Dermal Injection Research Articles

Pressure Offloading Injectable System (POIS): Evaluating the use of an injectable dermal filler for offloading painful pressure points during weight bearing activities

Fat pad atrophy is a condition characterized by the loss of natural fat on the plantar aspect of the foot. Fat pad restoration techniques directly address fat pad atrophy by increasing the overall thickness of subcutaneous tissue in the foot. Two subtypes of fat pad restoration, surgical dermal allograft and autolipotransplantation, are well-characterized treatment options for offloading high pressure regions of the foot. These methods have previously been shown to result in significant decreases in pain, improvement in the overall quality of life and decreases in the progression of dermal breakdown. However, the efficacy of a novel subtype of fat pad restoration, dermal injectables, is poorly characterized. This prospective, within-subjects design trial of thirty participants evaluated the safety and efficacy of an injectable hyaluronic acid dermal filler by measuring quality of life scores, ultrasound subcutaneous tissue thickness and gait pressure analysis. Each participant was followed for a one-year period with each study variable analyzed at 2 weeks, 12 weeks, 24 weeks and 54 weeks post-injection. Our study results revealed that a 1 milliliter injection of Juvederm® Voluma XC into regions of the foot with fat pad atrophy resulted in significantly higher Foot and Ankle Disability Index (FADI) scores over 54 weeks post-injection (p < 0.001, versus baseline), and significantly higher subcutaneous layer thickness over 54 weeks post-injection (p < 0.01, versus baseline), while no significant changes in the impulse gait percentages throughout the course of the study were evident (p >> 0.05, versus baseline). While follow-up studies are necessary, our preliminary study strongly suggests that Juvederm® Voluma XC (and other similar injectable dermal fillers) may present an efficacious, non-invasive, alternative treatment option to address fat pad atrophy.

The efficacy of polycaprolactone filler injection on enlarged facial pores

Facial pores, visible topographic change of skin representing enlarged openings of pilosebaceous follicles, are common aesthetic concern. The aim of this study was to examine the efficacy of polycaprolactone (PCL) filler on enlarged facial pores and skin texture improvement. A total of seven participants with enlarged facial pores were included in the study and underwent deep dermal injection of PCL based filler (Ellanse M, Sinclair Pharma; London, United Kingdom). Skin quality measurements including skin evenness, red areas, UV spots, wrinkles and pore numbers evaluated with an automated aesthetic camera (FotoFinder®, Teach Screen Systems software GmbH; Bad Birnbach, Germany) before and 3 months after the injection session. Adverse events during procedure were monitored and recorded. Subjects were asked to report any injection related side effects. The average size of enlarged pores was 33.51 ± 41 before treatment and 20.51 ± 35 after treatment. The difference was statistically significant (P< 0.05). The skin evenness, red areas, UV spots, and wrinkles showed no significant improvement after filler injection. No serious adverse events were reported at follow-up visit. The PCL based filler seems to be notably effective in improvement of enlarged facial pores especially in moderate to severe cases. However, further structured studies with larger sample size and control group could be more beneficial to elucidate the possible efficacy of PCL filler injection on the skin quality characteristics.

A Prospective Multicenter Study to Evaluate the Safety and Efficacy of the Topical Application of MYOWNN™, an Autologous Growth Factor Concentrate (AGFC) Serum, in Anti-Aging.

BackgroundGrowth factors from platelets have been emerging as a revolutionary treatment with the ability to induce cell growth in the skin, which results in retarding and reversing the aging process. Platelet-rich plasma (PRP) allows for greater release of growth factors and biologically active proteins, which in turn activates the cascade of stimulation of neoangiogenesis and collagen production. PRP is used in anti-aging and facial skin rejuvenation in the form of dermal injections and topical application during micro-needling. This study was conducted to assess the safety and efficacy of a topically applied face serum, MYOWNN™ (Wockhardt Ltd., Mumbai, India). MYOWNN™ is an autologous growth factor concentrate that has been made into a topical face serum.MethodsMale and female subjects in the age group between 30 and 55 years (both inclusive) with Fitzpatrick skin type III-V who had not taken any oral or topical treatments for at least four weeks before and any platelet-rich plasma (PRP) based facial treatment (injections) at least six months before the study entry were included. MYOWNN™ serum was applied on the face once daily at night, approximately 30 minutes before sleeping preferably, for a total duration of five months. Six parameters, i.e. spots, pores, wrinkles, texture, moisture, and pigmentation, were evaluated at regular intervals with Visage-LS (dermaindia®, Tamil Nadu, India), a face analysis system that gives the live status of these six parameters and is an advanced live status skin detection equipment together with shooting, analyzing, and displaying functions, as well as the subjective analysis, was performed by subjects and physicians using different globally accepted scales like physician’s global aesthetic improvement scale (PGAIS), subject’s global aesthetic improvement scale (SGAIS), subject satisfaction score (SSS), and wrinkle severity rating scale (WSRS). For analysis, a mixed model for repeated measures was used. The model had change from baseline as the dependent variable visit as a factor and baseline assessment result as a covariate. All primary and secondary efficacy endpoints were analyzed using Modified Intent-to-Treat (mITT) populations.ResultsImprovement in an average of six anti-aging parameters was observed as early as three months while statistically significant improvement was observed by the end of five months of application. A statistically significant improvement in wrinkles was observed by the end of three months of the application itself. There were no product-related adverse events reported.ConclusionsFive months of application of MYOWNN™ serum showed a statistically significant improvement in an average of six parameters of anti-aging and face rejuvenation with a p-value of 0.0150 (<5% level of significance (i.e. 0.05) and was also well-tolerated.

Air-toxin technique: Introduction and analysis of effect using a photoimaging system.

As an alternative to other approaches to facial rejuvenation, the air-toxin technique (dermal injection of air with micro-doses of botulinum toxin) is a promising method. We aimed to describe this novel technique and assess the overall safety and efficacy of the air-toxin technique in facial rejuvenation. A retrospective chart review was performed on cases treated with the air-toxin technique. A total of 47Korean patients underwent a single treatment session. Treatment efficacy was assessed objectively with serial VISIA® (Canfield Scientific, NJ, USA) skin analysis data and subjectively based on the patients' assessment scores at Week 12. A significant improvement in wrinkle (p<0.001), UV spot (p<0.001), and porphyrin (p=0.005) was objectively seen at 12weeks follow-up. Patients noted improvement in the categories wrinkle (p<0.01), redness (p=0.029), texture (p<0.001), dilated pore (p<0.001), and lifting (p<0.001) at Week 12 compared to baseline. No major adverse event was reported. Our data show that the air-toxin technique is efficacious in facial rejuvenation as shown by improved skin analysis parameters and patient assessment scores. Notably, there was some discrepancy between the objective and subjective parameters of improvement.

Sentinel Lymph Node in Breast Cancer, Our First Experience at Nicaragua. Case Report

Morton introduced cutaneous lymphoscintigraphy in melanoma. His results permitted to reproduce sentinel lymph nodes(SLN) in other areas. Krag and Weaver implemented portable gamma radiation detectors in breast cancer. The aim of this article is to describe the first expertise in our hospital using nuclear medicine in breast cancer and the methodological aspects of SLN and reviewing the international literature. Case Report: Female 54 years, no family history of breast cancer. Medical exam detected a mass of 3x2 cm in the upper outer quadrant of the left breast, there is no axillary mass. The Ultrasound: BIRADS IV A. Mammography: BI-RADS V Preoperative Classification: T2N0M0 Tru Cut Biopsy: Invasive carcinoma no type determined. Triple negative. Extension studies were negative. The lymphoscintigraphy done according to international protocol. Methylene blue was used in conjunction with the radiotracer; a periareolar sub dermal injection was given in the operating room. The Surgery performed on the day marked. After localized the scintigraphic hot spots in vivo with the gamma probe Nuclear Lab DGC II. The intraoperative frozen section analysis used with Haematoxylin and Eosin staining. Two SLN reported as metastases Negative. The axillary dissection was deferred. There were no complications. Post-surgical pathologic report showed invasive carcinoma no type determined size 35 x 30 x 28 mm, unifocal. In situ ductal carcinoma and in situ lobular carcinoma unidentified and lympho-vascular unidentified invasion. There is no tumoral extension to the skin. All margins were reported negative.pT2pN0. Conclusion: Each time that a new therapeutic tool is within reach of the oncologic patients, principally when his effectiveness have been demonstrated to long time. It to make true in low income country increase the challenge for her implementation. However, the multidisciplinary effort of the human resources and the help of the technology development of our institutions permeated to jump the hard barrier that this entails, achieving a great achievement to the patients with breast cancer in our country. This first effort is not distant from the reported in the international literature.

Plasma Radiofrequency Ablation for Scar Treatment.

Scars are a common disfiguring sequela of various events such as acne, hidradenitis suppurativa, surgery, trauma, and burns, which can lead to serious psychosocial problems with a negative effect on the quality of life. Many conventional approaches have been proposed for the treatment of scars, including surgical techniques, dermabrasion, chemical peels, topical silicone gel, 5-fluorouracile and dermal fillers injection or autologous fat transfer for atrophic scars, and corticosteroids injection for hypertrophic and keloid scars; however, they have sporadic effects. Ablative lasers, such as carbon dioxide laser or Erbium Yag laser, are associated with many collateral effects limiting their application. Non-ablative laser treatments have been shown to be safer and to have fewer side effects, but they have a reduction of clinical efficacy compared to ablative lasers and a minimal improvement of scars. The demand for minimal invasive and safe technology for the treatment of a scars has stimulated the search for more effective novel therapy with fewer collateral effects. Plasma radiofrequency ablation is a new technique consisting of the generation of plasma energy through the production of ionized energy, which thermally heats tissue in a uniform and controlled manner, through a plasma radiofrequency device, inducing a sublimation of the tissue. The aim of this study is to evaluate the effectiveness of P-RF ablation in the treatment of scars performed with D.A.S. Medical device (Technolux, Italia), which is a tool working with the long-wave plasma radiofrequency principle.

Factors Associated with Lymph Node Metastasis in Special Types of Invasive Breast Cancer at National Cancer Hospital in the Period of 2018 - 2021

This paper assesses the rate of lymph node metastasis and the correlation between lymph node metastasis and some pathological characteristics in special types of invasive breast cancer. In the paper, a descriptive cross‐sectional study was conducted on 200 patients with special types of invasive breast cancer at the Institute of Molecular Biology and Pathology - National Cancer Hospital from August 2020 to April 2021. The study results show that 32% of the 200 cases had nodal metastases. The factors associated with the increased risk of lymph node metastasis were of histological types (invasive lobular, invasive micropapillary carcinomas) (p = 0.000), high tumour grade (p = 0.000), the presence of lymphovascular invasion (p = 0.000), tumor-infiltrating lymphocytes (TILs) &lt; 10% (p = 0.000), the presence of tumor necrosis (p = 0.001), Her-2/neu overexpression (p = 0.01), Ki-67 ≥ 20% (p = 0.036), HER2-positive breast cancer (p = 0.015). Overall, the rate of lymph node metastasis was 32%. Histological type, tumour grade, the presence of lymphovascular invasion, TILs, tumor necrosis, Her-2/neu and Ki-67 expression, and molecular subtype were factors related to lymph node metastasis in special types of invasive breast cancer.&#x0D; Keywords:&#x0D; Lymph node metastasis, invasive breast cancer, special types.&#x0D; References&#x0D; [1] World Health Organization, Breast Tumors (5th ed), International Agency for Research on Cancer, Lyon, France, 2019.[2] K. M. Masters, S. L.Wong, R. C. Martin et al., Dermal Injection of Radioactive Colloid Is Superior to Peritumoral Injection for Breast Cancer Sentinel Lymph Node Biopsy: Results of A Multiinstitutional Study, Annals of Surgery, Vol. 233, No. 5, 2001, pp. 676, https://doi.org/10.1097/00000658-200105000-00012. [3] A. V. Ashturkar, G. S. Pathak, S. D. Deshmukh, H. T. Pandave, Factors Predicting the Axillary Lymph Node Metastasis in Breast Cancer: Is Axillary Node Clearance Indicated in Every Breast Cancer Patient? Indian Journal of Surgery, Vol. 73, No. 5,2011, pp. 331-335, https://doi.org/10.1007/s12262-011-0315-5. [4] M. R. Peter, D. L.Michelino, V. Tricia et al., Prediction of Axillary Lymph Node Status in Breast Cancer Patients by Use of Prognostic Indicators, JNCI: Journal of the National Cancer Institute, Vol. 86, No. 23, 1994, pp. 1771-1775, https://doi.org/10.1093/jnci/87.8.607. [5] R. Salgado, C. Denkert, S. Demaria et al., The Evaluation of Tumor-Infiltrating Lymphocytes (TILs) in Breast Cancer: Recommendations by An International TILs Working Group 2014, Annals of Oncology, Vol. 26, No. 2, 2015, pp. 259-271, https://doi.org/10.1093/annonc/mdu450. [6] K. H. Young, Statistical Notes for Clinical Researchers: Chi-Squared Test and Fisher's Exact Test, Restorative Dentistry &amp; Endodontics, Vol. 42, No. 2, 2017, pp. 152-155, https://doi.org/10.5395/rde.2017.42.2.152.[7] L. G. L. Tan, Y. Y. Tan, D. Heng, M. Y. Chan, Predictors of Axillary Lymph Node Metastases in Women with Early Breast Cancer in Singapore, Singapore Med J, Vol. 46, No. 12, 2005, pp. 693, https://doi.org/10.1016/s0959-8049(98)80134-2. [8] A. Barth, P. H. Craig, M. J. Silverstein, Predictors of Axillary Lymph Node Metastases in Patients with T1 Breast Carcinoma, Cancer, Vol. 79, No. 10, 1997, pp. 1918-1922, https://doi.org/10.1002/(SICI)10970142(19970515) 79:10&lt;1918::AID-CNCR12&gt;3.0.CO;2-Y. [9] Y. Iwasaki, Axillary Node Metastasis from T1N0M0 Breast Cancer: Possible Avoidance of Dissection in A Subgroup, Japanese Journal of Clinical Oncology, Vol. 28, No. 10, 1998, pp. 601-603, https://doi.org/10.1093/jjco/28.10.601. [10] G. Viale, S. Zurrida et al., Predicting the Status of Axillary Sentinel Lymph Nodes in 4351 Patients with Invasive Breast Carcinoma Treated in A Single Institution, Cancer, Vol. 103, No. 3, 2005, pp. 492-500, https://doi.org/10.1002/cncr.20809. [11] S. K. Çetintaş, M. Kurt et al., Factors Influencing Axillary Node Metastasis in Breast Cancer, Tumori Journal, Vol. 92, No. 5, 2006, pp. 416-422, https://doi.org/10.1177/030089160609200509. [12] T. V. To, A Study of Morphology, Immunohistochemistry and Their Prognostic Value in Breast Carcinoma, Ph.D Dissertation, Hanoi Medical University, Hanoi, 2004 (in Vietnamese).[13] R. Lauria, F. Perrone et al., The Prognostic Value of Lymphatic and Blood Vessel Invasion in Operable Breast Cancer, Cancer, Vol 76, No. 10, 1995, pp. 1772-1778, https://doi.org/10.1002/1097-0142(19951115)76 :10&lt;1772::AID-CNCR2820761014&gt;3.0.CO;2-O.[14] R. Yerushalmi, M. M. Hayes, K. A. Gelmon, Breast Carcinoma - Rare Types: Review of the Literature, Annals of Oncology, Vol. 20, No. 11, 2009, pp. 1763-1770, https://doi.org/10.1093/annonc/mdp245. [15] A. Caziuc, D. Schlanger, G. Amarinei, Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?, Vol. 8, No. 5, 2019, pp. 545, https://doi.org/10.3390/jcm8040545. [16] K. Takada, S. Kashiwagi, Y. Asano, Prediction of Lymph Node Metastasis by Tumor-Infiltrating Lymphocytes in T1 Breast Cancer, BMC Cancer, Vol. 20, No. 1, 2020, pp. 598, https://doi.org/10.1186/s12885-020-07101-y.[17] N. T. Ha, Evaluation of Axillary Lymph Node Status and Vascular Infiltration by Molecular Type of Breast Carcinoma, Master Thesis, Hanoi Medical University, Hanoi, 2018 (in Vietnamese).[18] J. Makki, Diversity of Breast Carcinoma: Histological Subtypes and Clinical Relevance, Clinical Medicine Insights: Pathology, Vol. 8, 2015, pp. 23-31, https://doi.org/10.4137/cpath.s31563. [19] L. A. Carey et al, Breast Cancer Subtypes, and Survival in the Carolina Breast Cancer Study, JAMA, Vol. 295, No. 21, 2006, pp. 2492, https://doi.org/10.1001/jama.295.21.2492.

Safety and Efficacy of Autologous Dermal Fibroblast Injection to Enhance Healing After Full-Thickness Rotator Cuff Repair: First-in-Human Pilot Study.

Background:There is growing interest in various biological supplements to improve tendon healing in patients after arthroscopic rotator cuff repair. The ideal biological supplement to strengthen rotator cuff remains unknown.Purpose:To assess the safety and efficacy of autologous cultured dermal fibroblast (ADF) injection on tendon-to-bone healing in patients after arthroscopic rotator cuff repair.Study Design:Case series; Level of evidence, 4.Methods:Included were 6 patients who underwent arthroscopic rotator cuff repair between June 2018 and March 2020; all patients had a full-thickness rotator cuff tear (>2 cm) involving the supraspinatus and infraspinatus tendons. The patients were injected with ADF between the repaired tendon and footprint during arthroscopic rotator cuff repair using the suture bridge technique. The safety of ADFs and the procedure was evaluated at 5 weeks postoperatively, and the anatomical healing of the repaired tendon was accessed at 6 months postoperatively using magnetic resonance imaging and at 12 months using ultrasonography. Outcomes including shoulder range of motion (ROM), visual analog scale (VAS) for pain, and functional scores were measured at 6 and 12 months postoperatively.Results:Adverse reactions to ADF injection were not observed at 6 months after surgery. VAS and functional scores at 6 and 12 months postoperatively were significantly improved compared with preoperative scores (all P < .05). However, there was no significant difference on any ROM variable between preoperative and postoperative measurements at 6 and 12 months (all P > .05). No healing failure was found at 6 and 12 months postoperatively.Conclusion:There was no adverse reaction to ADF injection, and all patients had successful healing after rotator cuff repair. A simple and easily accessible ADF injection may be a novel treatment option for increasing the healing capacity of torn rotator cuff tendons. Further clinical research is needed to verify the study results.

Central Retinal Artery Occlusion as a Complication in Invasive Aesthetic Cosmetology: a Clinical Case

Central retinal artery occlusion (CRAO) is a relatively rare form of acute retinal arterial ischemia that results in unilateral vision loss. The incidence of transient vision loss is estimated at approximately 14 cases per 100,000 people per year, while the incidence of CRAO is approximately 1–2 cases per 100,000 people. In the foreign literature, there are more and more publications about the development of iatrogenic vision loss after dermal cosmetic injections. We would like to present a clinical case that should be interesting for both practicing ophthalmologists and specialists of related specialties, especially for cosmetologists. Patient M., 42 years old, came to us with complaints of a sharp loss of vision to light perception in the right eye. From the anamnesis, it is known that two hours earlier, the patient was injected into the temporal region (plasma, anesthetic, epinephrine) in the cosmetology office. Lightning-fast deterioration of vision occurred at the time of the drug administration. The patient arrived at the clinic 2 hours after the onset of complaints. We conducted an ophthalmological examination of the patient, the diagnosis was made: occlusion of the central artery of the retina of the right eye, and immediately performed standard emergency therapy. After a course of conservative treatment in an ophthalmological hospital, a persistent decrease in visual functions and a violation of arterial blood circulation in the central retinal artery basin remained. The progressive increase in the number of minimally invasive cosmetic procedures in recent years, in particular, injections of dermal fillers, is associated with rare, but often fatal complications. This clinical situation should attract the attention of practicing ophthalmologists and cosmetologists to these types of complications, and improve the quality and speed of emergency medical care.

Granulomatous Reaction to Dermal Injection of Growth Factors from Umbilical Cord Blood-Derived Mesenchymal Stem Cells: A Case Report

Use of stem cells to treat various diseases in dermatology has been of interest. Conditioned media with the growth factors secreted from stem cells has been used as a topical agent. We report a case of foreign body granulomas that appeared days after dermal injection of the conditioned media mimicking scars at all injection sites.

The Utility of Indocyanine Green Dye Fluorescence Lymphography and Angiography During Wide Excision of Cutaneous Melanoma.

Background and Objectives. Lymph node status is the most important prognostic factor in cutaneous melanoma patients. Recent studies showed that indocyanine green (ICG) fluorescence lymphography helps locating sentinel nodes better. Sometimes, flap reconstruction is needed after wide excision of tumor. Indocyanine green fluorescence also simplifies the intraoperative design of flaps. This study investigates the use of ICG fluorescence in patients with cutaneous melanoma during operation. Methods. We performed a single-center, retrospective study of subjects with cutaneous melanoma using ICG lymphograhy and/or angiography during wide excision of tumor between 2015 and 2019. Patients received a dermal injection of ICG and patent blue (PB) dye. The positive node was excised. Indocyanine green angiography was utilized to visualize better skin paddle during flap reconstruction if needed. Results. A total of 37 sentinel lymph nodes (SLNs) were removed in 12 patients. Indocyanine green successful localization was found in 10 of the 12 patients (83%). Three patients were found with 6 metastatic nodes on final pathology. 100% of these 6 nodes were identified by ICG, while 83% (5/6) were positive PB. Three of the 12 patients received flap reconstruction after operation, and no major complications occurred. Conclusions. ICG dye lymphangiography is a good alternative for locating SLNs in patients with melanoma. It could also visualize well perfusion skin paddle during reconstruction. We reported a reproducible and simple method to utilize ICG fluorescence in cutaneous melanoma patients.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

Safety and efficacy of a carboxymethyl chitosan dermal injection device for the treatment of skin defects: a first-in-man, pilot, comparative, split-body study.

Injectable soft-tissue devices are increasingly used for improving skin defects and deficiencies related to ageing. To assess the safety and efficacy of KIO015, a new injectable soft-tissue device formulated with carboxymethyl chitosan for the intradermal treatment of skin defects associated with ageing. Twenty-two subjects (40-65 years) were randomized to receive injections in the neckline of KIO015 and a non-cross-linked HA-based device, and were followed for up to 10 months. Injection site reactions (ISRs) and adverse events (AEs) were documented. Skin improvement was assessed instrumentally and clinically. Skin biopsies at injection zones in the lower back were taken at Day 28 for histopathology and immunohistochemistry analyses, to further assess product performance. Histomorphometric analyses on rabbits and in vitro assessment of KIO015 antioxidant capacity were also conducted. KIO015 was very well tolerated. Only expected and transient ISRs were observed; mainly erythema and hematoma. No adverse local effects or foreign body granuloma were observed histologically. Both clinical and instrumental evaluations confirmed the performance of KIO015. The skin was firmer and more elastic. Skin hydration showed significant improvement three days after injection. KIO015 exhibited superior overall maintenance of skin hydration after 10 months as compared to HA. These clinical results were supported by in vitro trials and implantation tests in the rabbit. The results from this pilot study support the use of KIO015 as an innovative alternative to HA-based devices for intradermal treatment of skin disorders.

Asporin inhibits collagen matrix-mediated intercellular mechanocommunications between fibroblasts during keloid progression.

Keloids are fibrotic lesions that grow unceasingly and invasively and are driven by local mechanical stimuli. Unlike other fibrotic diseases and normal wound healing, keloids exhibit little transformation of dermal fibroblasts into α-SMA+ myofibroblasts. This study showed that asporin is the most strongly expressed gene in keloids and its gene-ontology terms relate strongly to ECM metabolism/organization. Experiments with human dermal cells (HDFs) showed that asporin overexpression/treatment abrogated the HDF ability to adopt a perpendicular orientation when subjected to stretching tension. It also induced calcification of the surrounding 3D collagen matrix. Asporin overexpression/treatment also prevented the HDFs from remodeling the surrounding 3D collagen matrix, leading to a disorganized network of thick, wavy collagen fibers that resembled keloid collagen architecture. This in turn impaired the ability of the HDFs to contract the collagen matrix. Asporin treatment also made the fibroblasts impervious to the fibrous collagen contraction of α-SMA+ myofibroblasts, which normally activates fibroblasts. Thus, by calcifying collagen, asporin prevents fibroblasts from linearly rearranging the surrounding collagen; this reduces both their mechanosensitivity and mechanosignaling to each other through the collagen network. This blocks fibroblast activation and differentiation into the mature myofibroblasts that efficiently remodel the extracellular matrix. Consequently, the fibroblasts remain immature, highly proliferative, and continue laying down abundant extracellular matrix, causing keloid growth and invasion. Notably, dermal injection of asporin-overexpressing HDFs into murine wounds recapitulated keloid collagen histopathological characteristics. Thus, disrupted interfibroblast mechanocommunication may promote keloid progression. Asporin may be a new diagnostic biomarker and therapeutic target for keloids.

Treatment effect of hemifacial dysplasia by injecting transplantation of autologous tissue in the second stage surgery for total auricle reconstruction

Objective: To observe the treatment effect of hemifacial dysplasia by injecting transplantation of autologous dermis and fat granules in the second stage surgery for total auricle reconstruction. Methods: From March 2013 to March 2018, 57 patients with unilateral microtia and mild-to-moderate hemifacial dysplasia were divided into concurrent treatment group (32 cases, including 13 females and 19 males and aged 6-33 years old with an average age of 12.5 years) and traditional treatment group (25 cases, including 10 females and 15 males and aged 6-21 years old with an average age of 11.3 years) according to the different surgical methods. Modified Nagata method of auricular reconstruction was chosen, in the second stage surgery (cranial ear angle plasty), patients in concurrent treatment group received the treatment of hemifacial dysplasia with autologous dermal and fat injection transplantation at the same time; Patients in traditional treatment group only received cranial ear angle plasty. Statistical analysis of the two groups of patients was carried out for the average operation time, the average length of hospital stay, the incidence of common complications and postoperative satisfaction rate. SPSS 21.0 software was used for statistical analysis. Results: The mean operation time of the concurrent treatment group (282.0±3.4)min was longer than that of the traditional treatment group (243.0±3.1)min, and the difference was statistically significant (t=9.884, P<0.05). There were no statistically significant differences in the average length of stay between the the concurrent treatment group (9.4±0.3)d and the traditional treatment group(9.5±0.2)d, t=0.256, P>0.05. There were no statistically significant differences in the incidence of common surgical complications between the concurrent treatment group (12.5%, 4/32) and the traditional treatment group(12.0%, 3/25), χ2=0, P>0.05. Postoperative satisfaction rate of the concurrent treatment group(90.6%, 29/32) was significantly higher than that of the traditional treatment group(56.0%, 14/25), the difference was statistically significant (χ2=9.081, P<0.05). Conclusions: Auricular reconstruction with treatment of hemifacial dysplasia should not significantly increase the average length of stay and the incidence of common complications compared with auricular reconstruction alone. Although the operation time is slightly extended, the scheme of concurrent treatment can reduce the times of operations, save medical resources and increase the satisfaction rate of patients.

Dermal bacterial LPS-stimulation reduces susceptibility to intradermal Trypanosoma brucei infection

Infections with Trypanosoma brucei sp. are established after the injection of metacyclic trypomastigotes into the skin dermis by the tsetse fly vector. The parasites then gain access to the local lymphatic vessels to infect the local draining lymph nodes and disseminate systemically via the bloodstream. Macrophages are considered to play an important role in host protection during the early stage of systemic trypanosome infections. Macrophages are abundant in the skin dermis, but relatively little is known of their impact on susceptibility to intradermal (ID) trypanosome infections. We show that although dermal injection of colony stimulating factor 1 (CSF1) increased the local abundance of macrophages in the skin, this did not affect susceptibility to ID T. brucei infection. However, bacterial LPS-stimulation in the dermis prior to ID trypanosome infection significantly reduced disease susceptibility. In vitro assays showed that LPS-stimulated macrophage-like RAW264.7 cells had enhanced cytotoxicity towards T. brucei, implying that dermal LPS-treatment may similarly enhance the ability of dermal macrophages to eliminate ID injected T. brucei parasites in the skin. A thorough understanding of the factors that reduce susceptibility to ID injected T. brucei infections may lead to the development of novel strategies to help reduce the transmission of African trypanosomes.

Filler in the foot: treatment of plantar fat pad atrophy with dermal fillers

A significant number of patients presenting to an aesthetics practice for anti-ageing treatments also have metatarsalgia secondary to age-related planter fat pad atrophy. Injections of dermal filler into the plantar fat pads has been shown to relieve foot pain and revolumise the plantar fat pads, leading to an improved quality of life for patients. Aesthetic practitioners, with their knowledge of dermal fillers and injection skills, are ideally situated to help these patients. This article reviews the relationship between metatarsalgia and plantar fat pad atrophy and the history dermal filler injections to the plantar fat pads. Types of dermal fillers suited for plantar implantation, technique for injections and possible adverse events are also reviewed.

Rejuvenation of Aged Human Skin by Injection of Cross-linked Hyaluronic Acid.

Dermal injection of chemically cross-linked hyaluronic acid (CL-HA) is a common procedure to smooth wrinkles and add fullness to the face. Due to its physical properties, CL-HA both fills space and exerts mechanical forces within the dermis. Dermal fibroblasts produce the collagen-rich extracellular matrix (ECM), which comprises the bulk of skin. Attachment to the ECM allows fibroblasts to achieve a stretched, morphology, which confers a functional phenotype that maintains collagen production. In aged/photoaged skin, collagen fibril fragmentation impairs fibroblast attachment, resulting in a collapsed morphology and reduced collagen production. This article describes investigations of the impact of CL-HA injection on fibroblast morphology and function in the aged/photoaged human skin. Fifty-three subjects, age 70 years or older, received a single injection of saline (vehicle control) and CL-HA (0.5 ml each) in separate adjacent skin sites on photodamaged forearm or sun-protected buttock skin. Full-thickness punch biopsies were obtained from injected skin sites at various times and analyzed for molecular and cellular changes. Injected CL-HA forms discreet pockets that localize to areas of the dermis that contain fragmented, loosely organized collagen fibrils. These CL-HA pockets fill space and apply mechanical forces on adjacent ECM that induce stretching of fibroblasts. This stretching is associated with increased collagen gene expression and deposition of mature collagen fibril bundles, which resemble those observed in young skin. CL-HA injected into aged/photoaged human dermis acts by both filling space and inducing production of collagen by dermal fibroblasts. Deposition of mature collagen, which remains in the skin for decades, likely confers long-term benefits. Reduced collagen production in aged/photoaged skin is an adaptive response of fibroblasts to ECM fragmentation, rather than inherent cellular aging mechanisms.

Scoping review of polycyclic aromatic hydrocarbons (PAH) human and experimental animal cancer studies

Background: The carcinogenicity of some PAHs has not been evaluated. To gauge feasibility of a potential systematic review of PAH cancer hazard, we conducted a scoping review on PAH cancer studies.Methods: We searched PubMed for human cancer studies and mapped them by exposure source and cancer type. For animal studies, we searched three databases for PAHs in general and 35 specific PAHs, excluding PAH listed in the Report on Carcinogens; studies were mapped by PAH, exposure route, and cancer sites.Results: Human cancer studies assessed exposure to PAH mixtures or surrogates from (1) the workplace using expert assessment or job exposure matrices, (2) the environment by measuring or modeling indoor or outdoor PAH exposure, or (3) all sources by measuring PAH biomarkers. Occupational studies reported lung and urinary bladder cancers most often, but also head and neck, pancreas, and other cancers. Environmental studies reported breast cancer, childhood leukemia, and others. Biomonitoring studies using PAH urinary biomarkers reported lung and breast cancers. Biomonitoring studies using PAH adducts, some including gene-environment interaction, reported lung, breast, and liver cancers.We selected animal studies using physiologically relevant exposures (oral, dermal, inhalation, intratracheal instillation, or IP injection). Laboratory animals were tested with individual PAHs. Most were mouse studies with dermal applications, and many reported skin cancer. The similar study of different PAHs could facilitate PAH comparisons. IP studies in mice reported lung and liver cancer. Anthracene, benzo[ghi]perylene, chrysene, cyclopenta[cd]pyrene, fluoranthene, and pyrene had increased cancer at two or more sites. Anthracene, chrysene, and benzo[c]fluorene has increased cancer via two exposure routes. No cancer sites were reported from the three rat studies with relevant exposures.Discussion: Both human and animal cancer literature are sufficient for systematic review of PAH cancer hazard. Integrating human cancer evidence across exposure scenarios will inform future assessments.

Myeloid Adherent Cells Are Involved in Hair Loss in the Alopecia Areata Mouse Model.

Alopecia areata (AA), which is defined as an autoimmune hair loss disease, has a serious impact on the quality of life for patients with AA worldwide. In this study, to our knowledge, a previously unreported method of AA induction in C3H mice has been established and validated. Using this method, we showed that dermal injection of 1-3 million of a mixture of skin cells freshly isolated from AA-affected skin induces AA in more than 80% of healthy mice. Contrary to the previous protocol, the induction of AA by this approach does not need any surgical AA skin grafting, cell manipulation, or high number of activated T cells. We also showed that dermal injection of adherent myeloid cells (mainly CD11b+) in healthy mice is as potent as a mixture of none adherent CD3+ T cells and CD19+ B cells in the induction of AA. Interestingly, most of the mice (7 out of 8) that received non-adherent cells developed AA universalis, whereas most of the mice (5 out of 7) that received adherent cells developed patchy AA. Finally, we found a high number of stage-specific embryonic antigen-expressing cells whose expression in monocytes in an inflammatory disease causes the release of inflammatory cytokines, TNF-α and IL-1β, from these cells in AA-affected skin.