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Keratoconus (KC) is a complex disease whose pathophysiology is only partially understood. The priority in management is to halt the progression of corneal deformation as soon as possible in the course of KC disease. Corneal cross-linking (CXL) is at present the only dedicated treatment for this purpose. Its biochemical mechanism of action leads to changes in the viscoelastic properties of the cornea induced by matrix bonding and renewal of keratocytes. The effect of CXL is difficult to quantify when measured in in-vivo conditions because of a lack of consistent tools adapted for clinical practice. Nevertheless, a large amount of evidence has been collected so far confirming the positive action of CXL on corneal structural reinforcement, and numerous studies have demonstrated significant efficacy in halting progression of KC with long-term follow-up. Published studies, however, are of relatively low scientific power given the great heterogeneity of the disease and the numerous associated biases in evaluation. The purpose of this paper is to summarize the consistent evidence of efficacy of CXL and to justify its role in our therapeutic armamentarium for management of progressive KC., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Keratoconus is a disease of the cornea that usually begins during puberty and progressively weakens its biomechanical structure. Keratoconic eyes show a conic shape and progressive thinning, both leading to irregular astigmatism and reduced vision that cannot be corrected by glasses. In early cases, special contact lens can partly compensate for the visual loss while they do not stop disease progression. Until recently, the only treatment option was a corneal transplant. In 1999, a technique called corneal collagen cross-linking (CXL) was used in human corneas suffering from keratoconus for the first time. CXL uses a process called photopolymerization to halt the progression of keratoconus with an efficacy of more than 95%. Today our challenge is to screen and identify patients early enough to offer a treatment on time before irreversible vision loss develops.

Introduction: Our aim was to compare the anti-inflammatory activity of two toothpastes, one including enoxolone 1%, the other including plant extracts and sodium bicarbonate., Material and Methods: Gingival fragments were kept alive ex-vivo. Inflammation, inflammatory mediators (SP and LPS) were applied to culture medium on contact with corium to induce inflammation. The effect of both toothpastes was assessed with histological and biochemical parameters (inflammatory cytokine IL8) of inflammation on the synthesis of collagen and cellular viability., Results: Both toothpaste "A" including enoxolone at 1% and "P" including plant extracts and sodium bicarbonate were effective on edema and vasodilatation. "A" acted on IL8 synthesis, unlike "P". Both toothpastes boosted collagen synthesis by fibroblasts. The percentage of cellular viability for "A" was superior to the currently admitted standard (80%), unlike to "P"., Discussion: The mechanisms of action of each toothpaste seem to be different. "A" modulates pro-inflammatory cytokine IL8 expression, unlike "P". The toothpaste "A" seems to be better tolerated., (Copyright © 2010. Published by Elsevier Masson SAS.)

Introduction: The aim of the present study was to evaluate the clinical usefulness of riboflavin- and ultraviolet-A (UV-A)-induced collagen cross-linking (CXL) on progressive keratoconus., Patients and Methods: Twenty eyes of 20 patients with progressive keratoconus were included in a prospective, nonrandomized pilot study. The preoperative progression of keratoconus was documented by an increase in maximum keratometry (Kmax) on serial corneal topographies. Preoperative corneal thickness was at least 400 microm. The postoperative progression of keratoconus was evaluated from corneal topography, best-corrected visual acuity (BCVA) testing, and corneal biomechanical properties assessed with the Ocular Response Analyzer (ORA). The follow-up time was between 3 and 18 months., Results: The steepening decreased significantly by 1.68+/-2.18 diopters (D) in the first year (p<0.05). The Kmax value decreased in 66% of eyes and remained stable in 17% (within+/-0.50 D). The mean preoperative BCVA was 0.49+/-0.22. Six months after the CXL treatment, the mean BCVA was 0.63+/-0.23 (p<0.05) and improved at least one line in 56.25% of eyes. The ORA values remained stable over the entire follow-up period., Discussion: Extensive experimental study showed a significant increase in corneal rigidity after riboflavin/UV-A-induced CXL., Conclusion: Preliminary results on the clinical effects of riboflavin/UV-A-induced CXL are encouraging in reducing the progression of keratoconus. Long-term results are necessary to evaluate the duration of the stiffening effect.

Aortic dissection is a rare but severe disease. Numerous risk factors have been reported, all leading to an alteration of arterial structures, particularly extracellular matrix. Aortic dissection is a complication of arterial hypertension, whatever its origin. Primary aldosteronism, frequent cause of secondary arterial hypertension, is associated with arterial structural alterations, indirectly by a pressure factor, and directly by aldosterone, which modifies collagen contents and elastin/collagen ratios. In addition to the three previously reported cases, the three cases reported in the present paper lead to the hypothesis of a causal relationship between aldosteronism and aortic dissection. The need for hypertension screening and diagnosis of its potential causes, namely primary aldosteronism, is highlighted.

We report the case of an atopic patient aged 16 with a perannual asthma. He has been treated since the age of 4 with inhaled corticosteroïds. His growth was regular until he was 14 when beclomethasone was replaced by fluticasone (both administered by pressurized inhaler) due to adrenal suppression. Growth inhibiting effects of different inhaled corticosteroids are discussed focusing mainly on their effect on collagen synthesis.

Type I and III collagens are the major components of skin dermis. Skin aging is related mainly to a decrease in type I collagen levels. Collagen I also plays an important role in wound healing. An enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of secretion of type I and III collagen in human fibroblast cultures with or without asiaticoside and madecassoside. Normal adult dermal fibroblast cultures were established using the explant method from a skin (lifting) sample obtained from a 50 year-old woman. Fibroblasts were grown to confluence in supplemented E 199 medium and after 24 hours of growth, products were added in serum free medium containing 0.15 mM sodium ascorbate. The media were then collected and type I and III collagen secretion levels determined. Kinetics of type I and III collagen secretion led to determine the effects to asiaticoside and madecassoside after 48 hours for collagen I secretion and 72 hours for collagen III. Two triterpenes with an ursenoic skeleton, asiaticoside and madecassoside, were shown to stimulate collagen secretion. Type I secreted collagen (for 10(4) fibroblasts per 48 hours) was increased for 25-30% with asiaticoside and madecassoside. Interestingly, only Madecassoside was able to increase significantly collagen III secretion.