RESUMO
Damaging the normal skin barrier results in a cascade of reactions resulting in scar formation. Transforming growth factors cause the proliferation of fibroblasts to myofibroblasts, which keep secreting collagen. There are indications, that the proliferation might be inhibited by adipose-derived stem cells (ADSC). Nanofat is a liquid substance containing ADSC. This review is based on five observational human studies, where nanofat was injected into a variant of scars. A significant improvement was demonstrated in all the studies. Scars treated within five years has a better chance of regeneration. Randomized controlled trials are warranted.
Assuntos
Adipócitos , Cicatriz , Adipócitos/metabolismo , Tecido Adiposo , Cicatriz/cirurgia , Colágeno , Humanos , Transplante Autólogo/métodosRESUMO
PURPOSE: The Region of Southern Denmark (RSD), covering 1.2 of Denmark's 5.6 million inhabitants, established a task force to (1) retrieve literature evidence for the clinical use of positron emission tomography (PET)/CT and provide consequent recommendations and further to (2) compare the actual use of PET/CT in the RSD with these recommendations. This article summarizes the results. METHODS: A Work Group appointed a professional Subgroup which made Clinician Groups conduct literature reviews on six selected cancers responsible for 5,768 (62.6 %) of 9,213 PET/CT scans in the RSD in 2012. Rapid Evidence Assessment was applied, using the methodology of systematic reviews with predefined limitations to search PubMed, Embase and the Cochrane Library for articles published in English/Danish/Swedish/Norwegian since 2002. PICO questions were defined, data recorded and quality appraised and rated with regard to strength and evidence level. Consequent recommendations for applications of PET/CT were established. The actual use of PET/CT was compared with these, where grades A and B indicated "established" and "useful" and grades C and D "potentially useful" and "non-recommendable" indications, respectively. RESULTS: Of 11,729 citations, 1,729 were considered for review, and 204 were included. The evidence suggested usefulness of PET/CT in lung, lymphoma, melanoma, head and neck, and colorectal cancers, whereas evidence was sparse in gynaecological cancers. The agreement between actual use of PET/CT and literature-based recommendations was high in the first five mentioned cancers in that 96.2 % of scans were made for grade A or B indications versus only 22.2 % in gynaecological cancers. CONCLUSION: Evidence-based usefulness was reported in five of six selected cancers; evidence was sparse in the sixth, gynaecological cancers. Actual use of PET/CT agreed well with recommendations.