Scar Morphology Research Articles

Using a Zipper Device to Minimize Scarring After Excision of Facial Nevi in Pediatric Patients.

This study aims to investigate the safety and effectiveness of using a zipper device to minimize scarring after facial nevi excision in pediatric patients. A total of 48 patients were included, with 23 in the control group and 25 in the zipper group. The zipper device was used immediately to equalize skin tension after facial nevi excision. The primary outcome was the scar width measured at 1, 3, 6, and 12 months postoperatively. The Vancouver Scar Scale (VSS) was used to assess patients' scars at postoperative 12 months as a secondary outcome. Two patients in the zipper group withdrew from the trial due to skin irritation. The symptom disappeared within a week after the zipper device was removed. The scar width in the zipper group was smaller than that in the control group at postoperative 1, 3, 6, and 12 months. In addition, the VSS scores for scarring also showed that patients in the zipper group had significantly better scar scores than those in the control group. At postoperative 6 months, scar morphology was essentially similar to that at post 12 months in both groups, and there was a significant positive correlation between scar morphology at the 2 time points. It is safe and effective to use this zipper device to minimize scarring after excision of facial nevi in pediatric patients, and we think it be a complementary therapeutic measure in pediatric patients after facial nevus excision. II.

Achieving ultra-low wear of Ti6Al4V alloy by introducing a sinusoidal nitriding layer via nanosecond pulsed laser irradiation

Introducing wear-resistant layers or constructing microtextures is normally employed to improve the wear resistance of materials. However, single role of the wear-resistant layer or microtexture still could not effectively address the wear issue of titanium alloys. In this study, a sinusoidal nitriding layer is directly fabricated on the Ti6Al4V surface by one-step laser irradiation. Chemical composition and microstructure analysis indicate that the nitriding layer contains TiN and α-Ti phases, and it is metallurgically bonded to the heat-affected zone. Friction wear tests show a 96.9 % reduction in wear rate with dry sliding and 99.6 % with oil lubrication, without exhibiting groove orientation dependence. The wear mechanism is discussed by scrutinizing the morphology of the wear scars and their corresponding cross-sections.

Lubricating properties of thymol-based deep eutectic solvents

PurposeThis study aims to prepare thymol-based deep eutectic solvents (DESs) and use them as lubricates for friction and wear tests to simulate the wear conditions of hybrid bearings.Design/methodology/approachThrough the characterization and analysis of the morphology of wear scars and the elemental composition of friction films, the tribological behavior and wear mechanism of sample materials as lubricants were investigated and the anti-wear mechanism of thymol-based DESs was discussed.FindingsThe findings demonstrate that because of the formation of a fluid lubrication film and excellent kinematic viscosity, the lubrication effect of the prepared DES is improved by about 50% compared to the base lubricating oil. The prepared [Ch]Cl-thymol DES has a better anti-friction and lubrication effect than citric-thymol, EG-thymol and urea-thymol DESs, with an average friction coefficient of about 0.04.Originality/valueIn this work, the friction reduction properties of thymol-based DESs were studied as lubricants for the first time, and the lubrication mechanism of sample materials was investigated.

Mesoscopic characteristics, microstructure evolution, friction mechanisms, and corrosion behavior of Ni60-SiCp coatings fabricated by laser-based directed energy deposition

The influence of varying SiCp on the mesoscopic characteristics, microstructural evolution, microhardness, frictional mechanisms, and corrosion resistance behavior of laser-based directed energy deposition Ni60-SiCp composite coatings was investigated. Coatings reinforced with varying SiCp, the innovative concept of the ''Temperature-SiCp joint effect'' mechanism was proposed. The microstructure was progressively refined due to the SiCp, while microhardness was affected by the solid solution strengthening and diffusion strengthening effects of high SiCp. Furthermore, based on wear scar morphologies, wear scar EDS analysis, and wear mechanism modeling, the frictional mechanisms were elucidated. Simultaneously, a clear understanding of the relationship between SiCp and corrosion behavior were established. It is evident that the analysis of SiCp reinforcement content in composite holds significant guiding significance.

Tribological and Chemical–Physical Behavior of a Novel Palm Grease Blended with Zinc Oxide and Reduced Graphene Oxide Nano-Additives

The role of industrial lubricants in machinery is to reduce friction and wear between moving components. Due to the United Nations’ tendency to reduce dependency on fossil fuel, a general awareness is strongly driven towards developing more eco-friendly lubricants. Palm oil possesses promising properties, which promote it to be a competitive alternative to the hostile mineral oils. Still, marginal oxidation stability, viscosity, and tribological properties remain critical issues for performance improvement. This paper presents an improved palm grease using reduced graphene oxide (rGO) and zinc oxide (ZnO) nano-additives at different concentrations. Oil and grease samples were tested for viscosity, oxidation stability, pour point, penetration, roll stability, dropping point, churned grease-oil release, copper corrosion, friction, and wear. ZnO additives enhanced the oxidation stability by 60% and shifted the pour point to 6 °C. Adding ZnO and rGO to the palm grease increased the load-carrying capacity between 30% and 60%, respectively, and reduced the friction coefficient by up to 60%. From the wear scar morphologies, it is believed that graphene 2D nanoparticles formed absorption layers which contributed to the increase in load-carrying capacity, while ZnO chemically reacted with the metallic surface layer, forming zinc compounds that resulted in a protective boundary lubricating film.

The Preparation of Crumpled Graphene Oxide Balls and Research in Tribological Properties.

In this study, crumpled graphene oxide balls (CGBs) were prepared via capillary compression using a rapidly evaporating aerosol droplet method. The CGBs were observed using scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HRTEM), and Raman spectroscopy. The size distributions of crumpled particles were obtained using a laser nanometer particle size analyzer (DLS). The dispersibility of the water and the ionic liquid (IL) was tested by ultrasonic dispersion. The tribological properties of water or ionic liquids containing crumpled graphene oxide ball additives (W/IL-CGB) were tested by a reciprocating friction tester and compared with water/ionic liquids with graphene oxide. The morphology of the wear scar was observed by a three-dimensional optical microscope and its lubrication mechanism was analyzed. The results show that the CGBs were successfully prepared by rapid evaporation of aerosol droplets, and the obtained CGBs were crumpled paper spheres. The CGBs had good water dispersion and ionic liquid dispersion, and IL-CGB has excellent anti-friction and anti-wear effects on steel-steel friction pairs. During the friction process, the CGB was adsorbed at the interface of the steel-steel friction pair to form a protective layer, which avoids the direct contact of the friction pair, thereby reducing friction and wear.

Effect of Dicarboxylic Acid Chain Length on the Tribological Properties of Aqueous Polyether Esters

ABSTRACTThis article presents the preparation of environmentally friendly water‐soluble lubricant additives. Adipic acid (AA), sebacic acid (SA) and dodecanedioic acid (DA) were individually subjected to esterification reactions with polyethylene glycol 1500 (PEG1500) to prepare a class of water‐soluble polyether esters (AAPEE1500, SAPEE1500 and DAPEE1500) (referred to as XAPEE1500s) that exhibit excellent water solubility and do not contain environmentally harmful elements. First, the molecular structure characterisation and functional group analysis of these additives will be conducted using an infrared spectrometer and a nuclear magnetic resonance spectrometer. Subsequently, the frictional properties of the additives in the base liquid (deionised water) will be investigated using an SRV‐V tribometer, Falex pin‐on‐disc tribometer and screw torque tester. The surface morphology of wear scars will be characterised and analysed using scanning electron microscopy (SEM) and a non‐contact 3D profilometer. Finally, the lubrication mechanism of the DAPEE1500 additive will be analysed using X‐ray photoelectron spectroscopy (XPS). The results indicate that the optimal lubrication performance is achieved when the added mass fraction of DAPEE1500 is at 3%. Compared with 0.5 wt% DAPEE1500, the average friction coefficient of 3 wt% DAPEE1500 decreased from 0.285 to 0.122, and the wear volume decreased from 25.52 × 10−5 μm3 to 10.96 × 10−5 μm3. The lubrication mechanism of polyether ester is the result of the combined action of its polar ester functional groups and long carboxylic acid chains in the structure. These polar functional groups can form a relatively firm adsorption film on the friction surface, while the long carboxylic acid chains act as a brush‐like isolating layer, thus demonstrating superior anti‐wear and anti‐friction performance.

Study on the tribological characteristics of surface triangular textured TC4 alloy prepared by SLM technology

Surface Triangular Textured TC4 Alloy specimens were prepared by 3D printing technology (SLM technology: selective laser fusion). Effects of wedge-shaped triangular textures with different texture area occupancy on hardness, friction and wear of the 3D printed TC4 alloy specimens were studied, in comparison with non- textured specimens. SFT -2 M pin-disc friction and wear testing machine was used to perform friction and wear experiments under 46 # mechanical oil lubrication conditions, and MH-500 Vickers hardness tester was used to measure hardness of the specimens. Scanning electron microscope (SEM), energy spectrometer (EDS), and electronic balance instrument were used to characterize the wear scar morphology, element content, wear amount, etc. of the specimens. Using the Fluent module in ANSYS Workbench software, we studied the mechanism for the reduction in the friction coefficient between friction pairs during the relative movement in lubricating oil. Results of the study show that the hardness of the 3D printing specimen is significantly greater than that of the non- textured one. In each group of experiments, the wedge triangular textured specimens showed better tribological properties, and the 3D printed specimen with an area occupancy of 22. 53 % exhibited the smallest average friction coefficient (0.17) and higher wear resistance than other specimens. The dynamic pressure effect due to the wedge triangle texture inside the lubricating oil film is the main reason for the reduced friction coefficient between the friction pairs.

Ventricular arrhythmia inducibility in porcine infarct model after stereotactic body radiation therapy

BackgroundVentricular arrhythmia (VA) is the primary mechanism of sudden death in patients with structural heart disease. Cardiac stereotactic body radiation therapy (SBRT) delivered to the scar in the left ventricle significantly reduces the burden of VA. ObjectiveThe goal of this study was to investigate the impact of SBRT on scar morphology and VA inducibility in a porcine infarct model. MethodsMyocardial infarction (MI) was created in 10 Yorkshire pigs involving the left anterior descending artery territory. Cardiac positron emission tomography and computed tomography were performed for targeted SBRT. Alternative pigs received SBRT at 25 Gy in a single fraction. The terminal experiment included endocardial mapping, programmed ventricular stimulation, and tissue harvesting. ResultsOf the 10 pigs infarcted, 2 died prematurely after MI and 8 (4 MI and 4 MI+SBRT) survived. Mean time from MI to SBRT was 48 ± 12 days, and mean time from SBRT to harvest was 32 ± 12 days. Scar was localized on intracardiac mapping in all pigs, and the scar was denser in the MI+SBRT compared with the MI-only group (33% ± 20% vs 14% ± 11%; P = .07). All 4 MI pigs had inducible VA during programmed stimulation, whereas only 1 of 4 pigs had inducible VA in the MI+SBRT arm (100% vs 25%; P = .07). No myocardial fibrosis was seen in the remote areas in either group. ConclusionSBRT reduced VA inducibility in pigs with scarring after MI. Endocardial mapping revealed denser scar in pigs receiving SBRT compared with those that did not, suggesting that SBRT suppresses VA inducibility through better scar homogenization.

Unveiling the language of scars: A patient-centric themed framework for comprehensive scar morphology

BackgroundScarring, a pervasive issue spanning across medical disciplines, lacks a comprehensive terminology for effective communication, patient engagement, and outcome assessment. Existing scar classification systems are constrained by specific pathologies, physician-centric features, and inadequately account for emerging technologies. This study refrains from proposing yet another classification system and instead revisits the foundational language of scar morphology through a theme analysis of primary patient complaints. MethodData encompassing five years of a high-volume scar practice was analysed. Primary complaints were aggregated into collective descriptors and further organized into theme domains. The resulting hierarchical map of presenting complaints revealed five key domains: Loss of Function, Contour, Texture, Vector, and Colour Presenting complaints were codified into 42 items, which were then categorised into 14 collective descriptor terms. The latter were in turn organised into five overarching themes. ResultLoss of Function, accounting for 10% of primary concerns, signifies reduced function attributed solely to the scar. Contour, encompassing 41% of concerns, pertains to scar height, shape, and depth. Texture, representing 12% of concerns, denotes tactile variations such as hardness, roughness, and moisture. Vector, comprising 13% of concerns, refers to scar tissue tension and associated distortions. Colour, the concern in 24% of cases, encompasses variations in pigmentation, vascularity, and exogenous pigments. DiscussionStandardized terminology enhances patient care, communication, and research. This study underscores the fundamental question of "what bothers the patient," reviving a patient-centred approach to scar management. By prioritizing themes based on patient complaints, this study innovatively integrates function, aesthetics, and patient experience. In conclusion, this study pioneers a paradigm shift in scar management by presenting a patient-driven theme framework that offers a common language for healthcare professionals and patients. Embracing this language harmonizes scar treatment, fosters innovation, and transforms scars from silent reminders into stories of resilience and healing.

Nasofacial Groove Pedicled Flap for the Reconstruction of Lateral Alar Defect.

The repair of nasal alar defects is challenging for plastic surgeons, and there is currently no standard operation. Herein, the authors reported the clinical outcomes of a nasofacial groove pedicled flap for the reconstruction of alar defect. This retrospective study included patients who underwent the nasofacial groove pedicled flap for the reconstruction of alar defect between January 2018 and June 2020. Photographs of standard facial postures were taken before and after surgery to record the surgical results of the patients. The patient's medical history was reviewed retrospectively. Self-reported satisfaction of patients on scar morphology and reconstructive effect were evaluated with a questionnaire survey. There were 26 eligible patients enrolled, and all patients were followed up for more than 1 year after surgery. All flaps were free of ischemia and necrosis and healed well. No patient experienced restricted nostril ventilation. Eight patients underwent reoperation to trim the flap pedicle and the scar. Eight patients (8/26) reported "very satisfied," and 17 patients (17/26) reported "satisfied" with the repair effect and scar morphology. One patient went through multiple laser treatments to improve her scars but still remained visible hyperpigmentation. She was dissatisfied with postoperative flap pigmentation but was satisfied with the correction effect. The clinical results indicated that the nasal groove flap was safe for the treatment of the lateral alar defect, and the patients were satisfied with the clinical results. The authors believe that this flap can be used as an alternative method for repairing the lateral alar defect. Level -IV, therapeutic study.

Combination Procedure for Acne Scars Revision, Is It Needed?

Background: The treatment of acne scars is a problem for dermatologist. Varied morphology of acne scars makes the treatment more difficult. Combination technique has high efficacy than monotherapy. The challenge is how to select best combination procedure for scar revision.
 Case presentation: A 43-year-old male present with acne scars since 5 years ago. Dermatological findings revealed atrophic acne scars (ice pick, boxcar, rolling) types on forehead, nose and cheeks. Diagnosis established as moderate atrophic acne scars with global acne scarring system (GASS) is 21. Patient treated with blunt canula subcision, hyaluronic acid (HA) filler, microneedling radiofrequency, 90% trichloroacetic acid chemical reconstruction of skin scars (TCA CROSS) and application of salmon polydeoxyribonucleotide (PDRN). Patient also received topical 0.05% retinoic acid, 4% niacinamide, and sunscreen for daily. After 10 days, there is flattening and disappear of ice pick and boxcar, elevating of rolling scar, GASS score is 15. Blunt cannula subcision and HA filler is safe, effective for rolling scar through fibrous band breaking and prevent re-adhesion. Microneedling RF is effective for boxcar, otherwise 90% TCA CROSS preferrable for ice pick scars. This combination procedure leading cellular necrosis in epidermis, collagen in dermis, and stimulate regeneration. Application of Salmon PDRN may promote wound healing, hydrate the epidermis, and prevent dyschromia.
 Conclusion: Combination of subcision, dermal filler, microneedling radiofrequency, 90% TCA CROSS, and Salmon PDRN has high efficacy for scar revision through collagen remodelling and acceleration wound healing.

Tribocorrosion behavior of TC18 titanium alloy: A discussion about the interaction between galvanic corrosion and wear

Titanium and aluminum couplings are susceptible to both corrosion and wear during their service life. When the passive film on the titanium surface is worn off, the galvanic effect will affect the corrosion-wear interaction, and tribocorrosion mechanism is altered accordingly. A combination of electrochemical techniques (Potentiostatic and Potentiodynamic Polarization), characterization of wear scar morphology (Scanning Electron Microscope, SEM and a 3D profilometer), and analysis of wear debris composition (Surface-Enhanced Raman Spectroscopy, SERS) were employed to clarify the tribocorrosion mechanism. The results show that the wear effect is predominant for the tribocorrosion of TC18 titanium alloy, and the corrosion-induced wear increment mainly comes from the ploughing effect of regenerated passive film. When the titanium alloy is coupled with aluminum, the corrosion acceleration is weak, while the cathodic reaction increases due to the negative shift of the corrosion potential. This results in the regenerated passive film containing a higher proportion of easily sheared low-valent titanium oxides and titanium hydrides, promoting the wear rate.

Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study.

The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.

Inhibition of phosphatidylinositol 3-kinase catalytic subunit alpha by miR-203a-3p reduces hypertrophic scar formation via phosphatidylinositol 3-kinase/AKT/mTOR signaling pathway.

Hypertrophic scar (HS) is a common fibroproliferative skin disease that currently has no truly effective therapy. Given the importance of phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA) in hypertrophic scar formation, the development of therapeutic strategies for endogenous inhibitors against PIK3CA is of great interest. Here, we explored the molecular mechanisms underlying the protective effects of miR-203a-3p (PIK3CA inhibitor) against excessive scar. Bioinformatic analysis, immunohistochemistry, immunofluorescence, miRNA screening and fluorescence in situ hybridization assays were used to identify the possible pathways and target molecules mediating HS formation. A series of in vitro and in vivo experiments were used to clarify the role of PIK3CA and miR-203a-3p in HS. Mechanistically, transcriptomic sequencing, immunoblotting, dual-luciferase assay and rescue experiments were executed. Herein, we found that PIK3CA and the phosphatidylinositol 3-kinase (PI3K)/AKT/mTOR pathway were upregulated in scar tissues and positively correlated with fibrosis. We then identified miR-203a-3p as the most suitable endogenous inhibitor of PIK3CA. miR-203a-3p suppressed the proliferation, migration, collagen synthesis and contractility as well as the transdifferentiation of fibroblasts into myofibroblasts in vitro, and improved the morphology and histology of scars in vivo. Mechanistically, miR-203a-3p attenuated fibrosis by inactivating the PI3K/AKT/mTOR pathway by directly targeting PIK3CA. PIK3CA and the PI3K/AKT/mTOR pathway are actively involved in scar fibrosis and miR-203a-3p might serve as a potential strategy for hypertrophic scar therapy through targeting PIK3CA and inactivating the PI3K/AKT/mTOR pathway.

Fire Rate of Spread and Growth Rate in a Set of 30 Global Wildfires: New Evidence of Extreme Fire Behavior

Wildfire science needs new methods to evaluate and predict wildfire behavior and impacts. In this study, we present a new algorithm that calculates the maximum fire rate of spread resulting from a fire progression map made of isochrones, according to 1) the shape of the isochrones, and/or 2) prevailing atmospheric wind direction. We have applied the algorithm to a set of 30 fires, differentiated according to the way the isochrone map was surveyed: by firefighters’ GPS positioning (in Europe, ~ 1-hour frequency), or by satellite data (North and South America, and Australia, ~ 12-hour frequency). The rate of spread was also related to the growth rate in hectares, and with the morphology of the fire scar. Our results reveal maximum speeds of 8.62 and 6.79 km/h for the GPS and satellite datasets respectively. In general, the GPS dataset shows faster runs that burn smaller extensions than the satellite dataset. Runs following wind direction are more elongated than the ones driven by other factors, which show more expansive runs. The algorithm presented here can be useful for the study of the factors influencing fire propagation.

Influence of Friction Stir Additive Manufacturing Parameters on Dry Friction and Wear Properties of Al-Mg-Si Alloy's Built Surfaces Fabricated by Sheet Lamination

Abstract In this article, friction-stir additive manufacturing, a solid-state process for rapid fabrication of large components, is employed to investigate laminated Al-Mg-Si alloy blocks. The study delves into microstructural changes, hardness distribution, and wear behavior on two distinct surfaces using various parameters such as rotational speed (800 and 1200 rpm), traverse speed (41 and 82 mm/min), and a 50% pin overlap for block fabrication. Macrographs demonstrate the influence of adjacent toolpath overlap on layer integrity through interfacial mixing and consolidation of plastically deformed material. Within the overall stirred zone, re-stirring effects lead to refined grain formation and the dissolution of Mg2Si precipitates, resulting in an uneven micro-hardness distribution due to varying thermal cycles. Notably, specimens with a traverse speed of 41 mm/min exhibit reduced wear loss, attributed to microstructural changes that enhance resistance to plastic deformation during sliding, thereby improving tribolayer stability. This enhancement is attributed to increased hardness arising from refined grains and the strain hardening effect. Interestingly, the study finds that the horizontal surface of the fabricated blocks displays superior wear resistance compared to the vertical surface, due to the more homogeneous microstructure in individual layers. Further analysis using FESEM and EDS unveils the presence of glaze layers, oxide films, galling surfaces, grooving, trimming impacts, ploughing marks, and the accumulation of wear debris within wide pits and on worn-out pin surfaces. Scar morphology reveals that both abrasive and adhesive wear mechanisms contribute to volumetric losses in the specimens.

Morphological characteristics of facial scars: A retrospective analysis according to scar location, onset, age, and cause.

The morphology of facial scars shows a wide variation in terms of texture and colour. To date, there are no reliable predictors of aberrant scarring. We conducted a retrospective analysis to identify factors associated with specific scar features and types. Photographs and medical records of 428 patients with facial scars were retrospectively reviewed. Patients with keloids were excluded. The mean age of the patients was 45.43 ± 23.13 years with a male-to-female ratio of 1:1.36. Atrophic scars were the most common (42.8%), followed by flat scars (38.7%) and hypertrophic scars (18.5%). Scars on the forehead were more likely to be atrophic, whereas scars on the chin/jaw and around the mouth were more likely to be hypertrophic. Hypopigmentation was significantly more common in scars located on the forehead. Redness (erythema) was significantly more common in scars located on the chin/jaw. Old scars were less likely to be erythematous, and hypertrophic. Atrophic scars were more common in younger patients. Scars caused by dermatologic conditions, such as acne, were more likely to be atrophic, whereas surgical scars had the lowest risk of being atrophic or hypertrophic. In conclusion, the location, onset, and cause of facial scars were associated with specific features of scars.

Effect of Mifepristone Preconditioning on Stress Response and Sex Hormone Levels after Combined Laparoscopic Treatment for Cesarean Scar Pregnancy: A Prospective Randomized Trial

Background: This study aimed to explore the effect of mifepristone pretreatment on stress response and sex hormone levels after combined laparoscopic treatment for cesarean scar pregnancy. Methods: We conducted a prospective, randomized, controlled study from January 2020 to September 2022. A total of 98 pregnant women with cesarean scar pregnancy were included and divided into two groups by the random number table method. The control group received hysteroscopy combined with laparoscopy treatment, and the observation group received mifepristone pretreatment before hysteroscopy, combined with laparoscopy treatment. The surgical efficacy, surgical indices, menstrual recovery time, postoperative residual muscle layer, and scar morphology were observed and evaluated. The ovarian hemodynamic indices, stress indices, and sex hormone levels were measured, and the incidence of complications such as postoperative infection and liver function impairment was calculated. Results: There was no significant difference in the surgical success rate between the two groups (97.96% vs 95.92%), as well as the thickness and proportion of residual muscle layer, the width, length, and depth of scars, and the incidence of postoperative complications (p > 0.05). Combined mifepristone pretreatment reduced intraoperative bleeding, shortened the average time for beta human chorionic gonadotropin (β-hCG) to fall to negative (20.5 days, p < 0.05) and vaginal bleeding (19.8 days, p < 0.05), lowered Vmax (49.8 cm/s, p < 0.05), and elevated resistance index (RI) (0.7, p < 0.05) and pulsatility index (PI) (2.5, p < 0.05). Moreover, combined mifepristone pretreatment reduced C-reactive protein (CRP: 8.1 mg/L, p < 0.05), cortisol (COR: 21.7 mg/L, p < 0.05), adrenocorticotropic hormone (ACTH: 40.2 ng/L, p < 0.05), as well as progesterone (P: 10.2 mmol/L, p < 0.05), luteinizing hormone (LH: 13.2 µg/L, p < 0.05), and follicle-stimulating hormone (FSH: 14.8 µg/L, p < 0.05). Combined mifepristone pretreatment promoted the recovery of menstruation (25 days, p < 0.05). Conclusion: Mifepristone pretreatment can promote postoperative recovery, reduce postoperative stress response, improve hemodynamics, regulate sex hormone levels, and promote the early recovery of menstruation in patients with cesarean scar pregnancy. Clinical Trial Registration: The study was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn), registration number: ChiCTR1800015514.

Scar characterisation to predict arrhythmia and death in ischaemic cardiomyopathy: insights from the REVIVED trial

Abstract Background Ischaemic cardiomyopathy continues to have unacceptably high mortality despite contemporary medical and device therapy (1). Ventricular arrhythmias are a leading cause of both death and morbidity in this population. Current guidelines recommend implantable cardioverter defibrillator (ICD) implantation in patients with a left ventricular ejection fraction (LVEF) below 35% but many who meet criteria never receive a therapy and there is a persistent sudden cardiac death risk in those who do not. Scar characteristics are not currently included in risk stratification algorithms, however both volume and entropy, a measure of myocardial heterogeneity, have been linked to arrhythmic risk. Purpose To assess whether left ventricular scar burden and morphology predicts fatal and non-fatal arrhythmia, independent of LVEF in severe ischaemic cardiomyopathy. Methods REVIVED-BCIS2 was a prospective, randomized controlled trial, which recruited 700 patients from 40 centres across the United Kingdom (1). Trial eligibility required the presence of ≥4 dysfunctional but viable myocardial segments; the majority of patients had viability assessed by cardiac magnetic resonance imaging (CMR). Semi-quantitative CMR scar burden was determined through consensus by two CMR experts in a blinded core laboratory. Scar morphology was further characterised by left ventricular entropy measured using novel dedicated software (TexRAD Ltd., Feedback plc, UK). The primary outcome was the composite of all-cause death and aborted sudden death (in turn, defined as appropriate ICD therapy or resuscitated cardiac arrest). Cox proportional hazard models were used to determine the effect of scar burden and entropy on clinical outcomes, adjusted for baseline LVEF, extent of coronary disease, type of implantable device and randomized treatment. Results Four hundred and ninety one patients underwent viability assessment by CMR and 478 were included in this analysis (Figure 1). Mean age was 69 ± 9; median follow up duration was 3.3 [2.3-4.9] years. By the end of trial follow up, 257/478 had a device in situ (CRT-D 99, ICD 147, CRT-P 11). The primary outcome occurred in 182 patients (38.1%). Each 10% increase in scar volume was associated with a 24% increase in the incidence of the primary outcome (adjusted HR per 10% 1.24, 95% CI: 1.11 to 1.39, p = 0.0002)(Figure 2). LVEF at baseline was not predictive (adjusted HR per 5% increase 0.94, 95% CI 0.86 – 1.02, p = 0.13). The relationship between LV entropy and outcomes will be presented at ESC. Conclusions In patients with severe ischaemic cardiomyopathy, scar volume was predictive of death and potentially fatal arrhythmias. Left ventricular ejection fraction was not a significant predictor in this cohort. Scar characteristics should form an integral part of risk stratification.Consort diagramPrimary outcome by scar burden