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Background: Microplasma fractional radiofrequency (MP FRF) technology has been increasingly used for acne scars. Nevertheless, little evidence has analyzed the factors influencing its effectiveness before and during treatment. Aims: To evaluate the clinical factors affecting the effectiveness of MP FRF therapy for atrophic acne scars. Methods: We analyzed retrospectively the clinical data of 79 acne scar patients treated with MP FRF technology. The outcome of interest included the effectiveness and adverse events after MP FRF treatment. Multivariable logistic regression was utilized to evaluate clinical factors associated with effectiveness after the initial session. Results: All patients received 115 sessions of MP FRF therapy (average: 1.5 sessions). Twenty‐eight (35.4%) patients improved moderately to excellently after one session. We found that the severe grade before treatment was negatively correlated with the effectiveness according to Goodman–Baron qualitative scores (OR = 0.02, 95% CI [0.001, 0.37], p = 0.009). The presence of icepick scars was also a negative correlation factor for the effectiveness (OR = 0.06, 95% CI [0.004, 1.00], p = 0.049). Furthermore, after excluding the effects of icepick scars and Goodman–Baron scores before treatment, ECCA scores were also correlated with effectiveness (OR = 1.04, 95% CI [1.01, 1.06], p = 0.009). Conclusion: MP FRF therapy was effective in treating atrophic acne scars with no permanent adverse events. The severity of Goodman–Baron qualitative scores and icepick scars were independent clinical factors affecting effectiveness, suggesting the possible requirement for additional treatments other than MP FRF for severe acne scars and icepick scars. [ABSTRACT FROM AUTHOR]

Background: Micronized acellular dermal matrix (mADM) can induce tissue regeneration and repair, and filling. Objectives: The efficacy and safety of (mADM) were evaluated in the treatment of atrophic acne scar. Methods: In this single‐blinded, self‐controlled, split‐face study, 16 patients (48 scar sites) were divided into treatment group (24 scar sites) and control group (24 scar sites). One side of the affected area was treated with mADM combined with platelet rich plasma (PRP) injection as the treatment group; the other side of the affected area was treated with PRP injection as the control group. The efficacy was evaluated by the Acne scar assessment scale (ASAS) and Acne Scar Weight Rating Scale (ECCA) 3 months after treatment. Results: After 3‐month treatment in 16 patients, the atrophic acne scars in both groups were all improved. The ASAS score and ECCA weight score in the treatment group was significantly lower than that in the control group (2.50 ± 0.51 vs. 3.62 ± 0.77 and 14.17 ± 10.18 vs. 31.88 ± 13.25; p < 0.001). Limitations: Short‐term 3‐month treatment period. Small sample size limits generalizability of results. Conclusion: The curative effect of mADM combined with PRP is significantly better than that of PRP alone. [ABSTRACT FROM AUTHOR]

[Display omitted] • Attenuated auxotrophic Salmonella Typhimurium was utilized for the anti-tumor effect. • Reduction of endotoxicity was rendered by lipid A modification. • Regulated expression of ClyA at higher cell density under QS signaling. • Engineered Salmonella Typhimurium enhanced safety and tumor invasion. • ClyA expressing Salmonella reduced 67 % of tumors in mouse CT 26 cancer model. The limitations of conventional cancer therapies necessitate target-oriented, highly invasive, and safe treatment approaches. Hence, the intrinsic anti-tumor activity of Salmonella can offer better options to combat cancers. This study aims to utilize attenuated Salmonella and deliver cytolytic protein cytolysin A (ClyA) under quorum sensing (QS) signaling for precise localized expression in tumors but not in healthy organs. The therapeutic delivery strain was imposed with tryptophan auxotroph for selective colonization in tumors by trpA and trpE deletion, and lipid-A and O-antigen were altered by pagL and rfaL deletions using lambda red recombination method. The strain was transformed with the designed QS-controlled ClyA expression vector which was validated by western blot. The in vivo passaged therapeutic strain was used for treatment four times at a weekly interval, with a dose of 5 × 106 CFU/mouse for cancer therapy. The attenuated strain induced minimal endotoxicity-related cytokines TNF-α, IL-1β, and IFN-γ and exhibited adequate colonization despite earlier exposure in mice. The QS-controlled ClyA expression was confirmed by western blot from bacterial cultures grown at different cell densities. The results demonstrated that the in vivo passaged strain preferentially colonized the tumor after vacating the spleen, liver, and lung, leaving no outward histological scars. The anti-cancer effect of the designed construct was evaluated in the murine CT26 colon cancer model. The expression of ClyA increased tumoricidal activity by 67 % compared to vector control. Hence, the anti-tumor effect of the engineered Salmonella strain was improved by ClyA expression via QS activation after achieving the threshold bacterial cell density. Further, immunohistochemical staining of the tumor and other organs corroborated the QS-controlled tumor-specific expression of ClyA. Overall, the results imply that the developed anti-cancer Salmonella has low endotoxicity and QS-controlled expression of ClyA as beneficial safety elements and supports recurrent Salmonella inoculation by O-antigen deficiency. [ABSTRACT FROM AUTHOR]

Proliferative vitreoretinopathy (PVR) is an abnormal and prolonged healing response to retinal injury (retinal detachment, post retinal detachment surgery) characterised by: pre/subretinal membrane formation; retinal gliosis and retinal shortening, retinal pigment epithelium cell proliferation; and increased glial (mainly Mu¨ller cells), fibroblast and inflammatory cell (macrophage, lymphocyte) activity, leading to tractional retinal holes/breaks and multiple costly eye operations suffered by patients. PVR can cause retinal re-detachment following primary surgical intervention for rhegmatogenous retinal detachment. Vitrectomy and scleral buckling surgery are the main approaches for treating PVR complications of retinal detachment. Patients require many operations to remove the scar tissue but vision results are suboptimal, and do not meet patient expectations. Over the past 40 years, this has been one of the greatest challenges for vitreoretinal surgeons and patients. Despite previous large clinical trials of multiple candidate drug therapeutics, no proven adjunctive treatment currently exists to either prevent, reduce, or treat PVR formation in retinal detachment. Both cellular proliferation and the intraocular inflammatory response are realistic targets for adjunctive treatments in PVR. The cellular components of PVR periretinal membranes (retinal pigment epithelial, glial, inflammatory and fibroblastic cells) proliferate and are thus targets for antiproliferative agents. In recent years, several new therapeutics have been tested, and we present an updated review of the clinical therapeutics for PVR in retinal detachment. [ABSTRACT FROM AUTHOR]

Seborrheic dermatitis is an inflammatory condition that usually presents with erythema, scaly greasy papules, and plaques affecting sebaceous gland‐rich areas and predominantly involving the face and scalp. The diagnosis of seborrheic dermatitis can often be rendered based on the clinical presentation. However, in certain cases, a biopsy can be useful to distinguish it from clinical mimics such as psoriasis, discoid lupus, and rosacea. Prominent sebaceous gland atrophy without scarring has been well‐described as an important and relatively specific clue for psoriatic or drug‐induced alopecia. However, sebaceous gland atrophy is not specific to psoriasis and has been demonstrated in seborrheic dermatitis, facial discoid dermatitis, and potentially may occur in other inflammatory dermatoses of the scalp. We report a 23‐year‐old female patient presenting with non‐scarring hair loss and histopathological findings demonstrating mild androgenetic alopecia and changes of seborrheic dermatitis with dramatic sebaceous gland atrophy. The patient had no history or evidence of psoriasis clinically. Our case suggests that in patients with seborrheic dermatitis, sebaceous gland atrophy may complicate the evaluation of alopecia biopsies and should be recognized as a pitfall. Seborrheic dermatitis should be included in the differential diagnosis of alopecia biopsies showing prominent sebaceous gland atrophy. [ABSTRACT FROM AUTHOR]

Key point Background Methods Results Conclusion The 1064‐nm picosecond laser with holographic optics demonstrated significant efficacy in treating atrophic acne scars.Picosecond lasers with fractionated optics have enabled the development of a breakthrough skin rejuvenation method. The authors compared the fractionated, non‐ablative neodymium‐doped yttrium aluminum garnet 1064‐nm picosecond laser with holographic optics and the fractional CO2 laser in treating atrophic acne scars.One side of each patient's face was randomly allocated and treated with three sessions of the 1064‐nm picosecond laser with holographic optics at 2‐month intervals. In contrast, the other side was treated with the fractional CO2 laser. Participants were followed up 3 months after the final session. The primary outcome included the physicians' evaluation using the ECCA grading scale and a four‐point scale to assess improvement. The patients' assessment of progress, their overall satisfaction and preferences, and the side effects were also evaluated.No significant difference was observed between the two lasers in terms of the mean ECCA scores after treatments (P = 0.209). The physicians' improvement assessment was more significant for the fractional CO2 laser (P = 0.001). The patients' evaluation of improvement and subjective satisfaction were consistent with physicians' four‐point scale results. The picosecond laser side had fewer adverse effects (P < 0.001).The fractionated, non‐ablative Nd: YAG 1064‐nm picosecond laser with holographic optics and the fractional CO2 laser were effective and safe in treating atrophic acne scars. Significantly better clinical outcomes were observed with the fractional CO2 laser, whereas fewer adverse effects were noted with the 1064‐nm picosecond laser with holographic optics. [ABSTRACT FROM AUTHOR]

Cellular senescence and fibrosis are two biological processes that are closely related to the development of many diseases. Cellular senescence can occur through mechanisms such as telomere shortening, DNA damage, and oxidative stress, leading to degradation of cell function and decreased ability to repair damage. More and more studies have shown that fibrosis and cell senescence are closely related, and cell senescence has been confirmed to be involved in the occurrence and development of scar fibrosis diseases. An in-depth understanding of the relationship between cellular senescence and scar fibrosis is helpful to find new therapeutic strategies and develop targeted drugs to reduce the process of scar fibrosis. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Ultrapluse CO2 fractional laser technology has emerged as an effective treatment for scar management. However, one drawback of this modality is the pain caused during the procedure. This study aims to explore the efficacy and safety of dezocine (DZC) as preemptive analgesia for reduction of pain induced by ultrapulse CO2 fractional laser treatment for acne scars.The study cohort included 78 outpatients with acne scars between February and April 2023. Patients were randomly assigned into three groups with intravenous injection (iv) of DZC prior to laser treatment: (1) control, iv of saline; (2) DZC group 1 (DZC_1), iv of DZC at 0.15 mg/kg; and (3) DZC_2, iv of DZC at 0.20 mg/kg. After 30 min, one session of ultrapulse CO2 fractional laser treatment on acne scars was performed. Hemodynamics, visual analogue scale (VAS), and anxiety visual analog test (AVAT) were monitored prior to, during, and after the procedure.Operative success rates for patients in the control, DZC_1, and DZC_2 groups were 34.6%, 84.6%, and 100%, respectively. DZC administered with either dosage significantly reduced the VAS and AVAT scores of patients in treatment groups as compared with the subjects in the control group during the course of ultrapulse CO2 fractional laser treatment. Patients in DZC_1 and DZC_2 groups did not show any significant difference in hemodynamic parameters, VAS, and AVAT scores. Temporary adverse effects such as nausea and dizziness were observed in some subjects after treatment; the symptoms were quickly dissolved after a rest in supine position.DZC as preemptive analgesia could effectively reduce pain and anxiety induced by ultrapulse CO2 fractional laser treatment in patients. This study provided an option of preemptive anesthesia to minimize the pain and discomforts associated with laser treatments in clinical practices. [ABSTRACT FROM AUTHOR]

Fibrosis is a pathological process, that could result in permanent scarring and impairment of the physiological function of the affected organ; this condition which is categorized under the term organ failure could affect various organs in different situations. The involvement of the major organs, such as the lungs, liver, kidney, heart, and skin, is associated with a high rate of morbidity and mortality across the world. Fibrotic disorders encompass a broad range of complications and could be traced to various illnesses and impairments; these could range from simple skin scars with beauty issues to severe rheumatologic or inflammatory disorders such as systemic sclerosis as well as idiopathic pulmonary fibrosis. Besides, the overactivation of immune responses during any inflammatory condition causing tissue damage could contribute to the pathogenic fibrotic events accompanying the healing response; for instance, the inflammation resulting from tissue engraftment could cause the formation of fibrotic scars in the grafted tissue, even in cases where the immune system deals with hard to clear infections, fibrotic scars could follow and cause severe adverse effects. A good example of such a complication is post-Covid19 lung fibrosis which could impair the life of the affected individuals with extensive lung involvement. However, effective therapies that halt or slow down the progression of fibrosis are missing in the current clinical settings. Considering the immunomodulatory and regenerative potential of distinct stem cell types, their application as an anti-fibrotic agent, capable of attenuating tissue fibrosis has been investigated by many researchers. Although the majority of the studies addressing the anti-fibrotic effects of stem cells indicated their potent capabilities, the underlying mechanisms, and pathways by which these cells could impact fibrotic processes remain poorly understood. Here, we first, review the properties of various stem cell types utilized so far as anti-fibrotic treatments and discuss the challenges and limitations associated with their applications in clinical settings; then, we will summarize the general and organ-specific mechanisms and pathways contributing to tissue fibrosis; finally, we will describe the mechanisms and pathways considered to be employed by distinct stem cell types for exerting anti-fibrotic events. [ABSTRACT FROM AUTHOR]

Excessive scar formation such as hypertrophic scars and keloids, resulting from trauma or surgical procedures, present a widespread concern for causing disfigurement, discomfort, and functional limitations. Macrophages play pivotal roles in maintaining tissue homeostasis, orchestrating tissue development, repair, and immune responses, and its transition of function and phenotype plays a critical role in regulating the balance between inflammation and tissue regeneration, which is central to cutaneous scar formation. Recent evidence suggests the involvement of Sonic Hedgehog (SHH) in the induction of anti-inflammatory M2-like macrophage phenotypes within tumor microenvironments. In our study, we observed increased SHH expression in human hypertrophic scars, prompting an investigation into its influence on macrophage polarization, efferocytosis, and cutaneous scar formation. Our findings reveal that SHH can enhance oxidative phosphorylation (OXPHOS) in macrophages, augment macrophage efferocytosis, and promote M2 polarization, finally contributing to the progression of cutaneous scar formation. Notably, targeting SHH signaling with vismodegib exhibited promising potential in mitigating scar formation by reversing the effects of enhanced OXPHOS and M2 polarization in macrophages. In conclusion, this study underscores the critical roles of macrophage metabolism, particularly OXPHOS, efferocytosis and SHH signaling in cutaneous scar formation. Understanding these mechanisms provides new avenues for potential interventions and scar prevention strategies. [ABSTRACT FROM AUTHOR]

This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to determine the optimal timing for intervention. A systematic search was conducted across four databases using a predefined search strategy. Studies included were randomized controlled trials, non-randomized studies, and case series focusing on laser therapy for CL/P scars. Data extraction and analysis were performed using Revman Software. A total of two randomized controlled trials, four non-randomized studies, and three case series were included in the analysis. The fractional CO2 laser was the most commonly utilized type of laser. Following laser therapy, there was a significant decrease in Vancouver Scar Scale (VSS) scores by 4.05 (95% CI, 2.10–5.99). Meta-analysis revealed that laser treatment groups exhibited a significantly lower mean VSS score (1.3; 95% CI, 0.02–2.67) compared to control groups. Moreover, initiating laser therapy intervention at one month postoperatively resulted in a significantly lower VSS score compared to initiation at three months postoperatively (difference of 1.70; 95% CI, 1.33–2.08). No severe complications were reported. Laser therapy demonstrates effectiveness and safety in improving CL/P scars, with earlier intervention yielding greater benefits. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic scarring results from myofibroblast differentiation and persistence during wound healing. Currently no effective treatment for hypertrophic scarring exists however, autologous fat grafting has been shown to improve scar elasticity, appearance, and function. The aim of this study was to understand how paracrine factors from adipose tissues and adipose-derived stromal cells (ADSC) affect fibroblast to myofibroblast differentiation. Methods: The transforming growth factor-β1 (TGF-β1) induced model of myofibroblast differentiation was used to test the effect of conditioned media from adipose tissue, ADSC or lipid on the proportion of fibroblasts and myofibroblasts. Results: Adipose tissue conditioned media inhibited the differentiation of fibroblasts to myofibroblasts but this inhibition was not observed following treatment with ADSC or lipid conditioned media. Hepatocyte growth factor (HGF) was readily detected in the conditioned medium from adipose tissue but not ADSC. Cells treated with HGF, or fortinib to block HGF, demonstrated that HGF was not responsible for the inhibition of myofibroblast differentiation. Conditioned media from adipose tissue was shown to reduce the proportion of myofibroblasts when added to fibroblasts previously treated with TGF-β1, however, conditioned media treatment was unable to significantly reduce the proportion of myofibroblasts in cell populations isolated from scar tissue. Conclusions: Cultured ADSC or adipocytes have been the focus of most studies, however, this work highlights the importance of considering whole adipose tissue to further our understanding of fat grafting. This study supports the use of autologous fat grafts for scar treatment and highlights the need for further investigation to determine the mechanism. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the accumulation of hyaline‐like material in the skin, oral mucosa, larynx, and brain. This study aimed to evaluate the dermatological findings and treatment responses of patients diagnosed with LP.This retrospective study included 41 patients diagnosed with LP at our clinic between May 2018 and January 2023. The diagnosis of LP was established in 22 patients by detecting mutations in the ECM1 gene. In comparison, in 19 patients, it was based on typical clinical findings and histopathological examination of lesioned skin. Clinical and demographic data such as dermatological findings, treatments received, and responses to treatment were recorded from patient files.All patients exhibited skin thickening and acneiform scars. The most commonly observed additional dermatological findings were moniliform blepharosis (60.9%), varioliform scars (29.2%), waxy papules and plaques (24.3%), and blisters with crusts (19.5%). Verrucous lesions, diffuse yellow plaques, and scarring alopecia were observed in adult patients, while hypopigmented lesions and blisters with crusts were seen in the pediatric age group. The most frequently used treatments were acitretin (14.6%) and systemic steroids (9.7%). No improvement in skin lesions was observed in patients treated with acitretin, whereas complete resolution of blisters with crusts was noted in patients treated with systemic steroids.In addition to the existing literature on dermatological manifestations of LP, hypopigmented lesions and atrophoderma vermiculatum‐like lesions can also be observed in these patients. We believe that short‐term systemic steroid therapy for vesiculobullous lesions can be considered for treatment. We think prospective studies with more patients and requiring long‐term follow‐up are needed regarding the effectiveness of acitretin treatment. [ABSTRACT FROM AUTHOR]

Background: Fibrogenesis within ovarian endometrioma (endometrioma), mainly induced by transforming growth factor-β (TGF-β), is characterized by myofibroblast over-activation and excessive extracellular matrix (ECM) deposition, contributing to endometrioma-associated symptoms such as infertility by impairing ovarian reserve and oocyte quality. However, the precise molecular mechanisms that underpin the endometrioma- associated fibrosis progression induced by TGF-β remain poorly understood. Methods: The expression level of lysine acetyltransferase 14 (KAT14) was validated in endometrium biopsies from patients with endometrioma and healthy controls, and the transcription level of KAT14 was further confirmed by analyzing a published single-cell transcriptome (scRNA-seq) dataset of endometriosis. We used overexpression, knockout, and knockdown approaches in immortalized human endometrial stromal cells (HESCs) or human primary ectopic endometrial stromal cells (EcESCs) to determine the role of KAT14 in TGF-β-induced fibrosis. Furthermore, an adeno-associated virus (AAV) carrying KAT14-shRNA was used in an endometriosis mice model to assess the role of KAT14 in vivo. Results: KAT14 was upregulated in ectopic lesions from endometrioma patients and predominantly expressed in activated fibroblasts. In vitro studies showed that KAT14 overexpression significantly promoted a TGF-β-induced profibrotic response in endometrial stromal cells, while KAT14 silencing showed adverse effects that could be rescued by KAT14 re-enhancement. In vivo, Kat14 knockdown ameliorated fibrosis in the ectopic lesions of the endometriosis mouse model. Mechanistically, we showed that KAT14 directly interacted with serum response factor (SRF) to promote the expression of α-smooth muscle actin (α-SMA) by increasing histone H4 acetylation at promoter regions; this is necessary for TGF-β-induced ECM production and myofibroblast differentiation. In addition, the knockdown or pharmacological inhibition of SRF significantly attenuated KAT14-mediating profibrotic effects under TGF-β treatment. Notably, the KAT14/SRF complex was abundant in endometrioma samples and positively correlated with α-SMA expression, further supporting the key role of KAT14/SRF complex in the progression of endometrioma-associated fibrogenesis. Conclusion: Our results shed light on KAT14 as a key effector of TGF-β–induced ECM production and myofibroblast differentiation in EcESCs by promoting histone H4 acetylation via co-operating with SRF, representing a potential therapeutic target for endometrioma-associated fibrosis. [ABSTRACT FROM AUTHOR]

A 74-year-old woman in good general health presented with a 5-year history of progressive hair loss over several years, interpreted as female androgenetic alopecia (AGA), and was treated with topical 5% Minoxidil without improvement. The patient's relevant medical history revealed infiltrating, triple-negative apocrine carcinoma of the right breast four years before, treated by quadrantectomy, radiation, lymphadenectomy and chemotherapy, with no recurrence at the last follow-up. On examination, there was an asymptomatic 15 × 15 cm firm and whitish area of scarring alopecia on the central scalp. Dermoscopy revealed multiple arborizing vessels and many telangiectasia. The clinical considerations included mainly cutaneous metastasis of breast carcinoma (alopecia neoplastica), pseudopelade of Broque and morpheaform basal cell carcinoma (BCC). A histopathologic examination revealed characteristic changes of morpheaform BCC with basaloid islands and cords of atypical basaloid cells diffusely infiltrating the dermis, embedded in a sclerotic and hypervascularized stroma. Secondary alopecia neoplastica due to morpheaform BCC on the scalp is an exceedingly rare entity, possessing subtle clinical features that may mimic both scarring and non-scarring alopecia. Delayed recognition may contribute to aggressive behavior and extensive local destruction. Treatment with hedgehog inhibitors in locally advanced BCC of the scalp, both in adjuvant and neoadjuvant modalities, is promising. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic scars (HS) are a common disfiguring condition in daily clinical encounters which brings a lot of anxieties and concerns to patients, but the treatment options of HS are limited. Black cloth ointment (BCO), as a cosmetic ointment applicable to facial scars, has shown promising therapeutic effects for facial scarring. However, the molecular mechanisms underlying its therapeutic effects remain unclear. Material and methods: Network pharmacology was first applied to analyze the major active components of BCO and the related signaling pathways. Subsequently, rabbit ear scar model was successfully established to determine the pharmacological effects of BCO and its active component β‐elemene on HS. Finally, the molecular mechanism of BCO and β‐elemene was analyzed by Western blot. Results: Through the network pharmacology, it showed that β‐elemene was the main active ingredient of BCO, and it could significantly improve the pathological structure of HS and reduce collagen deposition. BCO and β‐elemene could increase the expression of ER stress‐related markers and promote the increase of apoptotic proteins in the Western blot experiment and induce the apoptosis of myofibroblasts. Conclusions: Our findings indicate that the material basis for the scar‐improving effects of the BCO is β‐elemene, and cellular apoptosis is the key mechanism through which the BCO and β‐elemene exert their effects. [ABSTRACT FROM AUTHOR]

Introduction: Severe acne breakouts often lead to atrophic acne scars, which affect millions of people worldwide and can significantly affect a person's self‐confidence and self‐image. Given the difficulty in treating atrophic acne scars, this study aims to investigate the efficacy of topical phenytoin in the treatment of atrophic acne scars. Method: This split face clinical trial on 25 patients between the ages of 18 and 40 involved the application of microneedling on one side of the face, with three sessions taking place over the course of a month. On the other side, a 1% phenytoin cream was administered three times daily for 1 week following the microneedling procedure. Baseline information was collected for all patients, and follow‐up assessments were conducted during the treatment sessions and 2 months after the last session. The assessments included evaluating the number and area of pores and spots, determining scar severity, assessing patient satisfaction, and recording any potential complications. Results: Among patients, 20 individuals (80%) were females, and the average age of the participants was 35.96 ± 9.23. In terms of the fine pore area, despite the fine pore count, both groups showed improvement over time (p: 0.03 vs. 0.06). Also, regarding large pore count and area, and the count and area of spots, both groups showed improvement over time (p: 0.001). However, there were no significant differences between the two groups (p > 0.05). On the other hand, when it comes to acne scar grade and patients' satisfaction, the phenytoin group outperformed the control group in all follow‐up sessions and this difference was found to be significant (p: 0.001). It is worth noting that no complications were observed among any of the patients. Conclusion: It appears that combining phenytoin cream with microneedling has a more effective therapeutic outcome in enhancing atrophic acne scars, when compared to microneedling alone, and this method can be regarded as a viable alternative in treating these types of scars. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris often results in permanent scars, with atrophic scars being the most common type and posing a significant therapeutic challenge due to their prevalence and impact on patients' quality of life. Various treatment options exist, including the use of poly‐d,l‐lactic acid delivered via different methods. Objective: This study aimed to assess the efficacy and safety of poly‐d,l‐lactic acid delivered via laser‐assisted needle‐free microjet injection for treating atrophic scars. Methods: Five Korean participants with atrophic facial scars were recruited. Poly‐d,l‐lactic acid solution was administered via the Mirajet system in five sessions, with clinical assessments conducted at baseline, before each session, and at 12‐week and 22‐week follow‐ups. Outcome measures included the Global Aesthetic Improvement Scale and patient satisfaction scores. Results: Positive results were observed at the 12‐week and 22‐week follow‐ups, with high patient satisfaction and improvements in atrophic scars and skin texture. Mild discomfort and transient side effects were reported, with no adverse events observed during the follow‐up period. Conclusion: Poly‐d,l‐lactic acid delivered by a laser‐assisted needle‐free microjet injector was judged to be effective for improving atrophic the facial area. Further research, particularly through randomized controlled trials, is needed to validate these findings and assess the longer‐term safety and sustainability of outcomes. [ABSTRACT FROM AUTHOR]

Background: External ear canal exostoses are usually bilateral and broad-based, secondary to external ear canal chronic cold exposure, especially water. Objectives: The objectives were to analyze the influence of the surgeon's experience on the 3-year recurrence and on the complication. We also studied the influence of prolonged exposure to cold water on the incidence of recurrence. Material and Methods: This monocentric retrospective study included 98 ears operated for canalplasty between 2009 and 2016 by nine different operators including one senior, a junior, and seven beginner surgeons. Senior, Junior, and Beginner groups were compared. Results: 3-year recurrence rate was higher in the Beginner and Junior groups than in the Senior group (69% and 38% vs 18%, P =.001). Although there was a difference between the Beginner (69%) and Junior (38%) groups, it was not significant (P =.407). Among the recurrences, 48% had continued exposure to cold water while only 7% of the ears without recidivism were still exposed (P <.001, OR = 1.25 [4.4; 36.1]). The complication rates were similar between groups, concerning pain (8% vs 30% vs 12%), per procedure perforation (17% vs 10% vs 16%), scarring disorders (25% vs 20% vs 13%), and osteitis (8% vs 0% vs 1%). Hearing was unaffected. Conclusions: This is the first study evaluating the risk of recurrence of external ear canal exostoses after canalplasty based on the surgeon's experience. This risk of recurrence seems to decrease with the surgeon's experience. There was no difference in complication rates. [ABSTRACT FROM AUTHOR]

Background: Acne scar is an inflammatory condition, which commonly occurs in patients with acne vulgaris, especially in adults. Mesogels have been reported effective in improving atrophic acne scars. Aims: We investigated the efficacy of adding Profhilo (a hyaluronic acid‐based filler) to subcision as a new treatment method. Methods: Twelve patients aged 18–45 years with atrophic acne scars on both sides of the face participated in this single‐blinded, split‐face, randomized controlled trial. Each side of the face was randomly assigned to one of the treatment methods, including subcision alone and subcision + Profhilo. Patients in the Profhilo arm received mesogel (1 cc) in addition to the subcision procedure. Both methods were carried out two times at 1‐month intervals. Assessments were done based on the sonographic depth of scars, and two blinded observers examined photographs at baseline and 3 months after the final session and the results were reported based on an exclusively made formula as the total score. The Global Improvement Scale and Visual Analogue Scale (VAS) (for patient satisfaction) were also used. Results: The VAS score of patient satisfaction was statistically significant in the Profhilo arm, with a mean improvement of 528.08 and 219.06 in the subcision arm (p = 0.02). No significant difference was seen in total acne scar reduction comparing the two methods (29.74 in the Profhilo arm and 22.27 in the subcision arm, p = 0.56). Sonographic depth reduction was also non‐significant, with a mean of 29.21 in the Profhilo arm and 28.53 in the subcision arm (p = 0.4). The mean global improvement was reported as four in both arms, and no statistical significance was observed (p = 0.89). The best response to treatment belonged to the rolling subtype in both methods (p = 0.029 for the Profhilo arm and p = 0.001 for the subcision arm). Conclusion: Despite no significant difference between the methods, Profhilo is more effective due to a higher satisfaction rate and better physiologic effects. [ABSTRACT FROM AUTHOR]

Background: Prevailing tension‐reducing suture methods have a spectrum of issues. This study presents a straightforward yet highly efficacious suture technique known as the Split‐level Folding, Step‐type Tension‐relieving Suture technique, which could play a pivotal role in preempting incisional scarring. Aims: To introduce Split‐level Folding, Step‐type Tension‐relieving Suture technique and assess its effect on scar minimization. Methods: A retrospective analysis of 64 patients who underwent treatment utilizing the proposed suturing methodology. Assessment parameters included the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), scar width, complications, and all evaluated at 6‐ and 12‐month postoperatively. Results: At 12‐month follow‐up, the POSAS and VSS scores in the normal suture group (32.58 ± 5.43, 3.58 ± 1.39) were considerably higher than the step‐type suture group (29.75 ± 3.56, p = 0.0007; 2.78 ± 1.17, p = 0.0006). Moreover, the step‐type suture group showcased a significantly narrower average incision scar width (1.62 ± 0.36) than the normal suture group (1.87 ± 0.42, p = 0.0004). This novel tension‐relieving suture technique that effectively circumvents the occurrence of persistent localized eversion and other complications often associated with traditional tension‐relieving sutures. Conclusions: The Split‐level Folding, Step‐type Tension‐relieving Suture technique emerges as a highly promising option for averting incisional scarring. This suture method works well for incisions on the chest, back, and extremities, resulting in significantly better long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris is a common inflammatory disease associated with various sequelae after skin lesion remission. Acne erythema has been considered simple erythema or a vascular lesion; however, because the understanding of this disease has improved, acne erythema is currently considered an early scar with erythematous components. Aims: This study evaluated the efficacy of using both a 595‐nm pulsed dye laser (PDL) and 1565‐nm nonablative fractional laser (NAFL) for the treatment of erythematous scars caused by acne. Methods: Ninety patients with acne scars were equally randomized to two groups. Group A (n = 45) received treatment with the NAFL. Group B (n = 45) received treatment with the PDL and NAFL. Each patient underwent one treatment session and 4 weeks of follow‐up. Results: Qualitative (χ2 = 12.415; p < 0.05) and quantitative (t = 2.675; p < 0.05) scores of Groups A and B were determined using a global scarring grading system and exhibited statistically significant differences. The quantitative score of Group A was higher than that of Group B (6.67 ± 3.46 vs. 4.98 ± 2.44). The erythema areas of the groups differed significantly after treatment, with Group B exhibiting more notable score improvements (5.00 [3.10, 7.10] vs. 2.80 [1.65, 4.60]; Z = 3.072; p < 0.05). The erythema regression rate of Group B (88.9%) was significantly higher than that of Group A (66.7%) (χ2 = 20.295; p < 0.001). Adverse events, including redness and swelling (86.6%), scabbing (78.8%), and purpura (36.6%), occurred within 7 days for 86.6% of patients. Conclusions: The combined use of the PDL and NAFL is safe and effective for erythematous acne scars. [ABSTRACT FROM AUTHOR]

Background: Atrophic acne scarring is a common sequela of inflammatory acne, causing significant problems for affected patients. Although prolonged inflammation and subsequent aberrant tissue regeneration are considered the underlying pathogenesis, the role of epidermal stem cells, which are crucial to the regeneration of pilosebaceous units, remains unknown. Objectives: To examine the changes occurring in epidermal stem cells in atrophic acne scars. Methods: Changes in collagen, elastic fibre and human leukocyte antigen (HLA)‐DR expression were analysed in normal skin and inflammatory acne lesions at days 1, 3 and 7 after development. The expression of epidermal stem cell markers and proliferation markers was compared between normal skin and mature atrophic acne scar tissue. Results: In acne lesions, inflammation had invaded into pilosebaceous units over time. Their normal structure had been destructed and replaced with a reduced amount of collagen and elastic fibre. Expression of stem cell markers including CD34, p63, leucine‐rich repeat‐containing G protein‐coupled receptor (LGR)6 and LGR5, which are expressed in the interfollicular epidermis, isthmus and bulge of hair follicles, significantly decreased in atrophic acne scar tissue compared to normal skin. Epidermal proliferation was significantly reduced in scar tissue. Conclusions: These findings suggest that as inflammatory acne lesions progress, inflammation gradually infiltrates the pilosebaceous unit and affects the resident stem cells. This disruption impedes the normal regeneration of the interfollicular epidermis and adnexal structures, resulting in atrophic acne scars. [ABSTRACT FROM AUTHOR]

Clinicians and researchers have always faced challenges in performing surgery for rotator cuff tears (RCT) due to the intricate nature of the tendon‐bone gradient and the limited long‐term effectiveness. At the same time, the occurrence of an inflammatory microenvironment further aggravates tissue damage, which has a negative impact on the regeneration process of mesenchymal stem cells (MSCs) and eventually leads to the production of scar tissue. Tetrahedral framework nucleic acids (tFNAs), novel nanomaterials, have shown great potential in biomedicine due to their strong biocompatibility, excellent cellular internalisation ability, and unparalleled programmability. The objective of this research was to examine if tFNAs have a positive effect on regeneration after RCTs. Experiments conducted in a controlled environment demonstrated that tFNAs hindered the assembly of inflammasomes in macrophages, resulting in a decrease in the release of inflammatory factors. Next, tFNAs were shown to exert a protective effect on the osteogenic and chondrogenic differentiation of bone marrow MSCs under inflammatory conditions. The in vitro results also demonstrated the regulatory effect of tFNAs on tendon‐related protein expression levels in tenocytes after inflammatory stimulation. Finally, intra‐articular injection of tFNAs into a rat RCT model showed that tFNAs improved tendon‐to‐bone healing, suggesting that tFNAs may be promising tendon‐to‐bone protective agents for the treatment of RCTs. [ABSTRACT FROM AUTHOR]

Focal segmental glomerulosclerosis (FSGS) is a complex disease which describes different kinds of kidney defects, not exclusively linked with podocyte defects. Since nephrin mutation was first described in association with early-onset nephrotic syndrome (NS), many advancements have been made in understanding genetic patterns associated with FSGS. New genetic causes of FSGS have been discovered, displaying unexpected genotypes, and recognizing possible site of damage. Many recent large-scale sequencing analyses on patients affected by idiopathic chronic kidney disease (CKD), kidney failure (KF) of unknown origin, or classified as FSGS, have revealed collagen alpha IV genes, as one of the most frequent sites of pathogenic mutations. Also, recent interest in complex and systemic lysosomal storage diseases, such as Fabry disease, has highlighted GLA mutations as possible causes of FSGS. Tubulointerstitial disease, recently classified by KDIGO based on genetic subtypes, when associated with UMOD variants, may phenotypically gain FSGS features, as well as ciliopathy genes or others, otherwise leading to completely different phenotypes, but found carrying pathogenic variants with associated FSGS phenotype. Thus, glomerulosclerosis may conceal different heterogeneous conditions. When a kidney biopsy is performed, the principal objective is to provide an accurate diagnosis. The broad spectrum of phenotypic expression and genetic complexity is demonstrating that a combined path of management needs to be applied. Genetic investigation should not be reserved only to selected cases, but rather part of medical management, integrating with clinical and renal pathology records. FSGS heterogeneity should be interpreted as an interesting opportunity to discover new pathways of CKD, requiring prompt genotype–phenotype correlation. In this review, we aim to highlight how FSGS represents a peculiar kidney condition, demanding multidisciplinary management, and in which genetic analysis may solve some otherwise unrevealed idiopathic cases. Unfortunately there is not a uniform correlation between specific mutations and FSGS morphological classes, as the same variants may be identified in familial cases or sporadic FSGS/NS or manifest a variable spectrum of the same disease. These non-specific features make diagnosis challenging. The complexity of FSGS genotypes requires new directions. Old morphological classification does not provide much information about the responsible cause of disease and misdiagnoses may expose patients to immunosuppressive therapy side effects, mistaken genetic counseling, and misguided kidney transplant programs. [ABSTRACT FROM AUTHOR]

Purpose: After anterior cruciate ligament reconstruction (ACL‐R), a localised scar tissue called cyclops lesion may develop anterior to the graft causing knee extension deficits, pain, oedema, clicking and reduced knee function. This study determined the incidence of arthroscopic resection of a cyclops lesion within 2 years after ACL‐R and investigated the associations of patient characteristics and surgical techniques with the need for arthroscopic resection of a cyclops lesion. Methods: This study included patients who underwent primary ACL‐R with adult surgical technique from 2005 to 2019 at Aarhus University Hospital, Denmark. The cohort was identified in a national registry. To identify patients who had resected a cyclops lesion within the first 2 years after ACL‐R, patients' surgical records were reviewed. Results: In 2005–2019, 2556 patients underwent primary ACL‐R; 176 developed cyclops lesions that were resected within 2 years, equivalent to an incidence of 6.9% (95% confidence interval [CI]: 5.9–7.9). When stratified by the femoral drilling technique used, this incidence was 8.9% (95% CI: 7.7–10.3) with the anteromedial technique and 1.9% (95% CI: 1.0–3.1) with the transtibial technique. The incidence was 8.5% (95% CI: 6.8–10.3) in women and 5.7% (95% CI: 4.6–7.1) in men. Age, graft choice and the presence of cartilage or meniscal lesions did not affect the incidence. Conclusion: The overall incidence of a cyclops lesion removal within 2 years post‐ACL‐R was 6.9%. This was five times higher with the anteromedial femoral drilling technique than with the transtibial technique. Women had a 47% higher incidence of cyclops lesion removal than men. This is relevant for the surgeon when planning an ACL‐R. Level of Evidence: Level II [ABSTRACT FROM AUTHOR]

This article provides a review of the use of Janus Kinase inhibitors (JAKi) in the treatment of various types of scarring alopecia. It discusses the potential benefits of JAKi therapy in improving symptoms and hair regrowth in patients with conditions such as lichen planopilaris, central centrifugal cicatricial alopecia, folliculitis decalvans, frontal fibrosing alopecia, and dissecting cellulitis of the scalp. The article acknowledges the need for further research to fully understand the effectiveness and potential side effects of JAKi in this context. Overall, JAKi therapy shows promise but more investigation is required. [Extracted from the article]

Under different pathophysiological conditions, endothelial cells lose endothelial phenotype and gain mesenchymal cell-like phenotype via a process known as endothelial-to-mesenchymal transition (EndMT). At the molecular level, endothelial cells lose the expression of endothelial cell-specific markers such as CD31/platelet-endothelial cell adhesion molecule, von Willebrand factor, and vascular-endothelial cadherin and gain the expression of mesenchymal cell markers such as α-smooth muscle actin, N-cadherin, vimentin, fibroblast specific protein-1, and collagens. EndMT is induced by numerous different pathways triggered and modulated by multiple different and often redundant mechanisms in a context-dependent manner depending on the pathophysiological status of the cell. EndMT plays an essential role in embryonic development, particularly in atrioventricular valve development; however, EndMT is also implicated in the pathogenesis of several genetically determined and acquired diseases, including malignant, cardiovascular, inflammatory, and fibrotic disorders. Among cardiovascular diseases, aberrant EndMT is reported in atherosclerosis, pulmonary hypertension, valvular disease, fibroelastosis, and cardiac fibrosis. Accordingly, understanding the mechanisms behind the cause and/or effect of EndMT to eventually target EndMT appears to be a promising strategy for treating aberrant EndMT-associated diseases. However, this approach is limited by a lack of precise functional and molecular pathways, causes and/or effects, and a lack of robust animal models and human data about EndMT in different diseases. Here, we review different mechanisms in EndMT and the role of EndMT in various cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient's quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of ultrasound parameters in assessing the efficacy of transabdominal ultrasound (TAUS)‐guided suction curettage alone for cesarean scar pregnancy (CSP). Methods: Secondary retrospective analysis of a prospective study consisted of 137 women diagnosed with CSP who were performed TAUS‐guided suction curettage alone for the first time at Maternity and Child Health Care of Guangxi Zhuang Autonomous Region in China. Prior to surgery, an ultrasound examination was conducted. Based on the need for secondary intervention, the patients were categorized into failure group and success group, and the predictive factors for failure of TAUS‐guided suction curettage alone were analyzed. Results: Multivariate logistic regression showed that maximum diameter of the gestational sac>29 mm (odds ratio [OR] = 4.043, 95% CI: 1.100–14.862), residual myometrium thickness ≤1.8 mm (OR = 3.719, 95% CI: 1.148–12.048) and chorionic villi thickness at the scar >4.7 mm (OR = 15.327, 95% CI: 4.617–50.881) were independent predictors of failure in TAUS‐guided suction curettage alone for CSP. Furthermore, the logistic regression model that was jointly constructed by these three predictors demonstrated an area under the curve, sensitivity, specificity, and Youden index of 0.913, 0.912, 0.864, and 0.776, respectively. Conclusion: The maximum diameter of the gestational sac, residual myometrium thickness, and chorionic villi thickness at the scar has certain predictive efficacy of TAUS‐guided suction curettage alone for CSP. Nevertheless, it is more valuable to apply the model of this study, composed of the three ultrasound parameters, for this prediction purpose. [ABSTRACT FROM AUTHOR]

This article discusses the complications that can arise from a previous caesarean section, specifically focusing on the caesarean scar defect. It emphasizes the importance of recognizing and managing these complications, as they can occur even after a successful vaginal birth after caesarean section. The article describes the anatomical changes of the caesarean scar defect and its relationship with placenta accrete spectrum disorder. It also addresses the management of these complications during pregnancy, including a technique for myometrial uterine repair. The article provides case studies to demonstrate how knowledge of scar anatomy can be used to manage complications related to the caesarean scar defect. The authors suggest the potential benefit of dedicated teams in Obstetrics and Gynecology departments to manage scar complications and improve outcomes. [Extracted from the article]

Objective To investigate the application effect and potential mechanisms of erbium laser micro-peeling combined with topical complex Tongye burn oil in the treatment of facial atrophic acne scars. Methods A total of 63 patients with facial atrophic acne scars from July 2020 to December 2022 at Baise People's Hospital were randomly divided into an observation group (n=32) and a control group (n=31). The control group received treatment with 2940 nm erbium laser micro-peeling, while the observation group received treatment with 2940 nm erbium laser micro-peeling combined with topical complex Tongye burn oil. pre-treatment and post-treatment acne scar weight scores (ECCA), symptom recovery time, and adverse reactions were compared between the two groups. Results All patients completed the treatment. After treatment, the total effective rate in the observation group was 87.50%, which was significantly higher than the 77.42% in the control-group control group(P＜0.05). Both groups showed a reduction in ECCA scores after treatment, with the observation group having lower scores than the control group (P＜0.05). The observation group had a shorter duration of edema, erythema, and scab formation compared to the control group (P＜0.05). There was a statistically significant difference in the incidence of adverse reactions during the treatment period between the two groups (P＜0.05). Conclusion Topical complex Tongye burn oil can effectively assist in the treatment of facial acne scars with 2940 nm erbium laser micro-peeling, enhancing treatment efficacy and shortening recovery time and reducing adverse reactions. [ABSTRACT FROM AUTHOR]

Research indicates that long noncoding RNAs (lncRNAs) contribute significantly to fibrotic diseases. Although lncRNAs may play a role in hypertrophic scars after burns, its mechanisms remain poorly understood. Using chip technology, we compared the lncRNA expression profiles of burn patients and healthy controls (HCs). Microarray results were examined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) to verify their reliability. The biological functions of differentially expressed mRNAs and the relationships between genes and signaling pathways were investigated by Gene Ontology (GO) and pathway analyses, respectively. In contrast with HCs, it was found that 2738 lncRNAs (1628 upregulated) and 2166 mRNAs (1395 upregulated) were differentially expressed in hypertrophic scars after burn. Results from RT-PCR were consistent with those from microarray. GO and pathway analyses revealed that the differentially expressed mRNAs are mainly associated with processes related to cytokine secretion in the immune system, notch signaling, and MAPK signaling. The lncRNA expression profiles of hypertrophic scars after burn changed significantly compared with HCs. It was believed that the transcripts could be used as potential targets for inhibiting abnormal scar formation in burn patients. ● Chip technology was used to detect the differences in lncRNAs and mRNAs expression. ● The lncRNAs and mRNAs expression profiles of hypertrophic scars after burn differed. ● Processes presented in hypertrophic scars related to immune system、signaling pathway. ● The study may provide ideas for the treatment of hypertrophic scar after burn. [ABSTRACT FROM AUTHOR]

The current standard management of full-thickness or deep dermal burns is early tangential excision and skin grafting. A conservative approach to deep burns without the option of skin grafting results in delayed wound healing, possibly leading to wound infection and is associated with hypertrophic scarring and increased morbidity and mortality. The aim of this study was to improve the understanding of the management and availability to perform skin grafting for burns on the African continent. It also sought to identify challenges and perceived improvements. A web-based, structured, closed-formatted, multinational survey was designed to gather information on the current state and availability of skin grafting of burn wounds on the African continent. The questionnaire consisted of 27 questions, available in English and French. It was reviewed within the GAP-Burn collaboration network and sent to 271 health care professionals who had participated in a previous study and had initially been recruited by means of the snowball system. The questionnaire was completed 84 times (response rate: 31.0%), of which 3 were excluded. Responses originated from 22 African countries. The majority 71 (87.7%) resulted from countries with a low Human Development Index (HDI), 7 (8.6%) from medium HDI countries. Split thickness skin grafting (STSG) is performed in 51 (63.0%) centers. The majority considers STSG to reduce length of stay (72.8%) and improve scarring (54.3%), yet some indicated that STSG is associated with increased risk of donor site infection (8.6%) and severe bleeding (7.4%). Factors preventing increased grafting included lack of equipment and training. Skin grafting is not performed in a significant number of hospitals treating burns. The majority of the staff believe that more skin grafting would lead to a better outcome. Advocacy and improved infrastructure, human resources coupled with introduction to well-structured health coverage for all in African countries could help to better access and affordability in burn care. • The study is the first to systematically determine the current state of skin grafting in Africa. • The study seeks to understand the factors that limit the performance of skin grafting in burns and to identify potential improvements. • These findings might have major implications on future programs to improve treatment of patients with severe burns in resource constraint areas. [ABSTRACT FROM AUTHOR]

Scarring, 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. Data 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. Loss 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. Standardized 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. [Display omitted] • Scars lack a unified descriptive morphological terminology. Existing classification systems are inconsistent, not patient-focused, and don't account for new technology. • This study proposes a basic scar morphology nomenclature based on patient complaints, rather than creating a new classification system. • Primary complaints from 2520 patients seeking scar treatment were analysed and grouped into themes: Loss of Function (10%), Contour (41%), Texture (12%), Vector (13%), and Color (24%). • The resulting patient-centred terminology addresses the need for standardized scar treatment terminology that bridges communication gaps, supports education, and facilitates research. • The proposed framework adapts to new technologies, guiding treatment decisions and empowering patients and practitioners in the evolving field of scar management. [ABSTRACT FROM AUTHOR]

Burn wound healing can be significantly delayed by infection leading to increased morbidity and hypertrophic scarring. An optimal antimicrobial agent would have the ability to kill bacteria without negatively affecting the host skin cells that are required for healing. Currently available products provide antimicrobial coverage, but may also cause reductions in cell proliferation and migration. Cold atmospheric plasma is a partially ionized gas that can be produced under atmospheric pressure at room temperature. In this study a novel handheld Aceso Plasma Generator was used to produce and test Aceso Cold Plasma (ACP) in vitro and in vivo. ACP showed a potent ability to eliminate bacterial load in vitro for a number of different species. Deep partial-thickness and full-thickness wounds that were treated with ACP after burning, after excision, after autografting, and at days 5, 7, and 9 did not show any negative effects on their wound healing trajectories. On par with in vitro analysis, bioburden was decreased in treated wounds vs. control. In addition, metrics of hypertrophic scar such as dyschromia, elasticity, trans-epidermal water loss (TEWL), and epidermal and dermal thickness were the same between the two treatment groups.It is likely that ACP can be used to mitigate the risk of bacterial infection during the phase of acute burn injury while patients await surgery for definitive closure. It may also be useful in treating wounds with delayed re-epithelialization that are at risk for infection and hypertrophic scarring. A handheld cold plasma device will be useful in treating all manner of wounds and surgical sites in order to decrease bacterial burden in an efficient and highly effective manner without compromising wound healing. • ACP showed a potent ability to eliminate bacterial load in vitro for a number of different species. • ACP was compatible with deep partial thickness burn wound healing. • ACP was compatible with full thickness burn wound healing after skin grafting. [ABSTRACT FROM AUTHOR]

Joint bright- and black-blood MRI techniques provide improved scar localization and contrast. Black-blood contrast is obtained after the visual selection of an optimal inversion time (TI) which often results in uncertainties, inter- and intra-observer variability and increased workload. In this work, we propose an artificial intelligence-based algorithm to enable fully automated TI selection and simplify myocardial scar imaging. The proposed algorithm first localizes the left ventricle using a U-Net architecture. The localized left cavity centroid is extracted and a squared region of interest ("focus box") is created around the resulting pixel. The focus box is then propagated on each image and the sum of the pixel intensity inside is computed. The smallest sum corresponds to the image with the lowest intensity signal within the blood pool and healthy myocardium, which will provide an ideal scar-to-blood contrast. The image's corresponding TI is considered optimal. The U-Net was trained to segment the epicardium in 177 patients with binary cross-entropy loss. The algorithm was validated retrospectively in 152 patients, and the agreement between the algorithm and two magnetic resonance (MR) operators' prediction of TI values was calculated using the Fleiss' kappa coefficient. Thirty focus box sizes, ranging from 2.3mm2 to 20.3cm2, were tested. Processing times were measured. The U-Net's Dice score was 93.0 ± 0.1%. The proposed algorithm extracted TI values in 2.7 ± 0.1 s per patient (vs. 16.0 ± 8.5 s for the operator). An agreement between the algorithm's prediction and the MR operators' prediction was found in 137/152 patients (κ = 0.89), for an optimal focus box of size 2.3cm2. The proposed fully-automated algorithm has potential of reducing uncertainties, variability, and workload inherent to manual approaches with promise for future clinical implementation for joint bright- and black-blood MRI. [ABSTRACT FROM AUTHOR]

Metabolic disorders are risk factors for stroke exacerbating subsequent complications. Rapidly after brain injury, a glial scar forms, preventing excessive inflammation and limiting axonal regeneration. Despite the growing interest in wound healing following brain injury, the formation of a glial scar in the context of metabolic disorders is poorly documented. In this study, we used db/db mice to investigate the impact of metabolic perturbations on brain repair mechanisms, with a focus on glial scarring. First, we confirmed the development of obesity, poor glucose regulation, hyperglycaemia and liver steatosis in these mice. Then, we observed that 3 days after a 30‐min middle cerebral artery occlusion (MCAO), db/db mice had larger infarct area compared with their control counterparts. We next investigated reactive gliosis and glial scar formation in db/+ and db/db mice. We demonstrated that astrogliosis and microgliosis were exacerbated 3 days after stroke in db/db mice. Furthermore, we also showed that the synthesis of extracellular matrix (ECM) proteins (i.e., chondroitin sulphate proteoglycan, collagen IV and tenascin C) was increased in db/db mice. Consequently, we demonstrated for the first time that metabolic disorders impair reactive gliosis post‐stroke and increase ECM deposition. Given that the damage size is known to influence glial scar, this study now raises the question of the direct impact of hyperglycaemia/obesity on reactive gliosis and glia scar. It paves the way to promote the development of new therapies targeting glial scar formation to improve functional recovery after stroke in the context of metabolic disorders. [ABSTRACT FROM AUTHOR]

Background Macrostomia is a rare congenital anomaly characterized by enlargement of mouth at oral commissure. It is also known as tessier cleft 7. There are various techniques described for achieving optimal function and aesthetic results. We describe inferiorly based vermillion square flap with z plasty on the skin for correction of macrostomia. Methods A retrospective analysis of 7 patients with macrostomia operated over a period of last 9 year were included in the study. All operations were conducted by senior surgeon. Pre operative and post operative documentation was done by photography. Age at presentation, operative technique and outcome were analyzed. Parameters used for assessing outcome are position of commissure, symmetry, thickness of vermilion, scar result. Results In all the patients repaired with myoplasty and modified lower vermillion square flap, lip commissure was formed with satisfactory shape, position, thickness with no commissure contracture. One patient had hypertrophy scar. Conclusion Inferiorly based vermillion square flap with z plasty method produces satisfactory aesthetic and functional result in all patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The development of microfocused ultrasound and fractional radiofrequency-based devices has expanded the range of cosmetic treatment options for patients with skin of color. Fractional non-ablative laser treatments can also be safely performed in skin types III-VI with appropriate settings and adjunctive topical treatments. OBJECTIVE: We sought to review the available literature on the use of energy-based devices for treatment of facial skin conditions in skin types III-VI. METHODS: A PubMed search was performed on studies from 2010-2021 assessing safety and efficacy of fractional ablative and non-ablative lasers, radiofrequency, and microfocused ultrasound-based treatments for conditions such as acne scars, melasma, benign pigmented lesions, rhytids, and skin laxity in skin types III-VI. RESULTS: Seven randomized trials, fourteen prospective cohort studies, and six retrospective reviews were included. Combination treatment with fractional radiofrequency and non-ablative laser has demonstrated efficacy in the treatment of acne scars in skin of color with minimal adverse effects. Laser-assisted drug delivery with low-density 1927-nm thulium or diode lasers has been shown to reduce the number of treatments required for significant clearance of melasma as compared with other modalities. Microfocused ultrasound has been shown to safely treat skin laxity in skin of color. LIMITATIONS: There is a paucity of studies which include patients with skin type VI, limiting our overall understanding of the safety of these treatments in skin of color. CONCLUSION: There are numerous available studies demonstrating safety and efficacy of energy-based devices for the treatment of facial skin conditions in skin types III-VI, but the significant variation among their designs, methods of assessment, and study populations highlights the need for larger meta-analyses to further interpret their results. [ABSTRACT FROM AUTHOR]

Objectives: Magnetic resonance imaging (MRI) is the modality of choice for rectal cancer initial staging and restaging after neoadjuvant chemoradiation. Our objective was to perform a meta-analysis of the diagnostic performance of the split scar sign (SSS) on rectal MRI in predicting complete response after neoadjuvant therapy. Methods: MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through June 2023. Primary studies met eligibility criteria if they evaluated the diagnostic performance of the SSS to predict complete response on pathology or clinical follow-up in patients undergoing neoadjuvant chemoradiation. A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) of the SSS. Results: A total of 4 studies comprising 377 patients met the inclusion criteria. The prevalence of complete response in the studies was 21.7–52.5%. The pooled sensitivity and specificity of the SSS to predict complete response were 62.0% (95% CI, 43.5–78.5%) and 91.9% (95% CI, 78.9–97.2%), respectively. The estimated AUC for SSS was 0.83 (95% CI, 0.56–0.94) with a DOR of 18.8 (95% CI, 3.65–96.5). Conclusion: The presence of SSS on rectal MRI demonstrated high specificity for complete response in patients with rectal cancer after neoadjuvant chemoradiation. This imaging pattern can be a valuable tool to identify potential candidates for organ-sparing treatment and surveillance. Clinical relevance statement: SSS presents high specificity for complete response post-neoadjuvant. This MRI finding enhances rectal cancer treatment assessment and aids clinicians and patients in choosing watch-and-wait over immediate surgery, which can potentially reduce costs and associated morbidity. Key Points: •Fifteen to 50% of rectal cancer patients achieve complete response after neoadjuvant chemoradiation and may be eligible for a watch-and-wait strategy. •The split scar sign has high specificity for a complete response. •This imaging finding is valuable to select candidates for organ-sparing management. [ABSTRACT FROM AUTHOR]

Simple Summary: Routine resection of surgical scars could prevent scar recurrences after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases and pseudomyxoma peritonei. However, there is no clear evidence for resecting all surgical scars, irrespective of macroscopic suspicion of scar metastases, and scar resection is associated with wound complications. Careful macroscopic assessment of surgical scars is needed to avoid routine scar resection. This study aimed to analyze the correlation between macroscopically suspected and microscopically confirmed scar metastases, and to analyze the prognostic impact of not undergoing routine scar resection. This study showed that occult scar metastases were uncommon and patients not undergoing routine scar resection did not have worse recurrence-free or overall survival compared with those undergoing scar resection. Therefore, macroscopically benign-appearing scars can be left without resection, though resection should be performed in case of uncertainty. Background: Careful macroscopic assessment of surgical scars is needed to avoid routine scar resection during cytoreductive surgery (CRS) for peritoneal metastases (PM). This study aimed to analyze the correlation between macroscopically suspected and microscopically confirmed scar metastases (SMs), and to analyze the prognostic impact of not undergoing routine scar resection. Method: All patients with previous surgery, treated with CRS and hyperthermic intraperitoneal chemotherapy, for colorectal PM or pseudomyxoma peritonei (PMP), at Uppsala University Hospital in 2013–2021, were included. Macroscopic SMs in surgical reports were compared with histopathological analyses. Results: In total, 227 patients were included. Among colorectal PM patients (n = 156), SM was macroscopically suspected in 41 (26%) patients, and 63 (40%) underwent scar resection. SM was confirmed in 19 (30%). Among patients with macroscopic suspicion, 45% had confirmed SM (positive predictive value, PPV). A total of 1 of 23 (4%) patients with no macroscopic suspicion had SM (negative predictive value, NPV = 96%). Among the PMP patients (n = 71), SM was macroscopically suspected in 13 (18%), and 28 (39%) underwent scar resection, of whom 12 (43%) had SM. The PPV was 77%. Occult SM was found in 1 of 14 (NPV = 93%). Not undergoing routine scar resection did not affect recurrence-free survival (RFS, p = 0.2) or overall survival (OS, p = 0.1) in colorectal PM patients or PMP patients (RFS p = 0.7, OS p = 0.7). Conclusion: Occult SM is uncommon and scar resection does not affect RFS or OS. Therefore, macroscopically benign-appearing scars can be left without resection, though resection should be performed upon suspicion or uncertainty. [ABSTRACT FROM AUTHOR]

Simple Summary: The quality of life of patients with facial basal cell carcinoma significantly improves after surgery. Nevertheless, it remains inferior to those without the disease. Facial scarring has been identified as a contributing factor to adverse psychosocial changes. In this study, we explore the aesthetic assessment of facial scars within this specific patient group, aiming to uncover potential correlations between the severity of scars and the quality of life. This study comprises two phases as follows: scale validation and pilot with a sample size of 100 patients. The Lithuanian version of the POSAS 2.0 was established after a thorough psychometric evaluation, surpassing acceptable validity thresholds. The pilot phase findings show a notable improvement in scars during the later stages of postoperative recovery, with the initial identification of specific groups that perceive their scars more negatively. Given the observed correlations between the scar assessment and the quality of life, this study highlights the crucial role of addressing the aesthetic satisfaction of patients with surgically treated basal cell carcinoma. Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region. [ABSTRACT FROM AUTHOR]

Various surgical methods have so far been developed for treating rectovaginal fistula (RVF), each with its own advantages and disadvantages. The lack of standardized animal models of RVF is a major reason for the failure to establish a unified and effective surgical method for the treatment of RVF. This study aimed to explore the feasibility of an RVF animal model by magnetic compression and compare it with the traditional modeling method. Thirty-two female Japanese white rabbits were randomly divided into four groups: A, B, C, and D, based on how the rectovaginal septum was treated. The operation time, intraoperative blood loss, and model success rate of each group were determined. The experimental animals were euthanized 2 weeks after the operation. Their rectovaginal septum specimens were obtained. RVF was observed by the naked eye. The fistula size was measured. Histological changes of fistula were observed by hematoxylin and eosin and Masson staining. All rabbits completed the RVF model and survived 2 weeks after the operation. Groups A and B had no bleeding, while groups C and D had < 0.5 mL of bleeding. The magnet detached in 4–6 days in group A, while it remained in place for 2 weeks after surgery in group B. Only one group D rabbit had a plastic hose for 2 weeks after surgery. The RVFs of groups A and C healed by themselves. In group B, the fistula was well formed. In group D, fistula healing was observed in three animals and the diameter of the fistulas was only 2.82–4.64 mm in the other four animals. Groups B and D had a scar on the inner surface of fistulas. Our study shows that the magnetic compression technique based on the T-shaped magnet is a highly useful method to establishing a continuous and stable RVF model in rabbits. [ABSTRACT FROM AUTHOR]

BACKGROUND: Conductive biomaterials are considered potential candidates for transmitting electrical signals for myocardial repair. Combining cell-based or cellfree strategies with conductive biomaterials to replenish cardiomyocytes and/or restore electrical signaling pathways is a promising approach for cardiac repair. OBJECTIVE: To evaluate the effect of polypyrrole-chitosan conductive composite hydrogel on cardiac function in rats with myocardial ischemia-reperfusion injury. METHODS: The polypyrrole-chitosan conductive composite hydrogel was prepared by chemical oxidative polymerization. The micromorphology, biocompatibility and conductivity of the hydrogels were characterized. Thirty adult SD rats were selected to establish a myocardial ischemia-reperfusion injury model by clamping the left anterior descending branch of the heart and then releasing it. After 21 days of modeling, the rats were divided into three groups by the random number table method: Normal saline was injected into the left ventricular infarction area and infarction margin area in the blank group. Chitosan hydrogel was injected into the left ventricular infarction area and infarction margin area in the ordinary hydrogel group. The polypyrrole-chitosan conductive composite hydrogel was injected into the left ventricular infarction area and infarction margin area, with 10 rats in each group. The corresponding time points after modeling were set, and cardiac mechanical function (echocardiogram, pressure-volume analysis), cardiac electrophysiology (electrocardiogram, programmed electrical stimulation, optical mapping technology, microelectrode array technology, eight-lead electrocardiogram, and electrical resistivity of the scar area) and cardiac histology were detected. RESULTS AND CONCLUSION: (1) There were a lot of pores on the surface of the conductive composite hydrogel, and the conductivity was (3.19±0.03)× 10-3 mS/cm, which had good biocompatibility co-cultured with smooth muscle cells. (2) After 105 days of modeling, echocardiogram and pressure-volume analysis showed that compared with the blank group and the ordinary hydrogel group, the conductive composite hydrogel could significantly improve the contractile function of the heart of rats with myocardial ischemia-reperfusion injury. The results of electrocardiogram, programmed electrical stimulation, optical mapping technology, microelectrode array technology, eight-lead electrocardiogram, and electrical resistivity of the scar area examination at 105 days after modeling displayed that, compared with the blank group and the ordinary hydrogel group, the conductive composite hydrogel could significantly improve the electrical conduction function of the heart of rats with myocardial ischemia-reperfusion injury and reduce the occurrence of arrhythmia. Masson staining of heart tissue at 105 days after modeling exhibited that there were different degrees of fibrosis in the myocardial infarction area of the three groups. Compared with the normal saline group and the ordinary hydrogel group, the conductive hydrogel group had more normal myocardial tissue and less fibrosis in the myocardial infarction area. (3) The results verify that polypyrrole-chitosan conductive composite hydrogel may promote the repair of infarcted heart after ischemia-reperfusion injury by increasing the electrical conduction velocity of infarct scar area tissue, increasing scar thickness, enhancing synchronous cardiac contraction, and reducing damaged tissue. [ABSTRACT FROM AUTHOR]

Enterohemorrhagic Escherichia coli is considered one of the primary bacterial pathogens that cause foodborne diseases because it can survive in meat, vegetables and so on. Understanding of the effect of vegetable characteristics on the adhesion and proliferation process of EHEC is necessary to develop control measures. In this review, the amount and methods of adhesion, the internalization pathway and proliferation process of EHEC have been described during the vegetable contamination. Types, cultivars, tissue characteristics, leaf age, and damage degree can affect EHEC adhesion on vegetables. EHEC cells contaminate the root surface of vegetables through soil and further internalize. It can also contaminate the stem scar tissue of vegetables by rain or irrigation water and internalize the vertical axis, as well as the stomata, necrotic lesions and damaged tissues of vegetable leaves. After EHEC adhered to the vegetables, they may further proliferate and form biofilms. Leaf and fruit tissues were more sensitive to biofilm formation, and shedding rate of biofilms on epidermis tissue was faster. Insights into the mechanisms of vegetable contamination by EHEC, including the role of exopolysaccharides and proteins responsible for movement, adhesion and oxidative stress response could reveal the molecular mechanism by which EHEC contaminates vegetables. [ABSTRACT FROM AUTHOR]

Background: Caesarean scar disorders (CSDi) are an increasingly recognized consequence of caesarean sections, which can present with secondary infertility. Currently, there is limited data on the management of CSDi, and the subsequent fertility and pregnancy outcomes. Our aim was to examine different treatment methods and outcomes in a cohort of women with secondary infertility. Study design: This study involved a retrospective case series for patients (n = 26) diagnosed with and treated for a CSDi between 2008 and 2019 at a tertiary care centre in British Columbia, Canada, by one of three gynecologists with expertise in CSDi repair. Surgical repair was performed via laparoscopy for residual myometrial thickness (RMT) < 3.0 mm, and via hysteroscopy otherwise. Postoperative pregnancy rates and reproductive outcomes are reported. This study also included a search of the literature to gain an overview of the indications, outcomes, advantages, disadvantages, and risks associated with four surgical approaches (hysteroscopic, laparoscopic, vaginal, abdominal) used in the management of CSDi. A Medline and manual searches of referenced articles were conducted for this purpose. Results: Twenty-six patients with CSDi were diagnosed with secondary infertility (mean age = 36.4 years) during the study period. Twenty of these patients underwent surgical management, with 12 receiving hysteroscopic resection or ablation, and 8 receiving laparoscopic repair. Six patients had no treatment or are still awaiting management at this time. Postoperatively, 11/20 patients (55%) were able to successfully conceive at least once. 8/11 patients were from the hysteroscopy group (66% pregnancy rate) and 10/11 pregnancies resulted in live births at term. In the laparoscopy group, there were 3 pregnancies (37.5% pregnancy rate), including 2 term live births, and 1 preterm live birth at 26 weeks. With respect to our review of the literature, a total of 49 articles were included in our final review of surgical techniques used in the management of CSDi. Conclusions: This study suggests that surgical repair can improve pregnancy rates in patients with secondary infertility in the context of a confirmed CSDi. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hypertrophic scar is a skin fibrosis disease characterized by excessive proliferation of fibroblasts, epidermal thickening, and stratum corneum dysfunction. At present, the pathogenesis of Hypertrophic scar is still unclear. OBJECTIVE: To screen the core (Hub) genes and important signaling pathways in hypertrophic scar-related datasets based on bioinformatics, and then verify them by cell experiments to predict small molecule drugs that may have therapeutic effects on hypertrophic scar. METHODS: Datasets related to hypertrophic scar were searched from Gene Expression Omnibus (GEO) database, and differentially expressed genes were identified by R software analysis. Gene ontology and KEGG enrichment analyses were performed for differentially expressed genes. Protein-protein interaction network of differentially expressed genes was constructed using String online platform. Then, the key genes and core modules in the protein-protein interaction network were screened by Cytohubba and MCODE plugin-in Cytoscape software respectively, and the Hub genes were obtained by the intersection of the above key genes and the genes that formed the core module. Real-time fluorescent quantitative PCR was used to verify the difference in Hub gene mRNA expression between human hypertrophic scar and normal skin epidermal stem cells. The histological data from the Human Protein Atlas were used to verify the differences in the expression and distribution of Hub gene-encoded proteins in the two kinds of human tissues. Finally, the potential drugs for hypertrophic scar were predicted by the connectivity map database. RESULTS AND CONCLUSION: Among the identified differentially expressed genes, 102 genes were up-regulated and 702 genes were down-regulated. Gene ontology and KEGG analysis showed that the enriched signaling pathways and biological processes were mainly involved in tight junction, arachidonic acid metabolism, extracellular matrix receptor interaction, epidermal development and keratinization. Eight Hub genes were found to be closely related to the mevalonate pathway that regulates cholesterol metabolism, including HMGCS1, DHCR7, MSMO1, FDPS, MVK, HMGCR, MVD and ACAT2. Compared with the normal skin group, the mRNA expression of HMGCS1, DHCR7, MSMO1, FDPS, HMGCR, MVD and ACAT2 in the hypertrophic scar group decreased significantly (P < 0.05), while MVK mRNA expression had no significant change (P > 0.05). Except for MVK, the expression levels of other Hub gene-encoded proteins in normal skin tissue were higher than those in hypertrophic scar tissue (P < 0.05). The top 10 candidate drugs included protein kinase A inhibitor (H-89), serine protease inhibitor (Dabigatran-Etexilate), FLT3 inhibitor (sunitinib), among which resveratrol and β-sitosterol are plant extracts. To conclude, Hub genes closely related to mevalonate metabolism may affect the structure and function of the epidermis by regulating lipid metabolism, which may an important pathogenesis of hypertrophic scar. The small-molecule compounds identified in this study can be used as candidate drugs for the treatment of hypertrophic scar. [ABSTRACT FROM AUTHOR]

In our previous study, we developed a triple-negative breast cancer (TNBC) subtype classification that correlated with the TNBC molecular subclassification. In this study, we aimed to evaluate the predictor variables of this subtype classification on the whole slide and to validate the model's performance by using an external test set. We explored the characteristics of this subtype classification and investigated genomic alterations, including genomic scar signature scores. First, TNBC was classified into the luminal androgen receptor (LAR) and non-luminal androgen receptor (non-LAR) subtypes based on the AR Allred score (≥ 6 and < 6, respectively). Then, the non-LAR subtype was further classified into the lymphocyte-predominant (LP), lymphocyte-intermediate (LI), and lymphocyte-depleted (LD) groups based on stromal tumor-infiltrating lymphocytes (TILs) (< 20%, > 20% but < 60%, and ≥ 60%, respectively). This classification showed fair agreement with the molecular classification in the test set. The LAR subtype was characterized by a high rate of PIK3CA mutation, CD274 (encodes PD-L1) and PDCD1LG2 (encodes PD-L2) deletion, and a low homologous recombination deficiency (HRD) score. The non-LAR LD TIL group was characterized by a high frequency of NOTCH2 and MYC amplification and a high HRD score. [ABSTRACT FROM AUTHOR]