Doylestown Plus and GALAD Demonstrate High Sensitivity for HCC Detection in Patients With Cirrhosis.

Hepatocellular carcinoma (HCC) surveillance is associated with early tumor detection and improved survival in patients with cirrhosis.1 Surveillance is performed using semiannual abdominal ultrasound with or without α-fetoprotein (AFP); however, this strategy misses more than one-third of HCC at an early stage.2 These data highlight a need for novel surveillance strategies with higher accuracy for early HCC detection. GALAD and Doylestown Plus are novel biomarker panels that combine multiple biomarkers with patient demographic and clinical characteristics; both demonstrated promising accuracy in phase II case-control studies;3,4 however, case-control studies can overestimate biomarker performance, highlighting a need for phase III cohort and nested case-control studies.5 Our study aimed to compare multiple biomarkers (including AFP, GALAD, and Doylestown Plus) in a nested case-control study of patients with cirrhosis.

A randomized clinical trial to study the effect of silicone gel dressing and pressure therapy on posttraumatic hypertrophic scars.

To investigate the effect of pressure therapy (PG), silicone gel sheeting (SGS), and combined therapy on the management of posttraumatic hypertrophic scar (HS) using a randomized controlled clinical trial. A total of 104 subjects with HS mostly resulting from burns and scald injuries (63 men and 41 women; average age: 21.8 +/- 18.7 years) were recruited from Jiangsu People's First Affiliated Hospital in Nanjing, China. The mean scar formation period was 14.9 +/- 30.8 months. All subjects were randomly allocated into four groups, namely the PG, SGS, combined PG and SGS groups, and single-blinded control group for the treatment of 6 months. Standardized scar assessments (pigmentation, vascularity, thickness, pain, and itchiness) were conducted before the intervention, 2, 4, and 6 months of the intervention, and 1 month after completion of the program, respectively, to observe the progress of the treatments. The results showed that the combined therapy seemed to be more effective in improving the thickness of scar after 2 months of intervention (P < .001). After 6 months of intervention, both the combined therapy group and the PG group showed significant improvement in scar thickness. The improvement in scar thickness was most significant in the combined therapy group. SGS was found to be more effective in alleviating the pain and pruritus rather than the scar thickness. This randomized clinical trial has demonstrated the evidence of the effect of combined PG and gel intervention on posttraumatic HS. The PG group showed an improvement in scar thickness too. Further studies are needed to investigate the biomechanical and physiological effect that PG and gel sheeting would exert on the scar tissues.

A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population.

BACKGROUND: This study aimed to determine the efficacy of silicone gel (Cica-Care) on severe post-traumatic hypertophic scars among the Chinese population. METHOD AND MATERIALS: A randomized clinical trial (RCT) was conducted on 45 Chinese patients with post-traumatic hypertrophic scars. Twenty-two subjects were placed in the experimental group with silicone gel sheeting (SGS) applied 24h per day for 6 months while all subjects were taught to massage the scar daily for 15 min serving as the control intervention. Scar assessments were conducted regularly to measure the changes in thickness, pigmentation, vascularity, pliability, itchiness and pain. RESULTS: Two-way repeated ANOVA showed a significant difference between MT group and SGS group on scar thickness. The post hoc comparison analysis showed that the difference was significant at the post-2-month (p=0.008) and post-6-month (p<0.001) intervention. The SGS group also showed changes in pigmentation which resembled normal skin but no statistical significance was found. Pain, itchiness and pliability were also improved after intervention. CONCLUSION: This study indicated that silicone gel sheeting (Cica-Care) was effective to reduce thickness, pain, itchiness and pliability of the severe hypertrophic scar among the Chinese population. The moisturization effect of the tough and hard scar might contribute to the reduction of the skin thickness after 6 month's intervention.

Prevalence of hypertrophic scar formation and its characteristics among the Chinese population.

Each year in Hong Kong, about 350,000 surgical procedures are conducted for various types of conditions. Previous review indicated that the prevalence of hypertrophic scar among Caucasians ranged from 15% to 63% and that the incidence was even higher among non-Caucasians. This study aims to find out the prevalence rate of hypertrophic scar among the Hong Kong Chinese population after standardized surgical procedures. A systematic and objective scar measurement protocol is implemented in this study. The spectrocolorimeter, Miniscan XE plus was used to measure the scar pigmentation based on the theory of the CIE colour model. The tissue ultrasound palpation system (TUPS) was employed to measure scar thickness. From May 2001 to December 2003, 154 patients, who received surgical intervention at the Department of Orthopaedics and Traumatology of a large regional hospital, were invited to join a scar-screening test. One hundred and fifteen patients (74.67%) were found to have signs of hypertrophic scar based on thickness, pliability, pigmentation and vascularity (using the Vancouver scar scale (VSS) score). One hundred and one patients consented to have more comprehensive scar assessment. Results indicated that the scar thickness was 4.91+/-1.03 mm. Compared with the adjacent normal skin, the color of hypertrophic scar was significantly different in terms of lightness (d.f.=100, t=-19.36, p<0.01), redness (d.f.=100, t=15.75, p<0.01) and yellowness (d.f.=100, t=-11.48, p<0.01) using paired t-test analysis. Fourtysix point five percent and 33.7% among patients reported pain (2.19+/-2.74) and itchiness (1.47+/-2.53) over the scar. The objective scar assessments showed that more than 70% of scars had increase in thickness and pigmentation after surgery. More than 40% of patients reported pain and itchiness. The results showed that more than 70% of the scars in the HK Chinese population had become hypertrophic in terms of pigmentation, thickness and physical symptoms such as pain and itchiness 1 month after the surgical intervention. More long-term follow up study should be done to find out the prevalence and that it is essential to provide early intervention before the scar becomes problematic in management.

Application of tissue ultrasound palpation system (TUPS) in objective scar evaluation.

One of the characteristics of hypertrophic scarring is its raised appearance. Its maturation often results in increased thickness. Therapists usually rely on subjective observation and palpation to document scar thickness. The result of these subjective assessments may reflect only the superficial scar thickness but is unable to measure the whole scar volume and thickness under the skin surface. Measurement of scar thickness using ultrasound imaging has been previously reported, but has not been commonly used in clinics due to its complex operation method and high cost. In this study, we have adopted a newly developed and user-friendly Tissue ultrasound palpation system (TUPS) for the assessment of scar thickness. It consists of a finger size palpation probe, connected to an ultrasound transducer and an in-series load cell to measure the thickness of the soft tissue over the human body. The method of operation is easy and it can be used to measure skin thickness on various parts of the body, thus reflecting the skin thickness. The reliability of the TUPS in clinical application was tested on 30 subjects with a hypertrophic scar at a local hospital. Three raters implemented two assessments on each subject to study its test-retest and inter-rater reliabilities. It was then used to assess 100 subjects with various severity of hypertrophic scar caused by trauma, scald, burn or surgery. They were assessed using TUPS as well as the Vancouver Scar Scale (VSS) for rating scar thickness, pliability, pigmentation and vascularity. Two-way mixed intra-class correlation showed a high test-retest reliability with Intraclass Correlation Coefficient (ICC)=0.98 and inter-rater reliability ICC=0.84. Fair positive correlations with VSS thickness score and VSS total score r=0.34 (p<0.05) and 0.42 (p<0.05), respectively. A significant difference between two scar type groups (50 burn scald scars and 50 surgical scars) was demonstrated (d.f.=52.94, t=3.99, p<0.01). TUPS was proved to have high inter-rater, test-retest reliability and it had a moderate correlation with the VSS that clinicians used for assessment of the scar. This system is recommended for clinical assessment of scar thickness.

Validation of an objective scar pigmentation measurement by using a spectrocolorimeter.

Scar pigmentation changes throughout its maturation process and it is often used as one of the indicators for scar maturation, yet it is often rated subjectively. The purpose of this study was to investigate the application of a commercial spectrocolorimeter to produce a reliable measurement on scar pigmentation. Commission Internationale de l'Eclairage (CIE) model of color has been adopted in this study for measurement of scar pigmentation 24 patients with hypertrophic scars at different stages of maturation were selected for the study, were inspected by two therapists using the Vancouver scar scale (VSS) and then using spectrocolorimeter for inter-rater reliability. The measurements were taken after 30min by the same group of therapists (test-retest reliability). Results indicated that the inter-rater reliability among the three therapists was satisfactory, with intra-class correlation coefficient (ICC) (2, 2) from 0.50 to 0.99 in all the three color parameters. The test-retest reliability of the spectrocolorimeter was satisfactory with ICC (3, 6) ranged from 0.95 to 0.99. A significant difference was also noted between the measurements of normal skin and hypertrophic scar (P<0.00, t-values: from 2.78 to 0.05, d.f.: from 29.7 to 46.00) in all color parameters, except the chroma C(*). We also found a positive relationship between VSS scores and the spectrocolorimeter readings. The spectrocolorimeter is found to be a reliable instrument to quantify scar pigmentation and to differentiate normal skin and scar tissue. With further studies, the constructs of scar properties could further be explored using this spectrocolorimeter.