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BACKGROUND: Ureteral stricture (US) is a pathological stenosis in the urinary tract characterized by increased collagen synthesis and inflammation. Autophagy activation has been shown to ameliorate tissue fibrosis and protect against fibrotic diseases. Verapamil has beneficial therapeutic benefits on fibrotic disorders. The pharmacological effects of verapamil on fibroblast autophagy in US and the underlying mechanism need to be investigated further. METHODS: US patients were recruited to isolate scar tissues, hematoxylin-eosin (HE) and Masson trichrome staining were performed to analyze histopathological changes. The US animal model was established and administered with verapamil (0.05 mg/kg) in the drinking water. Transforming growth factor (TGF)-ß1 was adopted to facilitate collagen synthesis in fibroblasts. The mRNA and protein expressions were examined by qRT-PCR, western blot, immunofluorescence and immunohistochemistry. ELISA was adopted to measure interleukin (IL)-1ß and IL-6 levels. Molecular interaction experiments like dual luciferase reporter and chromatin immunoprecipitation (ChIP) assays were performed to analyze the interaction between signal transducers and activators of transcription 3 (STAT3) and RNA polymerase II associated factor 1 (PAF1). RESULTS: Herein, our results revealed that verapamil activated TGF-ß1-treated fibroblast autophagy and inhibited inflammation and fibrosis by repressing Ca2+/calmodulin-dependent protein kinase II (CaMK II) δ-mediated STAT3 activation. Our following tests revealed that STAT3 activated PAF1 transcription. PAF1 upregulation abrogated the regulatory effect of verapamil on fibroblast autophagy and fibrosis during US progression. Finally, verapamil mitigated US in vivo by activating fibroblast autophagy. CONCLUSION: Taken together, verapamil activated TGF-ß1-treated fibroblast autophagy and inhibited fibrosis by repressing the CaMK IIδ/STAT3/PAF1 axis.
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Autofagia , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina , Fibroblastos , Fibrosis , Factor de Transcripción STAT3 , Factor de Crecimiento Transformador beta1 , Obstrucción Ureteral , Verapamilo , Verapamilo/farmacología , Verapamilo/uso terapéutico , Autofagia/efectos de los fármacos , Animales , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina/metabolismo , Obstrucción Ureteral/tratamiento farmacológico , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/metabolismo , Factor de Transcripción STAT3/metabolismo , Humanos , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Masculino , Factor de Crecimiento Transformador beta1/metabolismo , Cicatriz/patología , Cicatriz/metabolismo , Cicatriz/tratamiento farmacológico , Cicatriz/etiología , Cicatriz/prevención & control , Modelos Animales de Enfermedad , Inflamación/metabolismo , Transducción de Señal/efectos de los fármacos , Femenino , Persona de Mediana EdadRESUMEN
BACKGROUND: Botulinum toxin A (BoNT-A) treatment has many uses in dermatology. Its mechanism of action and long-term effects for scar formation, rosacea, and antiaging are still being investigated. OBJECTIVE: To conduct a literature review on BoNT-A to further investigate its use in scar formation, rosacea, and antiaging. METHODS: A literature review was conducted using PubMed on botulinum toxin treatment for scar formation, rosacea, and antiaging. Studies discussing the toxin mechanism of action and treatment algorithm were included. The authors also provided their personal experience in BoNT-A use for these 3 conditions. RESULTS: The mechanism of action of Botulinum toxin A in improving scar formation, rosacea, and antiaging is now better understood. While it is effective in the short term, little is still known about how frequently treatment needs to be repeated and if there are any long-term effects. CONCLUSION: While in vitro studies have supporting evidence on the mechanism of action of BoNT-A on scar formation, rosacea, and antiaging, further studies are needed to identify long-term treatment effects.
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Toxinas Botulínicas Tipo A , Cicatriz , Queloide , Rosácea , Envejecimiento de la Piel , Humanos , Rosácea/tratamiento farmacológico , Queloide/tratamiento farmacológico , Queloide/prevención & control , Cicatriz/prevención & control , Cicatriz/tratamiento farmacológico , Cicatriz/etiología , Toxinas Botulínicas Tipo A/administración & dosificación , Envejecimiento de la Piel/efectos de los fármacos , Neurotransmisores/uso terapéutico , Neurotransmisores/farmacologíaRESUMEN
Skin scar formation following Bacille Calmette-Guérin (BCG) or smallpox (Vaccinia) vaccination is an established marker of successful vaccination and 'vaccine take'. Potent pathogen-specific (tuberculosis; smallpox) and pathogen-agnostic (protection from diseases unrelated to the intentionally targeted pathogen) effects of BCG and smallpox vaccines hold significant translational potential. Yet despite their use for centuries, how scar formation occurs and how local skin-based events relate to systemic effects that allow these two vaccines to deliver powerful health promoting effects has not yet been determined. We review here what is known about the events occurring in the skin and place this knowledge in the context of the overall impact of these two vaccines on human health with a particular focus on maternal-child health.
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Vacuna BCG , Cicatriz , Piel , Vacuna contra Viruela , Vacunación , Animales , Humanos , Vacuna BCG/administración & dosificación , Vacuna BCG/inmunología , Cicatriz/etiología , Cicatriz/patología , Cicatriz/inmunología , Piel/patología , Piel/inmunología , Viruela/prevención & control , Viruela/inmunología , Vacuna contra Viruela/administración & dosificación , Vacuna contra Viruela/inmunologíaRESUMEN
BACKGROUND: The inflammatory response and scar formation after spinal cord injury (SCI) limit nerve regeneration and functional recovery. Our research group has previously shown that the expression of astrocyte-derived lipocalin 2 (Lcn2) is upregulated after SCI, which correlates with neuronal apoptosis and functional recovery. Therefore, we speculate that astrocyte-specific knockdown of Lcn2 after SCI may lead to a better prognosis. METHODS: Tissue RNA sequencing, Western blotting, PCR, and immunofluorescence assays were conducted to assess the expression of Lcn2 following SCI in mice. Adeno-associated virus 9 (AAV9) transfection was employed to specifically reduce the expression of Lcn2 in astrocytes, and subsequent evaluations of scarring and inflammation were conducted. In vitro experiments involved treating primary astrocytes with TGF-ß or an A1-induced mixture (C1q, TNF-α and IL-1α) following Lcn2 knockdown. Finally, the intrathecal injection of recombinant Lcn2 (ReLcn2) protein was conducted post-injury to further confirm the role of Lcn2 and its underlying mechanism in SCI. RESULTS: Lcn2 expression was elevated in astrocytes after SCI at 7 dpi (days post injury). Lcn2 knockdown in astrocytes is beneficial for neuronal survival and functional recovery after SCI, and is accompanied by a reduced inflammatory response and inhibited scar formation. The inhibition of SMAD-associated signaling activation was identified as a possible mechanism, and in vitro experiments further confirmed this finding. ReLcn2 further activated SMAD-associated signaling and aggravated motor function after SCI. CONCLUSION: The upregulation of Lcn2 expression in astrocytes is involved in neuroinflammation and scar formation after SCI, and the activation of SMAD-associated signaling is one of the underlying mechanisms.
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Astrocitos , Cicatriz , Lipocalina 2 , Ratones Endogámicos C57BL , Proteínas Smad , Traumatismos de la Médula Espinal , Animales , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/patología , Traumatismos de la Médula Espinal/genética , Lipocalina 2/genética , Lipocalina 2/metabolismo , Ratones , Astrocitos/metabolismo , Cicatriz/etiología , Cicatriz/patología , Cicatriz/metabolismo , Proteínas Smad/metabolismo , Inflamación/metabolismo , Inflamación/patología , Inflamación/etiología , Masculino , Enfermedades Neuroinflamatorias/etiología , Femenino , Recuperación de la Función/fisiología , Células CultivadasAsunto(s)
Resección Endoscópica de la Mucosa , Neoplasias Gástricas , Humanos , Resección Endoscópica de la Mucosa/métodos , Resección Endoscópica de la Mucosa/instrumentación , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/complicaciones , Cicatriz/etiología , Cicatriz/cirugía , Antro Pilórico/cirugía , Masculino , Femenino , Persona de Mediana Edad , Anciano , Mucosa Gástrica/cirugía , Mucosa Gástrica/patología , Gastroscopía/métodosRESUMEN
One of the biggest neurophysiological science news headlines of the 2024 summer reported a critical link between post-traumatic stress disorder (PTSD), suicide, and brain injury from blast events in members of the elite US fighting force, Navy SEALS. Researchers from the Department of Defense/Uniformed Services University Brain Tissue Repository (DOD/USU BTR) had discovered a border of neural damage between the layers of white and gray matter comprising the cortical folds of service members' brains. Described as a distinctive anatomical line of astroglial scarring along the shared junctions of gray and white cellular zones of the brain, this tissue injury was unlike that observed for concussive brain trauma. Rather, it was consistent with blast biophysics of mammalian tissues. In this new study, the damage appears to be correlated with long-term, repeated exposure to blast waves from nearby explosions or firing weapons. A cascade of progressive unexplained behaviors, cognitive decline, and severe depression in the trained fighters ensued. This analysis suggested that repetitive, impulsive pressure waves traveling through the service members' heads and brains with each blast had compromised their cognitive centers, setting a downward trajectory in their mental and physical health.
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Traumatismos por Explosión , Lesiones Traumáticas del Encéfalo , Sustancia Gris , Personal Militar , Trastornos por Estrés Postraumático , Suicidio , Animales , Humanos , Traumatismos por Explosión/complicaciones , Traumatismos por Explosión/etiología , Traumatismos por Explosión/patología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/etiología , Explosiones , Sustancia Gris/lesiones , Sustancia Gris/patología , Trastornos por Estrés Postraumático/etiología , Cicatriz/etiología , Cicatriz/patologíaRESUMEN
Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars.
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Acné Vulgar , Cicatriz , Microscopía Confocal , Piel , Tomografía de Coherencia Óptica , Acné Vulgar/diagnóstico por imagen , Acné Vulgar/complicaciones , Humanos , Cicatriz/diagnóstico por imagen , Cicatriz/etiología , Cicatriz/diagnóstico , Tomografía de Coherencia Óptica/métodos , Microscopía Confocal/métodos , Piel/diagnóstico por imagen , Piel/patología , Índice de Severidad de la Enfermedad , Dermoscopía/métodos , Ultrasonografía/métodosRESUMEN
BACKGROUND: In treating post-traumatic scars, this study compared the safety and effectiveness of combined subcision with saline and microneedling versus combined subcision with platelet-rich plasma and microneedling. Combined subcision with saline and microneedling or combined subcision with platelet-rich plasma and microneedling were used to treat 36 consecutive individuals with post-traumatic scarring. The Modified Manchester score was used to assess texture change, pigmentation, and surface distortion changes. Each change was given a score between 1 and 4. A lower score (range: 3-12) indicates a better result. The mean of the three individual scores was determined. For best outcomes, each patient needed four treatment sessions for each scar, with a one-month follow-up period following the final treatment. The three variables in group B had mean scores of 1.4 ± 0.5, 2 ± 0.8, and 2.2 ± 0.9, respectively, for texture change, pigmentation, and surface distortion. With a mean score of 1.4 ± 0.5, texture change had the best response out of the three variables we evaluated. The investigator determined that the mean improvement score for patients in group B's overall appearance was 5.61 ± 1.19. The study has shown that the combination of subcision with platelet-rich plasma, and microneedling appears to be a promising treatment for posttraumatic scars due to its low risk and high efficacy. Our findings suggest that this is a safe method for treating posttraumatic scars, with few side effects and a low chance of recurrence. IRB LOCAL APPROVAL NUMBER: 04-2023-300279. CLINICAL TRIAL REGISTRY: NCT06135480.
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Cicatriz , Agujas , Plasma Rico en Plaquetas , Humanos , Femenino , Adulto , Cicatriz/etiología , Cicatriz/terapia , Cicatriz/diagnóstico , Masculino , Adulto Joven , Persona de Mediana Edad , Resultado del Tratamiento , Punción Seca/métodos , Punción Seca/instrumentación , Solución Salina/administración & dosificación , Adolescente , Terapia Combinada/métodos , Inducción Percutánea del ColágenoRESUMEN
The article presents an analysis of the plastic reconstructive surgery effectiveness for patients with an extended tracheal defect using an allograft based on the dura mater (DM) at the final stage of surgical treatment of laryngeal and tracheal cicatricial stenosis. The study included 20 patients with cicatricial stenosis of the larynx and trachea, who were previously performed plastic reconstructive treatment with scar tissue excision in the lumen of the respiratory tract and restoration of the supporting frame of the larynx and trachea using allografts based on costal allocartilage. The age of the patients ranged from 21 to 54 years, the duration of the disease was from 1 to 5 years. After a standard clinical and laboratory examination, with a mandatory video endoscopic examination of the larynx and trachea, multislice computed tomography of the larynx and trachea, patients underwent plastic closure of the tracheal defect using DM. Dynamic outpatient monitoring was carried out once a week for 1 month, once a month for 3 months, control examination was done 6 months after surgical treatment. The results of the study demonstrated a full-fledged social and labor rehabilitation of all 20 patients after the final stage of surgical treatment using DM, the absence of rejection reaction and migration of allo-implantation material, the preserved lumen of the larynx and trachea with a rigid supporting skeleton and the absence of anterior tracheal wall floatation. The use of DM as an additional strengthening of the anterior tracheal wall for patients with deficiency of muscular aponeurotic tissues and more than 2 cm size tracheal defect is highly effective at the final stage of surgical treatment for plastic closure of the tracheal defect.
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Cicatriz , Duramadre , Laringoestenosis , Procedimientos de Cirugía Plástica , Estenosis Traqueal , Humanos , Adulto , Masculino , Femenino , Laringoestenosis/cirugía , Laringoestenosis/etiología , Procedimientos de Cirugía Plástica/métodos , Persona de Mediana Edad , Estenosis Traqueal/cirugía , Estenosis Traqueal/etiología , Cicatriz/etiología , Cicatriz/cirugía , Duramadre/cirugía , Resultado del Tratamiento , Tráquea/cirugía , Laringe/cirugíaRESUMEN
This study aimed to analyze the efficacy and safety of microneedling (MN), both alone and in combination with other treatments, to refine the approach for treating acne scars using MN. We systematically searched Pubmed, Cochrane Library, Embase, and Web of Science for randomized controlled trials examining MN or its combinations in patients with acne scars. All statistical analyses were performed using Stata 18 software. A total of 24 studies involving 1546 participants were included. The analysis revealed that MN combined with chemical peels (CP) exhibited the best results in terms of degree of improvement, patient satisfaction, and treatment efficacy compared to other treatments examined, including MN alone, MN with hyaluronic acid (HA), MN with botulinum toxinA (TA), MN with platelet-rich plasma (PRP), PRP alone, CP, and laser therapy. The results for MN combined with additional treatments were obviously better than for MN alone. Side effects such as erythema, pain, and post-inflammatory hyperpigmentation showed no significant differences across all treatments assessed.
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Acné Vulgar , Cicatriz , Agujas , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Acné Vulgar/complicaciones , Acné Vulgar/terapia , Resultado del Tratamiento , Terapia Combinada/métodos , Cicatriz/etiología , Cicatriz/terapia , Cicatriz/diagnóstico , Agujas/efectos adversos , Satisfacción del Paciente , Quimioexfoliación/métodos , Quimioexfoliación/efectos adversos , Punción Seca/métodos , Punción Seca/efectos adversos , Ácido Hialurónico/administración & dosificación , Ácido Hialurónico/efectos adversos , Plasma Rico en Plaquetas , Terapia por Láser/métodos , Terapia por Láser/efectos adversos , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/efectos adversos , Inducción Percutánea del ColágenoRESUMEN
Objective: To investigate the value of myocardium scar area in predicting adverse cardiovascular events (MACEs) after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICM). Methods: The first part of this study was a retrospective study. Patients diagnosed with ICM and undergoing CABG surgery at Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2022 were enrolled as the discovery cohort. All patients underwent cardiac magnetic resonance-late gadolinium enhancement (CMR-LGE) before surgery. According to the occurrence of postoperative MACEs, the patients were divided into MACEs group and MACEs-free group. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. The primary endpoint was postoperative MACEs. Univariate and multifactor regression analyses were used to analyze the risk factors for MACEs. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive efficacy and optimal cut-off value of myocardial scar area for endpoint events. The second part of this study was a prospective study. Patients with ICM who received CABG at Beijing Anzhen Hospital, Capital Medical University from January 2023 to June 2023 were enrolled as a validation cohort, and were divided into MACEs group and MACEs-free group according to whether MACEs occurred after surgery. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. Verify the reliability of the cut-off value obtained by ROC curve in the validation cohort. Results: A total of 120 patients with ICM (30 patients in MACEs group and 90 patients in MACEs-free group), aged (61.6±8.7) years, including 93 males, were included in the discovery cohort. A total of 22 ICM patients (5 patients in MACEs group and 17 patients in MACEs-free group), aged (59.5±8.2) years, including 18 males, were included in the validation cohort. Multivariate Cox regression showed that myocardial scar area (HR=1.258, 95%CI 1.096-1.444, P=0.001) was an independent risk factor for the primary endpoint event. The area under ROC curve of myocardial scar area for predicting postoperative MACEs was 0.90 (95%CI 0.83-0.95), and myocardial scar area≥36.0% was the optimal cut-off value for predicting postoperative MACEs, and its sensitivity, specificity and accuracy were 96.7%, 72.2% and 78.3%, respectively. In the validation cohort, the sensitivity, specificity and accuracy of myocardial scar area in predicting postoperative MACEs in patients with ICM after CABG were 80.0%, 82.4% and 81.8%, respectively. Conclusion: Myocardial scar area is an independent risk factor for MACEs after CABG in patients with ICM, and myocardial scar area≥36.0% is the optimal cut-off value for predicting MACEs after CABG. Myocardial scar area can help to identify patients at high risk of surgery and provide a basis for risk stratification of patients.
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Cardiomiopatías , Cicatriz , Puente de Arteria Coronaria , Isquemia Miocárdica , Humanos , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Estudios Retrospectivos , Isquemia Miocárdica/etiología , Cicatriz/etiología , Cardiomiopatías/etiología , Factores de Riesgo , Femenino , Masculino , Estudios Prospectivos , Complicaciones Posoperatorias/etiología , Curva ROC , Persona de Mediana Edad , Miocardio/patologíaRESUMEN
BACKGROUND: Cesarean section (C-section) rates are increasing globally, and repeated C-sections are associated with increased maternal morbidity. Trial of labor after C-section (TOLAC) is an approach to reduce the recurrence of C-sections. However, limited research exists on the impact of cesarean scars on labor duration in TOLAC, considering the termination of labor through C-section and selection bias. This study aimed to investigate the impact of cesarean scars on labor duration in TOLAC participants, accounting for potential confounding factors and biases. METHODS: This retrospective cohort study included 2,964 women who attempted vaginal birth at a single center in Japan from 2012 to 2021. The study categorized participants into TOLAC (n = 187) and non-TOLAC (n = 2,777) groups. Propensity scores were calculated based on 14 factors that could influence labor duration, and inverse probability of treatment weighting (IPTW) was applied. Cox proportional hazards regression analysis estimated hazard ratios (HRs) for labor duration, with and without IPTW adjustment. Sensitivity analyses used propensity score matching, bootstrapping, and interval censoring to address potential biases, including recall bias in the reported onset of labor. RESULTS: The unadjusted HR for labor duration in the TOLAC group compared to the non-TOLAC group was 0.83 (95% CI: 0.70-0.98, P = 0.027), indicating a longer labor duration in the TOLAC group. After adjusting for confounding factors using IPTW, the HR was 0.98 (95% CI: 0.74-1.30, P = 0.91), suggesting no significant difference in labor duration between the groups. Sensitivity analyses using propensity score matching, bootstrapping, and interval censoring yielded consistent results. These findings suggested that the apparent association between TOLAC and longer labor duration was because of confounding factors rather than TOLAC itself. CONCLUSIONS: After adjusting for confounding factors and addressing potential biases, cesarean scars had a limited impact on labor duration in TOLAC participants. Maternal and fetal characteristics may have a more substantial influence on labor duration.
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Puntaje de Propensión , Esfuerzo de Parto , Parto Vaginal Después de Cesárea , Humanos , Femenino , Estudios Retrospectivos , Embarazo , Parto Vaginal Después de Cesárea/estadística & datos numéricos , Adulto , Japón , Factores de Tiempo , Cicatriz/etiología , Cesárea/estadística & datos numéricos , Trabajo de Parto , Estudios de CohortesRESUMEN
Endoscopic approach with recanalization and stenting is one of the methods for cicatricial tracheal stenosis. Major complications may occur if service life of stents is not observed. However, there are currently no clear timing for stenting. In world practice, there are no indications on lifelong stenting for cicatricial tracheal stenosis. Restenosis is more common after stent removal and requires repeated stenting or another treatment. In case of prolonged stenting, silicone stent should be periodically replaced with a similar one due to destruction of silicone rubber. As a rule, this maneuver is necessary after 1-3 years. Currently, there is no information about maximum allowable duration of stent without replacement and possible complications. Condition of trachea after prolonged stenting is also unknown. We present long-term (27 years) tracheal stenting with a silicone stent. Stent fragmentation and dislocation throughout this period led to respiratory failure and emergency removal. Tracheal lumen was satisfactory immediately after procedure. However, restenosis appeared after 1.5 months and required endoscopic dilation with discussion of appropriate treatment option. However, the patient refused tracheal resection with anastomosis and underwent repeated stenting with similar stent and favorable immediate result.
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Siliconas , Stents , Estenosis Traqueal , Humanos , Estenosis Traqueal/cirugía , Estenosis Traqueal/etiología , Resultado del Tratamiento , Cicatriz/etiología , Cicatriz/cirugía , Tráquea/cirugía , Masculino , Femenino , Persona de Mediana Edad , AdultoRESUMEN
INTRODUCTION: Patients' and surgeons' perceptions of cutaneous scarring can vary, causing unpleasant physical and psychological outcomes. This study aims to bridge the current scientific literature gap and understand the impact of patient-perceived scar cosmesis after anterior and posterior cervical spine surgery. METHODS: Retrospective review of patients ≥18 years old who underwent anterior or posterior cervical spine surgery from 2017 to 2022 at a large, urban academic group. To select patients with adequate time for surgical scar maturation, only patients who were greater than 6 months postsurgery were included. The Scar Questionaire Survey (SCAR-Q) survey, a surgical scar assessment tool, was administered to patients to assess patient perceptions of scar symptomatology, appearance, and psychosocial impact. Scores range from 0 to 100, with 100 as the best outcome. An additional 5-item Likert scale question was administered to assess overall surgical satisfaction. RESULTS: All 854 respondents who completed the survey were stratified into 2 groups "Unsatisfied vs. Satisfied." Patients who were "unsatisfied" with their surgery had the lowest outcome scores for SCAR-Q appearance, symptom, and psychosocial scores than those who were "Satisfied" (P < 0.001). Females had significantly "higher/more favorable" responses for SCAR-Q Appearance (77.5 vs. 82.8 P < 0.001) and Psychosocial (87.4 vs. 94.3 P < 0.001) scores compared to males. Regression analysis performed for each component score showed that increases in all 3 component scores were significant in patients in the satisfied group. CONCLUSIONS: Our study demonstrates that cervical spine surgery patients unsatisfied with their surgical outcome have lower scar-related scores, highlighting the impact of cosmetic closure and appearance.
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Vértebras Cervicales , Cicatriz , Satisfacción del Paciente , Fusión Vertebral , Humanos , Cicatriz/psicología , Cicatriz/etiología , Femenino , Masculino , Vértebras Cervicales/cirugía , Fusión Vertebral/psicología , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Complicaciones Posoperatorias/psicología , Complicaciones Posoperatorias/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique. METHODS: We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics. RESULTS: Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief. CONCLUSIONS: The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings. LEVEL OF EVIDENCE: IV.
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Mama , Hipertrofia , Mamoplastia , Humanos , Mamoplastia/métodos , Femenino , Estudios Retrospectivos , Adulto , Hipertrofia/cirugía , Mama/cirugía , Mama/anomalías , Persona de Mediana Edad , Cicatriz/etiología , Cicatriz/cirugía , Cicatriz/prevención & control , Estética , Colgajos Quirúrgicos , Calidad de Vida , Resultado del Tratamiento , Satisfacción del PacienteRESUMEN
BACKGROUND: Repeat endoscopic submucosal dissection for metachronous recurrence of esophageal squamous cell carcinoma close to previous endoscopic submucosal dissection scars is challenging. Therefore, this study evaluated the efficacy and safety of repeat endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma. METHODS: The study included 1680 patients. After propensity score matching, esophageal endoscopic submucosal dissection-related outcomes were compared between the post-endoscopic submucosal dissection scar group (n = 91) and first endoscopic submucosal dissection group (n = 910). The Kaplan-Meier method and log-rank tests were used to compare both groups' survival and local recurrence curves. RESULTS: After propensity score matching, the two groups showed no significant difference in en bloc resection rate (97.80% vs. 99.56%, p = 0.096), treatment time (64.75 min vs 61.33 min, p = 0.448), recurrence rate (3.30% vs. 2.20%, p = 0.458), and stricture rate (7.69% vs. 4.07%, p = 0.110). However, the perforation rate was higher in the post-endoscopic submucosal dissection scar group than in the first endoscopic submucosal dissection group (4.40% vs. 1.10%, p = 0.031). The 5-year overall survival rates in the post-endoscopic submucosal dissection scar and first endoscopic submucosal dissection groups were 88.6% and 89.0%, respectively. CONCLUSIONS: Repeated esophageal endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma yielded satisfactory clinical outcomes and survival rates. Therefore, repeat endoscopic submucosal dissection may effectively treat esophageal squamous cell carcinoma recurrence close to the initial endoscopic submucosal dissection scars.