Awareness of sun exposure risks and photoprotection for preventing pigmentary disorders in Asian populations: Survey results from three Asian countries and expert panel recommendations.

BACKGROUND: In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders. METHODS: An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure. RESULTS: A pre-meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post-inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun. CONCLUSIONS: Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad-spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders.

Burden of Skin and Subcutaneous Diseases in Indonesia 1990 to 2019.

is missing (Short communication).

Occupational lead exposure health risk assessment and heme biosynthesis: A study on batik artisans in yogyakarta, Indonesia.

This study aims to assess dermal and inhalation lead exposure levels among batik industry workers and evaluate noncarcinogenic and carcinogenic health risks associated with lead exposure. We investigate potential relationships between lead exposure (dermal average daily dose and inhalation exposure concentration) and the workers' blood hemoglobin levels (Hb), as well as their urinary ALA (u-ALA) concentrations. Additionally, we explore any possible associations between Hb and u-ALA levels among the workers and identify various factors influencing lead exposure levels. A total of 30 workers were recruited for the study. Interviews and exposure sampling were conducted to measure dermal and inhaled lead exposure. Sample analysis methods include XRF for exposure samples, spectrophotometry for u-ALA, and HiCN colorimetric for Hb. Carcinogenic and noncarcinogenic risk assessments, correlation analysis, as well as ANOVA for factors analysis, were performed. The average dermal exposure dose and inhalation exposure concentration of lead were 6.53 ± 3.2 ng/kg/day and 0.021 ± 0.015 µg/m3, respectively. Hazard Index (HI) values for all workers were below 1 (average: 0.372 ± 0.155), indicating no expected noncarcinogenic health effects due to lead exposure. The average Excess Lifetime Cancer Risk (ELCR) was (5.18 ± 3.84) × 10-8, significantly below acceptable limits. Correlation analysis revealed a significant negative correlation between Hb and u-ALA (r = -0.519, p = 0.058 for male workers and r = -0.531, p = 0.034 for female workers), supporting their use as lead exposure biomarkers. The factors analysis demonstrated a significant impact of working conditions on inhalation exposure (p = 0.018), with outdoor workers experiencing lower lead inhalation. This research provides crucial insights into potential dangers faced by batik workers due to lead exposure, emphasizing the importance of targeted interventions. The strong correlation between Hb and u-ALA indicates their combined effectiveness in detecting lead exposure, even at low levels. The study underscores the significance of outdoor work as a protective measure against inhaling heavy metals, such as lead, present in the air. The assessment of health risks associated with lead exposure in the batik industry lays the groundwork for informed decision-making and interventions to protect workers' well-being, particularly in informal sectors workplaces where health risks are often overlooked.

Glove-Induced Hand Dermatitis: A Study in Healthcare Workers during COVID-19 Pandemic in Indonesia.

Skin damage among healthcare workers has been reported by many centers around the world. Occupational hand dermatitis is one of the most commonly known occupational skin diseases and a socially significant health issue. The use of gloves is one of the risk factors for the occurrence and/or aggravation of hand dermatitis. This cross-sectional study involved healthcare workers in 14 referral hospitals for COVID-19 throughout Indonesia. Questionnaires were distributed to the participants, which consisted of the subject's characteristics, glove-related skin problems, history of glove use, and clinical history. This study involved a total of 845 healthcare workers. Approximately 156 healthcare workers (18.46%) had glove-induced hand dermatitis during the pandemic. Itchy skin was the most common symptom (44.23%), and the palm was the most frequently complained area (48.72%). There was a significant association between glove use and glove-induced hand dermatitis among healthcare workers. In particular, equal to or more than 2 hours per day of glove use was significantly associated with hand dermatitis. Glove-induced hand dermatitis also had a significant association with the subject's history of atopic dermatitis and previous history of hand dermatitis. The use of gloves by healthcare workers should be considered carefully, especially in individuals at increased risk, including those who use gloves for 2 hours or more per day and those who have a history of atopic or hand dermatitis, in order to prevent the incidence of glove-induced hand dermatitis among healthcare workers, as well as to provide a safe working environment.

The effect of preconditioning hypoxia in schwann-like-cells-derived adipose mesenchymal stem cells and rat sciatic nerve-derived stem cells: experimental research.

The preconditioning hypoxia for stem cells is a strategy to achieve effective conditions for cell therapy, indicate increased expression of regenerative genes in stem cell therapy, and enhance the secretion of bioactive factors and therapeutic potential of their cultured secretome. Objectives: This study aims to explore the response of Schwann-like cells derived from adipose-derived mesenchymal stem cells (SLCs) and Schwann cells rat sciatic nerve-derived stem cells (SCs) with their secretomes under normoxic and hypoxic conditions in vitro. Material and methods: SLCs and SCs were isolated from the adipose tissue and the sciatic nerve of the adult white male rat strain Wistar. Cells were incubated in 21% O2 (normoxic group) and 1%, 3%, and 5% O2 (hypoxic group) conditions. Concentration values of transforming growth factor-ß (TGF-ß), basic Fibroblast Growth factor (bFGF), brain-derived neurotrophic factor, glial-derived neurotrophic factor, vascular endothelial growth factor, and nerve growth factor were detected and calculated utilizing an enzyme-linked immunosorbent assay, and the growth curve was described. Results: SLCs and SCs indicated positive expression for mesenchymal markers and negative expression for hematopoietic markers. Normoxic conditions SLCs and SCs showed elongated and flattened morphology. Under hypoxic conditions, SLCs and SCs showed a classic fibroblast-like morphology. Hypoxia 1% gave the highest concentration in TGF-ß and bFGF from the SLCs group and TGF-ß, bFGF, brain-derived neurotrophic factor, and vascular endothelial growth factor from the SCs group. No significant differences in concentration of growth factors between the SLCs group compared to SCs group in all oxygen groups. Conclusions: Preconditioning hypoxia has an effect on the composing of SLCs, SCs, and their secretomes in vitro; no significant differences in concentration of growth factors between the SLCs group compared with the SCs group in all oxygen groups.

Experimental Analysis of Vaginal Laxity in Rats Treated With a Combination of Er:YAG Fractional Lasers and AMSC-MP.

Introduction: Vaginal laxity, a symptom of pelvic floor dysfunction observed in women, has many negative biological and psychological impacts. Laser treatments and stem cell-based therapies are emerging therapeutic methods for treating this condition. This study aimed to determine changes in vaginal laxity in model rats using a combination therapy of erbium-doped yttrium aluminium garnet (Er:YAG) fractional lasers and topical treatment with amniotic membrane stem cell metabolite products (AMSC-MP). Methods: The experimental animal population comprised 36 female white rats (Rattus norvegicus; 2-day-post-vaginal-delivery rats) allocated into the following four groups (n=9): K1, untreated two-day-post-vaginal-delivery rats; K2, two-day-post-vaginal-delivery rats treated with topical gel without AMSC-MP; P1, two-day-post-vaginal-delivery rats treated with Er:YAG fractional lasers and topical gel without AMSC-MP; P2, two-day-post-vaginal-delivery rats treated with Er: YAG fractional lasers and topical gel containing AMSC-MP. Immunohistochemical (IHC) examination was carried out for the expression and activity of heat shock protein 70 (HSP-70), collagen-1, tissue inhibitors of metalloproteinase 1 (TIMP-1) and matrix metalloproteinase 1 (MMP-1), as well as vaginal mucosal thickness. Results: There was a significant difference (P<0.05) in the expression of HSP-70 among all groups except K2 and P1 (P>0.05); there was no significant difference in type I collagen and TIMP-1 expression between the groups (P>0.05); there was a significant difference (P<0.05) in MMP-1 activity, with the activity in the K2 group (5.79±0.83) being higher than that in the P1 group (4.44±1.82) and that in the K1 group (5.74±1.03) being higher than that in the P2 group (4.24±1.55). Also, there was a significant difference in the thickness of the vaginal mucosa in all groups except K2 and P1 (P>0.05). Conclusion: Er:YAG fractional laser and AMSC-MP combination therapy improved vaginal laxity in model rats by increasing Hsp70 expression and vaginal mucosal thickness and decreasing MMP-1 activity.

Hazard identification and the prevalence of occupational skin disease in Indonesian Batik workers.

Batik, a resist-dyeing technique to decorate a special cotton fabric, has been practiced for centuries in Indonesia. Unfortunately, as an informal enterprise, batik industry activities lack work safety and health regulations. This study aimed to identify potential health hazards, including inventorying the chemicals to which the workers are exposed, the PPE profile, and investigating the prevalence of occupational skin diseases (OSD) in the batik industry. A cross-sectional study and an inventory of exposure to the chemicals were done in traditional batik workplaces in 5 districts in Yogyakarta province, Indonesia. The chemicals were classified as potential sensitizers/irritants, and the workers were examined and interviewed using the Nordic Occupational Skin Questionnaire-2002/LONG. Of 222 traditional batik workers, OSD were diagnosed in 61 (27.5%) workers, with occupational contact dermatitis was the most common OSD encountered (n = 23/61; 37.7%) (allergic contact dermatitis n = 7/23; irritant contact dermatitis n = 16/23). A smaller portion of other OSD was also encountered including callus, miliaria, and nail disorder (9%, 6.3%, and 5.9%, respectively). During each step of the traditional batik manufacturing process, the workers are exposed to substances that act as irritants and/or as potential contact allergens. However, only one-fourth of the workers used PPE regularly, particularly during the coloring process and wax removal (wet processes). Traditional batik manufacturing process exposes the worker to various physical and chemical hazards, resulting in a high prevalence of occupational skin diseases, especially contact dermatitis among the employees.

The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial.

Background Wound healing shows a unique interaction of several cells, growth factors and cytokines. The healing of chronic plantar ulcer of leprosy is influenced by various factors, one of which is the concentration of growth factors and cytokines related to the pathogenesis of impaired wound healing. Growth factors and cytokines can be found in the secretome of adipose mesenchymal stem cells. Aim To compare the effectiveness of topical adipose mesenchymal stem cell-conditioned medium and framycetin gauze dressing only on the healing of chronic plantar ulcer of leprosy. Methods In this randomised controlled trial, 32 patients with chronic plantar ulcer of leprosy were recruited. After detailed clinical and initial debridement, patients were randomised to two groups to receive either topical adipose mesenchymal stem cell-conditioned medium (n = 16) or framycetin gauze dressing only (n = 16) applied every three days for up to eight weeks, following which the ulcer size, adverse reactions and complications if any were monitored weekly. Results Healing percentage increased each week in all groups. Statistical differences between groups (P < 0.05) were observed from week 2 onwards for ulcer mean size reduction and from week 3 onwards for ulcer mean depth reduction. There were no adverse reactions or complications. Limitations Off-loading on subjects were not performed. Conclusion Adipose mesenchymal stem cell-conditioned medium is a potential therapeutic agent in the management of chronic plantar ulcer of leprosy.

Risk factors of occupational skin diseases among traditional batik manufacturing workers in Yogyakarta, Indonesia.

OBJECTIVE: Batik is one of the Indonesian traditional arts made by decorating fabric using the resist dyeing technique. Currently, batik manufacturing serves as an important source of livelihood in Indonesia. However, the production process of traditional batik involves a range of chemicals and some repetitive physical movements, making batik production inseparable from physical and chemical hazards which increase the risk of developing occupational skin diseases (OSD). This study aimed to identify the risk factors related to OSD, including occupational contact dermatitis (OCD), among traditional batik manufacturing workers in Yogyakarta, Indonesia. RESULTS: The study demonstrated that working duration (≥ 8 h daily) and type of work (wet process only) were statistically significant as risk factors for developing OSD. While for OCD, our results found that gender (male), history of atopy, and type of work (all and wet phase only) were risk factors for OCD development among traditional batik manufacturing workers.

Adipose-Derived Stem Cells (ASCs) for Regeneration of Intervertebral Disc Degeneration: Review Article.

The intervertebral disc (IVD) is an important structure in the human body because it functions as a weight-bearing. This structure undergoes a process of degeneration like the rest of the body and this process is known as intervertebral disc degeneration (IDD) which is the most common cause of low back pain (LBP). The current common management, either conservative or surgical, is pain-relieving and has not been able to restore degenerated disc optimally. Changes in the IVD microenvironment in IDD conditions make it difficult for the regeneration process to occur. Research to reverse the degeneration process continues to develop, one of them is the use of adipose-derived stem cells (ASCs). ASCs is superior due to the ability to differentiate into several other cells such as adipocytes, chondrocytes, and osteoblasts, it also has ability to act as immunomodulators by stimulating the migration of immune cells to damaged tissues. ASCs becomes a good choice because it is easy to obtain, low donor site morbidity, high proliferation rate, and excellent differentiation abilities. Research on the optimal preparation process for ASCs and their application to various disorders continues to advanced. This study aims to review the potential use of ASCs for regeneration of intervertebral disc degeneration.

Profile of Transepidermal Water Loss (TEWL), Skin Hydration, and Skin Acidity (pH) in Indonesian Batik Workers.

Chemical substances used during batik processing may affect the physiological function of the batik worker's skin barrier. This study assessed the level of transepidermal water loss (TEWL), skin hydration, and skin acidity in 61 batik workers from the batik center in Paseseh village, Tanjung Bumi subdistrict, Madura Island, Indonesia. Forty-five batik workers involved in dry work including drawing patterns on the cloth with wax and sixteen batik workers involved in wet work including dyeing the cloth with a dye bath were included in this study. The mean TEWL level in the dry work section was 59.87 ± 11.94 g/m2/h on the palmar and 29.00 ± 13.09 g/m2/h on the dorsal side of the hand, while the mean TEWL in the wet work section were 47.39 ± 9.66 g/m2/h on the palmar and 37.07 ± 10.00 g/m2/h on the dorsal side of the hand. The mean skin hydration level in the dry work section was 49.80 ± 19.16 arbitrary units (a.u.) for the palmar side and 52.77 ± 16.21 a.u. for the dorsal side of the hand, while the mean levels of skin hydration in the wet work section were 47 ± 12.73 a.u. and 62.94 ± 10.09 a.u. for palmar and dorsal side, respectively. The mean levels of skin acidity in the dry work section were 5.45 ± 0.19 for the palmar side and 5.30 ± 0.20 for the dorsal side of the hand, while the wet work section had 5.30 ± 0.19 and 5.10 ± 0.19 for the palmar and dorsal side of the hand, respectively. The TEWL levels were found to be higher on the palmar side of the hand in both the dry work and wet work sections, which was consistent with the measurement of skin hydration levels that were lower on the palmar side of the hand. The mean skin pH levels for both work sections were considered within the normal range.

Prolonged ICU Stay in Severe and Critically-Ill COVID-19 Patients Who Received Convalescent Plasma Therapy.

Background: Convalescent plasma administration in severe and critically-ill COVID-19 patients have been proven to not provide improvement in patients' outcome, yet it is still widely used in countries with limited resources due to its high availability and safety. This study aims to investigate its effects on ICU mortality, ICU length of stay (LoS), and improvement of oxygen support requirements. Methods: Data of all severe and critically-ill patients in our COVID-19 ICU was collected retrospectively between May and November 2020. We dichotomized the variables and compared outcome data of 48 patients, who received convalescent plasma to 131 patients, receiving standard of care. Data were analyzed using multiple logistic regression to make prediction models of mortality, length of stay, and oxygen support device requirement. Result: Overall mortality rate in our COVID-19 ICU was 55.3%, with a median overall length of stay of 8 (4-11) days. Less patients that received convalescent plasma presented with the need for mechanical ventilation on ICU admission (p < 0.001), but with comparable PaO2 to FiO2 (P/F) ratio (p=0.95). Factors that confounded mortality were obesity (aOR = 14.1; 95% CI (1.25, 166.7); p=0.032), mechanical ventilation (aOR = 333; 95% CI (4.5,1,000); p < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (aOR = 7.32; 95% CI (1.82, 29.4); p=0.005), and lower P/F ratio (aOR = 7.70; 95% CI (2.04, 29.4); p=0.003). ICU LoS was longer in patients, who had prior history of hypertension (aOR = 2.14; 95% CI (1.05, 4.35); p=0.036) and received convalescent plasma (aOR = 3.88; 95% CI (1.77, 8.05); p < 0.001). Deceased patients, who received convalescent plasma, stayed longer in the ICU with a mean length of stay of 12.87 ± 5.7 days versus 8.13 ± 4.8 days with a significant difference (U = 434; p < 0.000). The chance of improved oxygen support requirements was lower in obese patients (aOR = 9.18; 95%CI (2.0, 42.1); p < 0.004), mechanically ventilated patients (aOR = 13.15; 95% CI (3.75, 46.09); p < 0.001), patients with higher NLR (aOR = 2.5; 95% CI (1.07, 5.85); p=0.034), and lower P/F ratio (aOR = 2.76; 95% CI (1.1, 6.91); p=0.031). Conclusion: The length of stay of patients in the convalescent plasma group was significantly longer than the control group. There was no effect of convalescent plasma in ICU mortality and no improvement was observed in terms of oxygen support requirements.

Simple neutralization test report: Do probiotics contribute to COVID-19 therapy?

Background: There is an urgent need to identify effective therapy to treat coronavirus diseases 2019 (COVID-19). Supplement consumption is becoming popular in this pandemic era. An example of this is probiotic consumption to improve the host's immune system. Objective: This study aimed to prove whether antibodies from people taking probiotics could influence lactate dehydrogenase (LDH), adenosine triphosphate (ATP) values, and cell viability in vitro in peripheral blood mononuclear cells (PBMCs) inoculated with the SARS-CoV-2 spike protein as COVID-19 cells models. Methods: This was an experimental study with control and intervention groups, totally in 12 groups divided based on antibody levels, probiotic intervention, probiotic non-intervention group, SARS-CoV-2 infection group, and non-SARS-CoV-2 infection group. In vitro assays were carried out on PBMC cell cultures inoculated with S1 SARS-CoV-2 recombinant as a COVID-19 cell model. The COVID-19 cell model was given antibodies divided into three antibody level groups: sRBD levels of <3, 325.76 and 646.18. The cytotoxicity assessment examined increased levels of LDH, cytopathic activity by measuring ATP levels, and cell viability by XTT (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) assay. Data were analyzed with SPSS 21 for Windows. Results: This study showed a significant difference in the LDH value (p < 0.001) between each group. The difference in ATP values between groups was significant (p < 0.001). Meanwhile, the cell viability examination found that there was a tendency of decreased XTT (cell viability in %) when there was an increase of LDH and ATP. Conclusion: The change of LDH values occurred most in the antibody group that did not consume probiotics. The highest cytopathic activity based on the ATP values occurred in the infected cell culture group with antibody levels of 325.76 and consuming probiotics. In addition, LDH and ATP activities provided evidence of a significant influence on cell viability.

The role of probiotics in the treatment of adult atopic dermatitis: a meta-analysis of randomized controlled trials.

BACKGROUND: Atopic dermatitis (AD) is chronic inflammatory skin disease that is relapsing and a serious condition that disrupts the quality of life of affected individuals. Probiotics are an immunomodulator that can enhance the immune control of atopic dermatitis. METHODS: All randomized controlled trials of probiotics for the treatment of adult AD published before December 2020 were included in this study from the PubMed databases and manual searching. RESULTS: Six randomized controlled trials (n = 241) were selected for this meta-analysis study. Probiotics were effective in treating adult patients with AD, indicated by the decrease in Scoring Atopic Dermatitis/SCORAD (Mean Difference (MD) - 7.90, 95% CI - 7.25 to - 6.92; p < 0.00001; I2 = 96%) and improved quality of life (MD - 7.68, 95% CI - 14.08 to - 1.29; p = 0.02; I2 = 47%) which were statistically significant. However, skin severity, itch severity, Dermatology Life Quality Index (DLQI), IL-4, TFN-γ, and IgE showed no significant difference in this meta-analysis study (p > 0.05). LIMITATIONS: The study found no available data for side effects of probiotics. STRENGTH: This meta-analysis analyzed a total of 241 AD patients of Asian and European origin. CONCLUSION: The use of probiotics decreased SCORAD significantly in adult patients with AD. Probiotics can improve the quality of life of patients with AD. The use of probiotics in atopic dermatitis has been widely studied, with controversial results. This meta-analysis suggests that the use of probiotics can improve SCORAD and the quality of life of patients with atopic dermatitis.

Hypoxia Effects in Intervertebral Disc-Derived Stem Cells and Discus Secretomes: An in vitro Study.

Background: This study aimed to investigate the effects of hypoxia and normoxia preconditioning in rabbit intervertebral disc-derived stem cells (IVDSCs) and discus-derived conditioned medium (DD-CM)/secretomes in vitro. Transforming growth factor (TGF)-ß1, platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) have a role in the proliferation, development, differentiation, and migration of MSCs. Materials and Methods: Intervertebral discs were isolated from rabbit and incubated in normoxia and hypoxia 1%, 3%, and 5% (hypoxia groups) condition. Cell counting was performed after 24 hours of manipulation, then analyzed using one-way ANOVA. TGF-ß1, PDGF, FGF, and VEGF were measured using the ELISA. Results: The highest number of cells was in the hypoxia 3% preconditioning compared to the normoxia, hypoxia 1%, and hypoxia 5% groups. Hypoxia 3% also had the highest increase in PDGF protein production compared to normoxia, with hypoxia 1% and 5%. Among hypoxia groups, the highest secretions of VEGF and FGF proteins were in the hypoxia 3% group. Based on TGF-ß1 protein measurement, the hypoxia 1% group was the highest increase in this protein compared to other groups. Conclusion: Oxygen level in hypoxia preconditioning has a role in the preparation of IVDSCs and secretome preparation in vitro. The highest cell numbers were found in the treatment group with 3% hypoxia, and 3% hypoxia was significantly related to support IVDSCs preparation. Preconditioning with 3% hypoxia had higher PDGF and VEGF levels than other hypoxia groups.

Prospect of Stem Cells as Promising Therapy for Brachial Plexus Injury: A Systematic Review.

Background: Brachial plexus injury is an advanced and devastating neurological injury, for which both nerve surgery and tendon transfers sometimes remain insufficient in restoring normal movement. Stem cell therapy may be applicable to rescue the injured motor neurons from degeneration which potentially improves muscle strength. Study Design: Systematic Review; Level of evidence V. Data Sources: A systematic literature search was conducted on PubMed (MEDLINE), EMBASE, the Cochrane Library, and Scopus using the terms ("stem cell") AND ("brachial plexus") as search keywords. Methods: The process of study selection was summarized by PRISMA flow diagram. The study included in vivo and in vitro studies with English language, humans or animals with some brachial plexus injuries, interventions, some applications of stem cells to the groups of study, with functional, biomechanical, or safety outcomes. Results: In total, there were 199 studies identified from the literature sources where 75 articles were qualified for forward evaluation following selecting the titles and abstracts. Ten studies were finally included in this systematic review after full-text assessment. Stem cells can produce neurotrophic factors in vitro and in vivo in rats, and their level was increased after injury. Electrophysiological measurement showed that the intervention group had distinctly higher CMAP amplitude and evidently shorter CMAP latency than the model group. Application of bone marrow stem cells (BMSCs) showed an elevation in the numbers of axons and density of myelinated fibers, the density of nerve fibers, the diameter of regenerating axons, and a decrease in axonal degeneration. A study in humans indicated an improvement of the movements in a patient with traumatic total BPI after injection of Ad-MSC. It is associated with increased muscle mass and sensory recovery and also suggested that mononuclear cell injection enhances muscle regeneration and reinnervation in the partly denervated muscle of brachial plexus injury. Various muscle groups had obtained strength together with restoration, the muscle strength attained after the previous transplantation were preserved. The results of this review support stem cell treatment in brachial plexus injury. Conclusion: This review provides evidence of the positive effects of stem cell treatment in brachial plexus injury.

Efficacy and safety of picosecond laser for wrinkle in Indonesian skin.

Wrinkle is depressions of the skin that appears as a line on the skin, a major sign of skin aging. Laser is widely used for rejuvenation, but few reports that obtained in Indonesian skin. The increased melanin content in Indonesian skin can decrease therapeutic efficacy and promote adverse sequela. The Food and Drug Administration in 2014 gave clearance for picosecond 755 nm laser with diffractive lens array (DLA) in the treatment of wrinkles in skin types I-IV, the safety extends to patients of skin types IV-VI. This study investigated the efficacy and safety of picosecond 755 nm laser with DLA for wrinkle in forearm of the Indonesian patients. Twenty patients with Fitzpatrick skin type III-V were enrolled in this study. Clinical assessment of wrinkles was assessed with a dermatologic assessment form forearm photographic assessment scaled, and patients also rated their overall satisfaction. Evaluation was obtained at baseline and 1 month after treatment. Significant improvement in wrinkle at 1 month was noted (p < .05). Subject satisfaction indicated that 75% and 5% of patients were extremely satisfied and satisfied. No serious adverse events were reported. Picosecond 755 nm laser with DLA is an effective option for wrinkle in Indonesian skin without any adverse event.

Diagnostic Value of Neutrophil-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio, and Platelet-to-Lymphocyte Ratio in the Diagnosis of Erythema Nodosum Leprosum: A Retrospective Study.

Erythema nodosum leprosum (ENL) is an acute immune complex-mediated condition of the dermis, subcutaneous tissue, and other tissues seen in patients with multibacillary (MB) leprosy, causing severe impairment to patients' quality of life. To date, there is no standard diagnostic criteria for ENL. We aimed to study the diagnostic value and accuracy of Neutrophil-to-Lymphocyte ratio (NLR), Lymphocyte-to-Monocyte ratio (LMR), and Platelet-to-Lymphocyte ratio (PLR) in diagnosing ENL. This is an analytic retrospective study with a cross-sectional design that describes the distribution and clinical characteristics of all newly diagnosed MB patients of Dr. Soetomo General Hospital Surabaya in the years 2018-2020. NLR, LMR, and PLR were calculated for all patients, and a receiver operating characteristic curve (ROC) was generated to identify the cut-off points. Among a total of 182 patients with MB leprosy, 22 cases (12.09%) were reported with ENL. WBC, neutrophils, monocytes, and thrombocytes showed a positive correlation with the incidence of ENL, but not lymphocytes. The NLR cut-off point for the diagnosis of ENL was 4.99 (sensitivity 86.4%, specificity 82.5%, accuracy 82.97), while that of PLR was 237.46 (sensitivity 63.6%, specificity 73.1%, accuracy 71.98%). LMR had poor sensitivity and specificity levels of 50% and 28.7%, with cut-off point of 2.28 and accuracy of 31.32%. These results suggest that NLR and PLR could be potential biomarkers for the diagnosis of ENL.

Treating Vaginal Relaxation Syndrome Using Erbium: Yttrium Aluminum Garnet Fractional Laser: A Retrospective Study.

Objectives: Vaginal relaxation syndrome (VRS) comprises vaginal laxity and stress urinary incontinence (SUI). Laser vaginal tightening (LVT) therapy using a fractional erbium:yttrium aluminum garnet (Er:YAG) 2.940 nm laser may represent a nonsurgical option for both complaints. This study evaluates the effectiveness and side effects of fractional Er:YAG laser therapy in VRS patients. The improvement in VRS was evaluated. Materials and Methods: This is a retrospective study analyzing the medical records of patients treated with fractional Er:YAG laser therapy in our private clinic in Surabaya, Indonesia. Objective questions were asked to rate patients' satisfaction with the results of the therapy, namely dissatisfaction, and mild, moderate, or strong satisfaction. Statistical analysis used, data were input into tables in Microsoft Excel. Results: Twenty-four VRS patients (54% with vaginal laxity, 33% with SUI, and 13% with vaginal laxity and SUI) were studied. Most of the patients were 36-45-year-old and had 2 children, and 79% of the patients had had a vaginal delivery. After 3 LVTs, mild satisfaction was observed in 15% of patients, moderate satisfaction was noted in 54% of patients, and high satisfaction was noted in 31% of patients. Among 11 patients with SUI, 36% recovered after the first LVT, and 100% recovered after the second LVT therapy. One patient experienced mild fluor albus as a side effect. Conclusion: LVT therapy with a fractional Er:YAG laser was determined to be effective and safe as a treatment for VRS.

Pediatric Leprosy Profile in the Postelimination Era: A Study from Surabaya, Indonesia.

Children who live in leprosy-endemic areas are susceptible to infection due to early and frequent exposure to Mycobacterium leprae. Indonesia is on the verge of eliminating this disease (prevalence rate < 1/10,000 population), but pediatric leprosy continues to occur in low-endemic areas. This study aimed to evaluate pediatric leprosy over a decade in a tertiary hospital in Surabaya, Indonesia. A retrospective study of leprosy in children under 15 years old between 2010 and 2019 was conducted in the Morbus Hansen Division, Outpatient Clinic at Dr. Soetomo Hospital in Surabaya, Indonesia. Seventy pediatric leprosy cases were identified between 2010 and 2019, consisting of 58 multibacillary (MB)-type cases and 12 paucibacillary (PB)-type cases. Slit skin smear (SSS) was positive in 26 cases. There were two cases of grade-2 disability and 15 cases of leprosy reaction (erythema nodosum leprosum) in children at the time of diagnosis. There was an insignificant decline in the number of pediatric leprosy cases in the last 10 years. Cases and disabilities in children were found in some leprosy pocket areas even though the national elimination rate has been achieved. MB infections, disability, and treatment defaults were common problems in pediatric leprosy.