Human CD206+ Macrophages Show Antifibrotic Effects on Human Fibroblasts through an IL-6-Dependent Mechanism In Vitro.

BACKGROUND: Pathologic scarring including keloid and hypertrophic scar causes aesthetic and physical problems, and there are clinical difficulties (e.g., posttreatment recurrence) in dealing with pathologic scarring. Understanding the mechanisms that underlie scar control in wound healing will help prevent and treat pathologic scarring. The authors focused on CD206+ macrophages in the wound-healing process, and hypothesized that CD206+ macrophages have antifibrotic effects on fibroblasts. METHODS: The authors established a co-culture system for CD206+ macrophages and fibroblasts (cell ratio, 1:1). The authors examined the CD206+ macrophages' antifibrotic effects on fibroblasts after a 72-hour culture, focusing on fibrosis-related genes. To identify key factor(s) in the interaction between CD206+ macrophages and fibroblasts, the authors analyzed cytokines in a conditioned medium of the co-culture system. RESULTS: Under co-culture with CD206+ macrophages, expression of the following in the fibroblasts was significantly down-regulated: type 1 (fold change, 0.38) and type 3 collagen (0.45), alpha smooth muscle actin (0.24), connective tissue growth factor (0.40), and transforming growth factor-beta (0.66); the expression of matrix metalloproteinase 1 was significantly up-regulated (1.92). Conditioned medium in the co-culture showed a high interleukin (IL)-6 concentration (419 ± 88 pg/ml). When IL-6 was added to fibroblasts, antifibrotic changes in gene expression (as observed under the co-culture) occurred in the fibroblasts. CONCLUSIONS: The authors' in vitro results revealed that CD206+ macrophages have antifibrotic effects on fibroblasts by means of a paracrine mechanism involving IL-6. Understanding these effects, especially in vivo, will help elucidate the mechanism of scar control in wound healing and contribute to the development of new scar treatments.

Risk Factors for Macroscopic Haemoglobinuria After Sclerotherapy Using Ethanolamine Oleate for Venous Malformations.

OBJECTIVES: Sclerotherapy is an essential component of the treatment for venous malformations, and ethanolamine oleate (EO) is known as a useful sclerosing agent. However, macroscopic haemoglobinuria (MH) and subsequent renal impairment are severe complications after sclerotherapy using EO. The present study aimed to clarify the MH risk factors for better peri-operative management of venous malformations. METHODS: Data collected during 130 procedures involving 94 patients who were undergoing sclerotherapy using EO for venous malformation were retrospectively analysed. Pre-operative and operative variables, including sex, age, pre-operative body mass index, location, depth, type of lesion, size, number of procedures, type of drainage vein, ratio of sclerosant to air, and injected total dose of 5% EO per body weight (BW), were examined. Univariable analysis and multivariable logistic regression were performed to determine the possible risk factors for MH. RESULTS: Following sclerotherapy, MH occurred in 27.7% of patients, but no patient developed post-operative renal impairment because of aggressive hydration and haptoglobin administration. On univariable analysis, diffuse lesion, lesion size ≥50 cm2, and total injected dose of 5% EO ≥ 0.18 mL/kg were found to be the MH risk factors. Multivariable logistic regression analysis identified a total injected dose of 5% EO ≥ 0.18 mL/kg as the significant independent factor contributing to MH risk. CONCLUSIONS: Macroscopic haemoglobinuria is a reversible complication if immediate and appropriate interventions with aggressive hydration and haptoglobin administration are performed; therefore, it should be closely monitored following sclerotherapy, especially when using 5% EO ≥ 0.18 mL/kg.

Transconjunctival orbital fat repositioning for tear trough deformity in young Asians.

BACKGROUND: Tear trough deformity is a primary complaint in those who believe it causes an old and tired appearance. This deformity naturally increases with aging, but there are younger people that also complain about the appearance of their lower eyelid area. Recently, many authors have reported good results treating this deformity with transconjunctival orbital fat repositioning. Although Kawamoto has pointed out a possible need for a procedure modification in Asians with a brachycephalic face, thus far, there have been no reports evaluating such procedures in Asians. OBJECTIVE: In November 2004, to validate past clinical experiences, we planned a prospective study in young Japanese Asians to assess the efficacy of orbital fat repositioning for improvement of lower eyelid disfigurement. Our goal was to evaluate the viability of transconjunctival repositioning of orbital fat using a preseptal dissection and supraperiosteal pocket method. METHODS: The prospective study was performed in 20 Japanese patients younger than 40 years of age who were referred to our department over a 1-year period. These patients, in whom eyelid skin tightening was deemed unnecessary, underwent transconjunctival blepharoplasty. Using a transconjunctival incision, a preseptal dissection was performed, extending over the arcus marginalis. A supraperiosteal pocket was made below the orbicularis oculi muscle with blunt scissor dissection. The arcus marginalis was then released by cautery cutting. Both the orbital fat and orbital septum were anchored across the orbital rim with 5-0 polyglactin sutures. RESULTS: Results in 18 of 20 patients (90%) were rated as "excellent," the result for 1 patient (5%) was rated as "good," and the result for the 1 remaining patient was rated as "fair." No major eye or eyelid complications, such as lower eyelid retraction, ectropion, or diplopia, were observed. CONCLUSIONS: Transconjunctival orbital fat repositioning (incorporating preseptal dissection and supraperiosteal pockets) is an effective and safe method for relatively young Asians complaining of lower eyelid disfigurement.