The impact of mechanical cervical dilatation during elective cesarean section on postpartum scar integrity: a randomized double-blind clinical trial.

OBJECTIVE: The current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation. METHODS: A randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term ≥37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups. RESULTS: Four hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (P=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, P=0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (P=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (P=0.045). CONCLUSION: Cervical dilatation during elective CS is associated with thick scars with low incidence of scar defects.

Mécano-Stimulation™ of the skin improves sagging score and induces beneficial functional modification of the fibroblasts: clinical, biological, and histological evaluations.

BACKGROUND: Loss of mechanical tension appears to be the major factor underlying decreased collagen synthesis in aged skin. Numerous in vitro studies have shown the impact of mechanical forces on fibroblasts through mechanotransduction, which consists of the conversion of mechanical signals to biochemical responses. Such responses are characterized by the modulation of gene expression coding not only for extracellular matrix components (collagens, elastin, etc.) but also for degradation enzymes (matrix metalloproteinases [MMPs]) and their inhibitors (tissue inhibitors of metalloproteinases [TIMPs]). A new device providing a mechanical stimulation of the cutaneous and subcutaneous tissue has been used in a simple, blinded, controlled, and randomized study. MATERIALS AND METHODS: Thirty subjects (aged between 35 years and 50 years), with clinical signs of skin sagging, were randomly assigned to have a treatment on hemiface. After a total of 24 sessions with Mécano-Stimulation™, biopsies were performed on the treated side and control area for in vitro analysis (dosage of hyaluronic acid, elastin, type I collagen, MMP9; equivalent dermis retraction; GlaSbox(®); n=10) and electron microscopy (n=10). Furthermore, before and after the treatment, clinical evaluations and self-assessment questionnaire were done. RESULTS: In vitro analysis showed increases in hyaluronic acid, elastin, type I collagen, and MMP9 content along with an improvement of the migratory capacity of the fibroblasts on the treated side. Electron microscopy evaluations showed a clear dermal remodeling in relation with the activation of fibroblast activity. A significant improvement of different clinical signs associated with skin aging and the satisfaction of the subjects were observed, correlated with an improvement of the sagging cheek. CONCLUSION: Mécano-Stimulation is a noninvasive and safe technique delivered by flaps microbeats at various frequencies, which can significantly improve the skin trophicity. Results observed with objective measurements, ie, in vitro assessments and electron microscopy, confirm the firming and restructuring effect clinically observed.

Efficacy of micronutrient supplementation on skin aging and seasonal variation: a randomized, placebo-controlled, double-blind study.

BACKGROUND: Several studies have confirmed dramatic changes in skin surface parameters during the winter months. Although there are many studies supporting the positive effects of topical treatment, there are no published studies demonstrating the effects of oral supplementation in the prevention of negative skin changes during winter. The purpose of this study was to evaluate the efficacy of an oral micronutrient supplement in preventing the negative effects of winter weather on skin quality using noninvasive biometrologic instruments. METHODS: This study included 80 healthy female volunteers aged 35-55 years with phototype II-IV skin. Randomization was balanced. Two tablets of a micronutrient supplement (Perfectil® Platinum) or placebo were administered once daily for 4 months. The volunteers were examined at baseline, after 4 months, and 6 weeks after termination of treatment (month 5.5). The evaluation included skin microrelief by Visioscan® as the main outcome, and the secondary outcomes were results on standard macrophotography, skin tension by Reviscometer®, skin high-frequency ultrasound, and self-assessment. RESULTS: For all pseudoroughness and microrelief indicators, there was a significant increase from baseline to month 4 in the placebo group (P<0.05) but no change in the active group. Descriptive statistics for the mean minimum, mean maximum, and minimum to maximum ratio on the nonexposed study zone showed a significant and dramatic difference between baseline and month 4 and between baseline and month 5.5 (P<0.05) in the active group, indicating decreasing anisotropy of the skin. High-frequency ultrasound on the exposed study zone revealed that skin thickness was significantly decreased in the placebo group during winter but was stable in the treated group (P<0.01). The photography scaling and self-assessment questionnaire revealed no significant changes in either group. CONCLUSION: These results indicate that the skin is prone to seasonal changes during winter, particularly in exposed areas. The data also indicate that oral supplementation can be a safe treatment, with no serious side effects, and may prevent or even eliminate the negative effects of winter on the skin.

Dermal equivalents in oncology: benefit of one-stage procedure.

BACKGROUND: In oncology, dermal equivalent may be indicated to cover losses of substance related to skin tumors or after the removal of skin flaps. OBJECTIVE: To report our experience of two dermal equivalents, Matriderm 1 mm with a one-stage graft (DE1) and Integra DL with a two-stage graft (DE2) in oncology. PATIENTS AND METHOD: Retrospective, single-center study involving 16 patients. RESULTS: Sixteen patients received dermal equivalents as an alternative to flaps (7 cases), over tendinous areas (7 cases), and for cosmetic purposes (2 cases). Twelve patients received DE1 and four DE2. Wound healing times with DE1 were 4 weeks less than those with DE2. Three cases of infection were noted with DE2. The use of dermal equivalents as an alternative to skin flaps was effective, and no adhesions were found over the tendinous areas. CONCLUSION: The learning curve, the two-stage graft required with DE2, and not using a vacuum-assisted closure system can explain the high infection rate. The use of dermal equivalents is particularly indicated in the treatment of skin defect in oncology. The possibility of a one-stage graft with DE1 and combination with negative pressure therapy is beneficial.

Cutaneous differences between Black, African or Caribbean Mixed-race and Caucasian women: biometrological approach of the hydrolipidic film.

BACKGROUND/PURPOSE: Studies about the adaptation of ethnic types of skin to an environment radically different from their original environment are rarely found in the literature. We have evaluated the differences in the skin surface properties of three ethnic groups: Black, African or Caribbean Mixed-race and Caucasian women living in defined climatic conditions. METHODS: Biometrological evaluations of barrier function were made by measurements of transepidermal water loss (TEWL), skin hydration and skin dryness. To approach the skin protective coating we evaluated cutaneous lipid index (LI), cutaneous pH, skin frictional properties and skin wettability. RESULTS: The TEWL, cutaneous hydration, dryness and LI show no significant difference. Volunteers were given a self-assessment questionnaire regarding their hygiene and cosmetic practices. The results show that 100% of Black and 92% of African or Caribbean Mixed-race women use a hydrating product daily vs. only 16% of Caucasian women. They justify this practice by the 'dry skin' sensation that they feel if they do not use a moisturizer. We tried to assess objectively to the protective coating surface of the human skin: the hydrolipidic cutaneous film, by measurements of pH, frictional properties and wettability which show significant differences. We may suppose that the hydrophilic/lipophilic balance of the skin in these three ethnic groups is different. CONCLUSION: To interpret these results as accurately as possible, it would be interesting, in future investigations on the ethnic types of skin, to evaluate the sweat secretion, and to analyse each element of the sebaceous secretions quantitatively as well as qualitatively.

Development of a new sensor based on micro-electro-mechanical systems for objective in vivo measurement of the cutaneous temperature: application to foundations.

BACKGROUND/AIMS: The purpose of this work was to develop a new sensor for objective in vivo measurement of the cutaneous temperature based on micro-electro-mechanical systems (MEMS), and to compare these performances with those of a classical thermocouple. Research on this new sensor was carried out to allow the quantification of the thermal properties of the made-up skin. METHODS: Sixteen female subjects divided into two different age groups (18-35 and >50 years old) were recruited for this study. Several zones of the face and forearms were made up at random with foundations containing or not a thermoregulator raw material. The quantity of foundation applied on the skin was standardized and measurements were carried out first before make-up, and then 10 s and 5 min after make-up. The new sensor and the thermocouple were used successively on each zone. The cutaneous temperature was expressed in degrees celsius. RESULTS/CONCLUSION: The two systems are similar in terms of repeatability and reproducibility, with some differences in sensibility. The data measured by the MEMS sensor appear lower than those measured by the thermocouple. After make-up, the MEMS sensor detects a progressive increase of the temperature in time whereas the thermocouple detects a decrease. We found the same evolution on the face but in a more attenuated way. These results tend to show that the devices do not measure the same phenomenon. The thermocouple appears more sensitive to the thermal response of the made-up surface whereas the MEMS sensor appears more sensitive to the heat transfers in the interface between the skin and make-up.

Influence of the hydrophobic and hydrophilic characteristics of sliding and slider surfaces on friction coefficient: in vivo human skin friction comparison.

INTRODUCTION: The objective of this study was to investigate whether hydrophilic/hydrophobic balance (Hi/Ho) of the skin surface strongly modifies the friction coefficient (mu). The Hi/Ho balance is determined using the relationship between the critical surface tension gammac (Zisman's principle:which delimits the wetting capacity) and the surface tension of water gammaH2O (water: reference element of Hi/Ho balance). METHOD: Critical surface tension gammac was determined (according to Zisman's principle) through the measurement of advancing contact angle theta of a series of ethanol/water dilutions. Friction coefficient depends on several parameters: types of probe motions (rotational vs. linear), surface roughness and physicochemical parameters of surfaces in contact). In this study, the wettability parameters for six surfaces (human skin forearm, Teflon, silicone impression material 'Silflo', vinyl polysiloxane impression material 'resin' steel and glass) were measured and their influences were compared to friction coefficient mu. RESULTS: This study shows that the higher hydrophobia tendency of the surfaces, the lower friction coefficient. The use of three sliding materials (Teflon, steel and glass) of different Hi/Ho balance confirms the importance of these physicochemical parameters in mu. For example, Teflon with high hydrophobia has a low mu. Friction coefficient increased when hydrophobia of sliding and slider surfaces decreased. CONCLUSION: Friction coefficient value depends on the type of slider surface and its physicochemical properties. In vivo,the friction coefficient may quantify the influence of lubrificant/emolients/moisturizers. For example, the friction coefficient of hydrated skin (through the action of moisturizing products) is higher than the friction coefficient of dry skin. The relationship between the friction coefficient and the Hi/Ho balance can be reversed in the presence of water and sebum on forehead, for example.

Assessment of spray application of Saint GERVAIS water effects on skin wettability by contact angle measurement comparison with bidistilled water.

BACKGROUND: The skin is responsible for protecting the body from physical, chemical and microbial injuries. The stratum corneum is the top layer of the epidermis and it plays a key role in helping to contain moisture. When the skin becomes damaged, its ability to perform these functions is compromised. Dry skin is a common form of skin damage. Contact angle 0 between a surface and water is a good indicator of hydrophobic or hydrophilic tendency of surfaces. OBJECTIVE: To quantify the influence of spray application of an isotonic mineral water (Saint GERVAIS water) on the hydrophobic tendency of dry skin and to compare spreading of both types of water on the skin through 0 measurement of each water drop on the skin before and after mineral spray application. MATERIALS AND METHODS: Contact angles theta between skin surface and the two types of water (bidistilled and mineral water) were measured before and after application of mineral water by a system allowing the measurement of theta in vivo and in vitro. The cutaneous hydration, the temperature and pH were also measured before and after mineral water application. RESULTS: As for the application of mineral water, the cutaneous pH significantly increased so the strong skin acidity decreased. The cutaneous temperature was modified (a decrease of 2 degrees C was noted) and the cutaneous hydration was also increased (+47AU). The hydro-phobic tendency of the dry skin tested in this study was strongly decreased after mineral water application. This parameter was illustrated by a decrease of contact angle theta value. CONCLUSION: Saint GERVAIS water application allowed a regulation of skin pH, a fresh sensation on the skin and an increase in the cutaneous hydration. Moreover, the contact angle measurement with bidistilled water illustrated the increased wettability of the skin.