Clinical and laboratory results in vaginal wall restoration using a fractional-pixel-CO2 laser: histological findings and changes in the Ki67 protein and telomere length.

Thermal deposition of laser energy in the vaginal epithelium in genitourinary syndrome of menopause (GSM) results in clinical and biological effects, but many cellular and molecular changes indicating cell proliferation or senescence inhibition are unknown. The aim of this study is to evaluate the clinical efficacy of the fractional-pixel-CO2 laser in the possible improvement of GMS signs and symptoms that can be correlated with histological changes or with cellular or molecular indicators of restoration. A detailed prospective study was designed to assess 17 women diagnosed with GSM who were treated intravaginally with two laser sessions. Seven non-treated women diagnosed with GSM were used as controls. Three validated outcome questionnaires for assessment of quality of sexual life and urinary incontinence were performed. Vaginal biopsies were collected before the first laser treatment and 4 months following the second session. Histological status, elastin, collagen, and hyaluronic acid content of the biopsies were also evaluated. Cell proliferation was assessed by Ki67 staining. Telomere length (TL) was measured by qPCR. The results show an improvement of the clinical symptoms of GSM (p < 0.05), vaginal epithelium recovery and enhancement of collagen (p < 0.05), elastic fibers (p < 0.005), and hyaluronic acid (p < 0.0005) content in the lamina propria after fractional-pixel-CO2 laser treatment. The laser treatment induced a significant rise on the TL of vaginal epithelial cells (VECs), and a positive correlation was found between the improvements of the collagen and hyaluronic acid content and TL changes (r = 0.82, p < 0.05; r = 0.38, p < 0.05). The percentage of proliferative Ki67-positive VECs was increased in patients whose vaginal TL lengthened after laser treatment (p < 0.05). In conclusion, the results indicate that laser treatment may induce restoration of the vaginal epithelium which is associated to increased TL and proliferation in the VECs. Performing a TL assay could be a suitable tool to evaluate the efficacy of vaginal laser treatment.

Topical application of sh-oligopeptide-1 and clinical trials with cosmetic preparations: risk or fraud?

BACKGROUND: sh-oligopeptide-1 is a cosmetic that is considered to be the bioequivalent of the Epidermal Growth Factor (EGF). OBJECTIVE: The systematic search and selection of the information available on sh-oligopeptide-1, and field research on laboratories manufacturing cosmetics and the legal regulation of their products. METHODS: Specialised search in Medline and Google Scholar (March 2023). A total of 22 references were obtained and 12 articles were selected for analysis, 7 of which were included in Medline. 9 articles correspond to clinical trials that use sh-oligopeptide-1 as equivalent to a functional recombinant human EGF (hr-EGF). The manufacturers are investigated and they are requested to provide scientific information. RESULTS: Using an inactive ingredient, clinical trials are published with favourable results in order to treat diabetics and cancer patients. These trials do not follow medical standards. Active EGF is not a cosmetic, rather it is a potent unauthorised drug. Likewise, sh-oligopeptide-1 is not a functional EGF, and it is not authorised for medical treatments. Topical hr-EGF is not authorised as a medication in any concentration, except for clinical trials. However, sh-EGF (sh-oligopeptide-1) is authorised as a cosmetic in several different concentrations for generalised use, with unknown long-term risks. CONCLUSION: Clinical studies on sh-oligopeptide-1 have no scientific basis, as the preclinical bioactivity of this molecule has not been proven.

Tratamiento simultáneo secuencial con ultrasonidos focalizados de alta intensidad, láser de CO2 fraccionado y plasma rico en plaquetas para rejuvenecimiento facial en fototipos altos / Sequential simultaneous treatment with high-intensity focused ultrasound, fractional CO2 laser and platelet-rich plasma for facial rejuvenation in dark phototypes

Introducción y objetivo: La combinación de técnicas mínimamente invasivas es muy frecuente para tratar el envejecimiento de la piel. El objetivo de este ensayo es evaluar un protocolo de tratamiento intensivo para rejuvenecimiento facial en una sesión única, combinada y secuencial, empleando ultrasonidos focalizados de alta intensidad (HIFU), láser de CO2 fraccionado y plasma rico en plaquetas (PRP) autólogo. Material y método: Ensayo piloto para evaluar la eficacia y seguridad del tratamiento combinado en una muestra seleccionada de 15 pacientes (fototipos III-V) con signos evidentes de envejecimiento facial. La eficacia fue evaluada de forma enmascarada por 2 expertos independientes mediante comparación de fotografías antes del tratamiento y 3 meses después. Las variables analizadas (grado de dolor, laxitud, rejuvenecimiento global y satisfacción) se cuantificaron mediante escalas ordinales cuantitativas o cualitativas. La seguridad se evaluó mediante anotaciones de seguimiento en las historias clínicas. Resultados: Obtuvimos mejorías significativas en la reducción de la laxitud en los tercios superior, medio e inferior de la cara (p=0.026, p=0.011, p=0.003). En la escala de mejoría estética global, según los evaluadores expertos, 14 participantes (93%) se consideraron “mejorados” o “muy mejorados”. Todos los pacientes reconocieron algún tipo de mejoría, 9 indicaron estar “muy satisfechos”, 3 “satisfechos” y 3 “moderadamente satisfechos”. El tratamiento fue doloroso, pero suficientemente tolerado por la mayoría de pacientes. No aparecieron efectos adversos inesperados ni complicaciones importantes, con buena recuperación postoperatoria. En general los pacientes se reincorporaron a sus actividades laborales 10 días después del tratamiento. Conclusiones: El perfil de eficacia/seguridad del método ensayado ha sido muy favorable en la serie investigada. (AU)

Background and objective: The combination of minimally invasive techniques is very common to treat aging skin. The objective of this trial is to evaluate an intensive treatment protocol for facial rejuvenation, in a single, combined and sequential session, using high intensity focused ultrasound (HIFU), fractional CO2 laser and autologous platelet rich plasma (PRP). Methods: Pilot trial to evaluate the efficacy and safety of the combined treatment in a selected sample of 15 patients (phototypes III-V) with evident signs of facial aging. Efficacy was assessed blinded by 2 independent experts by comparing photographs before treatment and 3 months later. The variables analyzed (degree of pain, laxity, global rejuvenation and satisfaction) were quantified using ordinal quantitative or qualitative scales. Safety is assessed by follow-up notes in medical records. Results: Significant improvements in laxity reduction were achieved in the upper, middle, and lower thirds of the face (p=0.026, p=0.011, p=0.003). On the scale of global aesthetic improvement, according to the expert evaluators, 14 participants (93%) consider themselves "improved" or "very improved". All patients recognized some kind of improvement, 9 indicated being "very satisfied", 3 "satisfied" and 3 "moderately satisfied". The treatment was painful, but sufficiently tolerated by the majority of patients. There were no unexpected side effects or major complications, with good postoperative recovery. In general, the patients returned to their work activities 10 days after treatment. Conclusions: The efficacy/safety profile of the tested method has been very favorable in the series investigated. (AU)

¿Se Acaba La Crisis Del Coronavirus? Carencias En La Sanidad Y En La Política / Is the Coronavirus Crisis Over? Gaps in Healthcare and Politics

La crisis del coronavirus que sufrimos globalmente pronto debiera acabar. En el momento de escribir estetexto (17/4/2020), en el mundo se contabilizan más de 150 000 muertos por esta causa, y casi un millón decasos confirmados. Por la carencia de tests diagnósticos y por la política sanitaria de efectuar análisis, principalmente a los queingresan con respiratorios en los hospitales, se desconoce la cifra real de afectados, que debe ser muchomayor a los casos contabilizados. Nosotros, autores de esta carta al editor tenemos familiares afectados,incluso en Unidades de Cuidados Intensivos (UCI). Las autoridades sanitarias y políticas no paran de decirque lo peor está por llegar, y ciertamente, ciertamente, algo importante, que todos nos quedemos encasa. Una vez decretado por los Gobiernos el estado de alarma nacional, el cumplimiento del aislamientodebemos tomarlo como una obligación para todos.

The coronavirus crisis we are suffering globally should soon be over. As of this writing (4/17/2020), there have been 150,000 deaths accounted for due to this cause and almost one million confirmed cases worldwide. Due to the lack of diagnostic testing and health politics to carry out analysis, mainly to those who are admitted to hospitals with symptoms, we still do not know the actual number of affected individuals, but it must be much higher than reported cases. The authors themselves have affected family members, even in Intensive Care Units (ICU). The healthcare and political authorities continue to say that the worst is yet to come. And certainly, very important, that we all stay at home. Once the national state of emergency is declared by governments, physical distancing compliance should be taken as an obligation for all.

Clinical and histological results in the treatment of atrophic and hypertrophic scars using a combined method of radiofrequency, ultrasound, and transepidermal drug delivery.

Scars are problematic for thousands of patients. Scarring is a natural part of the healing process after an injury. However, the appearance of a scar and its treatment depend on multiple factors and on the experience of the therapist and the options available. Despite a plethora of rapidly evolving treatment options and technical advances, the management of atrophic and hypertrophic scars remains difficult. Innovative technologies provide an attractive alternative to conventional methods in the treatment of scars. The purpose of this trial was to determine the clinical and histological results of a method of treatment that combines radiofrequency, ultrasound, and transepidermal drug delivery. This was a prospective study conducted on 14 patients with scars of different sizes, types, and characteristics. All patients underwent six treatment sessions with the Legato device. Atrophic scars were treated with retinoic acid and hypertrophic scars with triamcinolone. Photographs and biopsies were taken before treatment and at 6 months after the last treatment session. The scars improved significantly (P < 0.0001). The mean attenuation in the severity of scars was 67% (range: 50-75%), where 100% indicates complete disappearance of the scar. Clinical and histological images of scar tissue in six patients in whom attenuation in the range of 55-75% was achieved are shown. Biopsies show regenerative changes in the scar tissue, in both the epidermis and dermis. The method makes it possible to treat extensive, heterogeneous scars on different sites with good results that are similar and predictable.

Attenuation of acne scars using high power fractional ablative unipolar radiofrequency and ultrasound for transepidermal delivery of bioactive compounds through microchannels.

BACKGROUND AND OBJECTIVE: To determine the efficacy and safety of a new method for treating acne scarring over a short-term period of 2 months and a long-term period of 6 months. MATERIALS AND METHODS: Six faces and 13 shoulders or backs for a total of 19 patients were treated, all of which displayed varying degrees of acne scarring, from moderate to severe. A newly developed high-power unipolar fractional ablative radiofrequency technology was used (iPixel™ RF, Alma Lasers, Caesarea, Israel), with acoustic pressure ultrasound guided dermal injection of the PixelTreat Scars preparation (Alma Lasers), through RF Pixel fractionated microchannels. All patients underwent four treatment sessions at 3-week intervals. RESULTS: Significant improvement was observed in scarring, both on the face (P < 0.0001), and on the back and shoulders (P < 0.0001). After 2 months, the percentage of fading on total scarring was 57% on the face and 49% on the back and shoulders; after 6 months, the percentage increased to 62% on the face, and 58% on the back and shoulders, respectively. Patients reported to be Somewhat Satisfied (16%), Satisfied (53%), and Very Satisfied (31%). No unexpected side effects to the ablation and no hypersensitive reactions to PixelTreat Scars were observed. CONCLUSION: The bimodal procedure is safe and effective in reducing acne scarring. This represents a new therapeutic alternative of great interest, to be used either as a monotherapy, or in combination with other treatments.

Camouflaging Facial Emphysema: a new syndrome.

Camouflaging Facial Emphysema, as is defined in this paper, is the result of a simple technique used by the patient to deform his face in order to prevent recognition at a police identity parade. The patient performs two punctures in the mucosa at the rear of the upper lip and, after several Valsalva manoeuvres, manages to deform his face in less than 15 min by inducing subcutaneous facial emphysema. The examination shows an accumulation of air in the face, with no laterocervical, mediastinal or thoracic affectations. The swelling is primarily observed in the eyelids and the orbital and zygomatic regions, whereas it is less prominent in other areas of the face. Patients therefore manage to avoid recognition in properly conducted police identity parades. Only isolated cases of self-induced facial emphysema have been reported to date among psychiatric patients and prison inmates. However, the facial emphysema herein described exhibits specific characteristics of significant medical, deontological, social, police-related, and legal implications.

Posology, efficacy, and safety of epidermal growth factor eye drops in 305 patients: logistic regression and group-wise odds of published data.

The aim of this article is to investigate clinical research on indications, posology, efficacy, and safety of epidermal growth factor (EGF) eye drops in the treatment of some human corneal disorders. Methods used include systematic search and selection of series of cases and clinical trials in Medline database up to January 2012, kappa index (K) to validate retrieval information, cumulative Mantel-Haenszel-stratified meta-analysis, 2×2 contingency table of randomized EGF-vehicle-controlled treated groups, and statistical program SPSSv12. Our results indicate that EGF eye drops appear to be a very effective treatment of acute heterogeneous corneal diseases, without significant adverse effects, with a 86.8% clinical efficacy reported by authors, a 98% (P<0.05) probabilistic expected efficacy, and 51.3 (17.4-148.7 confidence interval 95%; P<0.05) odds ratio EGF/vehicle. However, clinical trials are scarce, with low sample sizes and serious inconsistencies in EGF posology. EGF eye drops (50-1,000 ng, 2-3 times/day) could be a useful treatment for promoting postoperative refractive surgery, reversing cases of keratopathy secondary to systematic EGF receptor inhibitors, diabetic keratopathy, and other corneal and conjunctival disorders.

Epidermal growth factor receptor in corneal damage: update and new insights from recent reports.

Agonist and antagonist drugs acting on epidermal growth factor receptor (EGFR) signaling are emerging as a new possibility for pharmaceutical study and clinical manipulation of some skin and corneal disorders. EGFR activation appears to be effective in reducing the time of reepithelialization after corneal wound healing, with potential uses in penetrating keratoplasty, refractive surgery, alkali burns, diabetic keratopathy, keratopathy following chemotherapy, cornea transplantation, and dry eye. Most of the studies show therapeutic advantages of human recombinant epidermal growth factor (hrEGF) eye drops without showing adverse effects. In contrast, EGFR inhibition delays epithelial cell proliferation and stratification during corneal regeneration.The aim of this review is to summarize the most seminal discoveries and recent advances so as to clarify the role of the EGFR system in corneal physiology and pharmacology. Epidermal growth factor eye drops could be a first-choice treatment for promoting regeneration in numerous epithelial defects in the medium to long term.

The role of epidermal growth factor receptor in photodynamic therapy: a review of the literature and proposal for future investigation.

The epidermal growth factor receptor (EGFR) pathway seems to be an important contributor to the antiproliferative response to photodynamic therapy (PDT), in terms of cell death, apoptosis and tumour destruction. We reviewed all preclinical investigations in the scientific literature on the role of the EGFR pathway in PDT. A systematic search of Medline-indexed references up to March 2010 using the recommended strategies for Medline information retrieval and identifying relevant studies from systematic reviews, revealed 16 full articles that were exhaustively analysed. EGFR inhibition/degradation appeared to be a major effect of PDT in all investigations. PDT was found to result in a time-dependent reduction of EGFR expression, inhibition of tyrosine phosphorylation and induction of apoptosis during the regression of tumours. Within the time period of the PDT reaction, normal and malignant cells lose their responsiveness to EGF. The ERK1/2 and EGFR-PI3K-Akt pathways seem to be involved in cellular survival after PDT. Pharmacotherapy and immunotherapy to block EGFR activity combined with PDT seem to be very effective in reducing malignant tumours in vivo. The effect of PDT is associated with inactivation of the EGFR pathway, but biochemical and cellular phenomena are important and scarcely investigated. EGFR inhibitors and PDT act synergistically, and this is highly relevant for clinical use.

Factores de crecimiento, lesión celular, proteincinasas dependientes de ciclinas y sus inhibidores: su relevancia en la patología molecular del cáncer humano / Growth factors, cell damage, cyclin-dependent kinases and their inhibitors: relevance in molecular pathology of human cancer

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