Histological and ultrastructural changes of human skin and subcutaneous layer after use of stromal vascular fraction-enriched fat and adipose-derived stem cells: Anti-aging treatment

La propriet\ue0 rigenerativa dell innesto di grasso \ue8 stata descritta nella leteratura medica. Tuttavia, non \ue8 chiaro se i risultati clinici sono attribuibili alle cellule staminali o sono collegati ad altri componenti del tessuto adiposo. Questo lavoro si propone di analizzare i cambiamenti istologici e ultrastrutturali della cute e del tessuto sottocutaneo del viso invecchiati, dopo iniezione di innesto adiposo in aggiunta alla sua frazione vasculo-stromale (grasso arricchito con la FVS), ottenuto per centrifugazione, e di confrontare i risultati con quelli ottenuti con iniezione di cellule staminali mesenchimali espanse derivate da tessuto adiposo. Questo studio \ue8 stato condotto in venti (20) pazienti consecutivi, candidati per ritidectomia, di et\ue0 compresa tra i 45 e 65 anni. I pazienti sono stati sottoposti a prelievo di grasso mediante liposuzione dalla regione addominale. L'iniezione di grasso e la sua frazione vasculo-stromale o delle cellule staminali mesenchimali espanse \ue8 stata eseguito nelle zone preauricolari. Frammenti di pelle sono stati rimossi prima e 3 mesi dopo ogni trattamento e analizzati mediante microscopia ottica ed elettronica.Dopo il trattamento con il grasso arricchito con sua frazione vasculo-stromale, la cute ha mostrato una diminuzione della rete di fibre elastiche invechiate interessate da elastosi e la comparsa di nuove fibre elastiche oxytalan nel derma papillare. L'esame ultrastrutturale evidenzia un'architettura tridimensionale modificata del derma reticolare e la presenza di un letto microvascolare pi\uf9 ricco. Sono stati osservati risultati analoghi in seguito al trattamento con cellule staminali mesenchimali espanse.Questo studio dimostra che il trattamento sia con grasso arricchito con la frazione vasculo-stromale che con cellule staminali mesenchimali espanse modifica l\u2019architettura del derma e rappresenta un effetto di ringiovanimento della cute.The regenerative property of fat grafting has been described. However, it is not clear whether the clinical results are attributable to the stem cells or are linked to other components of the adipose tissue. This work is aimed at analysis of the histologic and ultrastructural changes of aged facial skin after injection of fat graft in addition to its stromal vascular fraction (SVF-enriched fat), obtained by centrifugation, and to compare the results with those obtained by the injection of expanded adipose-derived mesenchymal stem cells. This study was performed in twenty (20) consecutive patients who were candidates for face lift and whose ages ranged between 45 and 65 years. The patients underwent sampling of fat by liposuction from the abdominal region. The injection of fat and its stromal vascular fraction or expanded mesenchymal stem cells was performed in the preauricular areas. Skin Fragments were removed before and 3 months after each treatment and analyzed by optical and electron microscopy.After treatment with the autologous lipidic component and stromal vascular fraction (SVF-enriched fat), the skin showed a decrease in elastic fiber network (elastosis) and the appearance of new oxytalan elastic fibers in papillary dermis. The ultrastructural examination showed a modified tridimensional architecture of the reticular dermis and the presence of a richer microvascular bed. Similar results following treatment with expanded mesenchymal stem cells were observed.This study demonstrates that treatment with either fat and stromal vascular fraction (SVF-enriched fat) or expanded mesenchymal stem cells modifies the pattern of the dermis, representing a skin rejuvenation effect

Análise das trocas de implantes mamários nos últimos cinco anos na Clínica Ivo Pitanguy Analysis of implant exchange on the last five years at Ivo Pitanguy Clinic

INTRODUÇÃO: A cirurgia de aumento mamário foi a cirurgia plástica mais realizada no Brasil, em 2008. Com a evolução da técnica e da qualidade dos implantes de silicone, a taxa de complicações tem diminuído progressivamente, tornando a cirurgia mais segura. OBJETIVO: Demonstrar o perfil das pacientes submetidas à troca de implante mamário, nos últimos cinco anos, na Clínica Ivo Pitanguy, analisando as características dos implantes de silicone e as causas que motivaram a troca. MÉTODO: Foram analisadas, retrospectivamente, todas as pacientes submetidas a procedimentos cirúrgicos de troca, retirada ou reinclusão de implantes mamários, nos últimos cinco anos, num total de 59 pacientes em 68 procedimentos e 129 mamas operadas. RESULTADOS: O intervalo de tempo entre a colocação e a retirada dos implantes variou de 1 mês a 34 anos; 44 pacientes eram provenientes do nosso serviço e 24 de outros. Quarenta e três implantes eram, antes da troca, de poliuretano, 13 texturizados e seis lisos. O grande motivo de troca foi estético, com 50 casos, seguido por contratura capsular em 13 casos, e cinco casos de infecção, ruptura ou nódulo mamário. CONCLUSÃO: O principal motivo de troca de implantes foi estético, diferentemente da literatura. Os índices de contratura capsular e de infecção da loja do implante do presente estudo foram comparáveis aos apresentados em vários outros estudos.BACKGROUND: The breast augmentation surgery was the most performed in Brazil in 2008. With the evolution of the technique and the quality of the implants, complications have diminished, leading to a more secure procedure. OBJECTIVE: To assess the profile of patients submitted to implant exchange in the last five years at Ivo Pitanguy Clinic, analyzing the causes that led to implant removal. METHODS: We have analyzed all patients submitted to exchange, removal or replacement of mammary implants in the last five years, at a total of 59 patients, 68 procedures and 129 breasts operated. RESULTS: The time interval from the inclusion to the removal of the implants ranged from one month to 34 years; 44 patients have first operated at our service and 24 at other services. Forty three implants were, before the exchange, made of polyurethane, 13 texturized and six smooth. The major cause of the exchange was esthetic, with 50 cases, followed by capsular contracture, 13 cases and five cases of infection, rupture or breast nodule. CONCLUSION: The major reason of implants exchange was esthetic, differing from the literature. The capsular contracture and infection rates, at this study, were comparable to several others

Effect of use of Platelet-Rich Plasma (PRP) in skin with intrinsic aging process

Background: In previous papers, we demonstrated that the treatment of human photoaged skin with stromal-vascular fraction-enriched fat or expanded adipose-derived stem cells showed a decrease of elastosis and the appearance of new oxytalan elastic fibers in dermis and an increase in the vascular network. The utilization of fat plus platelet-rich plasma (PRP) led to an increase in the vascular permeability and reactivity of the nervous component. Objectives: The purpose of this study was to analyze the histologic and ultrastructural changes of human skin after the injection of only PRP in the retroauricular area that was not exposed to sun and did not present the photoaging process, in comparison with our previous results. Methods: This study was performed in 13 patients who were candidates for facelift and whose ages ranged between 45 and 65 years. The PRP injection was performed in the mastoidea area. Fragments of skin were removed before and 3 months after treatment and analyzed by optical and electron microscopy. Results: After the injection of PRP, we observed an increase of reticular dermis thickness because of the deposition of elastic fibers and collagen, with a fibrotic aspect. A modified pattern of adipose tissue was also found at the dermohypodermal junction. Significative regenerative aspects were not found at histologic and ultrastructural analysis. The presence of foci of moderate inflammation and microangiopathy were observed. Conclusions: Treatment with PRP increased reticular dermis thickness with a fibrotic aspect. In the long term, the presence of inflammation and microangiopathy caused by PRP injection could lead to trophic alteration of the skin and the precocious aging process

Expanded stem cells, stromal-vascular fraction, and platelet-rich plasma enriched fat: comparing results of different facial rejuvenation approaches in a clinical trial

BACKGROUND: In a previous study, the authors demonstrated that treatment with expanded adipose-derived stem cells or stromal vascular fraction (SVF)-enriched fat modify the pattern of the dermis in human beings, representing a skin rejuvenation effect. Considering that expanded stem cells require a cell factor, the authors wanted to assess similar results by replacing them with platelet-rich plasma (PRP), which is easier to obtain and for which an empirical regenerative effect has been already described.OBJECTIVES: To determine if PRP injection could replace the cutaneous regenerative effect of adipose-derived stem cells.METHODS: This study was performed in 13 patients who were candidates for facelift. The patients underwent sampling of fat by liposuction from the abdomen and submitted to one of three protocols: injection of SVF-enriched fat or expanded adipose-derived stem cells or fat plus PRP in the preauricular areas. Fragments of skin were removed before and 3 months after treatment and analyzed by optical and electron microscopy.RESULTS: The use of fat plus PRP led to the presence of more pronounced inflammatory infiltrates and a greater vascular reactivity, increasing in vascular permeability and a certain reactivity of the nervous component. The addition of PRP did not improve the regenerative effect.CONCLUSION: The use of PRP did not have significant advantages in skin rejuvenation over the use of expanded adipose-derived stem cells or SVF-enriched fat. The effect of increased vascular reactivity may be useful in pathological situations in which an intense angiogenesis is desirable, such as tissular ischemia. LEVEL OF EVIDENCE 4: Therapeutic

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation