Collagen Cross-linking Research Articles

Family-based whole-exome sequencing implicates a variant in lysyl oxidase like 4 in atypical femur fractures.

Atypical femur fractures (AFFs) are rare adverse events associated with bisphosphonate use, having unclear pathophysiology. AFFs also cluster in families and have occurred in patients with monogenetic bone diseases sometimes without bisphosphonate use, suggesting an underlying genetic susceptibility. Our aim was to identify a genetic cause for AFF in a Caucasian family with seven members affected by osteoporosis, including three siblings with bisphosphonate-associated AFFs. Using whole-exome sequencing, we identified a rare pathogenic variant c.G1063A (p.Gly355Ser) in lysyl oxidase like 4 (LOXL4) among 64 heterozygous rare, protein-altering variants shared by the three siblings with AFFs. The same variant was also found in a fourth sibling with a low-trauma femur fracture above the knee, not fulfilling all the ASBMR criteria of AFF and in one of 73 unrelated European AFF patients. LOXL4 is involved in collagen cross-linking and may be relevant for microcrack formation and bone repair mechanisms. Preliminary functional analysis showed that skin fibroblast-derived osteoblasts from the unrelated patient with the LOXL4 variant expressed less collagen type I and elastin, while osteogenic differentiation and mineralization were enhanced compared with two controls. In conclusion, this LOXL4 variant may underlie AFF susceptibility possibly due to abnormal collagen metabolism leading to increased formation of microdamage or compromised healing of microcracks in the femur.

Biofilm-Induced Bone Degradation in Osteomyelitis

Objectives: Osteomyelitis, marked by bone inflammation due to microbial infection, presents significant healthcare challenges. While the protective role of biofilm in bacterial immunity and persistence is well-documented, its direct impact on bone degradation in osteomyelitis remains inadequately characterized. This study aims to comprehensively examine the direct effects of biofilm-forming pathogens on human bone, providing new insights into the mechanisms of bone destruction in osteomyelitis. Methods: Bone sections were collected from patients undergoing total knee replacement surgery between January 2021 and December 2022 for this study at Sultan Qaboos University Hospital. Then samples were inoculated with Staphylococcus aureus to simulate in-vitro bone infection. We then used Raman spectroscopy and Scanning Electron Microscopy (SEM) for detailed analysis of the bacterial interaction with bone tissue. Results: SEM images depicted trabecular destruction caused by biofilm. Biofilm-forming pathogens contribute directly to bone exhibited by SEM images with marked trabecular destruction. Raman analysis showed a significant increase in the carbonate-phosphate ratio in inoculated samples (619%) compared to controls (47%). Mineral content decreased in inoculated samples, and the carbonate-to-amide I ratio reduced by 47% in inoculated and 80% in controls. The inoculated samples exhibited an 82% shift in collagen crosslinking compared to 72% in controls. Conclusion: This research enhances our comprehension of the mechanisms behind bone destruction in osteomyelitis and underscores the intricate role of biofilm in the disease's development. These findings highlight the importance of biofilm in bone degradation and its potential implications for managing infections.

Chemical Tools for Monitoring and Targeting Collagen Cross-linking.

The formation of collagen, the most abundant protein in mammals, is vital for the integrity of skin, tendons, and tissue in essentially any organ. Excessive collagen formation is, however, characteristic of fibrotic and malignant diseases, which include major global health issues. The diagnosis of abnormal collagen production and deposition is, therefore, critical for disease prognosis and helps guide treatment decisions. Here, we summarize our research on the development of tailored tools for monitoring and targeting excessive collagen crosslinking. We anticipate these tools will provide a deep understanding at the molecular level of collagen formation in normal and disease conditions with applications in imaging and disease treatment.

Effects and safety of combined corneal collagen crosslinking and intrastromal corneal ring segment treatment in patients with keratoconus: a retrospective study

PurposeTo evaluate the safety and efficacy of different time-point combinations of intrastromal corneal ring segment (ICRS) implantation using femtosecond technology) and corneal collagen crosslinking (CXL) for the treatment of moderate-to-severe keratoconus (KCC).MethodsThis study included 69 eyes of 69 patients with keratoconus who underwent ICRS and CXL treatment at an Eye Hospital between March 2020 and March 2023. The patients were divided into two groups: Group 1 (n = 33 eyes of 33 patients), which received ICRS and CXL treatment in one session, and Group 2 (n = 36 eyes of 36 patients), which included treatment with ICRS for at least 6 months following CXL application. Preoperative and postoperative evaluations included visual acuity, autorefractometer refraction, corneal tomographic measurements using the Sirius (CSO) Scheimpflug camera and the TONOREF™ III device, and documentation of observed complications. Uncorrected visual acuity (UCVA) and best-corrected spectacle visual acuity (BCVA) were measured in each eye individually, and visual acuity was assessed using the logarithm of the minimum angle of resolution (logMAR).ResultsIn Group 1, mean UCVA improved from 0.81 ± 0.34 to 0.45 ± 0.25 (p < 0.01), and mean BCVA improved from 0.76 ± 0.35 to 0.38 ± 0.20 (p < 0.01). In Group 2, mean UCVA improved from 0.71 ± 0.32 to 0.43 ± 0.30 (p < 0.01), and mean BCVA improved from 0.65 ± 0.25 to 0.31 ± 0.23 (p < 0.01). Both groups showed significant reductions in manifest spherical and cylindrical refraction (p < 0.01). Group 1 exhibited greater reductions in maximum keratometry (Kmax), flat keratometry (K1), steep keratometry (K2) (p < 0.05), and astigmatic aberration compared with group 2 (p < 0.01). The use of simultaneous or separate CXL and ICRS does not significantly increase the incidence of complications.ConclusionsBoth combined and separate CXL and ICRS treatments resulted in significant improvement in UCVA and BCVA and reduced manifest refraction. Although improvements were observed in groups 1 and 2 in terms of K1, K2, and Kmax at 6 months, the improvements were more pronounced in Group 1. These results highlight the potential benefits of simultaneous ICRS + CXL treatment and underscore the importance of optimising the timing of CXL treatment to achieve the best visual outcomes.

Type I and III collagen contents and μ-calpain autolysis as a function of dry ageing time for eight different muscles from Hanwoo cattle.

Type I and III collagen content exert contrasting influences on meat tenderness. μ-calpain autolysis has shown a correlation with beef tenderness. Thus, the study was designed to determine the changes in these proteins. Three hundred twenty-four Hanwoo cattle, including cows and steers, and eight muscles were evaluated for proteolysis during dry ageing period. The ratios of type I and III collagen were determined by densitometric scans of bands resolved by SDS-PAGE, and μ-calpain activity was determined using casein zymography. Proteins involved in proteolysis were analysed by LC-MS/MS. The ratio of type I and III collagen in every muscle showed a significant difference with increasing ageing times (p < 0.05). In steers, the ratio decreased with increased ageing time, and in cows, except for BF and DP muscles, a similar decreasing trend was observed. Significant differences in the ratio of type I and III collagen were found between different muscles of cows at the same ageing time (p < 0.05), but no significant differences were found in steer muscles at the same ageing time (p > 0.05). Casein zymogram results showed an inverse relationship between pH values and μ-calpain autolysis in every muscle. A significant reduction in μ-calpain activity was observed in all muscles with extended ageing times, while the rate of autolysis differed greatly (p < 0.05) between muscles at the same ageing time. Interestingly, electropherogram analysis showed that cow muscles had a higher μ-calpain activity than steer muscles. Ageing time significantly influenced proteolysis, with 24 proteins showing marked changes and being identified. The ageing times significantly affect the ratio of type I and III collagen, which coincided with the rate of μ-calpain autolysis in steers. The ratio of type I and III collagen had a significant changes during the ageing period from cows, which may be related to the amount of collagen cross-linking.

Keratoconus.

Keratoconus is a progressive eye disorder primarily affecting individuals in adolescence and early adulthood. The ectatic changes in the cornea cause thinning and cone-like steepening leading to irregular astigmatism and reduced vision. Keratoconus is a complex disorder with a multifaceted aetiology and pathogenesis, including genetic, environmental, biomechanical and cellular factors. Environmental factors, such as eye rubbing, UV light exposure and contact lens wearing, are associated with disease progression. On the cellular level, a complex interplay of hormonal changes, alterations in enzymatic activity that modify extracellular membrane stiffness, and changes in biochemical and biomechanical signalling pathways disrupt collagen cross-linking within the stroma, contributing to structural integrity loss and distortion of normal corneal anatomy. Clinically, keratoconus is diagnosed through clinical examination and corneal imaging. Advanced imaging platforms have improved the detection of keratoconus, facilitating early diagnosis and monitoring of disease progression. Treatment strategies for keratoconus are tailored to disease severity and progression. In early stages, vision correction with glasses or soft contact lenses may suffice. As the condition advances, rigid gas-permeable contact lenses or scleral lenses are prescribed. Corneal cross-linking has emerged as a pivotal treatment aimed at halting the progression of corneal ectasia. In patients with keratoconus with scarring or contact lens intolerance, surgical interventions are performed.

Quantitative Assessment of New Frontiers in Dermatochalasis and Periorbital Hyperpigmentation Treatment: The Role of Cross-Linked Porcine Collagen.

Collagen dermal fillers have shown efficacy in addressing age-related changes in facial appearance. However, their potential in rejuvenating the periorbital region remains unexplored. The aim of this study was to evaluate the effectiveness, clinical safety, and patient satisfaction associated with the utilization of collagen dermal fillers in individuals with dermatochalasis and periorbital hyperpigmentation. This study was reviewed and approved by the institutional review board of China Medical University Hospital (IRB No. CMUH107-REC2-157). Adults diagnosed with dermatochalasis or periorbital hyperpigmentation received periorbital injections of a sterile cross-linked highly-purified specific antigen free porcine dermal collagen (FACIALGAIN® Collagen Implant with Lidocaine, Sunmax Biotechnology Co. Ltd., Taipei, Taiwan) and were assessed for hydration, elasticity, pigmentation index, redness index, lightness value, and density with the DermaLab® Combo Multiparameter Skin Analysis System (Cortex Technology, Hadsund, Denmark) and Cutometer® Dual MPA 580 (Courage+Khazaka electronic GmbH, Köln, Germany). Data was collected prior to injection and at 1 week, 4 weeks, and 12 weeks after injection. Patient satisfaction on volume augmentation, decrease in hyperpigmentation, persistence, and overall satisfaction were also recorded. A total of 12 samples each were recruited for dermatochalasis and periorbital hyperpigmentation. For dermatochalasis subjects, hydration of the periorbital tissue significantly increased at week 1 and 4 (p = 0.011 and p = 0.015). Elasticity decreased by week 4 and persisted until week 12 (p = 0.001 and 0.014). For periorbital hyperpigmentation patients, lightness value increased significantly starting week 1 (p = 0.016), tapering off at week 12. Elasticity decreased by week 4 and persisted until week 12 (p = 0.002 and p = 0.002). Median overall patient satisfaction was 4 out of 5 for the dermatochalasis group and 4.5 out of 5 for the periorbital hyperpigmentation group, with a mild but insignificant decrease by week 12. DermaLab® Combo and Cutometer® Dual MPA 580 are considered effective methods for evaluating patients undergoing dermal filler injections. The utilization of cross-linked porcine collagen dermal filler injections can serve as a minimally invasive approach to enhance skin laxity in dermatochalasis and address discoloration in periorbital hyperpigmentation. However, it is important to note that regular treatments may be necessary to sustain the desired outcomes. 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/0026 .

Zr4+ and Al3+ coordinated cross-linked conductive collagen fibers/solvent-free polyurethane foam with ultra-low reflective electromagnetic shielding properties

In recent years, electromagnetic shielding materials with low reflectance have developed rapidly. However, high material cost, poor bonding fastness, weak mechanical properties and other problems seriously limit its effect in practical use. In this work, flexible conductive collagen fibers (CLF-Zr4+/Al3+-CNTs) were prepared using chromium tanned waste leather as ingredient, carbon nanotubes (CNTs) as conductive filler and transition metal ions as coordination crosslinking agents, and their molecular dynamics were investigated by quantum chemical simulation software. On this basis, a flexible conductive foam with the double layer and double core-clad structure containing carbon nanotubes was constructed using the solvent-free polyurethane (SFPU) chemical foaming technology, and their electromagnetic shielding properties and reflectance were studied. The experiment results showed that when the ratio of CLF-Zr4+/Al3+-CNTs to SFPU polyol is 1:9 and the impregnation times of CNTs are 2, the loading capacity of CNTs in conductive foam is 0.14 mg/cm3, the electrical conductivity is 57.8 S/m, and the thermal conductivity is 0.061 W/(m·K). Meanwhile, when the thickness is 3 cm, the electromagnetic shielding performance is 42.09 dB, and the reflection efficiency is 0.66 %, the lowest reflection efficiency reaches 0.16 % in the experiment. The mechanism of electromagnetic shielding in conductive foams with the double layer and double core-clad structure has been further explored. The experiment results proved that the flexible conductive foam has excellent mechanical properties, stability, heat insulation and flame retardant properties, and has excellent electromagnetic shielding and low reflection characteristics due to its abundant holes, functional group, interface and hierarchical structure.

Ancient and modern bone diagnosis: Towards a better understanding of chemical and structural feature alterations

Chemical and structural alterations hold great importance in the field of diagenesis. Attenuated Total Reflectance − Fourier Transform Infrared Spectroscopy (ATR-FTIR) is a valuable method for examining bio-apatite composition changes. Infrared spectroscopy (IR) and X-ray diffraction (XRD) were employed to analyze both modern and archaeological bone specimens. Organic and mineral component changes in modern and ancient samples were investigated. Ancient bone samples were collected from two archaeological sites in Jordan, dating back to the Iron and Byzantine ages. IR results indicated that collagen cross-links and mineral maturity are higher in modern bones compared to ancient bones. Additionally, the crystallinity index is higher in modern bones than in archaeological bones, while the carbonate to phosphate ratio (C/P) is lower in modern bones than in ancient ones. Curve fitting was applied to reveal the carbonate substitution inside the hydroxyapatite lattice within the IR region from 850 to 890 cm−1. A2-type carbonates (identified as υ2 of CO32−) denote hydroxyl site substitution, and B-type carbonates represent a substitution to the phosphate site. The full width at half maximum (FWHM) of the peak at 604 cm−1 from IR spectra reveals that crystallinity is higher in modern bones, as confirmed by the FWHM of the (002)-apatite pattern in XRD. Statistical analysis was conducted to validate these findings, ensuring the robustness of the results. Finally, the results obtained in this investigation align with previous literature reports regarding ATR-FTIR ratios. This suggests that modern bones have better crystallinity compared to ancient bones. Furthermore, the ATR-FTIR ratios indicate that the hydroxyl and phosphate sites of modern bones undergo more substitution than older bones. The findings of this study not only enhance our understanding of the diagnostic processes in archaeological bone specimens but also have broader implications for fields such as archaeology, anthropology, and forensics, where the analysis of bone composition and structural changes can provide valuable insights into the history and characteristics of ancient remains.

Progression of corneal thinning and melting after collagen cross-linking for keratoconus.

To study the aetiology, diverse clinical manifestations, therapeutic interventions, and prognoses in patients with corneal thinning after collagen cross-linking (CXL) treatment. a retrospective observational study of all patients presenting with corneal thinning after collagen cross-linking, in a tertiary eye care hospital in south India from 2011 to 2017. Preoperative details were noted. Patients who presented with corneal thinning were subjected to investigative measures to assess thinning, received appropriate management, and underwent follow-up evaluations. Among the 12 patients, 8 were female and 4 were male, all of whom had undergone standard classical CXL. The duration between CXL and corneal melting/thinning onset varied from 5 to 12 years. Notably, among female patients, 2 were pregnant, 2 were lactating mothers, 1 was undergoing in vitro fertilization (IVF) treatment, and 1 had comorbid diabetes mellitus and hyperthyroidism. Clinical examination revealed corneal thinning accompanied by hypopyon in 1 patient, corneal perforation with shallow anterior chamber in 1 patient, and epithelial defect with crystalline deposit in another patient, the remaining patients exhibited corneal thinning. Corneal thinnest corneal thickness measurements ranged from 212 to 351 µm. Treatment approaches included penetrating keratoplasty (PKP) in 2 patients, deep anterior lamellar keratoplasty (DALK) in 1 patient, cyanoacrylate glue application in 1 patient, and awaiting DALK/PKP in three patients, 4 patients showing no signs of increased thinning. The incidence of corneal thinning after collagen cross-linking is less but fulminant, requiring timely and appropriate management to prevent visual complications.

Save sight keratoconus registry study: Transepithelial versus epithelium-off corneal crosslinking

PurposeCorneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus and can be performed with the epithelium on or off. Evidence is needed to guide clinicians and patients on whether they should have transepithelial or epithelium-off CXL. The aim of this study was to determine the safety and efficacy of transepithelial and epithelium-off CXL. DesignAn observational prospective study was conducted using real-world data from patients in the Save Sight Keratoconus Registry. MethodsPatients with no previous intervention before CXL were included. The primary outcomes were adverse events, change in Kmax, habitual visual acuity and minimum corneal thickness from baseline to 12 months follow up. Mixed effects regression models evaluated changes in outcomes adjusted for age, sex, eye laterality, practices, and baseline outcomes. ResultsThere were 46 eyes (37 patients) and 1203 eyes (976 patients) included treated with transepithelial and epithelium-off CXL, respectively. At 12 months follow up, the habitual visual acuity, pinhole visual acuity, Kmax, K2 and minimum corneal thickness were not significantly different between epithelium-off and transepithelial CXL. There were fewer adverse events recorded in transepithelial compared to epithelium-off CXL. ConclusionEpithelium-off and transepithelial CXL were similarly effective, measured by visual acuity and corneal curvature, to stabilise and prevent progression between baseline and 12 months follow-up in keratoconus. Transepithelial CXL had fewer adverse events compared to epithelium-off CXL.

Riboflavin-ultraviolet-A collagen crosslinking treatments in improving dentin bonding and resistance to enzymatic digestion

Background/purposeThe efficacy of riboflavin-ultraviolet-A (RF-UVA) treatment in crosslinking collagen and improving dentin bonding has been proven. However, biodegradation of the hybrid layer may compromise the bonding. The purpose of this study was to evaluate different RF-UVA treatments regarding their ability to preserve dentin bonding from enzymatic digestion. Materials and methodsCollagen subjected to different RF (0.1 %, 1 %)-UVA (1, 2, 5 min) treatments and 5 % glutaraldehyde (GA), without or with enzymatic digestion, were examined by gel electrophoresis (SDS-PAGE). Twenty-five teeth with exposed dentin were primed with one of three RF-UVA treatments (0.1 %RF/1-minUVA, 0.1 %RF/2-minUVA, and 1 %RF/1-minUVA), GA, or distilled water after acid-etching, then restored with an adhesive and a resin composite. After 24-h storage, these teeth were sectioned into microbeams. Half of them received an early microtensile bond strength (μTBS) test, while the other half was stored in enzyme solution for 7 days before testing. Nanoleakage and hybrid layer degradation were examined by TEM. ResultsAccording to SDS-PAGE results, all groups showed the dissipation of intense γ bands of collagen after digestion. For the early bonded specimens and after enzymatic digestions, 0.1 %RF/2-minUVA treated group presented the highest μTBS and none of premature failure. Its TEM images showed less nanoleakage after digestion, which is contributed to the well suspended collagen fibrils and resin infiltration in the hybrid layer. ConclusionRF-UVA treatment attained collagen crosslinking effects to improve resin-dentin bonding. 0.1 %RF/2-minUVA effectively enhanced dentin bond strength and resistance to enzymatic digestion by optimally expanding dentinal collagen matrix to facilitate hybrid layer formation.

Structural determinants of tendon multiscale mechanics and their sensitivity to mechanical stimulation during development in an embryonic chick model

There is an abrupt increase in the multiscale mechanical properties and load-bearing capabilities of tendon during development. While prior work has identified numerous changes that occur within the collagenous structure during this developmental period, the primary structural elements that give rise to this abrupt increase in mechanical functionality, and their mechanobiological sensitivity, remain unclear. To address this knowledge gap, we used a shear lag model along with ultrastructural imaging, biochemical/thermodynamic assays, and multiscale mechanical testing to investigate the dynamic structure-function relationships during late-stage embryonic chick development and to establish their sensitivity to mechanical stimulation. Mechanical testing and modeling suggested that the rapid increase in multiscale mechanics can be explained by increases in fibril length, intrafibrillar crosslinking, and fibril area fraction. To partially test this, we inhibited collagen crosslinking during development and observed a drastic reduction in multiscale mechanical behavior that was explained by a reduction in both fibril modulus and length. Using muscle paralysis to investigate mechanosensitivity, we observed a significantly impaired multiscale mechanical response despite minimal changes in fibril diameter and fibril area fraction. Additionally, the shear lag model found a trend toward lower fibril lengths with paralysis and experimental data found decreased crosslinking and fibril modulus values following flaccid paralysis. Together, these data suggest that both intrafibrillar crosslink formation and fibril elongation are critical to the formation of load-bearing capabilities in tenogenesis and are sensitive to mechanical loading. These findings provide critical insights into the biological and structural mechanisms that give rise to tensile load-bearing soft tissue. Statement of SignificanceDespite prior work investigating the structural and mechanical changes that occur during tendon development, there has not been a comprehensive analysis of how these simultaneous changes in structure and function are connected. In this study, we performed a comprehensive battery of mechanical and structural assessments of embryonic chick tendons and input these data into a shear lag model to estimate the individual importance of each structural change to the tendon mechanical properties. Additionally, we inhibited muscle activity in the embryos to evaluate the impact of mechanical stimulation on these evolving structure-function relationships during tendon development. These data provide insight into the primary structural elements that produce the tensile load-bearing capabilities of tendon, which will inform efforts to produce tissue engineered tendon replacements.

Reconstructive surgical therapy of peri-implant defects with ribose cross-linked collagen matrix and crosslinked hyaluronic acid – a prospective case series

ObjectiveTo investigate the efficacy of ribose-crosslinked collagen (RCLC) matrices functionalized by crosslinked hyaluronic acid (xHya) for reconstructive treatment of class I and III (b-c) peri-implantitis lesions in a transmucosal healing mode.Materials and methodsThirteen patients presenting with 15 implants were included in this prospective case series. Upon flap reflection, the implants were thoroughly decontaminated employing glycine powder air polishing and adjunctive sodium hypochlorite. For defect augmentation, xHyA was administered to the bony defect walls, exposed implant surfaces, and the RCLC matrix before defect grafting. The full-thickness flap was readapted and sutured around the implant neck for transmucosal healing. Baseline and respective values at the 12 months post-op evaluation were recorded for the clinical parameters peri-implant probing depth (PPD), buccal soft tissue dehiscence (BSTD) and bleeding on probing (BoP). Furthermore, two independent investigators analyzed radiographic changes in the defect area. The mean changes for all variables were analyzed with a paired t-test.ResultsThe initial mean PPD was 7.2 ± 1.9 mm, and BoP was present in 63% of sites. After 12 months, PPD at the latest visit was 3.2 ± 0.66 mm, which amounted to a respective 3.9 ± 1.85 mm reduction, while the BoP frequency dropped to 10% at all sites. Radiographic bone fill was accomplished for 62.8% of the former defect area, accompanied by a mean MBL gain of 1.02 mm around the treated implants (all p < 0.001).ConclusionsWithin the limits of this case series, we conclude that the proposed treatment sequence substantially improved peri-implant defects and offered a simplified but predictive technique.Clinical relevanceReconstructive treatment approaches for peri-implantitis are effective but remain non-superior to open flap debridement. Further research on novel biomaterial combinations that may improve reconstructive treatment outcomes are warranted. Ribose-crosslinked collagen matrices biofunctionalized by hyaluronic acid used in this study yield improved clinical and radiographic peri-implant conditions after 12 months.Graphical

Corneal scarring after epithelium-off collagen cross-linking

Abstract Collagen cross-linking (CXL) is considered as a successful therapeutic approach for corneal conditions like keratoconus and corneal ectasia. Despite its efficacy in stabilizing these conditions, the occurrence of post-CXL scars remains a concern. Keratoconus and other corneal ectasias are characterized by structural weaknesses in the cornea. This weakness contributes to the vulnerability of corneal scar formation. In addition, corneal biomechanics and tissue properties play a significant role in scar development. Procedural factors during CXL, including duration and intensity of ultraviolet light exposure, the concentration and type of riboflavin, and the precise application of treatment, have been identified as potential causes of scar formation. Individual patient factors such as variations in healing response and genetic predispositions, associated ocular allergy, and chronic contact lens wear can also impact scar development post-CXL. Understanding these variables is essential for risk stratification and personalized treatment approaches, ultimately optimizing patient outcomes. In addition, regular follow-up visits and patient education are essential to ensure optimal healing and minimize scar related complications. We have tried to explain the numerous reasons of scarring following epithelium-off CXL by conducting a thorough Medline search and reviewing our clinical images. This review serves as a concise overview of the causes and risk factors associated with scar formation after epithelium-off CXL.

Permeation characteristics and cross-linking efficacy of iontophoresis-assisted riboflavin delivery for accelerated riboflavin-ultraviolet A scleral collagen cross-linking in porcine eyes

The purpose of this study is to investigate whether the iontophoresis-assisted riboflavin delivery to posterior sclera with less delivery time, can achieve the same riboflavin permeation efficiency as the passive soaking way, and its effect on the mechanical properties of posterior sclera for accelerated scleral collagen cross-linking (A-SXL). In this study, 0.1% riboflavin solution was applied into the posterior sclera of porcine eyes either by the iontophoresis-assisted or passive soaking method, with delivery time of 5, 7.5, 10, 12.5, 15, 17.5, and 20 min, respectively. The fluorescence intensity and the distribution of riboflavin concentration in the 10 μm frozen sections of the sclera were evaluated by fluorescence inverted microscope. The posterior sclera with riboflavin treatment through either the iontophoresis-assisted or the passive soaking method for different durations ranging from 5 to 20 min was treated with ultraviolet A (UVA) irradiation at an intensity of 10 mW/cm2 for 9 min. The elastic modulus was determined at the physiological strain level using the uniaxial tensile test after ASXL. The results showed that the fluorescence intensity of riboflavin increased by prolonging the delivery time in both the iontophoresis and passive soaking groups, and the permeation depth of riboflavin remained constant over 15 min. The fluorescence intensity in the iontophoresis group was significantly higher than in the passive soaking group at 12.5 min and 15 min, respectively. The elastic modulus at 12.5 min in the iontophoresis group was significantly higher than in the passive soaking group at the same delivery time and showed no significant difference compared to the passive soaking group at 20 min. In conclusion, it indicated that iontophoresis-assisted delivery could not only shorten the surgery time but also achieve similar mechanical performance to the passive soaking method in ASXL.

Impact of cathepsin K-induced proteoglycans degradation on dentin collagen

ObjectivesThis study aimed to investigate the effects of cathepsin K (catK) on proteoglycans (PGs) and the subsequent impacts on dentin collagen degradation. Materials and MethodsDemineralized dentin samples were prepared and divided into the following groups: deionized water (DW), 0.1 U/mL chondroitinase ABC (C-ABC), and 1 μM odanacatib (ODN). Then, they were immersed for 48 h and then incubated in 1 mL of PBS (pH=5.5) at 37 °C for 5 d. Glycosaminoglycan (GAG) were examined to explore the degradation of PGs by catK. To determine the effect of catK-mediated PGs on dentin collagen degradation, hydroxyproline (HYP) assays, assessment of the degree of dentin crosslinking, and scanning electron microscopy (SEM) were assessed. Statistical analysis was conducted using one-way ANOVA followed by Tukey’s tests or Welch's ANOVA followed by Dunnett's tests at a significance level of 0.05. ResultsThe production of GAG was significantly lower in the ODN group than in the DW group (P < 0.05), revealing that PG degradation was reduced in dentin after ODN treatment. Additionally, ODN treatment minimized the gaps in collagen fibers, improved fiber arrangement, and significantly increased the degree of collagen crosslinking, subsequently reducing the total amount of collagen fiber degradation in the dentin (P < 0.05). ConclusionsCatK-mediated degradation of PGs negatively impacted the stability of collagen fibers, promoted gaps, led to a less organized arrangement of dentin collagen fibers, ultimately increasing collagen degradation.

Corneal densitometry changes post-CXL for keratoconus: Comparative evaluation of epithelium-off, contact lens-assisted, and transepithelial techniques.

To evaluate changes in corneal backscattering after collagen cross-linking (CXL) for progressive keratoconus and compare its course with different techniques - standard epithelium-off CXL (SCXL), contact lens-assisted CXL (CACXL), and transepithelial CXL (TECXL). Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Retrospective comparative study. Ninety-four eyes (SCXL: 47, CACXL: 30, and TECXL: 17) were compared. Corneal haze was quantified using Scheimpflug tomography, pre- and post-CXL at 1, 3, 6, and 12 months. The baseline mean density score of the central anterior stromal layer was 16.14 ± 7.07, 15.85 ± 7.89 and 15.89 ± 7.21 in SCXL, CACXL, and TECXL groups, respectively (P 0.93). After SCXL, the score increased to 28.83 and 31.34 at 1 and 3 months, respectively (both P < 0.001) and dropped at 6 months (28.66, P < 0.001) and 12 months (23.72, P 0.003). Post-CACXL, the mean densitometry peaked at 3 months (20.35, P 0.14) and returned toward baseline at 6 months (18.82, P 0.15). After TECXL, it increased slightly at 1 month (18.47, P 0.17), decreased at 3 months (14.88, P 0.7), and plateaued over 1 year. No correlation with visual acuity was seen. Corneal haze increased significantly after SCXL, peaking at 3 months, declining over 6-12 months, and returning to baseline at 12 months. In contrast, post-TECXL and -CACXL, there was an insignificant increase in anterior corneal haze, which returned to baseline within 3-6 months.

Porcine Cross-Linked Collagen Matrix for Peri-Implant Vertical Soft Tissue Augmentation: A Randomized Prospective Observational Study.

The mucosa height has always been of interest in modern implant dentistry to obtain biomimetic results. Papilla height, mucosa scalloping, and free mucosal margin level are crucial to achieve "pink aesthetics". The aim of this study was to investigate the vertical increase in the peri-implant soft tissues with a porcine cross-linked collagen matrix (Geistlich Fibro-Gide®). Methods: A total of 60 patients were divided into the following three groups: Group 1-patients who received porcine cross-linked collagen matrix for vertical soft tissue augmentation and a cover screw combined with a coronally advanced flap (CAF); Group 2-patients who received the collagen matrix combined with a healing abutment and CAF; Group 3 (control group)-patients who received a traditional surgical approach based on crestal incision and no collagen matrix as well as no CAF. Results: The average horizontal tissue thickness growth after 3 months was more effective for Group 1 (1.35 ± 1.23 mm) compared to Group 2 (0.85 ± 0.67 mm) and the control group (0.20 ± 0.41 mm). The average tissue height growth was 1.05 ± 1.39 mm for Group 1, 0.32 ± 1.28 mm for Group 2, and -0.05 ± 0.39 mm for the control group. Finally, the average increase in the band of keratinized mucosa was 0.60 ± 1.23 mm for Group 1, -0.60 ± 0.94 mm for Group 2, and 0.45 ± 0.60 mm for the control group. Conclusions: The combination of the CAF, porcine cross-linked collagen matrix, and cover screw resulted in better clinical results compared to Group 2 and 3.

An Evaluation of Skin and Immunological Responses after Using a Novel Cross-Linked Porcine-Based Dermal Injectable Collagen with Lidocaine for Nasolabial Fold Correction.

Background: Hypersensitivity to the new dermal injectable porcine-based collagen with lidocaine featuring a novel cross-linking technology (test filler) for nasolabial fold correction was compared to the commercially available traditional cross-linked dermal injectable porcine-based collagen with lidocaine (control filler). Methods: Recruited participants (n = 279) received a single 0.1 mL intradermal injection of either test filler or control filler in the left forearm as a screening skin allergy test. Injection sites were assessed clinically at 24 h post-implant. Treatment was given to 252 successfully screened participants, and injection sites were monitored for 21 days. Immunological examinations were performed at screening and then at 4 and 24 weeks post-treatment. Observations for adverse events continued until the 52nd week. Results: Intradermal allergy testing results were negative for all the test recipients (0/124) and positive for two control recipients (2/132, 1.5%). Most of the participants exhibited no changes in serum immunoglobulin (IgG, IgM) and complement (C3, C4) levels. No serious adverse events related to the device were recorded. Most adverse events were common complications of dermal filler treatment and were related to the injection site. Most adverse effects were resolved or under control by 52 weeks. Conclusions: Hypersensitivity reactions with the test filler were lower than those with the control filler, validating the safe use of test filler for nasolabial fold correction without the need for pretreatment skin testing.