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Knowles AJ. Advocating for Enhanced Patient Engagement in Breast Cancer Care: Impact of Residual Increased Lateral Adiposity and Consideration of the Pursuit of "Living Flat". Clin Breast Cancer 2024; 24:e186-e194. [PMID: 38326163 DOI: 10.1016/j.clbc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
Breast cancer is a significant health concern, accounting for a substantial proportion of cancer cases. Despite improvements in cancer survivorship, many women still require mastectomy as part of their therapeutic treatment. Mastectomy alone or delayed breast reconstruction (DBR) are two options available to women not suitable for immediate breast reconstruction at initial mastectomy. However, the presence of increased lateral adiposity (ILA) following mastectomy, commonly referred to as ``dog-ears,'' can lead to discomfort and aesthetic concerns. This paper explores the benefits and harms of ILA postmastectomy and its impact on patient satisfaction when choosing between mastectomy alone or DBR. A literature search was completed within OVID Medline, 1946-current, with the following terms, filtered for relevance: "mastectomy," "autologous reconstruction," "scar," "body image/dysmorphia," "patient-reported outcomes," "reconstructive surgical procedures/excess skin," "surgical flaps/dog ear." The disparity between clinical support and educational resources available for patients considering DBR options compared to those choosing mastectomy alone or pursuit of "living flat" is discussed. A common theme from qualitative research was the reported feeling of lack of inclusion in reconstruction planning by the patient. There were instances reported of residual skin remaining postmastectomy, against patient wishes. The findings emphasized the importance of shared decision-making and comprehensive preoperative education to ensure that patients are well-informed and satisfied with their chosen treatment approach. Further research is needed to address the specific needs and preferences of patients opting for mastectomy and to improve surgical techniques and education regarding living-flat options.
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Affiliation(s)
- Aaron J Knowles
- Pioneer Wound healing and Lymphoedema Centres, Eastbourne, United Kingdom.
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Menashe S, Heller L. Keloid and Hypertrophic Scars Treatment. Aesthetic Plast Surg 2024:10.1007/s00266-024-03869-7. [PMID: 38453710 DOI: 10.1007/s00266-024-03869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen. OBJECTIVE To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device. METHODS Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3-1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded. RESULTS A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics. CONCLUSIONS The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars. LEVEL OF EVIDENCE II 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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Affiliation(s)
- Shaked Menashe
- The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery, Shamir Medical Center Be'er Ya'akov, Shamir Medical Center Assaf Harofeh, Tel Aviv, Israel.
| | - Lior Heller
- The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery, Shamir Medical Center Be'er Ya'akov, Shamir Medical Center Assaf Harofeh, Tel Aviv, Israel
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Brockmann T, Simon A, Brockmann C, Fuchsluger TA, Pleyer U, Walckling M. [Corneal wound healing-Pharmacological treatment]. Ophthalmologie 2024; 121:245-258. [PMID: 38411733 DOI: 10.1007/s00347-024-02021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Physiological wound healing of the cornea is a complex process and involves numerous multifactorial tissue processes. A proper wound healing, especially without the formation of light-scattering scars, is essential to preserve the integrity and function of the cornea. Misdirected wound healing is of vast clinical relevance as it can lead to corneal fibrosis and the loss of optical transparency with subsequent reduction of visual acuity, up to blindness. In addition to the understanding of the pathophysiological mechanisms, the knowledge of therapeutic concepts and options for treating corneal wound healing disorders and fibrosis is essential to counteract a permanent damage of the cornea as early as possible. Nowadays, various pharmacological and surgical options are available for treatment. The decision, appropriate selection and indication for the optimal treatment depend primarily on the genesis and clinical appearance of the corneal wound, fibrosis or scar. The treatment of wound healing disorders ranges from the use of topical therapy and supportive measures up to tissue replacement procedures. As long as the mechanical stability of the cornea is intact and wound healing processes are still ongoing, a pharmacological modulation is reasonable, which is discussed in this article.
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Affiliation(s)
- Tobias Brockmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland.
- Fachbereich SciTec, Ernst-Abbe-Hochschule Jena, Carl-Zeiss-Promenade 2, 07745, Jena, Deutschland.
| | - Alexander Simon
- Fachbereich SciTec, Ernst-Abbe-Hochschule Jena, Carl-Zeiss-Promenade 2, 07745, Jena, Deutschland
| | - Claudia Brockmann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland
| | - Thomas A Fuchsluger
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Marcus Walckling
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Doberaner Str. 140, 18057, Rostock, Deutschland
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Frank K, Zeng R, Sedlbauer S, Prantl L, Giunta R, Cotofana S, Moellhoff N, Alfertshofer M, Kaye K, Brébant V. The Influence of Scar Patterns After Reduction Mammoplasty on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthetic Plast Surg 2024; 48:250-258. [PMID: 37853080 PMCID: PMC10917861 DOI: 10.1007/s00266-023-03689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Given that scars are acknowledged as the primary cause of postoperative dissatisfaction following reduction mammoplasty, it is imperative to comprehend the patient's visual perception of different scar patterns in order to enhance patient satisfaction. To achieve this, eye-tracking technology provides an unbiased method of evaluating how observers assess breast scars. METHODS 58 participants (32 females and 26 males) between the ages of 19 and 82 years (mean age of 29.47 ± 10.98 years) were shown 18 color photographs, taken at 3 viewing angles (right 45° oblique, frontal and frontal view with arms raised), from 6 patients undergone reduction mammoplasty with the inverted T-scar technique (3 patients) or no-vertical-scar technique (3 patients). The images were presented to every participant for a fixed duration of 5 s each. Eye-tracking device was used to collect and analyze the gaze data of viewers. RESULTS The nipple-areola complex (NAC) and the periareolar scar captured observers' gaze faster, had longer duration and more count of eye fixation than all other parts of breast scars, regardless of the viewing angle and scar pattern. Moreover, the scar region in the inverted T-scar pattern received greater and faster visual attraction of observer's gaze than the no-vertical-scar pattern. CONCLUSION The NAC and the periareolar scar seem to be perceived as the most important regions for breast aesthetics. The findings can be helpful to assist plastic surgeons in determining the most appropriate technique for reduction mammoplasty, meanwhile underlining the importance of a fine periareolar scar and symmetric NAC for excellent aesthetic outcomes. This is to our best knowledge the first study using eye-tracking technology in evaluating reduction mammoplasty outcomes. This study explored the influence of different scar patterns after reduction mammoplasty on eye movements and gaze patterns among observers. The study have validated the significance of the NAC and the periareolar scar for breast aesthetics and revealed that the scar region in the inverted T-scar pattern may be judged less visually attractive than the no-vertical-scar pattern. LEVEL OF EVIDENCE V 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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Affiliation(s)
| | - Rui Zeng
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephanie Sedlbauer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Riccardo Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Vanessa Brébant
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Osman MA, Kassab AN. Fractional Er:YAG laser versus fractional CO2 laser in the treatment of immature and mature scars: a comparative randomized study. Arch Dermatol Res 2024; 316:75. [PMID: 38236287 PMCID: PMC10796705 DOI: 10.1007/s00403-023-02764-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Mai Abdelraouf Osman
- Dermatology and Laser at Dermatology Unit, Medical Laser Applications, National Institute of Laser Enhanced Sciences (NIlES) Cairo University, 25 Giza St, Giza, 11236, Egypt.
| | - Ahmed Nazmy Kassab
- ENT and Laser at ENT Unit, Medical Laser Applications, National Institute of Laser Enhanced Sciences (NIlES) Cairo University, 25 Giza St, Giza, 11236, Egypt
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Mao K, Li J, Zhu X, Sun H, Zhong S, Mao W. Signal mining study of severe cutaneous adverse events of valaciclovir or acyclovir based on the FAERS database. Expert Rev Clin Pharmacol 2024; 17:101-110. [PMID: 38069611 DOI: 10.1080/17512433.2023.2294002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study aimed to explore a comprehensive empirical investigation and assess SCARs related to valaciclovir or acyclovir based on FAERS database from FDA, thus providing a theoretical foundation for the rational application of drugs in clinic. METHODS SCARs reports relevant to valaciclovir or acyclovir were searched in FAERS database from the 2004 Q1 to 2023 Q2. These data were further mined by a proportional analysis and Bayesian approach to detect signals of SCARs caused by two drugs. Meanwhile, the clinical characteristics, onset time, correlation, and stratification analysis of the two drugs in SCARs were analyzed. RESULTS Both drugs exhibited positive signals for drug reaction with DRESS, AGEP, TEN, SJS-TEN overlap and SJS. The median onset time of SCARs caused by valaciclovir or acyclovir was 30 days vs 10 day for DRESS, 11 days vs 9 days for AGEP, 17 days vs 12 days (TEN) and 12 days vs 8 days (SJS). Excluding the effect of combinational drugs, there was an association between the two antiviral drugs and SCARs. CONCLUSION By analyzing the FAERS database, the risk trends of SCARs caused by valaciclovir or acyclovir have been identified, providing valuable insights to recognize various types of SCARs in clinics.
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Affiliation(s)
- KaiLi Mao
- Department of Pharmacy, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - Jiang Li
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - XinLiang Zhu
- Department of Pharmacy, HuZhou Central Hospital, The Affiliated HuZhou Hospital, ZheJiang University School Of Medicine, HuZhou, Zhejiang, China
| | - HuaYu Sun
- Department of Pharmacy, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - SongYang Zhong
- Department of Pharmacy, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - WeiLi Mao
- Department of Pharmacy, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China
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Myung J, Kwon YS, Hyun MH, Lee SJ. Development and Validation of the Korean Version of the Multidimensional Non-Suicidal Self-Injury Scar Scale. Psychiatry Investig 2024; 21:83-91. [PMID: 38281739 PMCID: PMC10822741 DOI: 10.30773/pi.2023.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE Non-Suicidal Self-Injury (NSSI) scars are common in individuals with NSSI experiences. However, little is known about NSSI scars because related tools are limited. This study aimed to develop and validate the Korean version of the multidimensional Non-Suicidal Self-Injury Scar Scale (K-NSSI-ScarS), consisting of three components: NSSI scar measurement, NSSI scar cognition, and NSSI scar concealment. METHODS A total of 333 Korean adults with at least one NSSI scar and history of NSSI within the last 5 years (age: 18 to 39 years) completed the online survey. We conducted exploratory (n=133) and confirmatory (n=200) factor analyses of NSSI scar cognition. To measure the internal consistency of each subfactor of the scar cognition and scar concealment components, we used Cronbach's α. Kappa and intraclass correlation coefficients were used to measure the test-retest reliability of the entire scale. We also assessed the convergent and construct validity of the K-NSSI-ScarS. RESULTS Factor analyses showed a 5-factor structure consisting of 23 items. Internal consistencies and test-retest reliability were excellent. The moderate correlation between the five subfactors of NSSI scar cognition and related concepts (e.g., acquired capability of suicide) confirmed the convergent validity. Lastly, moderate correlations were found between NSSI scar concealment, self-concealment, NSSI scar measurement information, and the five subfactors of NSSI scar cognition. CONCLUSION The results verify the psychometric properties and support the necessity of a multidimensional NSSI scar scale.
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Affiliation(s)
- Jinwoo Myung
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Young-Sil Kwon
- College of General Education, Chung-Ang University, Seoul, Republic of Korea
| | - Myoung-Ho Hyun
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Seo Jeong Lee
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Republic of Korea
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Zagzoog FH, Bukhari M, Almohizea MI, Almothahbi AS. Efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:13-21. [PMID: 37709923 DOI: 10.1007/s00405-023-08226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To evaluate the efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions. METHODS MEDLINE, Cochrane Central, Web of Science, and Scopus databases were searched in April 2023 for relevant clinical trials. Inclusion criteria were clinical trials evaluating the efficacy of PRP in benign vocal fold lesions. We conducted a comparative double-arm analysis using the pooled mean difference (MD) and 95% confidence interval (CI). Outcomes of interest included the vocal handicap index (VHI), the Jitter and Shimmer percentages, and the noise-to-harmonic ratio (NHR). RESULTS Six studies matched the inclusion criteria. The pooled analysis shows that PRP was associated with significantly lower VHI scores compared with the control (MD = - 5.06, p < 0.01). Regarding the Jitter percentage, the PRP group was not superior to the control group at 2 and 4 weeks. However, the results revealed that PRP significantly reduced the Jitter percentage at 3 months (MD = - 0.61, p = 0.0008). The overall analysis favored the PRP arm significantly (p < 0.001). As for the Shimmer percentage, the combined effect estimate favored the PRP group (MD = - 1.22, p = 0.002). Subgroup analysis according to the time did not reveal any significant differences between studies at 2 weeks, 4 weeks, and 3 months. The analysis of the NHR outcome revealed a significant difference between both groups (MD = -1.09, p = 0.01). However, at 4 weeks, the treatment group had a significantly lower NHR % compared to the control group (MD = - 0.61, p = 0.02). There was no significant difference at 3 months (MD = - 2.14, p = 0.14). CONCLUSIONS Platelet-rich plasma is effective in reducing VHI scores, Jitter and Shimmer percentages, and NHR values. This effect is more evident after follow-up, especially 3 months.
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Affiliation(s)
- Faisal H Zagzoog
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Manal Bukhari
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed I Almohizea
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Saeed Almothahbi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Waibel JS, Waibel H, Sedaghat E. Scar Therapy of Skin. Facial Plast Surg Clin North Am 2023; 31:453-462. [PMID: 37806679 DOI: 10.1016/j.fsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Scar therapy is truly important in medicine. Patients experience great loss in quality of life with scars. There are many treatment modalities that help treat scars, including topical, intralesional, surgical, and energy-based devices. In addition, early intervention can help mitigate scar formation. Lasers represent a major innovation in the treatment of all types of scars. Treating scars is a multimodal and multispecialty endeavor. This article highlights the use of many therapies to treat scars and scar symptoms including pruritus, pain, and range of motion. This also highlights key literature including multiple recent consensus guidelines in treating scars.
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Affiliation(s)
| | - Hannah Waibel
- Southern Methodist University; Private Practice: Miami Dermatology and Laser Institute, 7800 Southwest 87th Avenue Suite B200, Miami, FL 33173, USA; Baptist Hospital, Miami, FL, USA; Dermatology Faculty, Miller School of Medicine, University of Miami
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Mamalakis M, Garg P, Nelson T, Lee J, Swift AJ, Wild JM, Clayton RH. Artificial Intelligence framework with traditional computer vision and deep learning approaches for optimal automatic segmentation of left ventricle with scar. Artif Intell Med 2023; 143:102610. [PMID: 37673578 DOI: 10.1016/j.artmed.2023.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 09/08/2023]
Abstract
Automatic segmentation of the cardiac left ventricle with scars remains a challenging and clinically significant task, as it is essential for patient diagnosis and treatment pathways. This study aimed to develop a novel framework and cost function to achieve optimal automatic segmentation of the left ventricle with scars using LGE-MRI images. To ensure the generalization of the framework, an unbiased validation protocol was established using out-of-distribution (OOD) internal and external validation cohorts, and intra-observation and inter-observer variability ground truths. The framework employs a combination of traditional computer vision techniques and deep learning, to achieve optimal segmentation results. The traditional approach uses multi-atlas techniques, active contours, and k-means methods, while the deep learning approach utilizes various deep learning techniques and networks. The study found that the traditional computer vision technique delivered more accurate results than deep learning, except in cases where there was breath misalignment error. The optimal solution of the framework achieved robust and generalized results with Dice scores of 82.8 ± 6.4% and 72.1 ± 4.6% in the internal and external OOD cohorts, respectively. The developed framework offers a high-performance solution for automatic segmentation of the left ventricle with scars using LGE-MRI. Unlike existing state-of-the-art approaches, it achieves unbiased results across different hospitals and vendors without the need for training or tuning in hospital cohorts. This framework offers a valuable tool for experts to accomplish the task of fully automatic segmentation of the left ventricle with scars based on a single-modality cardiac scan.
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Affiliation(s)
- Michail Mamalakis
- Insigneo Institute for in-silico, Medicine, University of Sheffield, Sheffield, S1 4DP, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield, S1 4DP, UK.
| | - Pankaj Garg
- Department of Cardiology, Sheffield Teaching Hospitals Sheffield S5 7AU, UK
| | - Tom Nelson
- Department of Cardiology, Sheffield Teaching Hospitals Sheffield S5 7AU, UK
| | - Justin Lee
- Department of Cardiology, Sheffield Teaching Hospitals Sheffield S5 7AU, UK
| | - Andrew J Swift
- Department of Computer Science, University of Sheffield, Regent Court, Sheffield, S1 4DP, UK; Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James M Wild
- Insigneo Institute for in-silico, Medicine, University of Sheffield, Sheffield, S1 4DP, UK; Polaris, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Richard H Clayton
- Insigneo Institute for in-silico, Medicine, University of Sheffield, Sheffield, S1 4DP, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield, S1 4DP, UK.
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11
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Albalat W, Ghonemy S, Saleh A, Elradi M. Microneedling combined with botulinum toxin-A versus microneedling combined with platelet-rich plasma in treatment of atrophic acne scars: a comparative split face study. Arch Dermatol Res 2023; 315:839-846. [PMID: 36334117 PMCID: PMC10085893 DOI: 10.1007/s00403-022-02446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Atrophic post-acne scarring constitutes a troublesome cosmetic concern for both patients and dermatologists. Old and new therapies as well as combinations are being introduced to achieve a satisfactory response. Microneedling has been used either alone or under different combinations for its treatment. The aim was to compare its combination with topical platelet-rich plasma versus its combination with topical Botulinum Toxin-A. METHODS 30 subjects with different types and grades of atrophic post-acne scars completed the study. Right side of the face was treated with microneedling and platelet-rich plasma while the left side was treated microneedling and Botox. Response was assessed using two different scales. Patient satisfaction and pain were also assessed. RESULTS Regarding response to therapy and according to the quartile grading scale, there was no statistically significant difference between the two sides where (23.4% & 13.3%) of the right and left sides, respectively, had an excellent response. Regarding the difference in the qualitative global scarring grading system before and after treatment, there was a highly statistically significant improvement on both sides with higher improvement on the right side than left side but in a non-statistically significant way. CONCLUSIONS Both combinations present efficacious options for treating acne scars with comparable efficacy. TRIAL REGISTRATION Registered and approved prospectively by the ethical review board of the faculty of medicine, Zagazig University.
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Affiliation(s)
- Waleed Albalat
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Soheir Ghonemy
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Ayat Saleh
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Mona Elradi
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt.
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Delgado-Miguel C, Miguel-Ferrero M. Preliminary results of the use of carboxytherapy in the treatment of pathologic scars: A minimally invasive alternative. J Pediatr Surg 2023; 58:679-683. [PMID: 36641310 DOI: 10.1016/j.jpedsurg.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Carboxytherapy involves injecting carbon dioxide in the dermal and subcutaneous layers to achieve an increase in the local microvascularization of the tissue where it is applied. Our aim is to analyze its effectiveness in the treatment of pathological scars, as well as its adverse effects. METHODS We conducted a prospective single-center study in patients under 18 years of age with atrophic and hypertrophic scars caused by surgical interventions or trauma, mainly burns. Each patient underwent two sessions, 6 weeks apart in time. Scar quality was evaluated using the Vancouver Scar Scale before the first session and 6 weeks after the second session. Adverse effects observed during the procedure and at follow-up in outpatient clinic were collected. RESULTS A total of 16 patients were included (5 males; 11 females), with a median age of 12.7 years (interquartile range 8.5-15.2), in whom 25 pathologic scars were treated (14 atrophic and 11 hypertrophic). All sessions were performed under sedation, and patients were discharged the same day, without the need for hospitalization. Regarding scar quality, an improvement was observed in the median Vancouver scale score at 6 weeks after the second session (7 points) compared to the initial median score (12 points), this difference being statistically significant (p = 0.031). No serious adverse effects were observed during the procedure or during subsequent follow-up, with a median follow-up of 14 weeks. CONCLUSIONS Carboxytherapy is an effective and safe minimally invasive therapy for pathologic scars, achieving a significant improvement in scar quality, with almost no contraindications. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Prospective Single-Center Case Series.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, SC, USA; Department of Pediatric Surgery, La Paz Children´s University Hospital, Madrid, Spain.
| | - Miriam Miguel-Ferrero
- Department of Pediatric Surgery, La Paz Children´s University Hospital, Madrid, Spain
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Gharib K, Seoudy W, Rageh MA, Abdelsatar S, Khater E. Treatment of Post-acne Scarring with Long-pulsed and Q-switched 1,064nm Nd:YAG Laser. J Clin Aesthet Dermatol 2023; 16:32-37. [PMID: 37077932 PMCID: PMC10110289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Background Acne scarring is one of the most dramatic consequences of inflammatory acne. It can lead to physical disfigurement and psychological burden on the affected individuals. Many treatment options for post-acne scarring are used, with variable results. Nonablative lasers, such as the 1,064nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, are known to ameliorate acne scar appearance by stimulating collagen production and dermal remodeling. Objectives We sought to evaluate the clinical efficacy, safety, and long-term effects of long-pulsed and Q-switched 1,064nm Nd:YAG lasers in the treatment of acne scars. Methods From March to December 2019, a total of 25 patients with different skin types with acne scars were treated. Patients were divided into two groups. In Group I, 12 patients received a combination of Q-switched 1,064nm Nd:YAG laser, then long-pulsed 1,064nm Nd:YAG laser. In Group II, 13 patients received a combination of long-pulsed 1,064nm Nd:YAG laser, then Q-switched 1,064nm Nd:YAG laser. All patients received a total of six sessions at two-week intervals. Results There were no statistically significant differences between the studied groups in skin type, lesions, or scar type. A positive response with either good or excellent results was documented in 43 patients, corresponding to 86. Six percent of the patients included in this study. Excellent response was observed in a total of 17 patients (26.6%). Twenty-six patients (60%) showed a moderate-to-good response, while seven patients (13.4 %) showed a fair response. The majority of patients in this study had an excellent-to-good response, with an 86.6% improvement of post-acne scars after laser sessions. Conclusion Q-switched and long-pulsed 1,064nm Nd:YAG lasers are considered an efficient and safe modality for the treatment of mild and moderate post-acne scars. Both lasers can enhance dermal collagen remodeling and spare the epidermis with minimal downtime after the procedure.
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Affiliation(s)
- Khaled Gharib
- Drs. Gharib and Khater and Ms. Abdelsatar are with the Department of Dermatology, Faculty of Medicine, Zagazig University in Zagazig, Egypt
| | - Wael Seoudy
- Dr. Seoudy is with the Department of Dermatology, Faculty of Medicine, Misr University for Science & Technology in 6th of October City, Egypt
| | - Mahmoud A. Rageh
- Dr. Rageh is with the Department of Dermatology, Faculty of Medicine, Al-Azhar University in Cairo, Egypt
| | - Sahar Abdelsatar
- Drs. Gharib and Khater and Ms. Abdelsatar are with the Department of Dermatology, Faculty of Medicine, Zagazig University in Zagazig, Egypt
| | - Elsayed Khater
- Drs. Gharib and Khater and Ms. Abdelsatar are with the Department of Dermatology, Faculty of Medicine, Zagazig University in Zagazig, Egypt
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14
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Zhang L, Lv J, Yin Y, Ling G, Zhang P. Rapidly separable microneedle patch for the controlled and sustained release of 5-fluorouracil. Int J Pharm 2023; 635:122730. [PMID: 36796660 DOI: 10.1016/j.ijpharm.2023.122730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
5-Fluorouracil (5-FU) is frequently used in the treatment of tumors and swollen tissues. However, traditional administration methods can result in poor patient compliance and require to administrate frequently due to the short T1/2 of 5-FU. Herein, the 5-FU@ZIF-8 loaded nanocapsules were prepared using multiple emulsion solvent evaporation methods to enable the controlled and sustained release of 5-FU. To decrease the drug release rate and enhance patient compliance, the obtained pure nanocapsules were added to the matrix to fabricate rapidly separable microneedles (SMNs). The entrapment efficiency (EE%) of 5-FU@ZIF-8 loaded nanocapsules was in the range of 41.55-46.29 %, and the particle size of ZIF-8, 5-FU@ZIF-8, and 5-FU@ZIF-8 loaded nanocapsules were 60 nm, 110 nm, and 250 nm respectively. According to the release study in vivo and in vitro, we concluded that 5-FU@ZIF-8 nanocapsules could achieve the sustained release of 5-FU and that the burst release of nanocapsules could be elegantly handled by incorporating nanocapsules into the SMNs. What's more, the use of SMNs could improve patient compliance due to the rapid separation of needles and backing of SMNs. The pharmacodynamics study also revealed that the formulation would be a better choice for the treatment of scars due to the advantages of painlessness, separation ability, and high delivery efficiency. In conclusion, the SMNs containing 5-FU@ZIF-8 loaded nanocapsules could serve as a potential strategy for some skin diseases therapy with controlled and sustained drug release behavior.
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Affiliation(s)
- Lijing Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China
| | - Jiatong Lv
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China
| | - Yannan Yin
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China
| | - Guixia Ling
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China.
| | - Peng Zhang
- Wuya College of Innovation, Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenyang 110016, China.
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15
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Moulton KL. Exploring tattoo artists' understanding of decorative non-medical professional tattooing as a method of scar camouflage and decoration. PSYCHOL HEALTH MED 2023; 28:540-547. [PMID: 35341392 DOI: 10.1080/13548506.2022.2057556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Research surrounding the use of decorative tattooing by non-medical professional tattooists as a form of scar camouflage or decoration is limited. This study provides critical and deepening insights into tattoo artists' experiences of tattooing scars, to help inform a more in-depth understanding of its uses from a health and wellbeing perspective. Specifically, it aimed to explore qualitatively, the different methods and techniques used by non-medical tattoo professionals to cover up or decorate scars, which can have a psychological impact on those affected. Six tattoo artists from legitimate UK based studios were identified through snowballing and purposive sampling methods. Data collection involved semi-structured telephone interviews. The data was then transcribed, and thematic analysis was then performed. Five themes were identified: Personal Opinion of Scar Camouflage Tattooing, Tattooing Methods, Scars and Tattooing Risks, Positive Impact, and Understanding of Customer Experience. These themes were then broken down into more specific sub-themes. The discussion considers these findings in relation to theory and existing literature, for example, around understanding of role, and makes recommendations for future study in this field.
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Affiliation(s)
- Kieran Lane Moulton
- Department of Health and Social Science (Centre for Appearance Research), University of the West of England, Bristol, UK
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16
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Doomen MCHA, Rijpma D, Pijpe A, Meij-de Vries A, Niessen FB, Karaoglu S, de Vet HCW, Gevers T, van Zuijlen PPM. A clinimetric assessment of the validity and reliability of 3D technology for scar surface area measurement. Burns 2022; 49:583-594. [PMID: 36764836 DOI: 10.1016/j.burns.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The quality of scars has become an important outcome of burn care. Objective scar assessment through scar surface area measurement enables quantification of scar formation and evaluation of treatment efficacy. 3D technology has proven valid and reliable but often remains cumbersome, expensive, and time-consuming. 3D technology with depth sensors on mobile devices has become available and might surpass these limitations. This study provides a clinimetric assessment of the validity and reliability of a 3D system with a depth sensor for scar surface area measurement. METHODS A technology involving a depth sensor mounted on a mobile device was used. Images and analyses were made with a custom-made software application. A standardized one-keyframe image capturing procedure was followed. To assess validity, stickers with predefined dimensions (8.01 cm2 - 77.70 cm2) were imaged in a single observer setting on various body parts of healthy volunteers. To assess reliability, hypertrophic scars, keloids, and normotrophic scars were imaged and rated by two observers independently. Data are expressed as mean (+/-SD), Coefficient of Variation (CV), Intraclass Correlation Coefficients (ICC), and Limits of Agreements (LoA). RESULTS Eighty stickers placed on 20 healthy volunteers showed validity with CV between 0.62%- 1.67% for observer A and 0.75%- 1.19% for observer B. For the reliability study, 69 scars on 36 patients were included. Mean scar surface area ranged from 0.83 cm2 to 155.59 cm2. Mean scar surface area measurement was 13.83 cm2 (SD 23.06) for observer A and 13.59 cm2 (SD 23.31) for observer B. Adjusted interobserver CV for trained observers is estimated as 5.59%, with corresponding LoA = 0 ± 0.15 x mean surface area. Interobserver ICCs were 0.99-1.00. CONCLUSION This 3D technology with a depth sensor for measuring scar surface area provides valid and reliable data and thereby surpasses expensive and time-consuming 3D cameras.
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Affiliation(s)
- M C H A Doomen
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centers, Beverwijk 1941 AJ, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - D Rijpma
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands.
| | - A Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - A Meij-de Vries
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands
| | - F B Niessen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands
| | - S Karaoglu
- 3DUniversum, 1098 XH Amsterdam, the Netherlands
| | - H C W de Vet
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan1117, Amsterdam, the Netherlands
| | - T Gevers
- 3DUniversum, 1098 XH Amsterdam, the Netherlands
| | - P P M van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands; Department of Plastic, Reconstructive & Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands.
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Abstract
Scarring has major psychological and physical repercussions. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities. It is more efficient to prevent hypertrophic scars than treat them; early diagnosis of a problem scar can considerably impact the overall outcome. Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed. Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.
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Affiliation(s)
- Jacky Edwards
- Consultant Nurse (Burns), Programme Lead and Representative for Major Trauma and Burns Clinical Reference Group, Manchester Burns Course
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18
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Kaur G, Williams N, Vidhun R, Stroever S, Dodge JL. The Gallbladder and Vermiform Appendix as Quality Assurance Indicators in Autopsy Pathology. Am J Clin Pathol 2022; 157:858-862. [PMID: 34871340 DOI: 10.1093/ajcp/aqab199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We investigate the number of autopsy reports that did or did not document the presence or absence of the gallbladder or appendix or document abdominal scars in patients following cholecystectomy or appendectomy. We also report gallbladder and appendix pathology at autopsy. METHODS Autopsy reports from patients 18 years or older autopsied at a community teaching hospital between January 1, 2009, and December 31, 2018 were reviewed. Nonabdominal autopsies were excluded. Histopathologic examination of the gallbladder and appendix was only performed if gross pathology was seen. RESULTS Of the 385 autopsies studied, 48 (12.5%) had cholecystectomies, of which 6 (12.5%) did not document abdominal scars. Sixty-two (16.1%) had appendectomies, of which 12 (19.4%) did not document abdominal scars. The presence or absence of the gallbladder and appendix was not documented in 6 (1.6%) and 16 (4.2%) of reports, respectively. Pathology was seen in 87 (25.8%) gallbladders and 4 (1.2%) appendixes. CONCLUSIONS Absence of the gallbladder or appendix is a relatively common autopsy finding. Auditing autopsy reports for documentation of their presence or absence, along with associated abdominal scars, are potential quality assurance indicators of autopsy reports. Documentation of these elements could be improved by changing the autopsy template or using synoptic reporting.
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Affiliation(s)
- Gagandeep Kaur
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
| | - Nathan Williams
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
| | - Ramapriya Vidhun
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
| | - Stephanie Stroever
- Department of Research and Innovation, Nuvance Health , Danbury, CT , USA
| | - Jessica L Dodge
- Department of Pathology and Laboratory Medicine , Danbury, CT , USA
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Ojelade O, Iyasere O, Durosaro S, Abdulraheem I, Akinde A. Social isolation impairs feed intake, growth and behavioural patterns of catfish under culture conditions. Animal 2022; 16:100521. [PMID: 35472534 DOI: 10.1016/j.animal.2022.100521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
Globally, the culture of fishes is important for food production. There is a growing interest in understanding and improving the welfare of cultured fish from both ethical and production perspectives. Social isolation is a common practice in catfish farming. This study assessed how social interactions affect the feeding behaviour, growth performance, and behavioural pattern of Clarias gariepinus under different social conditions. Juveniles of African catfish with a mean weight of 23.6 ± 1.09 g were stocked in 20L-aquaria (1.7 m × 1.2 m × 1.0 m) and fed twice daily in isolated (one fish/tank; N = 6 replicates) and non-isolated (six fish/tank; N = 6 replicates) conditions for a 36-day experimental period. Feed intake and growth response were monitored, while behavioural patterns were observed twice per week using focal sampling techniques for a total of 40 minutes per day. Wilcoxon two-sample tests and GLMs were used to analyse the data. Social context significantly (P < 0.001) affected the feed intake, feeding duration, and other observed behavioural patterns. However, the time of feeding (P > 0.001) did not affect the feed intake or the duration of feeding. Fish cultured in non-isolated conditions consumed more pellets (63 ± 2.36). The duration of feeding was longer in isolated conditions (431 s) while the latency to feed increased significantly (P < 0.001) from the first and fifth day of the experiment for the non-isolated and isolated, respectively. Behaviourally, isolated groups were inactive (Ws = 446.34, z = 5.397; P < 0.01) and displayed fewer aggressive acts (Ws = 0.95, z = 1.19; P < 0.01), while non-isolated groups were more active (Ws = 564.39, z = -5.397; P < 0.01) and displayed more escape attempts (Ws = 11.56, z = -5.47; P < 0.01). Non-isolated groups had higher (Ws = 23.41, z = 1.06; P < 0.01) number of scars and bruises. Furthermore, non-isolated fish had a higher specific growth rate (2.36 ± 0.12), feed conversion ratio (1.27 ± 0.01) and a better condition factor (1.01 ± 0.08). Conclusively, these findings are relevant to African catfish welfare as social isolation changes the behavioural attributes, feeding pattern and growth rate of C. gariepinus. However, social context should be monitored since it resulted in more scars and bruises, which might affect the acceptability and welfare of this aquatic fish species.
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Affiliation(s)
- O Ojelade
- Department of Aquaculture and Fisheries Management, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria.
| | - O Iyasere
- Department of Animal Physiology, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - S Durosaro
- Department of Animal Breeding and Genetics, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - I Abdulraheem
- Department of Aquaculture and Fisheries Management, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - A Akinde
- Department of Aquaculture and Fisheries Management, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
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Bakry OA, Samaka RM, Fayez N, Seleit I. Krox20 Expression in Abnormal Scars: An Immunohistochemical Study. J Cosmet Dermatol 2022; 21:5116-5126. [PMID: 35416391 DOI: 10.1111/jocd.14986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/12/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scars are the end outcome of healing. They are grouped into several types, the common of which are keloid, hypertrophic and atrophic scars. The role of Krox20 in skin and hair physiology and pathology had emerged. Overexpression of Krox20 was sufficient to stimulate collagen gene expression and myofibroblast differentiation and is necessary for transforming growth factor-β (TGF-β) induced profibrotic responses. OBJECTIVE to investigate the role of Krox20 in abnormal scar pathogenesis. Hopefully, this insight can set the route for newer therapeutic approaches. MATERIALS AND METHOD This study was carried out on 30 cases [10 cases of keloid, 10 cases of atrophic scars and 10 cases with hypertrophic scars (HTS)] and 10 age and gender-matched apparently healthy subjects as a control group. Thirty biopsies were taken from perilesional areas. Evaluation of Krox20 expression was done using standard immunohistochemical technique. RESULTS Krox20 was downregulated in epidermis of scar biopsies compared to perilesional and normal skin (P=0.02) while it was overexpressed in fibroblasts in lesional scar biopsies compared to perilesional and normal skin (P<0.001). Keloid cases have significantly higher Krox20 expression in fibroblasts compared with HTS cases (P <0.001). Krox20 had significantly nucleocytoplasmic pattern of staining in scar cases compared with normal skin (P<0.001). CONCLUSION Krox20 overexpression may have a role in scar pathogenesis through up-regulation of multiple genes associated with tissue remodeling and wound healing. This may open an avenue for research for new therapies based on Krox20 inhibition.
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Affiliation(s)
- O A Bakry
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University, Egypt
| | - R M Samaka
- Department of Pathology, Faculty of Medicine, Menoufiya University, Egypt
| | - N Fayez
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University, Egypt
| | - I Seleit
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University, Egypt
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Al Qurashi AA, Siddiqi AK, Alghamdi AA, Aljalfan AAN, Almenhali AA, Al Jabr FA, Rashid AM, Almas T, Menezes RG. Effectiveness of Autologous Fat Transfer in the Treatment of Scar-Related Conditions: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:2564-2572. [PMID: 35411408 DOI: 10.1007/s00266-022-02869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions. METHODS PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model. RESULTS 9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036). CONCLUSION Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required. 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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Affiliation(s)
- Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | | | | | | | | | | | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ritesh G Menezes
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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22
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Zhang B, Yang E, Zhang H. Efficacy of Early Application of 1540 nm Non-ablative Fractional Laser and Silicones to Improve Post-epicanthoplasty Scars. Aesthetic Plast Surg 2022; 46:2452-2458. [PMID: 35364722 DOI: 10.1007/s00266-022-02866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
The combination of epicanthoplasty and blepharoplasty is a popular choice in Asians to acquire a pair of charming big eyes. However, the obvious scarring in the medial canthal area may result in unsatisfactory aesthetic outcomes. Recently, various laser treatments have been used to deal with scars had achieved detectable improvement, but only a few studies investigating the efficacy of lasers used in post-epicanthoplasty scarring were developed. A total of 70 participants who underwent Z-epicanthoplasty were enrolled in this prospective clinical trial and were randomly assigned to the groups of 1540nm non-ablative fractional laser (NAFL) combined with silicones treatment and silicones alone treatment. The NAFL-exposure in the treated group was additionally applied to the medial canthal area on day 21 postoperatively, compared with the participants in the control group who had only been treated with the daily usage of silicone sheets for 12 hours and silicone gels twice for 5 months after scab had fallen from the skin. Scar evolution was performed by patient and observer scar assessment Scales (POSAS) and visual analogue scale (VAS) for 21 days, and 6 months postoperatively. 64 participants have completed the entire follow-up process. The scar recovery was statistically detected in treated group compared with the control group at 6-month postoperatively assessed by POSAS, especially in pliability of scars. Furthermore, the VAS evaluations showed superior satisfaction in treated group. The early treatment of NAFL combined with silicones has improved scar formation in medial canthal region after epicantholplasties efficiently.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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Bellei B, Migliano E, Picardo M. Research update of adipose tissue-based therapies in regenerative dermatology. Stem Cell Rev Rep 2022; 18:1956-1973. [PMID: 35230644 DOI: 10.1007/s12015-022-10328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 12/09/2022]
Abstract
Mesenchymal stromal/stem cells (MSCs) have a spontaneous propensity to support tissue homeostasis and regeneration. Among the several sources of MSCs, adipose-derived tissue stem cells (ADSCs) have received major interest due to the higher mesenchymal stem cells concentration, ease, and safety of access. However, since a significant part of the natural capacity of ADSCs to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines, lipids, and extracellular matrix components, several studies focused on cell-free strategies. Furthermore, adipose cell-free derivatives are becoming more attractive especially for non-volumizing purposes, such as most dermatological conditions. However, when keratinocytes, fibroblasts, melanocytes, adipocytes, and hair follicle cells might not be locally sourced, graft of materials containing concentrated ADSCs is preferred. The usage of extracellular elements of adipose tissue aims to promote a self-autonomous regenerative microenvironment in the receiving area restoring physiological homeostasis. Hence, ADSCs or their paracrine activity are currently being studied in several dermatological settings including wound healing, skin fibrosis, burn, and aging.The present work analyzing both preclinical and clinical experiences gives an overview of the efficacy of adipose tissue-derivatives like autologous fat, the stromal vascular fraction (SVF), purified ADSCs, secretome and extracellular matrix graft in the field of regenerative medicine for the skin.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Emilia Migliano
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
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Yue S, Ju M, Su Z. A Systematic Review And Meta-Analysis: Botulinum Toxin A Effect on Postoperative Facial Scar Prevention. Aesthetic Plast Surg 2022; 46:395-405. [PMID: 34609526 DOI: 10.1007/s00266-021-02596-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Postoperative facial scarring can be a significant psychological burden for patients to carry after surgery, often resulting in prolonged mental health dysfunction. Currently, there is no established method to prevent facial scar formation; however, there are several methods to prevent facial scar hyperplasia and improve scar quality. Botulinum toxin A (BTA) has been widely used due to its properties of muscle paralysis and known success in plastic surgery and cosmetology. This meta-analysis aimed to evaluate the efficacy of BTA in preventing postoperative facial scar hyperplasia and improving scar quality. METHODS PubMed, MEDLINE, EMBASE, web of science, and Cochrane libraries were searched for randomized controlled trials (RCTs) (published before May 2021) wherein BTA was used for the treatment of facial scars. The efficacy and safety of BTA were evaluated by the following scales: the Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), Observer Scar Assessment Scale (OSAS), Patient Scar Assessment Scale (PSAS), and Stony Brook Scar Evaluation Scale (SBSES); the BTA effect on scar width and complications was also assessed. RESULTS Ten RCTs involving 114 cases were included. Through quantitative analysis, the BTA injection group had a higher VAS score, lower VSS score, lower OSAS score, and smaller scar width. However, no significant difference was noted in the incidence of postoperative complications between the two groups. CONCLUSIONS This meta-analysis demonstrated that BTA can safely improve the appearance of postoperative facial scars by significantly inhibiting scar hyperplasia and improving scar quality. 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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Affiliation(s)
- Shuai Yue
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
| | - Mengran Ju
- Department of Plastic and Reconstructive Surgery, Chengdu Badachu Medical Aesthetics Hospital, Chengdu, 610000, China
| | - Zhe Su
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China
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Maki J, Mitoma T, Mishima S, Ohira A, Tani K, Eto E, Hayata K, Masuyama H. A case report of successful vaginal delivery in a patient with severe uterine prolapse and a review of the healing process of a cervical incision. Case Rep Womens Health 2022; 33:e00375. [PMID: 34987980 PMCID: PMC8703083 DOI: 10.1016/j.crwh.2021.e00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of severe uterine prolapse during childbirth is approximately 0.01%. Moreover, to the best of our knowledge, no reports detail the healing process of the cervix during uterine involution. This report describes successful vaginal delivery and the healing process of postpartum uterine prolapse and cervical tears in a patient with severe uterine prolapse. Case presentation A patient in her 40s (gravida 3, para 1, abortus 1) with severe uterine prolapse successfully delivered a live female baby weighing 3190 g at 38 + 5 weeks of gestation by assisted vaginal delivery. Uterine prolapse had improved to approximately 2° by 2 months postoperatively. On postpartum day 4, during the healing process of cervical laceration, the thread loosened in a single layer of continuous sutures due to uterine involution, and poor wound healing was observed. The wound was subsequently re-sutured with a two-layer single ligation suture (Gambee suture + vertical mattress suture). However, on postpartum day 11, a large thread ball was hindering the healing of the muscle layer, which improved with re-suturing. Conclusion Although vaginal delivery in a patient with severe uterine prolapse is possible in some cases, the cervix should be sutured, while considering cervical involution after delivery. Pregnancies with complete uterine prolapse are exceedingly rare. When suturing the uterus, involution after delivery should be considered. This is the first report on the healing process of cervical canal lacerations.
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Affiliation(s)
- Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Tomohiro Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Sakurako Mishima
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Akiko Ohira
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kazumasa Tani
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kei Hayata
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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Mariani LG, Ferreira LM, Rovaris DL, Bonamigo RR, Kiszewski AE. Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae. An Bras Dermatol 2022; 97:37-44. [PMID: 34848114 PMCID: PMC8799848 DOI: 10.1016/j.abd.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Infantile hemangiomas (IH) occur in approximately 4% to 10% of the pediatric population. The identification of clinical subtypes and conditions that indicate increased risk for complications is essential for therapeutic success. OBJECTIVES To identify risk factors for complications, recurrence and unaesthetic sequelae. METHODS Retrospective cohort of patients with infantile hemangiomas undergoing follow-up at the Dermatology Service of Universidade Federal de Ciências da Saúde de Porto Alegre, between 2006 and 2018. RESULTS 190 patients were included; 24% had some type of complication, ulceration being the most frequent, and 86% required treatment. On correlation, ulceration was statistically related to mixed IH (p = 0.004), segmental IH (p < 0.01) and location in the gluteal region (p = 0.001). The mean time of treatment with propranolol was 12.7 months. Patients with PHACES syndrome and segmental infantile hemangioma required longer treatment (p < 0.001 and p = 0.0407, respectively), as well as those who started treatment after five months of life (p < 0.0001). Recurrence occurred in 16.6% of the treated patients, all-female; 94% were located on the head and neck (mainly on the upper eyelid, cyrano, S3 segment, and with parotid involvement); 61% and 38.8% were of the mixed and deep subtypes, respectively. Approximately 1/3 of the patients had some unaesthetic sequelae. STUDY LIMITATIONS As this is a retrospective study, data and photos of some patients were lost. CONCLUSIONS Mixed and segmental hemangiomas are risk factors for ulceration and sequelae. Recurrence occurs more often in females and segmental hemangiomas. Segmental infantile hemangioma and PHACES syndrome require a longer time of treatment. Specific protocols are required for infantile hemangiomas with a high risk of recurrence.
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Affiliation(s)
- Letícia Gaertner Mariani
- Postgraduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Diego Luiz Rovaris
- Department of Physiology and Biophysics, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renan Rangel Bonamigo
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Service of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ana Elisa Kiszewski
- Service of Dermatology, Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
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Nelson N, Portnoy PS, Kuppa JO, Rocroi I, Tatel E, Diaz A, Mehta KM. Patterns of torture among forcibly displaced Eritrean men in California: A cross-sectional study. Torture 2021; 31:53-63. [PMID: 34606477 DOI: 10.7146/torture.v31i1.121786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION This study was conducted to address a lack of information in the literature regarding the frequency and consequences of specific types of torture and abuse among Eritreans seeking asylum in the United States. METHODS Cross-sectional study of Eritreans seeking asylum in the United States presenting to a human rights clinic for forensic medical and psychological evaluations based on Istanbul Protocol. Reports were eligible for inclusion if subjects: 1) immigrated from Eritrea 2) reported torture and abuse in Eritrea, 3) were 18 or older. 59 reports met inclusion criteria. Demographic features of individuals, reported history and specific types of torture, and physical and psychological sequelae were analyzed. RESULTS Over 300 instances of torture were reported, an average of about 6 per person. The primary forms of torture reported were beating (87.7%) and forced positioning (57.9%). 90% of asylum seekers examined had physical findings which were consistent with the torture they reported, some of which had clinical as well as forensic significance. 86% of asylum seekers met diagnostic criteria for post-traumatic stress disorder. CONCLUSION Eritreans seeking asylum in the United States bear a high burden of post-traumatic physical and psychological morbidity.
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Mamalakis M, Garg P, Nelson T, Lee J, Wild JM, Clayton RH. MA-SOCRATIS: An automatic pipeline for robust segmentation of the left ventricle and scar. Comput Med Imaging Graph 2021; 93:101982. [PMID: 34481237 DOI: 10.1016/j.compmedimag.2021.101982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Multi-atlas segmentation of cardiac regions and total infarct scar (MA-SOCRATIS) is an unsupervised automatic pipeline to segment left ventricular myocardium and scar from late gadolinium enhanced MR images (LGE-MRI) of the heart. We implement two different pipelines for myocardial and scar segmentation from short axis LGE-MRI. Myocardial segmentation has two steps; initial segmentation and re-estimation. The initial segmentation step makes a first estimate of myocardium boundaries by using multi-atlas segmentation techniques. The re-estimation step refines the myocardial segmentation by a combination of k-means clustering and a geometric median shape variation technique. An active contour technique determines the unhealthy and healthy myocardial wall. The scar segmentation pipeline is a combination of a Rician-Gaussian mixture model and full width at half maximum (FWHM) thresholding, to determine the intensity pixels in scar regions. Following this step a watershed method with an automatic seed-points framework segments the final scar region. MA-SOCRATIS was evaluated using two different datasets. In both datasets ground truths were based on manual segmentation of short axis images from LGE-MRI scans. The first dataset included 40 patients from the MS-CMRSeg 2019 challenge dataset (STACOM at MICCAI 2019). The second is a collection of 20 patients with scar regions that are challenging to segment. MA-SOCRATIS achieved robust and accurate performance in automatic segmentation of myocardium and scar regions without the need of training or tuning in both cohorts, compared with state-of-the-art techniques (intra-observer and inter observer myocardium segmentation: 81.9% and 70% average Dice value, and scar (intra-observer and inter observer segmentation: 70.5% and 70.5% average Dice value).
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Affiliation(s)
- Michail Mamalakis
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield S1 4DP, UK.
| | - Pankaj Garg
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Tom Nelson
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Justin Lee
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Jim M Wild
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Polaris, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Richard H Clayton
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield S1 4DP, UK
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Machado BHB, Zhang J, Frame J, Najlah M. Treatment of Scars with Laser-Assisted Delivery of Growth Factors and Vitamin C: A Comparative, Randomised, Double-blind, Early Clinical Trial. Aesthetic Plast Surg 2021; 45:2363-74. [PMID: 33881605 DOI: 10.1007/s00266-021-02232-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Scarring can jeopardize the final result of plastic surgeries. Deep dermal injuries activate dermal fibroblasts that produce excessive amount of collagen and inflammatory cytokines and growth factors, which contributes to increased fibrous tissue and scarring tissue formation. OBJECTIVES The aim of this early study, double-blind, prospective, randomised clinical trial was to investigate the use of laser-assisted drug delivery (LADD) for scar improvement to support the establishment of LADD as standard therapy modality and to indicate suitable drugs for dermal administration. MATERIAL AND METHODS In total, 132 patients seeking scar treatment were consented and randomised. The control group (64 patients) received laser resurfacing immediately followed by skin surface application of Vitamin C and 68 patients received laser treatment followed by skin surface application of a cosmeceutical containing growth factors (GFs) and Vitamin C. Photographs were obtained before and three months after the procedure and submitted to three-dimensional reconstruction by the software Dermapix®. Objective measurements provided by the software were statistically analysed and established the differences in the treatment result between the two groups. RESULTS There was a significant reduction in scar roughness and volume in both groups (p < 0.01). Mann-Whitney test confirmed that the group treated vitamin C and GFs presented significantly better results than the group treated with vitamin C alone (p < 0.01). CONCLUSION LADD has proven efficient as scars were reduced in both study groups. Furthermore, the addition of growth factors provided statistically significant better outcomes and resulted in more inconspicuous scars. No adverse reactions were observed. CLINICAL TRIAL REGISTRATION Plataforma Brasil under the number CAAE: 63710716.2.0000.5664. LEVEL OF EVIDENCE II 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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Qiao Z, Yang H, Jin L, Li S, Wang X. The Efficacy and Safety of Botulinum Toxin Injections in Preventing Postoperative Scars and Improving Scar Quality: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2021; 45:2350-62. [PMID: 33674930 DOI: 10.1007/s00266-021-02196-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/15/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Scars exposed on the body surface lead to a large psychological burden on patients. However, no satisfactory scar treatments exist. Botulinum toxin type A is a neurotoxin that has been widely applied in the plastic and cosmetic surgery field. The purpose of this meta-analysis was to assess the efficacy and safety of botulinum toxin in scar management. METHODS PubMed, the Cochrane Library, EMBASE, MEDLINE, and Web of Science were searched for randomized controlled trials that evaluated the efficacy of botulinum toxin injections in preventing postoperative scars and improving scars quality and were published prior to Dec. 29, 2020. The outcome indicators were the visual analog scale score, Vancouver scar scale score, Stony Brook scar evaluation scales score, scar width, patient self-assessment results, and complications. RESULTS Seventeen randomized controlled trials with a total of 633 cases were identified in this meta-analysis. The quantitative synthesis results showed that compared with the control group, the botulinum toxin group had a significantly lower VSS score (MD = -0.97, 95%CI = -1.56 to -0.39, p = 0.001), higher VAS score (MD = 1.26, 95%CI = 1.04 to 1.47, p < 0.00001), thinner scar width (MD = -0.25, 95%CI = -0.37 to -0.12, p < 0.0001) and higher patient satisfaction (RR = 3.38 95%CI = 1.45 to 7.89, p = 0.005). There were no significant differences between the two groups in the number of adverse events. CONCLUSIONS This meta-analysis demonstrated that botulinum toxin injections can significantly improve cosmetic appearance and postoperative scar quality. At the therapeutic dose, no significant complications were observed, indicating that botulinum toxin injections are safe. 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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Rosicka K, Hill M, Wdowski MM. Skin anisotropy: Finding the optimal incision line for volar forearm in males and females. J Mech Behav Biomed Mater 2021; 124:104805. [PMID: 34474321 DOI: 10.1016/j.jmbbm.2021.104805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Proper understanding of skin biomechanics, viscoelasticity and investigation of skin tension vectors is necessary to find optimal incision lines. Great tension across a healing wound after any surgical procedure might lead to forming hypertrophic scars. The aim of the study was to investigate tension lines in volar forearm skin in young males and females, in order to ensure best incision line. METHODS Five biomechanical and viscoelastic parameters were measured using a hand-held myotonometer: Oscillation Frequency [Hz], Dynamic Stiffness [N/m], Logarithmic Decrement of tissue's natural oscillation, Mechanical Stress Relaxation Time [ms], and Creep. Measurements were taken in four different directions; Along Forearm, Across Forearm, Along Langer's Line and Across Langer's Line. RESULTS Significant main effects for direction were found for Oscillation Frequency (p < 0.001, η2 = 0.371) [Hz], Dynamic Stiffness (p < 0.001, η2 = 0.522) [N/m], Logarithmic Decrement (p < 0.001, η2 = 0.083), Mechanical Stress Relaxation Time (p < 0.001, η2 = 0.494) [ms] and Creep (p < 0.001, η2 = 0.480). For each parameter except for logarithmic decrement results obtained Along Langers Line and Across Forearm were significantly different to Across Langers Line and Along Forearm (p < 0.001, d = -2.76 - 2.66). Significant main effects for sex were found for logarithmic decrement Along Forearm (p < 0.001, d = 1.698) and Across Langer's Line (p = 0.021, d = 1.697). CONCLUSIONS Our results suggested that optimal incision line for this age group in males and females could potentially be performed diagonally i.e. Across Langer's Line or parallel i.e. Along Forearm to forearm axis. These directions would provide the lowest tension across a healing wound and possibly minimalize the risk of hypertrophic scarring post incision.
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Affiliation(s)
- K Rosicka
- Department of Biological Sciences, Faculty of Physical Culture in Gorzów Wlkp., Poznań University of Physical Education, Gorzów Wlkp, Poland.
| | - M Hill
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, United Kingdom
| | - M M Wdowski
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, United Kingdom
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Ge X, Sun Y, Lin J, Zhou F, Yao G, Su X. Effects of multiple modes of UltraPulse fractional CO 2 laser treatment on extensive scarring: a retrospective study. Lasers Med Sci 2021; 37:1575-1582. [PMID: 34436696 PMCID: PMC8971167 DOI: 10.1007/s10103-021-03406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022]
Abstract
The main therapeutic options for extensive scarring (e.g., > 20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients’ judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became flatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.
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Affiliation(s)
- Xiaojing Ge
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Yute Sun
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Jing Lin
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Fang Zhou
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Gang Yao
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Xin Su
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China.
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Caso H, Bertrand B, Philandrianos C, Abellan Lopez M, Casanova D. A new surgical approach in the treatment of tracheostomy scars. ANN CHIR PLAST ESTH 2021:S0294-1260(21)00034-0. [PMID: 34088500 DOI: 10.1016/j.anplas.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2021] [Accepted: 05/01/2021] [Indexed: 11/21/2022]
Abstract
The tracheostomy procedure presents some long term complications such as the depressed scar. It can be responsible for a tracheal tug, invaginated scar, inaesthetic scar or all of them. No consensus has emerged in the treatment of this type of pathological scarring. We want to propose a new surgical approach to correct all these three pathological scarring mechanism by a subcutaneous flap in single operation.
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Maki J, Nakatou H, Tani K, Eto E, Hayata K, Yamamoto D, Kai K, Tamada T, Akamatsu K, Kawanishi K, Nakamura K, Masuyama H. The Spiral Trial: A multicenter, randomized, controlled trial of Spiral thread sutures versus conventional thread sutures to prevent thinning of uterine scars following elective cesarean section. Contemp Clin Trials 2021; 107:106449. [PMID: 34023514 DOI: 10.1016/j.cct.2021.106449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/17/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this randomized controlled trial (RCT) is to investigate whether Spiral-thread sutures are superior to conventional sutures (0-Vicryl) for preventing uterine scar thinning following elective cesarean section. METHODS This multicenter, parallel-group RCT will be conducted in four hospitals across three medical regions in Japan to assess 200 women (≥20 years old) with singleton pregnancies who are scheduled to undergo cesarean sections. Eligible women will be randomly assigned (1:1 ratio) to receive either the conventional uterine suture continuous absorption thread, which is most commonly used in Japan, or the Spiral thread. The primary endpoint is the degree of scar thinning, measured by transvaginal ultrasonography 6-7 months postoperatively, to evaluate the position of the uterus (anterior or posterior tilt) and myometrial wound thickness. The degree of thinning will be compared between the groups, and four measurements (mm) of the thinning area, including caudal distance, depth of the depression, remaining thickness of the myometrium on the serous side of the most depressed area, and width of the depression, will be recorded in the sagittal view on transvaginal ultrasound. Secondary endpoints will include total operative time, suture application time (from birth to the end of uterine suturing), operative blood loss, number of additional Z-sutures or continuous sutures required to stop bleeding, maternal abnormality frequency (surgical complications and postoperative infections), surgeon's years of experience, and clinical interpretation of individual subscale scores. DISCUSSION This study shall provide important evidence on the optimal suture for preventing hysterotomy wound thinning after the first cesarean section. TRIAL REGISTRATION National Institute of Public Health, Japan: jRCT1062200001 (May 7, 2020; https://rctportal.niph.go.jp/en/detail?trial_id=jRCT1062200001) and Okayama University Certified Review Board: CRB6180001 (April 9, 2020, version 3.0).
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Affiliation(s)
- Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hikari Nakatou
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kazumasa Tani
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kei Hayata
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Dan Yamamoto
- Department of Obstetrics and Gynecology, National Hospital Organization Fukuyama Medical Center, 4-14-17, Okino-kamicho, Fukuyama City, Hiroshima 720-8520, Japan
| | - Kenji Kai
- Department of Obstetrics and Gynecology, National Hospital Organization Fukuyama Medical Center, 4-14-17, Okino-kamicho, Fukuyama City, Hiroshima 720-8520, Japan
| | - Takashi Tamada
- Department of Obstetrics and Gynecology, Iguchi Perinatal and Obstetrics and Gynecology Hospital, 71-4 Kambe-cho, Fukuyama City, Hiroshima 720-2122, Japan
| | - Kazuyo Akamatsu
- Department of Obstetrics and Gynecology, Iguchi Perinatal and Obstetrics and Gynecology Hospital, 71-4 Kambe-cho, Fukuyama City, Hiroshima 720-2122, Japan
| | - Kunihiro Kawanishi
- Department of Obstetrics and Gynecology, Yashima General Hospital, 2105-17 Yashima-Nishi-machi, Takamatsu City, Kagawa 761-0113, Japan
| | - Keiichiro Nakamura
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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Suijker J, Zheng KJ, Pijpe A, Nasroe F, Meij-de Vries A. The Skin-Sparing Debridement Technique in Necrotizing Soft-Tissue Infections: A Systematic Review. J Surg Res 2021; 264:296-308. [PMID: 33845413 DOI: 10.1016/j.jss.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Skin-sparing debridement (SSd) was introduced as an alternative to en bloc debridement (EBd) to decrease morbidity caused by scars in patients surviving Necrotizing soft-tissue infections (NSTI). An overview of potential advantages and disadvantages is needed. The aim of this review was to assess (1) whether SSd is noninferior to EBd regarding general outcomes, that is, mortality, length of stay (LOS), complications, and (2) if SSd does indeed result in decreased skin defects. METHODS A systematic literature search was performed according to the PRISMA guidelines. All human studies describing patients treated with SSd were included, when at least of evidence level consecutive case series. Studies describing up to 20 patients were pooled to improve readability and prevent overemphasis of findings from single small studies. RESULTS Ten studies, one cohort study and nine case series, all classified as poor based on Chambers criteria for case series, were included. Compared to patients treated with EBd, patients treated with SSd had no increased mortality rate, LOS or complication rate. SSd-treated patients had a high rate (75%) of total delayed primary closure (DPC) in the pooled case series. CONCLUSION The current available evidence is of insufficient quality to conclude whether SSd is noninferior to EBd for all assessed outcomes. There are suggestions that SSd may result in a decreased need for skin transplants, which could potentially improve the (health related) quality of life in survivors. Experienced surgical teams could cautiously implement SSd under close monitoring, ideally with uniform outcome registry.
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Everaars KE, Welbie M, Hummelink S, Tjin EPM, de Laat EH, Ulrich DJO. The impact of scars on health-related quality of life after breast surgery: a qualitative exploration. J Cancer Surviv 2021; 15:224-233. [PMID: 32816201 PMCID: PMC7966197 DOI: 10.1007/s11764-020-00926-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/01/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of this research was to explore women's experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). MATERIAL AND METHODS A qualitative study using semi-structured face-to-face interviews was conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were "physical and sensory symptoms," "impact of scar symptoms," "personal factors," "impact of scar interventions," and "change over time." RESULTS The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. CONCLUSION Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. IMPLICATIONS FOR CANCER SURVIVORS Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.
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Affiliation(s)
- Kristel E. Everaars
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Marlies Welbie
- Research Center Healthy and Sustainable Living, Research group Methodology of Practice-Based Research, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Stefan Hummelink
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Esther P. M. Tjin
- Research Center Healthy and Sustainable Living, Research group Innovation in Healthcare Processes in Pharmacology, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands
| | - Erik H. de Laat
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic Surgery, Radboudumc, Geert Grooteplein-Zuid 10, 6500 HB Nijmegen, The Netherlands
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Palmieri B, Noviello A, Corazzari V, Garelli A, Vadala M. Skin scars and wrinkles temporary camouflage in dermatology and oncoesthetics: focus on acetyl hexapeptide-8. Clin Ter 2021; 171:e539-e548. [PMID: 33151254 DOI: 10.7417/ct.2020.2270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of study is to evaluate the aesthetic outcome of specific formulated cosmeceutical product to mask and reduce the appearance surgical scars or unappealing skin tags in chronic diseases, such as cancer METHODS In a spontaneous, anecdotal, retrospective study, 26 patients with skin disorders appealed to Second Opinion Medical Network (Modena, Italy), required masking and improving the skin appearance. To evaluate the aesthetic improvement of skin imperfections, a gelcream containing 10% of acetyl hexapeptide-8 (registered trademark Argireline®) was selected, that can be applied directly upon the lesion, followed by a light massage in the treated area for a few minutes RESULTS The skin quality parameters (hydration, elasticity, sebum), photographs and investigators clinical assessment have been performed before and after the treatment and demonstrated that this cream significantly improved the skin values and the self-image expectation of each patient. No allergic reactions were documented during the period treatment CONCLUSIONS The topical administration of this cosmeceutical cream is a safe and effective alternative to the invasive procedures, to improve the quality of life in patients with some skin disorders such as cancer, surgical scars, hidradenitis, aging wrinkles
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Affiliation(s)
- B Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, Modena, Italy,Second Opinion Medical Network, Modena, Italy
| | - A Noviello
- Oncology Training International Oncology Esthetics (OTI), Milan, Italy
| | - V Corazzari
- Second Opinion Medical Network, Modena, Italy
| | - A Garelli
- Plastic and reconstructive surgery, Roma, Italy
| | - M Vadala
- Second Opinion Medical Network, Modena, Italy
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Sylakowski K, Wells A. ECM-regulation of autophagy: The yin and the yang of autophagy during wound healing. Matrix Biol 2021; 100-101:197-206. [PMID: 33421547 DOI: 10.1016/j.matbio.2020.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
Wound healing is a complex sequence of tissue protection, replacement, and reorganization leading to regenerated tissue. Disruption of any of these steps results in the process being incomplete as an ulcer or over-exuberant as a hypertrophic scar. Over the past decade, it has become evident that the extracellular matrix and associated components orchestrate this process. However, the cellular events that are induced by the extracellular matrix to accomplish wound healing remain to be defined. Herein we propose that matrix-regulated cellular macro-autophagy is key to both the tissue replacement and resolution stages of healing by directing cellular function or apoptosis. Further, disruptions in matrix turnover alter autophagic function leading to chronic wounds or scarring. While the literature that directly investigates autophagy during wound healing is sparse, the emerging picture supports our proposing a model of the centrality of the matrix-autophagy modulation as central to physiologic and pathologic healing.
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Affiliation(s)
- Kyle Sylakowski
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261, United States; VA Pittsburgh Healthcare Systems, Pittsburgh, PA 15213, United States
| | - Alan Wells
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15261, United States; VA Pittsburgh Healthcare Systems, Pittsburgh, PA 15213, United States; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, United States; Department of Computational & Systems Biology, University of Pittsburgh, Pittsburgh, PA 15260, United States; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15213, United States.
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Morales-Sánchez MA, De Villafranca-Dugelby A, Cruz FJS, Peralta-Pedrero ML. Methodological quality of clinical trials of keloid scars. CIR CIR 2020; 88:591-598. [PMID: 33064692 DOI: 10.24875/ciru.20001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background There is heterogeneity in the design of clinical trials (CT) for the treatment of keloid scars that compromises the validity of their results. Objective To assess the methodological quality of the CT published on keloid scars, mainly the outcomes used in them. Method Articles of CT for keloid scars were analyzed, their methodological quality was evaluated following the CONSORT guidelines and the risk of bias based on the Cochrane tool. All the clinical outcomes measured in CT were identified. Results Fifty-two full-text articles were evaluated, of which, only 3.84% of the CT mentioned important changes in the methodology after starting patient recruitment. Fifty-nine percent of the CT were assessed as high risk of performance bias due to mistakes in blinding participants and personnel. The most frequent outcome was the height or thickness of the keloids. Conclusions We recommend that participants with hypertrophic scars should be excluded from keloids' clinical trials, and that the main outcome must be the scar height and flattening. The pain and quality of life of patients should also be measured.
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Affiliation(s)
- Martha A Morales-Sánchez
- Unidad de Investigación del Centro Dermatológico Dr. Ladislao de la Pascua, Servicios de Salud Pública de la Ciudad de México, Ciudad de México, México
| | - Andrea De Villafranca-Dugelby
- Unidad de Investigación del Centro Dermatológico Dr. Ladislao de la Pascua, Servicios de Salud Pública de la Ciudad de México, Ciudad de México, México
| | - Fermín Jurado-Santa Cruz
- Unidad de Investigación del Centro Dermatológico Dr. Ladislao de la Pascua, Servicios de Salud Pública de la Ciudad de México, Ciudad de México, México
| | - María L Peralta-Pedrero
- Unidad de Investigación del Centro Dermatológico Dr. Ladislao de la Pascua, Servicios de Salud Pública de la Ciudad de México, Ciudad de México, México
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Krastev TK, Schop SJ, Hommes J, Piatkowski A, van der Hulst RRWJ. Autologous fat transfer to treat fibrosis and scar-related conditions: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2020; 73:2033-2048. [PMID: 32948494 DOI: 10.1016/j.bjps.2020.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/22/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Autologous fat transfer (AFT), also known as lipofilling, has been demonstrated to be more than just a filler. Through both mechanical dissection and local tissue remodelling mediated by stem cells, it is thought to improve scar quality, function and even pain. This paper aims to investigate the evidence regarding its safety and effectiveness for treating fibrosis and scar-related conditions. METHODS A literature search was performed in PubMed, Embase and the Cochrane Library to identify relevant studies. Extensive data extraction and standardization allowed conducting a meta-analysis. RESULTS Forty-five studies (3033 patients) provided sufficient data for meta-analysis. The AFT treatment resulted in significant increase in satisfaction scores of both patient and surgeon (p = 0.001). Furthermore, a significant overall scar improvement was also found in the evaluation using the Patient and Observer Scar Assessment Scale, with the most notable effect in the scar stiffness (p<0.001) and pliability (p = 0.004). In patients with severe pain, AFT resulted in a significant pain reduction of 3.7 points on the Visual Analogue Scale (p<0.001). Last, but not the least, the evidence suggests a significant recovery of radiotherapy-induced tissue damage (p = 0.003) and function (p = 0.012). On average, 1.4 procedures were required to achieve the desired result. Minor complications occurred in 4.8% of the procedures. CONCLUSIONS AFT is a promising treatment for fibrosis and scar-related conditions. Future research should focus on determining the long-term effects of AFT on fibrosis, pain and function. In addition, it would be crucial to quantify the mechanical and regenerative properties of fat as well as the effect of added supplements or stem cells.
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Affiliation(s)
- Todor K Krastev
- Department of Plastic, Reconstructive and Hand surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
| | - Sander J Schop
- Department of Plastic, Reconstructive and Hand surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Juliette Hommes
- Department of Plastic, Reconstructive and Hand surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Rene R W J van der Hulst
- Department of Plastic, Reconstructive and Hand surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
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Heidari Beigvand H, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Safari S, Rezaei-Tavirani M, Mansouri V, Heidari MH. Assessment of Laser Effects on Skin Rejuvenation. J Lasers Med Sci 2020; 11:212-219. [PMID: 32273965 DOI: 10.34172/jlms.2020.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Laser skin resurfacing has changed the approach of facial skin rejuvenation over the past decade. This article evaluates the laser effects on skin rejuvenation by the assessment of laser characteristics and histological and molecular changes, accompanied by the expression of proteins during and after laser-assisted rejuvenation of skin. It is important to note that different layers of skin with different cells are normally exposed to the sun's UV radiation which is the most likely factor in aging and damaging healthy skin. To identify the expression of proteins, using validated databases and reviewing existing data could reveal altered proteins which could be analyzed and mapped to investigate their expression and their different effects on cell biological responses. In this regard, proteomics data can be used for better investigation of the changes in the proteomic profile of the treated skin. Different assessments have revealed the survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases (MMPs) and heat shock proteins (HSPs) as a result of different low-power laser therapies of skin. There are a wide range of biological effects associated with laser application in skin rejuvenation; therefore, more safety considerations should be regarded in the application of lasers in skin rejuvenation.
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Affiliation(s)
- Hazhir Heidari Beigvand
- Firoozabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Rezaei-Tavirani
- Firoozabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Proteomics Research Center, Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Mansouri
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Heidari
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wang Y, Wang J, Zhang J, Hu C, Zhu F. Effectiveness and Safety of Botulinum Toxin Type A Injection for Scar Prevention: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2019; 43:1241-1249. [PMID: 30903249 DOI: 10.1007/s00266-019-01358-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of active scar prevention in postoperative scar management is important. Botulinum toxin type A (BTXA) has been shown to improve postoperative scars in the past decades. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of BTXA injection for scar prevention. METHODS The authors searched the databases of Medicine, Embase, the Cochrane Library, Web of Science, and CINAHL from inception through November 2018 for randomized controlled trials (RCTs) reporting the use of BTXA in scar prevention. The outcomes were the visual analogue scale (VAS) score, Vancouver Scar Scale score, scar width, patient satisfaction and adverse events. RESULTS A total of nine RCTs were identified in this systematic review and meta-analysis. The VAS score was significantly higher in the BTXA group than in the control group (weighted mean difference (WMD) = 1.32, 95% confidence interval (CI) = 1.06-1.58, P < 0.00001). The Vancouver Scar Scale score was significantly lower in the BTXA group (WMD = - 1.25, 95% CI = - 2.23 to - 0.26, P = 0.01). The scar width was also significantly smaller in the BTXA group (WMD = - 0.18, 95% CI = - 0.24 to - 0.12, P < 0.00001). There was a significant difference in terms of patient satisfaction between the BTXA group and the control group (relative risk (RR) = 1.38, 95% CI = 1.09-1.74, P = 0.007). Only two studies reported complications, and other studies reported no complications during the follow-up period. CONCLUSIONS This systematic review and meta-analysis demonstrates that BTXA injection can reduce scar width in wounds and improve the overall appearance of postoperative scars and suggests that BTXA may be a safety therapy for scar prevention. LEVEL OF EVIDENCE II 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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Haar RJ, Wang K, Venters H, Salonen S, Patel R, Nelson T, Mishori R, Parmar PK. Documentation of human rights abuses among Rohingya refugees from Myanmar. Confl Health 2019; 13:42. [PMID: 31534473 PMCID: PMC6745767 DOI: 10.1186/s13031-019-0226-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decades of persecution culminated in a statewide campaign of organized, systematic, and violent eviction of the Rohingya people by the Myanmar government beginning in August 2017. These attacks included the burning of homes and farms, beatings, shootings, sexual violence, summary executions, burying the dead in mass graves, and other atrocities. The Myanmar government has denied any responsibility. To document evidence of reported atrocities and identify patterns, we interviewed survivors, documented physical injuries, and assessed for consistency in their reports. METHODS We use purposive and snowball sampling to identify survivors residing in refugee camps in Bangladesh. Interviews and examinations were conducted by trained investigators with the assistance of interpreters based on the Istanbul Protocol - the international standard to investigate and document instances of torture and other cruel, inhuman, and degrading treatment. The goal was to assess whether the clinical findings corroborate survivors' narratives and to identify emblematic patterns. RESULTS During four separate field visits between December 2017 and July 2018, we interviewed and where relevant, conducted physical examinations on a total of 114 refugees. The participants came from 36 villages in Northern Rakhine state; 36 (32%) were female, 26 (23%) were children. Testimonies described several patterns in the violence prior to their flight, including the organization of the attacks, the involvement of non-Rohingya civilians, the targeted and purposeful destruction of homes and eviction of Rohingya residents, and the denial of medical care. Physical findings included injuries from gunshots, blunt trauma, penetrating trauma such as slashings and mutilations, burns, and explosives and from sexual and gender-based violence. CONCLUSIONS While each survivor's experience was unique, similarities in the types and organization of attacks support allegations of a systematic, widespread, and premeditated campaign of forced displacement and violence. Physical findings were consistent with survivors' narratives of violence and brutality. These findings warrant accountability for the Myanmar military per the Rome Statute of the International Criminal Court (ICC), which has jurisdiction to try individuals for serious international crimes, including crimes against humanity and genocide. Legal accountability for these crimes should be pursued along with medical and psychological care and rehabilitation to address the ongoing effects of violence, discrimination, and displacement.
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Affiliation(s)
- Rohini J. Haar
- Division of Epidemiology and Biostatistics, University of California, Berkeley. School of Public Health, Berkeley, CA USA
| | - Karen Wang
- Yale School of Medicine, Section of General Internal Medicine, New Haven, CT USA
| | - Homer Venters
- New York University College of Global Public Health, New York, NY USA
| | - Satu Salonen
- University of Massachusetts/Family Health Center of Worcester, Worchester, MA USA
| | - Rupa Patel
- Department of Medicine, Washington University in St. Louis, St. Louis, MI USA
| | | | - Ranit Mishori
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Biagi LG, Sañudo A, Bagatin E. Severe Acne and Metabolic Syndrome: A Possible Correlation. Dermatology 2019; 235:456-462. [PMID: 31484190 DOI: 10.1159/000501986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE Chronic inflammatory skin diseases have been shown to increase or predispose metabolic or vascular damage. However, little is known about systemic effects of the pro-inflammatory state of severe acne. We analyzed data of 85 patients at Lipid Outpatient Clinics (UNIFESP/EPM) who were treated for metabolic syndrome (MS). Medical history and physical examinations were performed in order to search characteristics of acne scars. METHODS Patients' electronic records were accessed for one year. The ones presenting MS were evaluated by clinical examination in order to detect presence of acne scars. Clinical analysis comprised anamnesis, measurement of abdominal circumference, blood pressure, and body mass index (BMI). Laboratory tests included fasting glucose, CBC, serum levels of insulin, triglycerides, LDL, HDL, ALT, AST, urea, and creatinine. Statistical analysis consisted of prevalence (95% CI) of acne history/scars among patients treated at the Lipid Outpatient Clinics. The χ2 test, Pearson's test, or Fisher's exact test was used to evaluate the association of social and demographic data, clinical and lab exams with the presence of MS or acne scars. Statistical 5% significance level was adopted. RESULTS Fifty-two patients confirmed having a medical history of acne, and 33 denied. Acne scars were found in 61.17%. There was no statistical difference between the groups according to medium value of BMI, hypertension, abdominal circumference, and serum levels of hemoglobin, leucocytes, platelets, triglycerides, LDL, HDL, AST, ALT, glycemia, creatinine, and urea. Twenty-seven out of the 52 patients with acne history presented acne scars, which symbolizes a 31.76% prevalence. This equals a 51.92% prevalence among all patients with acne history. There was no statistical difference among groups according to mean (±SD) in data such as family history, weight, BMI, hypertension, abdominal circumference, serum levels of hemoglobin, leucocytes, platelets, LDL, HDL, AST, ALT, glycemia, creatinine, and urea. A statistical difference in the triglyceride level was present, being elevated in patients with acne scars. DISCUSSION Apart from the limitation (small sample size), a correlation between acne and MS could be suggested. The high prevalence of acne history/scars in patients treated for MS may indicate a possible correlation with any type of acne. This hypothesis may raise discussion about an association like the already proven risk of metabolic alterations in other inflammatory chronic dermatoses, such as psoriasis or rosacea, regardless of acne severity. We highlight the importance of early treatment and follow-up for patients with MS that could be observed in this study, as clinical and laboratory criteria were all within normal levels among patients from that specific outpatient clinic. Results can draw attention to evaluation of clinical and laboratory investigation related to risk of MS. It corroborates to early diagnosis and prevention of complications of MS. Further studies are needed to confirm our findings.
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Affiliation(s)
- Lucas Garcia Biagi
- Medical School of São Paulo (EPM), Federal University of São Paulo (UNIFESP)/São Paulo Hospital (HSP), São Paulo, Brazil,
| | - Adriana Sañudo
- Department of Preventive Medicine, Medical School of São Paulo (EPM), Federal University of São Paulo (UNIFESP)/São Paulo Hospital (HSP), São Paulo, Brazil
| | - Edileia Bagatin
- Department of Dermatology, Medical School of São Paulo (EPM), Federal University of São Paulo (UNIFESP)/São Paulo Hospital (HSP), São Paulo, Brazil
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Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. Botulin Toxin Use in Scars/Keloids Treatment. Open Access Maced J Med Sci 2019; 7:2979-2981. [PMID: 31850103 PMCID: PMC6910812 DOI: 10.3889/oamjms.2019.783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 12/27/2022] Open
Abstract
Botulinum toxin (BTX) is a neurotoxin protein derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions which include scar prevention and treatment with good results The complex mechanism underlying those results is not completely understood but several mechanisms were proposed release inhibition of different substances like (TGF)-β, substance P, calcitonin gene-related peptide (CGRP) and glutamate thus modulating cutaneous inflammation and wound healing. We analysed the published data on BTX off label applications on scars and keloids retrieved from PubMed.
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Affiliation(s)
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Petar Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | | | | | | | | | - Jovana Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | - Goran Sijan
- Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Nenad Stepic
- Chief of Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Nguyen Van Thuong
- Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Massimo Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of G. Marconi, Rome, Italy
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Tan CWX, Tan WD, Srivastava R, Yow AP, Wong DWK, Tey HL. Dissolving Triamcinolone-Embedded Microneedles for the Treatment of Keloids: A Single-Blinded Intra-Individual Controlled Clinical Trial. Dermatol Ther (Heidelb) 2019; 9:601-611. [PMID: 31376063 PMCID: PMC6704225 DOI: 10.1007/s13555-019-00316-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Keloids are a prevalent chronic skin disorder with significant psychosocial morbidity. Intralesional corticosteroid injections are the first-line treatment but are painful and require repeated injections by medical professionals. Dissolving microneedles are a novel method of cutaneous drug delivery that induces minimal/no pain and can be self-administered. The objective of the study was to evaluate the efficacy and safety of triamcinolone-embedded dissolving microneedles in treatment of keloids. METHODS This was a single-blind, intra-individual controlled two-phase clinical trial of 8-week duration each. Two keloids per subject were selected for (1) once-daily 2-min application with microneedles for 4 weeks, followed by no treatment for the next 4 weeks, or (2) non-intervention as control. Primary outcome was change in keloid volume as assessed by a high-resolution 3D scanner. RESULTS There was significant reduction in keloid volume compared with controls after 4 weeks of treatment. This reduction was greater with a higher dosage of triamcinolone used. CONCLUSIONS Once-daily application of dissolving triamcinolone-embedded microneedles significantly reduced the volume of keloids. The treatment was safe, can be self-administered and can serve as an alternative for patients unsuitable for conventional treatments. TRIAL REGISTRATION Trial Registry: Health Science Authority (Singapore) Clinical Trials Register Registration number: 2015/00440.
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Affiliation(s)
| | | | - Ruchir Srivastava
- Institute of Infocomm Research, Agency for Science, Technology and Research, Singapore, Singapore
| | - Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Damon W K Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Hong Liang Tey
- National Skin Centre, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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47
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Gojowy D, Kauke M, Ohmann T, Homann HH, Mannil L. Early and late-recorded predictors of health-related quality of life of burn patients on long-term follow-up. Burns 2019; 45:1300-1310. [PMID: 31176508 DOI: 10.1016/j.burns.2019.03.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Unintentional and intentional burn injuries vary across age groups, gender, income, and global region. In high-income countries, the trend over the last several years has been a reduction in burn incidence, burn severity, length of hospital stay, and mortality rate. However, there is a lack of data on predictors of the health-related quality of life (HRQoL) of major burn survivors extending beyond a follow-up period of 10 years. PATIENTS AND METHODS This single-center cross-sectional study is considering 42 long-term severe burn survivors with deep partial thickness burns and an affected total body surface area (TBSA) of ≥20%. For study eligibility design a minimum follow-up of 10 years was obligatory. Entitled individuals were asked to fill in the generic Short Form 36 (SF-36) questionnaire. The physical (PCS) and mental (MCS) component scores of the SF-36 were used as the primary outcome variables. Putative predictor variables were drawn from medical records. Burn-specific functionality and scar tissue quality were assessed using the Burn Specific Health Scale-Brief (BSHS-B) questionnaire and the Patient and Observer Scar Assessment Scale (POSAS), respectively. Correlation between putative predictor variables and SF-36 norm scores were evaluated by Pearson- and Point-Biserial correlation as well as multivariate linear regression. The SF-36 norm scores were compared to the general German population. RESULTS Mean follow-up was 14 (±3) years with a minimum and maximum of 10 and 28 years, respectively. Mean age at the time of the incident was 37 (±17) years. The majority of individuals were male (74%). The mean burn size was 39 (±17) % (TBSA) with 76% of the individuals showing a full thickness burn. SF-36 norm scores were not statistically different from the general population. Statistically significant independent predictor variables of the physical summary score were: age at the time of the injury (-0.381), time since injury (-0.466), length of hospital stay (-0.356), limb amputation (-0.318), unemployment (-0.433), work (0.593), hand function (0.601), body image (0.518), affect (0.355), simple abilities (0.602), burns involving the hands (-0.339) and back (-0.343), POSAS patient- (-0.521) and observer scores (-0.483). In multivariate analysis, work (4.315), the POSAS Score (-2.082) and the age at the time of the incident (-0.242) were statistically significant predictors. Statistically significant independent predictor variables of the mental summary score were: duration of mechanical ventilation (-0.459), hand function (0.415), body image (0.502), sexual activity (0.625), social support (0.542), burns involving the back (-0.315) and affect (0.692). In multivariate analysis, affect (13.844) and the length of mechanical ventilation (-0.115) were statistically significant independent predictor variables. CONCLUSION Ten years after the burn incident, the quality of life was on average comparable to the one in the general population. Multiple variables seem to influence the physical and mental long-term outcome. Herein presented data may support in adapting and designing follow-up strategies tailored to a patient's burn-specific circumstances.
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Affiliation(s)
- David Gojowy
- Department for Hand Surgery and Plastic Surgery, Burn Center, BG Trauma Center Duisburg, Klinikum Duisburg, Germany.
| | - Martin Kauke
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Ohmann
- Department for Hand Surgery and Plastic Surgery, Burn Center, BG Trauma Center Duisburg, Klinikum Duisburg, Germany
| | - Heinz-Herbert Homann
- Department for Hand Surgery and Plastic Surgery, Burn Center, BG Trauma Center Duisburg, Klinikum Duisburg, Germany
| | - Lijo Mannil
- Department for Plastic and Aesthetic Surgery, St. Vinzenz Hospital, Cologne, Germany
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Gass J, Mitchell S, Hanna M. How do breast cancer surgery scars impact survivorship? Findings from a nationwide survey in the United States. BMC Cancer 2019; 19:342. [PMID: 30971201 PMCID: PMC6458748 DOI: 10.1186/s12885-019-5553-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 03/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background The surgical treatment of breast cancer has been associated with negative consequences for patients’ body image, sexual functioning, mental health, and social adjustment. Recent advances in the surgical approach to breast cancer allow the oncologic surgeon to safely optimize cosmetic outcomes. Little is known about the possible relevance of surgical scars. The aim of this research was to gather the perspective of breast cancer survivors themselves on the issue of surgical scars and their negative impact on survivorship. Methods An internet survey was conducted nationwide in the United States among women who reported being surgically treated by lumpectomy, mastectomy, or both procedures for breast cancer. To improve generalizability, census-based enrollment quotas were applied for geographic region, health insurance, and income. Results The five hundred respondents reported lumpectomy only (n = 215), mastectomy only (n = 140), or both surgeries (n = 132). In response to the statement, “I do not like the location of my surgical scar”, 64% of lumpectomy-only respondents and 67% of mastectomy-only respondents agreed somewhat or strongly. Only 26% of lumpectomy respondents and 14% of mastectomy respondents reported minimal or no negative impact as a consequence of the surgical scars. Conclusion Consistent with previous literature, this nationwide US survey shows that the majority of women feel negatively affected by their breast cancer surgery scars. Surgeons should consider this outcome when planning surgery, which may improve patients’ survivorship journey. Electronic supplementary material The online version of this article (10.1186/s12885-019-5553-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Gass
- Department of Obstetrics and Gynecology, Woman & Infants Hospital, Women & Infants Breast Health Center, 1 Blackstone Place, 2nd floor, Providence, RI, 02905, USA. .,Department of Surgery, Alpert Medical School, Brown University, Providence, RI, USA.
| | | | - Michael Hanna
- Mercury Medical Research & Writing, New York, NY, USA
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49
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Abstract
A keloid is the result of an abnormal wound healing response to a variety of skin injuries, characterized by a well-circumscribed, firm, irregular, mildly tender, and pink to purple hyperpigmented lump with a glossy surface. The present case reports on excessive formation of keloid due to repetitive mammographies causing symptomatic, cosmetically disturbing symptoms.
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Affiliation(s)
- Tim Pruimboom
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Marc R Scheltinga
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
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50
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Wallace HJ, Cadby G, Melton PE, Wood FM, Falder S, Crowe MM, Martin LJ, Marlow K, Ward SV, Fear MW. Genetic influence on scar height and pliability after burn injury in individuals of European ancestry: A prospective cohort study. Burns 2018; 45:567-578. [PMID: 30595539 DOI: 10.1016/j.burns.2018.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic model adjusting for age, sex, number of surgical procedures and % total body surface area of burn in subjects of European ancestry. No individual genetic variants achieved the cut-off threshold of significance. Gene regions were analysed for spatially correlated single nucleotide polymorphisms and significant regions identified using comb-p software. This gene list was subject to gene pathway analysis to find which biological process terms were over-represented. Using this approach biological processes related to the nervous system and cell adhesion were the predominant gene pathways associated with both SH and SP. This study suggests genes associated with innervation may be important in scar fibrosis. Further studies using similar and larger datasets will be essential to validate these findings.
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Affiliation(s)
- Hilary J Wallace
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Phillip E Melton
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Science, Curtin University, Perth, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Sian Falder
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Margaret M Crowe
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Lisa J Martin
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Karen Marlow
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sarah V Ward
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
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