage I, TGF-β1) were positive in immunohistology. Protein expressions in TGF-β1/Smad2/3 pathway were increased in accordance with HS during the development process by western blotting. It was finally proved that scar reconstructed by this model matches a real-world human HS. This is a stable, easy to reproduce model for studying the scar formation process and its properties.
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Affiliation(s)
- Zehua Li
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China; Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Guangzhou, Guangdong, China
| | - Shenghong Li
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Kecheng Li
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiao Jiang
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jinrong Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China; Innovative Technology Research Institute of Tissue Repair and Regeneration, Key Laboratory of Regenerative Medicine, Ministry of Education, Guangzhou, Guangdong, China
| | - Hongwei Liu
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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When Testosterone Needs to be Contrasted: A Preliminary Study of Scar Prevention in Transmen Top Surgery with an Innovative Galenic Preparation. Aesthetic Plast Surg 2020; 44:1006-1013. [PMID: 32198638 DOI: 10.1007/s00266-020-01678-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Transmen are individuals who live a marked incongruence between the assigned gender and the experienced gender. Crucial and life-changing steps in their transition are testosterone treatment and mastectomy to remove the stigma of feminine identity. After surgery, patients' attention turns to the scars, often not aesthetically pleasant. We thus created an innovative galenic preparation for scar treatment after surgery composed by spironolactone, alfa bisabolol and silicone gel. Functional outcomes, side effects and satisfaction were assessed. METHODS For the present prospective randomized controlled study, 30 patients with similar demographic characteristics who underwent double incision mastectomy with NA grafts between February 2014 and June 2019 were selected. The treatment Group A (n = 15) was treated for 12 months with "Top Surgery Scar go," the control Group B (n = 15) with silicon gel. Statistical analysis including Wilcoxon test and Kruskal-Wallis test per variable was performed. To assess satisfaction, a second Wilcoxon test was applied. RESULTS The differences between Group A and Group B were statistically significant, especially at T12 with very low p values. Satisfaction was greater in Group A (p value = 3e-4). No major side effects were noticed in Group A. CONCLUSIONS TSSgo scar innovative treatment showed long-term efficacy in comparison with silicon gel in terms of improved scar tissue texture, pigmentation, pliability and height. It is easy to set up, cost-effective and safe. Further studies are necessary to better assess efficacy and validity of TSSgo, but it appears to be promising as the new treatment of reference for scar management after top surgery in transmen. 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.
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Surakunprapha P, Winaikosol K, Chowchuen B, Punyavong P, Jenwitheesuk K, Jenwitheesuk K. A Prospective Randomized Double-blind study of silicone gel plus Herbal Extracts Versus Placebo in Pre-sternal hypertrophic scar prevention and amelioration. Heliyon 2020; 6:e03883. [PMID: 32405550 PMCID: PMC7210591 DOI: 10.1016/j.heliyon.2020.e03883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/17/2019] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Post-surgical hypertrophic scar is more frequently reported in Asians. Many modalities can treat scars but there have not been any publications to define the efficacy of silicone gel plus herbal extracts for scar prevention or amelioration. Design 48 patients, who underwent median sternotomy were randomized and double-blinded to 2 groups to use topical silicone gel plus herbal extract gel or placebo for 6 months. Patients were treated either with topical silicone gel plus herbal extract gel or control using only placebo for 6 months. The scars were observed by experienced plastic surgeons using the Vancouver scar scale. Setting A single tertiary care center at Khon Kaen University. Paticipants 48 patients who underwent median sternotomy were enrolled in this study. All patients were aged over 18 years. All the wounds were sutured with polyglycolic 4/0 subcuticular suture material and did not receive other scar management before participating in this study. Intervention The silicone gel plus herbal extract gel (Bangkok Botanica, Bangkok, Thailand) in semi-liquid form was formulated from 15% Herbal extract (Allium Cepa extract, Centella Asiatica extract, Aloe Vera extract and Paper Mulberry extract), 50% polydemethysiloxane, 30% cyclopentasiloxane and 5% silica. The placebo gel was a composite of water, acrylate, C10-30 alkyl acrylate cross-polymer, polysorbate 20 and fragrance that was similar in color and consistency as that of the active gel and packed in the similar sealed packages. Main outcome measures The scar was assessed using the Vancouver scar scale to determine pigmentation, vascularity, pliability and height. Results the study showed the silicone gel plus herbal extract gel could improve scar amelioration in height (p = 0.005) and pliability (p < 0.001) when compared to the placebo. The vascularity and pigmentation showed improvement using silicone gel plus herbal extracts but the improvement was not statistically significant. Conclusion The silicone gel plus herbal extracts gel was effective for scar improvement in median sternotomy wounds.
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Affiliation(s)
- Palakorn Surakunprapha
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bowornsilp Chowchuen
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puttama Punyavong
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kriangsak Jenwitheesuk
- General Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwan Jenwitheesuk
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Yazdi MK, Vatanpour V, Taghizadeh A, Taghizadeh M, Ganjali MR, Munir MT, Habibzadeh S, Saeb MR, Ghaedi M. Hydrogel membranes: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 114:111023. [PMID: 32994021 DOI: 10.1016/j.msec.2020.111023] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022]
Abstract
Hydrogel membranes (HMs) are defined and applied as hydrated porous media constructed of hydrophilic polymers for a broad range of applications. Fascinating physiochemical properties, unique porous architecture, water-swollen features, biocompatibility, and special water content dependent transport phenomena in semi-permeable HMs make them appealing constructs for various applications from wastewater treatment to biomedical fields. Water absorption, mechanical properties, and viscoelastic features of three-dimensional (3D) HM networks evoke the extracellular matrix (ECM). On the other hand, the porous structure with controlled/uniform pore-size distribution, permeability/selectivity features, and structural/chemical tunability of HMs recall membrane separation processes such as desalination, wastewater treatment, and gas separation. Furthermore, supreme physiochemical stability and high ion conductivity make them promising to be utilised in the structure of accumulators such as batteries and supercapacitors. In this review, after summarising the general concepts and production processes for HMs, a comprehensive overview of their applications in medicine, environmental engineering, sensing usage, and energy storage/conservation is well-featured. The present review concludes with existing restrictions, possible potentials, and future directions of HMs.
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Affiliation(s)
- Mohsen Khodadadi Yazdi
- Center of Excellence in Electrochemistry, School of Chemistry, College of Science, University of Tehran, Tehran, Iran
| | - Vahid Vatanpour
- Department of Applied Chemistry, Faculty of Chemistry, Kharazmi University, Iran, Tehran.
| | - Ali Taghizadeh
- Center of Excellence in Electrochemistry, School of Chemistry, College of Science, University of Tehran, Tehran, Iran
| | - Mohsen Taghizadeh
- Center of Excellence in Electrochemistry, School of Chemistry, College of Science, University of Tehran, Tehran, Iran
| | - Mohammad Reza Ganjali
- Center of Excellence in Electrochemistry, School of Chemistry, College of Science, University of Tehran, Tehran, Iran; Biosensor Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Tajammal Munir
- College of Engineering and Technology, American University of the Middle East, Kuwait; Department of Chemical and Materials Engineering, The University of Auckland, New Zealand
| | - Sajjad Habibzadeh
- Department of Chemical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Mohammad Reza Saeb
- Department of Resin and Additives, Institute for Color Science and Technology, P.O. Box: 16765-654, Tehran, Iran
| | - Mehrorang Ghaedi
- Chemistry Department, Yasouj University, Yasouj 75918-74831, Iran.
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Cui X, Zhu J, Wu X, Yang S, Yao X, Zhu W, Xu P, Chen X. Hematoporphyrin monomethyl ether-mediated photodynamic therapy inhibits the growth of keloid graft by promoting fibroblast apoptosis and reducing vessel formation. Photochem Photobiol Sci 2020; 19:114-125. [PMID: 31934700 DOI: 10.1039/c9pp00311h] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Photodynamic therapy (PDT) has been shown to significantly inhibit fibroblast activity. However, the effect of PDT mediated by the photosensitizer hematoporphyrin monomethyl ether (HMME) on keloids is not known well. The aim of our study was to examine the efficacy of HMME-PDT in cellular and animal models of keloids. Keloid fibroblasts (KFbs) were isolated from human keloid specimens and the proliferation, invasion, and migration of KFbs after HMME-PDT treatment was examined in vitro. Apoptosis in cells was measured by flow cytometry. Cysteinyl aspartate specific proteinase 3 (Caspase3) expression was determined by immunofluorescence staining and western blot. HMME-PDT inhibited KFbs proliferation, invasion, migration, increased apoptosis rate and enhanced caspase3 and cleaved caspase3 expression. The keloid graft transplantation was performed by using nude mice. The growth of the graft was monitored every third day. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) mRNA expression were detected by quantitative real time PCR. It was observed that HMME-PDT attenuated graft growth and reduced vessel density in the keloid grafts. However, HMME-PDT did not alter IL-6 and TNF-α mRNA expression in the keloid grafts. Moreover, HMME-PDT suppressed transforming growth-β1 (TGF-β1) and small phenotype and Drosophila Mothers Against Decapentaplegic 3 (Smad3) expression in both KFbs and keloid grafts. Collectively, the evidence suggests that HMME-PDT inhibits the growth of the keloid graft by promoting the apoptosis of fibroblasts and reducing vessel formation of the keloid graft.
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Affiliation(s)
- Xiaomei Cui
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Jing Zhu
- Department of Dermatology, Wuxi People's Hospital, Wuxi, 214000, China
| | - Xiaoyan Wu
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Shengju Yang
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xiaodong Yao
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Wenyan Zhu
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Pan Xu
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xiaodong Chen
- Department of Medical Cosmetology, Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Jourdan M, Madfes DC, Lima E, Tian Y, Seité S. Skin Care Management For Medical And Aesthetic Procedures To Prevent Scarring. Clin Cosmet Investig Dermatol 2019; 12:799-804. [PMID: 31695468 PMCID: PMC6820568 DOI: 10.2147/ccid.s218134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
Abstract
An estimated 100 million people per year in developed countries acquire scars following surgical procedures whether it be elective, therapeutic or reparative. Scarring from surgery can have a significant physical and psychological impact depending on the colour, relief, size, body location, surface area or function. Whether a procedure be life-saving such as a mastectomy, a caesarean, or a mole excision, or aesthetic such as breast reconstruction or laser treatment, patients are increasingly concerned with having an aesthetic scar outcome. With improved surgical and technological advances, elective surgery and cosmetic procedures are becoming safer and easier to perform in both hospitals and outpatient clinics. This means that more people elect to undergo procedures for an increasing number of indications on varied body areas including the face, back and limbs but also breasts, ears or genitalia. Therefore, taking the final scar outcome into consideration both before and after a procedure is becoming particularly important to ensure that controlled healing occurs with minimal discomfort. As the healing process varies from one procedure to another, and from one body part to another, each wound requires specific care. Dermatologists are well placed to manage wound healing but there remains a need for them to be involved in wound management and help surgeons better manage the wound healing process beyond wound closure and infection control. Basic skin care can play a role to protect the skin barrier function, control inflammation and enhance natural healing. The objective of this review is to provide recommendations based on published literature for the role basic skin care plays in supporting continued wound management following invasive procedures.
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Affiliation(s)
- Marie Jourdan
- Centre Laser International de la Peau - Paris (CLIPP), Paris, France
| | | | - Emerson Lima
- Santa Casa de Misericórdia, Jaqueira, Recife, Brazil
| | - Yan Tian
- Department of Dermatology, The General Hospital of Air Force, Beijing, People's Republic of China
| | - Sophie Seité
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
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36
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The safety and efficacy of botulinum toxin for management of scars: A systematic review with meta-analysis and trial sequential analysis. Toxicon 2019; 166:24-33. [DOI: 10.1016/j.toxicon.2019.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
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37
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Nguyen JK, Weedon J, Jakus J, Heilman E, Isseroff RR, Siegel DM, Jagdeo JR. A dose-ranging, parallel group, split-face, single-blind phase II study of light emitting diode-red light (LED-RL) for skin scarring prevention: study protocol for a randomized controlled trial. Trials 2019; 20:432. [PMID: 31307501 PMCID: PMC6631489 DOI: 10.1186/s13063-019-3546-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Skin fibrosis is a significant global health problem that affects over 100 million people annually and has a profoundly negative impact on quality of life. Characterized by excessive fibroblast proliferation and collagen deposition, skin fibrosis underlies a wide spectrum of dermatologic conditions ranging from pathologic scars secondary to injury (e.g., burns, surgery, trauma) to immune-mediated diseases. Effective anti-scarring therapeutics remain an unmet need, underscoring the importance of developing novel approaches to treat and prevent skin fibrosis. Our in vitro data show that light emitting diode-red light (LED-RL) can modulate key cellular and molecular processes involved in skin fibrosis. In two phase I clinical trials (STARS 1 and STARS 2), we demonstrated the safety and tolerability of LED-RL at fluences of 160 J/cm2 up to 480 J/cm2 on normal human skin. METHODS/DESIGN CURES (Cutaneous Understanding of Red-light Efficacy on Scarring) is a dose-ranging, randomized, parallel group, split-face, single-blind, mock-controlled phase II study to evaluate the efficacy of LED-RL to limit post-surgical skin fibrosis in subjects undergoing elective mini-facelift surgery. Thirty subjects will be randomly allocated to three treatment groups to receive LED-RL phototherapy or temperature-matched mock irradiation (control) to either periauricular incision site at fluences of 160 J/cm2, 320 J/cm2, or 480 J/cm2. Starting one week post-surgery (postoperative days 4-8), treatments will be administered three times weekly for three consecutive weeks, followed by efficacy assessments at 30 days, 3 months, and 6 months. The primary endpoint is the difference in scar pliability between LED-RL-treated and control sites as determined by skin elasticity and induration measurements. Secondary outcomes include clinical and photographic evaluations of scars, 3D skin imaging analysis, histological and molecular analyses, and adverse events. DISCUSSION LED-RL is a therapeutic modality of increasing importance in dermatology, and has the potential to limit skin fibrosis clinically by decreasing dermal fibroblast activity and collagen production. The administration of LED-RL phototherapy in the early postoperative period may optimize wound healing and prevent excessive scarring. The results from this study may change the current treatment paradigm for fibrotic skin diseases and help to pioneer LED-RL as a safe, non-invasive, cost-effective, portable, at-home therapy for scars. TRIAL REGISTRATION ClinicalTrials.gov, NCT03795116 . Registered on 20 December 2018.
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Affiliation(s)
- Julie K Nguyen
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.,Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Jeremy Weedon
- Statistical Design & Analysis Research Division, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jeannette Jakus
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Edward Heilman
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - R Rivkah Isseroff
- Dermatology Service, Sacramento VA Medical Center, Mather, CA, USA.,Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Daniel M Siegel
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.,Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Jared R Jagdeo
- Department of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA. .,Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY, USA.
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38
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Li C, Wang P, Fu Z, Li Y, Li S. Swainsonine inhibits proliferation and collagen synthesis of NIH-3T3 cells by declining miR-21. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:2256-2264. [PMID: 31184213 DOI: 10.1080/21691401.2019.1620255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Chao Li
- Department of Burn and Plastic Surgery, Heze Municipal Hospital, Heze, China
| | - Peipei Wang
- Department of Burn and Plastic Surgery, Heze Municipal Hospital, Heze, China
| | - Ziyang Fu
- Department of Burn and Plastic Surgery, Heze Municipal Hospital, Heze, China
| | - Yongtao Li
- Department of Burn and Plastic Surgery, Heze Municipal Hospital, Heze, China
| | - Shouju Li
- Department of Burn and Plastic Surgery, Heze Municipal Hospital, Heze, China
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39
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Hu AC, Hong EM, Toubat O, Sivoraphonh R, Barnes C, Moy WJ, Krasieva TB, Wong BJF. Multiphoton Microscopy of Collagen Structure in Ex Vivo Human Skin Following Electrochemical Therap
y. Lasers Surg Med 2019; 52:196-206. [DOI: 10.1002/lsm.23094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Allison C. Hu
- School of MedicineUniversity of CaliforniaIrvine California 92617
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Ellen M. Hong
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Omar Toubat
- Keck School of Medicine of USCLos Angeles California 90033
| | - Ryan Sivoraphonh
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Christian Barnes
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvine, Orange California 92868
| | - Wesley J. Moy
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
| | - Tatiana B. Krasieva
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
| | - Brian J. F. Wong
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvine California 92612
- Department of Biomedical EngineeringUniversity of CaliforniaIrvine California 92617
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvine, Orange California 92868
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40
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Sjöqvist S, Ishikawa T, Shimura D, Kasai Y, Imafuku A, Bou-Ghannam S, Iwata T, Kanai N. Exosomes derived from clinical-grade oral mucosal epithelial cell sheets promote wound healing. J Extracell Vesicles 2019; 8:1565264. [PMID: 30719240 PMCID: PMC6346716 DOI: 10.1080/20013078.2019.1565264] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023] Open
Abstract
The oral mucosa exhibits unique regenerative properties, sometimes referred to as foetal-like wound healing. Researchers from our institute have used sheets of oral mucosa epithelial cells (OMECs) for regenerative medicine applications including cornea replacement and oesophageal epithelial regeneration for stricture prevention. Here, we have isolated exosomes from clinical-grade production of OMEC sheets from healthy human donors (n = 8), aiming to evaluate the clinical potential of the exosomes to stimulate epithelial regeneration and to improve understanding of the mode-of-action of the cells. Exosomes were isolated from conditioned (cExo) and non-conditioned (ncExo) media. Characterization was performed using Western blot for common exosomal-markers: CD9 and flotillin were positive while annexin V, EpCam and contaminating marker GRP94 were negative. Nanoparticle tracking analysis revealed a diameter of ~120 nm and transmission electron microscopy showed a corresponding size and spherical appearance. Human skin fibroblasts exposed to exosomes showed dose-dependent reduction of proliferation and a considerable increase of growth factor gene expression (HGF, VEGFA, FGF2 and CTGF). The results were similar for both groups, but with a trend towards a larger effect from cExo. To study adhesion, fluorescently labelled exosomes were topically applied to pig oesophageal wound-beds ex vivo and subsequently washed. Positive signal could be detected after as little as 1 min of adhesion, but increased adhesion time produced a stronger signal. Next, labelled exosomes were added to full-thickness skin wounds in rats and signal was detected up to 5 days after application. cExo significantly reduced the wound size at days 6 and 17. In conclusion, exosomes from OMEC sheets showed pro-regenerative effects on skin wound healing. This is the first time that the healing capacity of the oral mucosa is studied from an exosome perspective. These findings might lead to a combinational therapy of cell sheets and exosomes for future patients with early oesophageal cancer.
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Affiliation(s)
- Sebastian Sjöqvist
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Taichi Ishikawa
- Division of Molecular Microbiology, Iwate Medical University, School of Dentistry, Iwate, Japan
| | - Daisuke Shimura
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshiyuki Kasai
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Aya Imafuku
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Sophia Bou-Ghannam
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.,Department of Biomedical Engineering, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Takanori Iwata
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuo Kanai
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
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41
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Tan WQ, Fang QQ, Shen XZ, Giani JF, Zhao TV, Shi P, Zhang LY, Khan Z, Li Y, Li L, Xu JH, Bernstein EA, Bernstein KE. Angiotensin-converting enzyme inhibitor works as a scar formation inhibitor by down-regulating Smad and TGF-β-activated kinase 1 (TAK1) pathways in mice. Br J Pharmacol 2018; 175:4239-4252. [PMID: 30153328 DOI: 10.1111/bph.14489] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/19/2018] [Accepted: 08/16/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Angiotensin-converting enzyme (ACE), an important part of the renin-angiotensin system, is implicated in stimulating the fibrotic processes in the heart, lung, liver and kidney, while an ACE inhibitor (ACEI) promotes physiological tissue repair in these organs. The mechanism is closely related to TGF-β1 pathways. However, the reported effects of applying ACEIs during scar formation are unclear. Hence, we explored the anti-fibrotic effects of an ACEI and the molecular mechanisms involved in a mouse scar model. EXPERIMENTAL APPROACH After a full-thickness skin wound operation, ACE wild-type mice were randomly assigned to receive either ramipril, losartan or hydralazine p.o. ACE knockout (KO) mice and negative control mice only received vehicle (water). Wound/scar widths during wound healing and histological examinations were recorded at the final day. The ability of ACEI to reduce fibrosis via TGF-β1 signalling was evaluated in vitro and in vivo. KEY RESULTS ACE KO mice and mice that received ramipril showed narrower wound/scar width, reduced fibroblast proliferation, decreased collagen and TGF-β1 expression. ACEI attenuated the phosphorylation of small mothers against decapentaplegic (Smad2/3) and TGF-β-activated kinase 1 (TAK1) both in vitro and in vivo. The expression of ACE-related peptides varied in murine models with different drug treatments. CONCLUSIONS AND IMPLICATIONS ACEI showed anti-fibrotic properties in scar formation by mediating downstream peptides to suppress TGF-β1/Smad and TGF-β1/TAK1 pathways. These findings suggest that dual inhibition of Smad and TAK1 signalling by ACEI is a useful strategy for the development of new anti-fibrotic agents.
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Affiliation(s)
- Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Qing-Qing Fang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Xiao Z Shen
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Physiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jorge F Giani
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tuantuan V Zhao
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peng Shi
- Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Li-Yun Zhang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Zakir Khan
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - You Li
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Liang Li
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ji-Hua Xu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Ellen A Bernstein
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kenneth E Bernstein
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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42
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Amini-Nik S. Time Heals all Wounds- but Scars Remain. Can Personalized Medicine Help? Front Genet 2018; 9:211. [PMID: 29988374 PMCID: PMC6023985 DOI: 10.3389/fgene.2018.00211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/25/2018] [Indexed: 01/24/2023] Open
Affiliation(s)
- Saeid Amini-Nik
- Sunnybrook Research Institute, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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43
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Sharobaro VI, Ivanov YV, Panchenkov DN, Baranov AV, Penaev AA, Stepanova YA, Romanets OP, Penaeva SA, Alimova SM. [The role of CO2-laser in scarring management]. Khirurgiia (Mosk) 2018:67-74. [PMID: 29798994 DOI: 10.17116/hirurgia2018567-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the role of CO2-laser in treatment of various scars and to determine the indications for its application. PATIENTS AND METHODS It has been carried out a prospective analysis of treatment of 218 patients with scars of different duration, locations and anatomic areas with the use of CO2-laser for the period 2011-2017. POSAS scale and sonography were used for analysis. RESULTS 1. Laser therapy is not effective for scarring-related functional defects (contractures, ectropion, microstomia), when surgery is indicated. 2. The outcomes of treatment (both surgical and laser) depend on the time of existence of the scars rather their cause and anatomical region. 3. Laser therapy is not effective enough for formed scars existing over 12 months. 4. Laser therapy is effective for immature scars, especially indicated for cicatricial deformation when the aesthetics cannot be repaired with traditional surgery. CONCLUSION Application of CO2-laser in scars treatment with regard to its real efficiency determines the effectiveness of therapy.
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Affiliation(s)
- V I Sharobaro
- Federal Research Clinical Center for Specialized Medical Care and Medical Texhnologies of Federal Medical Biological Agency of Russia; Pirogov Russian National Research Medical University
| | - Yu V Ivanov
- Federal Research Clinical Center for Specialized Medical Care and Medical Texhnologies of Federal Medical Biological Agency of Russia; Evdokimov Moscow State University of Medicine and Dentistry
| | - D N Panchenkov
- Federal Research Clinical Center for Specialized Medical Care and Medical Texhnologies of Federal Medical Biological Agency of Russia; Evdokimov Moscow State University of Medicine and Dentistry; State Research Center for Laser Medicine
| | | | | | | | | | | | - S M Alimova
- Pirogov Russian National Research Medical University
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44
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Esquirol-Caussa J, Herrero-Vila E. Human recombinant epidermal growth factor in skin lesions: 77 cases in EPItelizando project. J DERMATOL TREAT 2018; 30:96-101. [DOI: 10.1080/09546634.2018.1468546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jordi Esquirol-Caussa
- Centro Médico Teknon, Barcelona, Spain
- Servei Universitari de Recerca en Fisioteràpia (SURF), Escoles Universitàries Gimbernat (adscrites a la Universitat Autònoma de Barcelona), Barcelona, Spain
| | - Elisabeth Herrero-Vila
- Centro Médico Teknon, Barcelona, Spain
- Servei de Medicina Preventiva, Àptima, Terrassa, Barcelona, Spain
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45
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Hibbard JC, Friedstat JS, Thomas SM, Edkins RE, Hultman CS, Kosorok MR. LIBERTI: A SMART study in plastic surgery. Clin Trials 2018; 15:286-293. [PMID: 29577741 DOI: 10.1177/1740774518762435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. METHODS We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. RESULTS We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. CONCLUSION We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.
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Affiliation(s)
- Jonathan C Hibbard
- 1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 School of Mathematics, Institute for Advanced Study, Princeton, NJ, USA
| | - Jonathan S Friedstat
- 3 Division of Burns, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Renee E Edkins
- 5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Scott Hultman
- 5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Kosorok
- 1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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46
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Fang QQ, Wang XF, Zhao WY, Ding SL, Shi BH, Xia Y, Yang H, Wu LH, Li CY, Tan WQ. Angiotensin-converting enzyme inhibitor reduces scar formation by inhibiting both canonical and noncanonical TGF-β1 pathways. Sci Rep 2018; 8:3332. [PMID: 29463869 PMCID: PMC5820264 DOI: 10.1038/s41598-018-21600-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 02/07/2018] [Indexed: 12/26/2022] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEIs) can improve the fibrotic processes in many internal organs. Recent studies have shown a relationship between ACEI with cutaneous scar formation, although it has not been confirmed, and the underlying mechanism is unclear. In this study, we cultured mouse NIH 3T3 fibroblasts with different concentrations of ACEI. We measured cell proliferation with a Cell Counting Kit-8 and collagen expression with a Sirius Red Collagen Detection Kit. Flow cytometry and western blotting were used to detect transforming growth factor β1 (TGF-β1) signaling. We also confirmed the potential antifibrotic activity of ACEI in a rat scar model. ACEI reduced fibroblast proliferation, suppressed collagen and TGF-β1 expression, and downregulated the phosphorylation of SMAD2/3 and TAK1, both in vitro and in vivo. A microscopic examination showed that rat scars treated with ramipril or losartan were not only narrower than in the controls, but also displayed enhanced re-epithelialization and neovascularization, and the formation of organized granulation tissue. These data indicate that ACEI inhibits scar formation by suppressing both TGF-β1/SMAD2/3 and TGF-β1/TAK1 pathways, and may have clinical utility in the future.
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Affiliation(s)
- Qing-Qing Fang
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China.,Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Xiao-Feng Wang
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China.,Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Wan-Yi Zhao
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China.,Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Shi-Li Ding
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Bang-Hui Shi
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China.,Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Ying Xia
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.,Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China.,Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Hu Yang
- Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Li-Hong Wu
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China
| | - Cai-Yun Li
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China. .,Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, PR China. .,Department of Plastic Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, PR China.
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47
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The Effect of Tranilast 8% Liposomal Gel Versus Placebo on Post-Cesarean Surgical Scars: A Prospective Double-Blind Split-Scar Study. Dermatol Surg 2017; 43:1157-1163. [PMID: 28825957 DOI: 10.1097/dss.0000000000001140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tranilast (N-[3, 4-dimethoxycinnamoyl] anthranilic acid), an antiallergic drug, has been shown to attenuate scar formation possibly through inhibition of transforming growth factor beta 1 activity and consequent suppression of collagen synthesis in fibroblasts. OBJECTIVE The authors aimed at evaluating the efficacy and safety of tranilast 8% gel in improving the appearance and symptoms of new post-cesarean section surgical wounds. METHODS In this prospective double-blind split-scar study, the authors treated each half scar of 26 women with either tranilast 8% liposomal gel or tranilast-free liposomal gel (placebo). Treatment was applied twice daily for 3 months. Twenty women completed the trial. Scar halves were evaluated by 2 investigators and by the patients 9 months after the last application using the Patient and Observer Scar Assessment Scale (POSAS). The participants also rated overall satisfaction and recorded side effects of the treatment. RESULTS The mean POSAS scores at 9 months post-treatment were significantly lower for tranilast-treated half scars compared with placebo-treated half scars (p < .001). The women were significantly more satisfied with the tranilast-treated half-scar appearance (p = .002). Three participants reported itching and erythema on the tranilast-treated side. CONCLUSION Topical tranilast 8% gel provided significantly better postcaesarian section scar cosmesis and user satisfaction compared with placebo.
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48
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Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies. J Am Acad Dermatol 2017; 76:1027-1042. [PMID: 28522039 DOI: 10.1016/j.jaad.2016.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022]
Abstract
The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.
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Affiliation(s)
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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49
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Evidence-Based Scar Management: How to Improve Results with Technique and Technology. Plast Reconstr Surg 2017; 138:165S-178S. [PMID: 27556757 DOI: 10.1097/prs.0000000000002647] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. METHODS A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. RESULTS For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. CONCLUSION Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.
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50
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Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet 2016; 388:1427-1436. [PMID: 27707499 PMCID: PMC5380137 DOI: 10.1016/s0140-6736(16)31406-4] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 12/21/2022]
Abstract
Improvements in acute burn care have enabled patients to survive massive burns that would have once been fatal. Now up to 70% of patients develop hypertrophic scars after burns. The functional and psychosocial sequelae remain a major rehabilitative challenge, decreasing quality of life and delaying reintegration into society. Approaches to optimise healing potential of burn wounds use targeted wound care and surgery to minimise the development of hypertrophic scarring. Such approaches often fail, and modulation of the established scar is continued although the optimal indication, timing, and combination of therapies have yet to be established. The need for novel treatments is paramount, and future efforts to improve outcomes and quality of life should include optimisation of wound healing to attenuate or prevent hypertrophic scarring, well-designed trials to confirm treatment efficacy, and further elucidation of molecular mechanisms to allow development of new preventive and therapeutic strategies.
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Affiliation(s)
- Celeste C Finnerty
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; The Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX, USA; the Sealy Center for Molecular Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA.
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, ON, Canada; Division of Plastic Surgery Department of Surgery and Immunology, University of Toronto, ON, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ludwik K Branski
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA
| | - Juan P Barret
- Department of Plastic Surgery and Burns, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Peter Dziewulski
- St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, UK; StAAR Research Unit, Faculty of Medical Sciences, Anglia Ruskin University, Chelmsford, UK
| | - David N Herndon
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA; The Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA
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