Snodgrass procedure for distal penile and mid-shaft hypospadias repair in children

Introduction. Hypospadias is one of the most frequent penile malformations in newborn boys. Warren Snodgrass developed the «tubularized incised plate» (TIP) urethroplasty that is the most often procedure used in the surgical treatment of distal hypospadias for the last 20 years. Despite the great popularity of the technique, its no less famous Grafted TIP (GTIP) modification appeared. The technique is aimed at filling the defect in the urethral site with a foreskin free flap followed by tubularized urethroplasty.Purpose of the study. To compare the outcomes of TIP and GTIP procedures in our clinic which have been performed in the last 10 years.Materials and methods. One hundred-fourteen boys with hypospadias (aged 6 mo – 15 years) were operated on using the TIP technique and its modification GTIP during 2010 – 2020 (Sochi Center of Motherhood and Childhood Protection). The patients were: boys up to 1 year – 27 (23.7%), from 1 to 3 years – 57 (50%), 4 – 7 years – 19 (16.7%), from 8 to 14 years – 14 (12.3%). Primary repair was done in 112 cases (98.2%), the second procedure was done in 2 (1.8%) cases. There were 94 (82.5%) boys with distal hypospadias and 20 (17.5%) children with mid-shaft hypospadias. All patients were examined 3 and 12 months after surgery. We assessed the degree of skin scar process on the penile shaft, the location of the meatus and the quality of urination during the examination.Results. We observed 27 (23.7%) complications after urethroplasty out of 114 treated boys. There were 13 (11.4%) cases of urethral fistula, which were secondary repaired 6 months later. Meatal stenosis was observed in 2 (1.8%) cases, which required secondary meatoplasty. Repeat urethroplasty was done in 10 (8.7%) cases due to neourethral suture failure. There were also 2 (1.8%) cases of secondary penile curvature that required repeat surgery. The good cosmetical and functional results were achieved finally in all children.Conclusion. The analysis of our ten-year experience of using TIP-urethroplasty and its GTIP modification did not reveal significant differences in the overall incidence of postoperative complications. Yet, using the TIP procedure is associated with more fistulas. There were more cases of urethral suture failure in children whom the GTIP technique was performed. Our data suggest the need for a selective approach in the formation of indications for using TIP and GTIP procedures, along with research aimed at finding criteria for patient selection.

The Use of Adipose-Derived Stem Cells (ADSCs) and Stromal Vascular Fraction (SVF) in Skin Scar Treatment—A Systematic Review of Clinical Studies

In recent years, lipofilling became a popular scar treatment method. Its beneficial outcomes have been partly attributed to the regenerative capacity of adipose-derived stem cells (ADSCs), suspended in an extracellular matrix—the stromal vascular fraction (SVF). The aim of this review was to verify if existing data support the clinical use of ADSC-related interventions in scar treatment. A systematic search of the literature was performed in July 2020 in five databases (Medline, Cochrane, Web of Science, Scopus and Embase). Articles written in English, except for reviews, letters and editorials, were identified and screened for eligibility. We looked for reports of any outcomes in scars treated with ADSCs or SVF. Data from selected articles were extracted and the quality of each study was assessed. Five hundred and fourteen studies were identified in the primary search, of which nineteen were eventually included in the systematic review. Extracted data pointed to beneficial microscopic, functional and aesthetic outcomes in a total of 665 patients. Six studies included comparative interventions—platelet-rich plasma or CO2 fractional laser. Collected data give low-to-average quality evidence for beneficial effects of ADSC-related interventions in scar treatment. Some studies suggest that these interventions are noninferior to PRP or fractional CO2 laser.

Wavelet Bilateral Filter Algorithm-Based High-Frequency Ultrasound Image Analysis on Effects of Skin Scar Repair

It aimed to explore the application value of high-frequency ultrasound image based on the wavelet bilateral filtering algorithm in the repair evaluation of hypertrophic scar and keloid, as well as the expression change of nerve growth factor (NGF). 72 patients with scars admitted to hospital from October 2018 to October 2019 were chosen and classified as hypertrophic scar patients (group A) and keloid patients (group B), with 36 cases in each group. All patients received scar repair treatment, and another 30 normal skin volunteers (group C) were selected. High-frequency ultrasound images based on the wavelet bilateral filter algorithm were utilized for skin examination. The expression differences of NGF and pro-NGF in each group were measured by immunohistochemical staining and Western blot. The results showed that the denoising effect (signal-to-noise ratio (PSNR) = 33.2762), structural similarity (SSIM = 0.8963), and edge similarity (FoM = 0.2975) of the proposed algorithm were better than those of bilateral filtering and wavelet soft-threshold algorithms. The skin thickness of groups A and B was considerably higher relative to that of group C ( P < 0.05), but the echo intensity of the skin dermis of groups A and B was evidently inferior to that of group C ( P < 0.05). The results of immunohistochemistry showed that in contrast to group C, the average optical density of NGF in groups A and B increased remarkably ( P < 0.01). In contrast to group C, the positive expression of pro-NGF in groups A and B was notably reduced ( P < 0.05). Western blot results showed that relative to group C, the expression of NGF protein in groups A and B was increased greatly ( P < 0.01), but the expression of pro-NGF protein in groups A and B was reduced ( P < 0.01). The results suggested that the wavelet bilateral filter algorithm can be adopted to evaluate pathological skin scars, and pathological skin scar formation was closely related to the expression levels of NGF and pro-NGF.

Statistical analysis of predictors of the effectiveness of complex therapy in patients with skin scarring

The variation of indicators that characterize skin scarring increases in patients with metabolic syndrome, which may affect the effectiveness of therapeutic measures. It has been found that pathological processes in the skin scar in the initial state correlate to the greatest extent with the index of insulin resistance, the atherogenic coefficient and the coefficient of antioxidant protection. It is proved that the effectiveness of complex physiotherapy with the addition of the internal intake of medium-mineralized water «Essentuki №17» directly correlates with an increase in tissue sensitivity to insulin and the activation of antioxidant enzymes, as well as with a decrease in dyslipidemia. Linear regression equations are presented to determine significant predictors of treatment effectiveness, which can lead to the creation of individualized therapeutic programs using preformed and natural physical factors.

Scientific validation of three-dimensional stereophotogrammetry compared to the IGAIS clinical scale for assessing wrinkles and scars after laser treatment

Measuring outcomes from treatments to the skin is either reliant upon patient’s subjective feedback or scale-based peer assessments. Three-Dimensional stereophotogrammetry intend to accurately quantify skin microtopography before and after treatments. The objective of this study is comparing the accuracy of stereophotogrammetry with a scale-based peer evaluation in assessing topographical changes to skin surface following laser treatment. A 3D stereophotogrammetry system photographed skin surface of 48 patients with facial wrinkles or scars before and three months after laser resurfacing, followed immediately by topical application of vitamin C. The software measured changes in skin roughness, wrinkle depth and scar volume. Images were presented to three observers, each independently scoring cutaneous improvement according to Investigator Global Aesthetic Improvement Scale (IGAIS). As for the results, a trend reflecting skin/scar improvement was reported by 3D SPM measurements and raters. The percentage of topographical change given by the raters matched 3D SPM findings. Agreement was highest when observers analysed 3D images. However, observers overestimated skin improvement in a nontreatment control whilst 3D SPM was precise in detecting absence of intervention. This study confirmed a direct correlation between the IGAIS clinical scale and 3D SPM and confirmed the efficacy and accuracy of the latter when assessing cutaneous microtopography alterations as a response to laser treatment.

The Features of the Connective Tissue Morphological Change During a Skin Scar Formation After a Cesarean Section

During a skin scar formation morphofunctional change of skin structures takes place. The action of external mechanical factors can lead to prolongation of reparative processes in the scar and to the change in the morphometric parameters of its components.Research goal: to study the features of the skin structural components morphological change in secundipara women during a connective tissue scar formation after a cesarean section.Material and methods. The materials for the study were the fragments of a connective tissue scar with an adjacent area of intact skin taken from 30 women after operative delivery by Caesarean section. On scanning electron microscopy, morphometric parameters were measured, which enabled to assess the cell composition and the changes in the fibrous components of the connective tissue scar.Results. Analyzing the thickness of the fibers in the same age group, the thickening of the fibers was observed in direct proportion to the number of births. Comparing different age groups with the same number of births, the thinning of collagen fibers was observed. The most pronounced changes were observed in women having three or more deliveries.Conclusion. Under the influence of the stretching force in the skin, a structural change of the connective tissue scar occurs. This change is due to the thickening of collagen structures, the decrease in the density of collagen structures location, the increase in the number of lymphocytes and macrophages.

MicroRNA-27a-3p promotes proliferation and migration by up-regulation of perlecan in murine fibroblast cell line NIH/3T3

IntroductionSkin scar is a common cutaneous complication, the outcome of which is unpleasant. Several microRNAs (miRs) participate in the process of skin scar formation. We aimed to explore the role of miR-27a-3p in NIH/3T3 mouse fibroblasts as well as the downstream protein and signaling cascades.Material and methodsmiR-27a-3p was aberrantly expressed in NIH/3T3 cells, followed by measurements of cell viability, migration and expressions of proteins related to proliferation and migration. Perlecan expression in cells aberrantly expressing miR-27a-3p was examined by Western blot analysis. Reporter gene assay was conducted to assess the relationship between miR-27a-3p and perlecan. Then, whether miR-27a-3p affected NIH/3T3 cells through regulating perlecan was ascertained. The effects of aberrantly expressed miR-27a-3p and perlecan on expression levels of VEGF, bFGF and key kinases in the MAPK/ERK and the PI3K/AKT pathways were detected.ResultsCell viability and migration were enhanced and protein expression levels of Cyclin D1, MMP-2 and MMP-9 were up-regulated by miR-27a-3p overexpression in NIH/3T3 cells. Then, we found that perlecan was positively correlated with miR-27a-3p expression, and its knockdown abrogated the effects of miR-27a-3p overexpression on NIH/3T3 cells. Finally, we found that the expression levels of VEGF and bFGF as well as phosphorylated levels of MAPK, ERK, PI3K and AKT were increased by miR-27a-3p overexpression, and those increases were reversed by perlecan knockdown.ConclusionsmiR-27a-3p promotes proliferation and migration of NIH/3T3 cells through up-regulating perlecan expression. Meanwhile, miR-27a-3p up-regulates expression levels of VEGF and bFGF, and activates MAPK/ERK and PI3K/AKT pathways through up-regulating perlecan expression.

Symphysiotomy Using Posterior Approach

The invention relates to an apparatus used in the separation of the Symphysis pubis joint from its posterior aspect. This process medically named as Symphysiotomy. The apparatus consists of 3 parts: (1). Size 14G cannula which is 14cm in length, made of stainless steel and has a sharp bevel and thickened posterior part to enable the user to have a good grip on it during usage. (2). A stylet 14cm long made of stainless steel to fit in the inside of the cannula to prevent coring of the tissues during the introduction of the cannula. It has a vertical end to stop the advancement inside the cannula. (3). A cutter which is 14cm long and made of stainless steel and fits inside the cannula when the stylet is removed. Its front part is sharp on one side to cut through the ligament and cartilage of the symphysis pubis from its posterior aspect. Its back has a half-circle end to prevent the cutter from advancing beyond the bevel of the cannula inside the tissues. This is a life-saving operation and used to widen the diameter of the pelvis during certain situations of obstructed delivery of the baby. The design of the apparatus and instructions of its use enable doctors and midwives to perform the symphysiotomy procedure once they are trained on its use. The use of the invention avoids bleeding, injury to urethra and bladder, and avoids the formation of skin scar. The symphysiotomy scalpel obtained patent status from the King Abdulaziz City for Science & Technology (5910 dated 20 May 2018).

Scientific Validation of Three-Dimensional Stereophotogrammetry Compared to the IGAIS Clinical Scale for Assessing Wrinkles and Scars after Laser Treatment

Background: Measuring outcomes from treatments to the skin is either reliant upon patient’s subjective feedback or scale-based peer assessments. Three-Dimensional stereophotogrammetry intend to accurately quantify skin microtopography before and after treatments. Objective: To compare the accuracy of stereophotogrammetry and a scale-based peer evaluation in assessing topographical changes to skin surface following laser treatment. Methods: A 3D stereophotogrammetry system photographed skin surface of 48 patients with facial wrinkles or scars before and three months after laser resurfacing, followed immediately by topical application of vitamin C. The software measured changes in skin roughness, wrinkle depth and scar volume. Images were presented to three observers, each independently scoring cutaneous improvement according to Investigator Global Aesthetic Improvement Scale (IGAIS) Scale. Results: A trend reflecting skin/scar improvement was reported by 3D-SPM measurements and raters. The percentage of topographical change given by the raters matched 3D SPM findings. Agreement was highest when observers analyzed 3D images. However, observers overestimated skin improvement in a nontreatment control whilst 3D-SPM was precise in detecting absence of intervention. Conclusion: This study confirmed a direct correlation between the IGAIS clinical scale and 3D-SPM and confirmed the efficacy and accuracy of the latter when assessing cutaneous microtopography alterations as a response to laser treatment.