Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis

BACKGROUND

Keloids are common benign skin lesions originating from a disorganized fibroproliferative collagen response; these lesions often lead to both physical and psychological problems. The optimal treatment for keloids is yet to be standardized. Intralesional injection, which is simple and nontraumatic, is one of the most commonly used treatment modalities for these lesions. In this study, we compared 5 different drugs (intralesional injections) for the treatment of keloids in terms of efficacy.

METHODS

We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials on the safety and efficacy of triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil, and bleomycin were included in this study.

RESULTS

This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to predict the rank of each intervention (by efficacy and adverse event rate). The predicted ranking by efficacy was as follows: TAC plus 5-FU, BTA, bleomycin, TAC, 5-FU, and verapamil; the predicted ranking by adverse events was as follows: TAC, 5-FU, TAC plus 5-FU, and BTA. Funnel plot analysis revealed no publication bias.

CONCLUSIONS

Botulinum toxin A and TAC plus 5-FU appear to have outstanding therapeutic efficacy for keloids. The rate of adverse events was similar among BTA, TAC, 5-FU, and TAC plus 5-FU. Nonetheless, additional reviews of rigorous, large-scale randomized controlled trials are warranted for further validation of our findings.

Cellular and exosomal GPx1 are essential for controlling hydrogen peroxide balance and alleviating oxidative stress in hypoxic glioblastoma

Tumor hypoxia promotes malignant progression and therapeutic resistance in glioblastoma partly by increasing the production of hydrogen peroxide (H2O2), a type of reactive oxygen species critical for cell metabolic responses due to its additional role as a second messenger. However, the catabolic pathways that prevent H2O2 overload and subsequent tumor cell damage in hypoxic glioblastoma remain unclear. Herein, we present a hypoxia-coordinated H2O2 regulatory mechanism whereby excess H2O2 in glioblastoma induced by hypoxia is diminished by glutathione peroxidase 1 (GPx1), an antioxidant enzyme detoxifying H2O2, via the binding of hypoxia-inducible factor-1α (HIF-1α) to GPx1 promoter. Depletion of GPx1 results in H2O2 overload and apoptosis in glioblastoma cells, as well as growth inhibition in glioblastoma xenografts. Moreover, tumor hypoxia increases exosomal GPx1 expression, which assists glioblastoma and endothelial cells in countering H2O2 or radiation-induced apoptosis in vitro and in vivo. Clinical data explorations further demonstrate that GPx1 expression was positively correlated with tumor grade and expression of HIF-1α, HIF-1α target genes, and exosomal marker genes; by contrast, it was inversely correlated with the overall survival outcome in human glioblastoma specimens. Our analyses validate that the redox balance of H2O2 within hypoxic glioblastoma is clinically relevant and could be maintained by HIF-1α-promoted or exosome-related GPx1.

The 3D printed conductive grooved topography hydrogel combined with electrical stimulation for synergistically enhancing wound healing of dermal fibroblast cells

Patients with extensive cutaneous damage resulting from poor wound healing often have other comorbidities such as diabetes that may lead to impaired skin functions and scar formation. Many recent studies have shown that the application of electrical stimulation (ES) to cutaneous lesions significantly improves skin regeneration via activation of AKT intracellular signaling cascades and secretion of regeneration-related growth factors. In this study, we fabricated varying concentrations of gelatin-methacrylate (GelMa) hydrogels with poly(3,4-ethylenedioxythiophene) (PEDOT): polystyrene sulfonate (PSS), which is a conductive material commonly used in tissue engineering due to its efficiency among conductive thermo-elastic materials. The results showed successful modification of PEDOT:PSS with GelMa while retaining the original structural characteristics of the GelMa hydrogels. In addition, the incorporation of PEDOT:PSS increased the interactions between both the materials, thus leading to enhanced mechanical strength, improved swelling ratio, and decreased hydrophilicity of the scaffolds. Our GelMa/PEDOT:PSS scaffolds were designed to have micro-grooves on the surfaces of the scaffolds for the purpose of directional guiding. In addition, our scaffolds were shown to have excellent electrical conductivity, thus leading to enhanced cellular proliferation and directional migration and orientation of human dermal fibroblasts. In vivo studies revealed that the GelMa/PEDOT:PSS scaffolds with electrical stimulation were able to induce full skin thickness regeneration, as seen from the various stainings. These results indicate the potential of GelMa/PEDOT:PSS as an electro-conductive biomaterial for future skin regeneration applications.

[Clinical research about the consecutive pain and flubiprofen axetil analgesia following uvulopalatopharyngoplasty]

Objective:To evaluate the postoperative pain degree on OSAHS patients following UPPP, analyze the pain characteristic during seven consecutive days, and discuss the mechanism. To observe the analgesia effect by using flubiprofen axetil. Finally making a comprehensive understanding about UPPP perioperative period and providing more choices about analgesia treatment.Method:Fifty-five patients who underwent UPPP in the First Hospital of China Medical University were divided into analgesia group（n=30）and control group（n=25）.Normal saline 50 ml+ flubiprofen axetil 100 mg was used bid for pain relief in analgesia group during seven days following operation, and normal saline 50ml was used in control group.A visual analog scale(VAS) was used for measuring mean pain intensity each day during the period from operative day to the post-operative 7th day，scores were recorded. Continuous changes about pharynx pain were observed and VAS pain scores were compared betweenanalgesia groupand control group. Result:VAS pain scores were the highest on the operative day and the post-operative 1st day, median (interquartile range) was 7（5.5-8.25），7（6-8）respectively,then decreased gradually. The most significantly decrease happened on the post-operative 2nd and 5th day(P<0.01). Pain scores in analgesia group were most significantly lower than control group from the operative day to the post-operative 4th day(P<0.01), were lower during the post-operative 5th and 6th day(P<0.05),no difference on the post-operative 7th day. Conclusion:The most painful period following UPPP is from the operative day to the post-operative 1st day, then pain decreases gradually. The pain reduces significantly on the post-operative 2nd and 5,6th day.Surgical trauma, in flammatory reaction and suture pulling may be the reason of pain. Flubiprofen axetil effectively reduces pain and the suggested analgesia period is from the operative day to the post-operative 4th-6th day.

A Comparative Study of Digital and Anatomical Techniques in Skull Base Measurement

This study compared the accuracy of measurements of the skull base made using computed tomography (CT) images and an image-guided surgery system with those made using scientific callipers in order to evaluate the practicability of replacing conventional direct anatomical measurements with digitized techniques in skull base surgery. Important bony landmarks and parameters were measured using the three different methods in 25 cadaver skull bases. No statistically significant differences were observed between the methods. Coefficient of variation calculations indicated that data obtained from CT images was the most stable. Digital methods of navigation have the potential to reflect individual skull base anatomical features more accurately than traditional group-based data, but it is important to assess their accuracy. This study demonstrated that CT imageology and image-guided surgery systems can provide accurate anatomical measurements. Digital methods are also more flexible and less variable, and may have wide applications in this field. Though not perfect, digital imaging is a promising tool for skull base surgery.

The classification of posterior petrous meningiomas and its clinical significance

This retrospective analysis of the clinical records of 42 patients was used to study the clinical significance of a classification system for posterior petrous meningiomas. According to clinical manifestations and radiological images, posterior petrous meningiomas were classified into three types: type I (cerebella type; 12 patients), tumours involved and compressed the cerebellum; type II (cranial nerve type; 16 patients), tumours involved the cranial nerves; and type III (combined type; 14 patients), tumours involved more than one structure such as the cerebellum, cranial nerves and the brain stem. All patients underwent microneurosurgery and the total resection rate was 90%. It was more difficult totally to resect type II and III tumours than type I tumours and the post-operative functional outcomes were worse. Microneurosurgical techniques and skills are critical to increase the total resection rate of posterior petrous meningiomas in order to decrease the mortality and disability rates.

AnthracnoseTracer: A Spatiotemporal Model for Simulating the Spread of Anthracnose in a Lupin Field

ABSTRACT A spatiotemporal model has been developed to simulate the spread of anthracnose, initiated by infected seed, in a lupin field. The model quantifies the loss of healthy growing points of lupin in all 1-m(2) subunits of a field throughout a growing season. The development of growing points is modeled as a function of temperature using a 1-day time step, and disease-induced compensatory growth is accounted for. Dispersal of spores is simulated explicitly using Monte Carlo techniques. Spread of spores occurs during rainfall events on a 1-h time step. The distance traveled by spores is partially dependent on wind speed and is generated by adding the values selected from half-Cauchy distributions. The direction of travel of the spores is influenced by wind direction. The model has been employed to produce a theoretical assessment of damage from disease in two environments at five levels of seed infection. It was calculated that in a susceptible lupin cultivar with a 0.01% initial seed infection, anthracnose would cause approximately 15% loss of healthy growing points in a high rainfall environment in Western Australia. In a low rainfall environment, similar damage would be unlikely even with a much higher (1%) level of seed infection.

[Clinical study on treatment of early glottic carcinoma with different cordectomy]

OBJECTIVE

To explore the advantage of KTP laser cordectomy in the treatment of early glottic carcinoma.

METHOD

Follow-up observation on 30 patients who had KTP laser cordectomy and 18 patients who had laryneal split cordectomy was applied, then their postoperative laryngeal structure's change, the quality of voice and the quality of life (QOL) were compared and analyzed.

RESULT

The patient group treated by KTP laser grew out a piece of new cord just at the place where it was excised after half a year, and the quality of voice was obviously improved near to norm, and they had higher QOL. On the contrary, the other group had no newly grown cord, their quality of voice was better in the first half year but was worse last out. Their QOL was lower than the laser group before decannulation and the same as the laser group after the decannulation. There are 2 cases recurrented in the laser group and 1 case recurrented in the laryneal split group, the two groups all had no metastasis and death in laryneal carcinoma by 2-4 years follow up postoperation.

CONCLUSION

On the basis of effecting radical cure, the early glottic carcinoma treated with non-contact KTP laser with suspension laryngoscope can result in good recuperating in laryngeal structure, less injury and high QOL. So it makes micro-injury treatment in laryngeal carcinoma come true and better than the laryngeal split cordectomy.

Surface protein phosphorylation by ecto-protein kinase is required for the maintenance of hippocampal long-term potentiation

During the induction of long-term potentiation (LTP) in hippocampal slices adenosine triphosphate (ATP) is secreted into the synaptic cleft, and a 48 kDa/50 kDa protein duplex becomes phosphorylated by extracellular ATP. All the criteria required as evidence that these two proteins serve as principal substrates of ecto-protein kinase activity on the surface of hippocampal pyramidal neurons have been fulfilled. This phosphorylation activity was detected on the surface of pyramidal neurons assayed after synaptogenesis, but not in immature neurons nor in glial cells. Addition to the extracellular medium of a monoclonal antibody termed mAb 1.9, directed to the catalytic domain of protein kinase C (PKC), inhibited selectively this surface protein phosphorylation activity and blocked the stabilization of LTP induced by high frequency stimulation (HFS) in hippocampal slices. This antibody did not interfere with routine synaptic transmission nor prevent the initial enhancement of synaptic responses observed during the 1-5 min period immediately after the application of HFS (the induction phase of LTP). However, the initial increase in the slope of excitatory postsynaptic potentials, as well as the elevated amplitude of the population spike induced by HFS, both declined gradually and returned to prestimulus values within 30-40 min after HFS was applied in the presence of mAb 1.9. A control antibody that binds to PKC but does not inhibit its activity had no effect on LTP. The selective inhibitory effects observed with mAb 1.9 provide the first direct evidence of a causal role for ecto-PK in the maintenance of stable LTP, an event implicated in the process of learning and the formation of memory in the brain.

The leaf infection process and resistance to Pleiochaeta setosa in three lupin species

In field experiments in Western Australia, Lupinus albus cv. Kiev Mutant was very susceptible, L. angustifolius cv. Yorrel was susceptible, and L. luteus cv. Motiv 369 was resistant to brown spot caused by Pleiochaeta setosa. The process of leaf infection by P. setosa was examined on these 3 Lupinus species and cultivars. Field infection occurred on young plants almost exclusively on the lower side of leaves from conidia splashed from the soil. More conidia per cm2 leaf surface were deposited on Kiev Mutant than on Yorrel or Motiv 369. In humid chambers at 15�C, 94-98% of conidia germinated on all species after 24 h. On all species, appressorial formation began 6 h after inoculation, but fewer appressoria were formed on Motiv 369 (27% of germinated conidia) than on the other 2 species (average 55%) after 24 h. Leaf penetration was directly through the cuticle via appressoria with few stomata1 penetrations. Efficiency of lesion formation (expressed as the number of lesions produced per 100 conidia deposited) was greater on Kiev Mutant and Yorrel (8.3 and 7.2%) than on Motiv 369 (2.3%). More lesions per cm2 leaf area were produced on Kiev Mutant (2.4) than on Yorrel (0.7) or Motiv 369 (0.3), but average lesion size was similar in each variety. Lesions expanded from 200-250 8m at 3 days to > 500 8m radius at 16 days after inoculation. During lesion expansion, P. setosa hyphae grew 50-200 8m beyond the border of necrotic lesions on Kiev Mutant, remained at the border of lesions on Yorrel, and were 100-200 8m inside the border of lesions on Motiv 369. Lesions on the susceptible cultivars Kiev Mutant and Yorrel (but not Motiv 369) were surrounded by a large chlorotic halo up to 2 mm from the outside necrotic lesion border. More lesions per cm2 leaf area were required to cause defoliation in Motiv 369 than in Kiev Mutant and Yorrel. Brown spot resistance in Motiv 369 is expressed as a reduction in defoliation. This appears to result from reduced attachment of conidia, reduced efficiency of infection and lesion formation, restricted growth of mycelia in lesions, reduced chlorosis, and delayed leaf senescence. Fewer conidia were produced on defoliated leaves of Motiv 369 in field plots.

Surface phosphorylation by ecto-protein kinase C in brain neurons: a target for Alzheimer's beta-amyloid peptides

The powerful regulatory machinery of protein phosphorylation operates in the extracellular environment of the brain. Enzymatic activity with the catalytic specificity of protein kinase C (PKC) was detected on the surface of brain neurons, where it can serve as a direct target for neurotrophic and neurotoxic substances that control neuronal development and cause neurodegeneration. This activity fulfilled all the criteria required of an ecto-protein kinase (ecto-PK). Detailed analysis of surface protein phosphorylation in cultured brain neurons using specific exogenous substrates (casein, histones, and myelin basic protein), inhibitors (PKC-pseudosubstrate 19-36; K252b) and antibodies (anti-PKC catalytic region M.Ab.1.9, antibodies to the carboxy-terminus of eight PKC isozymes) revealed several types of ecto-PK activity, among them ecto-PKs with catalytic specificity of the PKC isozymes zeta and delta. The activity of the neuronal ecto-PKC is constitutive and not stimulated by phorbol esters. the phosphorylation of a 12K/13K surface protein duplex by ecto-PKC-delta was found to be developmentally regulated, with peak activity occurring during the onset of neuritogenesis. Alzheimer's amyloid peptides beta 1-40 and beta 25-35 applied at neurotrophic concentrations stimulated the phosphorylation of endogenous substrates of ecto-PKC activity in brain neurons but inhibited specifically this surface phosphorylation activity with the same dose-response relationships that cause neurodegeneration. As may be expected from a relevant pathophysiological activity, beta-amyloid peptide 1-28 did not inhibit this surface phosphorylation.(ABSTRACT TRUNCATED AT 250 WORDS)