Efficacy and Safety of Corticosteroid in Combination with 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis.

BACKGROUND: Addressing hypertrophic scars and keloids poses a significant challenge in the realm of preventive and curative medicine. Combination corticosteroid with 5-fluorouracil (5-FU) is presumed to enhance the treatment of hypertrophic scars and keloids, although supportive evidence is lacking. This study is aimed at comparing the efficacy and safety profile of a combined corticosteroid and 5-FU regimen in treating hypertrophic scars and keloids. METHODS: A comprehensive search was conducted for pertinent studies across various databases, including Web of Science, PubMed, Google Scholar, Cochrane Library, and Medline. The calculation of weighted mean difference (WMD), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CIs) was executed. Additionally, the Cochrane Collaboration's Risk of Bias Tool was utilized to evaluate potential bias risks. RESULTS: A total of 15 studies were involved. The effectiveness based on patient self-assessment and the effectiveness based on observer assessment were significantly higher in the corticosteroid+5-FU group compared to those treated with control. A meta-analysis of scar height showed that the corticosteroid+5-FU group performed better than the control group (WMD = -0.38, 95% CI -0.58 to -0.18). There was no significant difference between the corticosteroid+5-FU group and the control group in improving scar vascularity, pliability and pigmentation. The result revealed that the corticosteroid+5-FU group of patients had less adverse effect of hypopigmentation, skin atrophy and telangiectasia than the control group. CONCLUSION: The combined use of corticosteroids and 5-FU appears to be a more effective strategy for the treatment and prevention of hypertrophic scars and keloids, as evidenced by greater improvements in scar height and overall effectiveness, coupled with a reduced incidence of side effects. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A network meta-analysis for the comparison of efficacy and safety of interleukin (IL)-23 targeted drugs in the treatment of moderate to severe psoriasis.

A variety of interleukin-23 targeted drugs have been used to treat moderate to severe psoriasis, but it is not clear which is most effective. This network meta-analysis compared and summarized the short-term efficacy and safety of interleukin-23 (IL-23) targeted drugs in the treatment of moderate to severe psoriasis. PubMed, Embase, Web of Science, and Cochrane Library were used to search randomized controlled trials (RCTs) about the treatment of moderate to severe psoriasis with ustekinumab (Ust), guselkumab (Gus), tildrakizumab (Til), and risankizumab (Ris). Bayesian Network Meta-analysis (NMA) was used to calculate Psoriasis Area and Severity Index 75%, 90%; Physician Global Assessment score of 0 or 1 (PGA 0/1); Dermatology Life Quality Index of 0 or 1 (DLQI 0/1), and safety (adverse events [AEs]) effect estimates (odds ratio OR) and 95% confidence intervals. Direct, indirect, and network meta-analysis estimates were calculated using a random-effects model. The GRADE method was used to assess the quality of evidence for each pair-wise comparison. In addition, the surface under the cumulative ranking curve (SUCRA) analysis was used to rank the treatment level for each outcome indicator. This network meta-analysis included 14 RCTs with 8402 patients. The results indicate that the curative effect of the IL-23 targeted drugs is better than that of a placebo. Network meta-analysis showed that Ris90 mg and Ris180 mg were significantly more effective than Til (5, 25, 100, and 200 mg), Ust (45 mg, 90 mg, body weight-based administration), Gus 100 mg and Ris (75 and 150 mg). Regarding safety, there is no significant difference in the risk of adverse events between drugs targeting IL-23 and placebo. In addition, according to the ranking of SUCRA, Ris 90 mg has the best efficacy index for PASI 75 and PGA 0/1, with SUCRA values of 97.6% and 97.1%, respectively. Ris 180 mg ranked first in PASI 90 (91.1%), while Ris 75 mg performed best in DLQI 0/1 (73.7%). In this network meta-analysis, risankizumab showed the best curative effect in the short-term treatment of moderate to severe psoriasis, and the risk of adverse events was not significantly different from placebo. However, more research data are needed for further study in the field of cost to evaluate which drug strikes the most favorable balance among efficacy, safety, and cost of access.

Refractive index modulating Raman spectroscopy based on perovskite PMN-PT ceramics.

A three-layer planar waveguide structure comprising a perovskite (1-x)Pb(Mg1/3Nb2/3Nb2/3)O3-xPbTiO3 (PMN-PT) ceramic sandwiched by two silver films is designed and called PMPW. Using the high sensitivity of ultrahigh-order modes, theoretical analysis is performed to calculate the effective refractive index (ERI) of the PMPW. A detailed analysis of the Raman spectrum of PMN-PT at 795 cm-1 is performed. A comparison of the numerical analysis and experimental results reveals that the nonlinear change in ERI plays a primary role in the Raman signal variation. Analysis of the Raman spectrum of a sample deposited on PMPW confirms that it is effective for modulating Raman signals.

Changes in protein profiles of guinea pig sclera during development of form deprivation myopia and recovery.

PURPOSE: To investigate changes in protein profiles of posterior sclera in guinea pigs during development of form deprivation myopia and recovery. METHODS: Three groups of guinea pigs (developing form deprivation myopia, recovering from the myopia and normal control) were evaluated for protein profiles of the posterior sclera using two-dimensional gel electrophoresis. Protein spots with a different intensity of at least threefold among the 3 groups were further identified with mass spectrometry. Key proteins associated with ocular growth (crystallins) were examined at mRNA levels using RT-PCR. RESULTS: Moderate myopia was induced at 7 weeks of monocular deprivation and then more gradually recovered toward the previous refractive status 4 days after re-exposure of the eye to normal visual conditions. The profile of all protein spots at the posterior sclera was similar for both the deprived and the recovery eyes but distinct between either of the 2 experimental eyes and the normal control eyes. Twenty-six and 33 protein spots were differentially expressed in the deprived and the recovery eyes, respectively, compared to the normal control eyes. In contrast, the number of proteins differentially expressed between the deprived and the recovery eyes was only 5. Among the different subtypes of crystallins, ßB2-crystallin was down-regulated and ßA4-crystallin was upregulated in the deprived eyes at both protein and mRNA levels compared to the normal control eyes. The trend of expression for ßA3/A1-crystallin was also similar at both mRNA and protein levels for the deprived eyes. However, αA-crystallin mRNA in the recovery eyes was upregulated while αA-crystallin itself was down-regulated. A similar inconsistency in expression of ßA3/A1-, ßA4-, and ßB2-crystallins between the protein and mRNA levels also occurred in the recovery eyes. CONCLUSIONS: Proteomic analysis provides a useful survey of the number of proteins whose levels change during form deprivation myopia and the subsequent recovery. In particular, the crystallins changed during the development of form deprivation myopia and recovery. The changes in crystallin protein levels were consistent with that in mRNA levels during the development stage of form-deprivation myopia (FDM). However, the changes of most crystallin protein levels were mismatched with mRNA levels during the recovery stage.

Study on Dalfampridine in the treatment of Multiple Sclerosis Mobility Disability: A meta-analysis.

OBJECTIVE: Systematic Review was used to evaluate the efficacy and safety of Dalfampridine (DAP) in the treatment of Mobility Disability (MS) in patients with Multiple Sclerosis. METHODS: Clinical randomized controlled studies about DAP and placebo in the treatment of Mobility Disability in patients with Multiple Sclerosis until March 2019 were explored by searching Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Literature screening, data extraction, quality assessment, and statistical analysis were performed by using Stata 14.0. RESULTS: 10 papers were included in the meta-analysis, and the number of patients was 2100. In conclusion, the application of DAP in clinical can significantly improve the Mobility Disability of patients [OR = 2.73, 95%CI (1.66, 4.50), P<0.001, I2 = 74.1%] and boost the mobility speed of patients in Timing 24 Minute Walk Test (T24FW) [SMD = 3,08, 95%CI(1,58, 4.58), P<0.001, I2 = 98.7%]. There are no significant differences of the incidence of adverse events [RR = 1.06, 95%CI (0.99, 1.14), P = 0.928, I2 = 0.0%] and urinary tract infection [RR = 1.21, 95%CI(0.91, 1.60), P = 0.145, I2 = 37.2%] between the DAP test group (Doses≤10 mg) and the placebo control group, and the incidence of adverse events [RR = 1.14, 95%CI(1.02, 1.28), P = 0.793, I2 = 0.0%] and urinary tract infection[RR = 3.05, 95%CI(1.04, 8.99), P = 0.680, I2 = 0.0%] for the DAP test group (Doses>10 mg) is a litter higher than the placebo control group. CONCLUSION: DAP can effectively improve Mobility Disability in patients with Multiple Sclerosis, which is safe and reliable in specific DAP usage doses.

Recovery from axial myopia induced by a monocularly deprived facemask in adolescent (7-week-old) guinea pigs.

PURPOSE: Guinea pigs have been increasingly used as an animal model for experimental myopia. Infant guinea pigs are susceptible to recovery from myopia within 2 weeks of form deprivation. This study investigated whether adolescent guinea pigs are susceptible to recovery from myopia after a longer period of form deprivation. METHOD: Twenty-two guinea pigs (age of 3 weeks) were randomly assigned to two groups: MDF (monocularly deprived facemask, n=11) and normal control (free of form deprivation, n=11). All animals underwent biometric measurement (refraction, corneal curvature and axial length) prior to the experiment. Animals in the MDF group wore a facemask that covered the right eye for 4 weeks. The MDF was then removed and biometric measurement was performed immediately and at 2, 6, 10 and 14 days. The same measurement was performed in the normal control group at time-points matching those of the MDF group. RESULTS: The MDF eyes were approximately 4D more myopic with a greater increase in vitreous length by 0.12 mm compared to either the fellow or the normal control eyes after form deprivation (p<0.01). This relative myopia shifted rapidly towards hyperopia within 2 days after removal of the MDF, followed by a more gradual recovery. A complete recovery occurred by 6 days after removal of the MDF compared to the fellow and normal control eyes (p>0.05). Vitreous length in the MDF eyes slightly reduced within 2 days after removal of the MDF and then remained steady. The MDF eyes were similar to both the fellow and normal control eyes in vitreous length (p>0.05) 6 days after removal of the MDF. There was no significant difference between the MDF, fellow and normal control eyes in the other axial components during the form deprivation and recovery period. CONCLUSION: Adolescent guinea pigs are susceptible to recovery from MDF-induced myopia. The refractive recovery is mainly correlated to the inhibited axial elongation of the vitreous chamber of the previously deprived eyes.