Tissue Stromal Vascular Fraction Improves Early Scar Healing:A Prospective Randomized Multicenter Clinical Trial

Background Wound healing and scar formation depends on a plethora of factors. Given the impact of abnormal scar formation, interventions aimed to improve scar formation would be most advantageous. The tissue stromal vascular fraction (tSVF) of adipose tissue is composed of a heterogenous mixture of cells embedded in extracellular matrix. It contains growth factors and cytokines involved in wound-healing processes, eg, parenchymal proliferation, inflammation, angiogenesis, and matrix remodeling.Objectives The aim of this study was to investigate the hypothesis that tSVF reduces postsurgical scar formation.Methods This prospective, double-blind, placebo-controlled, randomized trial was conducted between 2016 and 2020. Forty mammoplasty patients were enrolled and followed for 1 year. At the end of the mammoplasty procedure, all patients received tSVF in the lateral 5 cm of the horizontal scar of 1 breast and a placebo injection in the contralateral breast to serve as an intrapatient control. Primary outcome was scar quality measure by the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes were obtained from photographic evaluation and histologic analysis of scar tissue samples.Results Thirty-four of 40 patients completed follow-up. At 6 months postoperation, injection of tSVF had significantly improved postoperative scar appearance as assessed by the POSAS questionnaire. No difference was observed at 12 months postoperation. No improvement was seen based on the evaluation of photographs and histologic analysis of postoperative scars between both groups.Conclusions Injection of tSVF resulted in improved wound healing and reduced scar formation at 6 months postoperation, without any noticeable advantageous effects seen at 12 months.</p

Locally acquired hepatitis E in the Netherlands:associated with the consumption of raw pig meat?

We here present 2 patients who developed hepatitis E, without having been abroad or in contact with anyone who did, indicating locally acquired hepatitis E. We point out that the consumption of raw pig meat could be of relevance in HEV-associated hepatitides in the Netherlands

Complete Pseudoepiphyses With Associated Enhanced Growth in Hands and Feet:A Report of 2 Siblings-Case Report

We present 2 siblings with multiple complete pseudoepiphyses in their hands and feet with associated symptomatic enhanced growth. Physical examination of the 6-year-old boy revealed long slender fingers and hyperplastic great toes. Radiography showed complete pseudoepiphyses in the first metacarpals, proximal and middle phalanges of the hands, and proximal phalanges of the feet. The patient's younger brother had a similar phenotype with slightly milder functional complaints. Genetic analysis did not reveal an underlying syndrome in these siblings. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved

Adamalysins in biology and disease

ADAMs (a disintegrin and metalloprotease) are membrane-bound enzymes, capable of shedding a multitude of proteins from the surface of the cell. They are therefore considered crucial modulators of physiological and pathophysiological processes. The structure and function of ADAMs is related to those of a family of snake venom metalloproteases which also possess a potential adhesion domain as well as a potential protease domain. Mammalian ADAMs are involved in various biological and disease-related processes, such as cell-cell fusion, adhesion and intracellular signalling. Functional involvement has been described in sperm-egg binding and fusion, trophoblast invasion and matrix degradation during pregnancy, angiogenesis and neovascularization. Clinically, ADAMs are implicated in pathological processes, including cancer, inflammation, neurodegeneration and fibrosis, through shedding of the apoptosis-inducing FAS ligand, cytokines and growth factors. A second group of proteins within the ADAM family has recently been discovered. These contain several thrombospondin-like repeats in their C-terminal regions, in the absence of the transmembrane domain known to be present in ADAMs. These proteins were called the ADAMTS (ADAM with thrombospondin domains) family. The relevance of ADAMTS enzymes has become evident in patients with a deficiency in ADAMTS-13, a von Willebrand factor cleaving protease. These patients develop thrombotic thrombocytopenic purpura, a devastating thrombotic disorder caused by widespread microvascular thrombi composed of platelets and von Willebrand factor (VWF). Here we focus on the genetic, developmental, functional and disease-related aspects of ADAMs and ADAMTS. Finally we discuss the perspectives of the therapeutical potential of ADAMs in disease

The Effect of Eyelid Cooling on Pain, Edema, Erythema, and Hematoma after Upper Blepharoplasty:A Randomized, Controlled, Observer-Blinded Evaluation Study

Background: The purpose of this study was to investigate the efficacy of eyelid cooling to reduce postoperative pain, edema, erythema, and hematoma after upper blepharoplasty. Methods: After bilateral upper blepharoplasty in 38 consecutive patients, one eyelid per patient was randomized for cooling with an ice pack, and the other eyelid was left uncooled. Pain was scored by the patients using a visual analogue scale (0 to 10) 1 hour and 1 day after surgery. Degree of edema, erythema, and hematoma were scored by the patients on a four-point rating scale (no, minimal, moderate, or severe) 1 hour, 1 day, 1 week, and 2 months after surgery. Light photography was obtained 1 week after surgery for scoring the degree of bruising on a four-point rating scale by a blinded observer. Results: Pain did not differ between cooled and uncooled eyelids on the day of surgery. However, pain in cooled eyelids was significantly lower 1 day after surgery (p = 0.046), yet absolute pain scores were low (median, 0 and 0.5, on a scale of 10). Edema, erythema, or hematoma did not differ between cooled and uncooled eyelids on any of the time points studied. Conclusions: Cooling of eyelids after upper blepharoplasty does not reduce edema, erythema, or hematoma of the eyelids, but reduces pain 1 day after surgery. However, because the degree of pain seems clinically irrelevant and because the majority of patients indicate that they have no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty as a rule of thumb can be abandoned