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Frontiers in Medicine 2021The skin is a flexible organ that forms a barrier between the environment and the body's interior; it is involved in the immune response, in protection and regulation,...
The skin is a flexible organ that forms a barrier between the environment and the body's interior; it is involved in the immune response, in protection and regulation, and is a dynamic environment in which skin lipids play an important role in maintaining homeostasis. The different layers of the skin differ in both the composition and amount of lipids. The epidermis displays the best characteristics in this respect. The main lipids in this layer are cholesterol, fatty acids (FAs) and ceramides. FAs can occur in free form and as components of complex molecules. The most poorly characterized FAs are very long-chain fatty acids (VLCFAs) and ultra long-chain fatty acids (ULCFAs). VLCFAs and ULCFAs are among the main components of ceramides and are part of the free fatty acid (FFA) fraction. They are most abundant in the brain, liver, kidneys, and skin. VLCFAs and ULCFAs are responsible for the rigidity and impermeability of membranes, forming the mechanically and chemically strong outer layer of cell membranes. Any changes in the composition and length of the carbon chains of FAs result in a change in their melting point and therefore a change in membrane permeability. One of the factors causing a decrease in the amount of VLCFAs and ULCFAs is an improper diet. Another much more important factor is mutations in the genes which code proteins involved in the metabolism of VLCFAs and ULCFAs-regarding their elongation, their attachment to ceramides and their transformation. These mutations have their clinical consequences in the form of inborn errors in metabolism and neurodegenerative disorders, among others. Some of them are accompanied by skin symptoms such as ichthyosis and ichthyosiform erythroderma. In the following review, the structure of the skin is briefly characterized and the most important lipid components of the skin are presented. The focus is also on providing an overview of selected proteins involved in the metabolism of VLCFAs and ULCFAs in the skin.
PubMed: 34497816
DOI: 10.3389/fmed.2021.730855 -
Plastic and Reconstructive Surgery Dec 2019Acellular dermal matrix is used in most postmastectomy implant-based breast reconstructions in the United States. It is believed to be safe, despite a slightly increased... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acellular dermal matrix is used in most postmastectomy implant-based breast reconstructions in the United States. It is believed to be safe, despite a slightly increased complication rate. Although never established in a unifying study, the primary advantage of acellular dermal matrix is believed to be an enhanced aesthetic result, thus justifying the added expense. The purpose of this study was to assess the aesthetic benefits of acellular dermal matrix in expander-to-implant breast reconstruction.
METHODS
A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was performed including all original studies examining aesthetic outcomes of expander-to-implant breast reconstructions with acellular dermal matrix compared to muscular coverage. Direct-to-implant and prepectoral studies were excluded from the evaluation. The results were aggregated and reported as a summary.
RESULTS
Among 883 studies identified, 49 full-text articles were reviewed and nine articles ultimately met inclusion criteria. All nine studies were not randomized. Of these, three articles (1448 total patients) evaluated reconstruction aesthetic outcomes by patient satisfaction, whereas six articles evaluated the aesthetic outcomes by external observer (504 total patients). None of the articles evaluating patient satisfaction reported a difference between acellular dermal matrix and muscular reconstruction. Five of the six articles using objective outcomes demonstrated significant improvement in aesthetic outcome in the acellular dermal matrix group.
CONCLUSIONS
Although little evidence exists evaluating the aesthetic benefits of acellular dermal matrix for expander-to-implant breast reconstruction, the data suggest that objective observers consider acellular dermal matrix-assisted expander-to-implant breast reconstructions aesthetically superior to reconstruction with only muscular coverage, but patients appear to be equally satisfied with both reconstructive options.
Topics: Acellular Dermis; Breast Implantation; Breast Implants; Breast Neoplasms; Esthetics; Female; Humans; Mastectomy; Patient Satisfaction; Reoperation; Tissue Expansion; Tissue Expansion Devices
PubMed: 31764630
DOI: 10.1097/PRS.0000000000006212 -
The Cochrane Database of Systematic... Jul 2017Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are one of the surgical operations used to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence.
OBJECTIVES
To determine the effects of traditional suburethral slings on stress or mixed incontinence in comparison with other management options.
SEARCH METHODS
We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles.
SELECTION CRITERIA
Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence.
DATA COLLECTION AND ANALYSIS
At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data.
MAIN RESULTS
We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months.One medium-sized trial compared traditional suburethral sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43).One trial found that traditional slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21)Seven trials compared slings with open abdominal retropubic colposuspension. Participant-reported incontinence was lower with the slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long-term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the sling procedure but a 50% increase in urinary tract infection with the sling procedure compared with colposuspension. Fewer women developed prolapse after slings (compared with after colposuspension) in two small trials but this did not reach statistical significance.Twelve trials addressed the comparison between traditional sling operations and minimally invasive sling operations. These seemed to be equally effective in the short term (RR for incontinence within first year 0.97, 95% CI 0.78 to 1.20) but minimally invasive slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms.Six trials compared one type of traditional sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Participant-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45, 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Gore-Tex in one trial.Data for comparison of bladder neck needle suspension with suburethral slings were inconclusive because they came from a single trial with a small specialised population.No trials compared traditional suburethral slings with anterior repair, laparoscopic retropubic colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting participant characteristics.For most of the comparisons, clinically important differences could not be ruled out.
AUTHORS' CONCLUSIONS
Traditional slings seem to be as effective as minimally invasive slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional slings may be more cost-effective compared with collagen injection but not cost-effective when compared with minimally invasive sling operations. Reliable evidence to clarify whether or not traditional suburethral slings may be better or worse than other surgical or conservative management options is lacking.
Topics: Adult; Female; Humans; Polytetrafluoroethylene; Randomized Controlled Trials as Topic; Suburethral Slings; Treatment Outcome; Urinary Incontinence; Urinary Incontinence, Stress
PubMed: 28743177
DOI: 10.1002/14651858.CD001754.pub4 -
The Journal of Craniofacial Surgery Jul 2018Adipofascial flaps (AFF) with acellular dermal matrix (ADM) have the potential to reconstruct neural tube defects without sacrificing muscle that may be critical for... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Adipofascial flaps (AFF) with acellular dermal matrix (ADM) have the potential to reconstruct neural tube defects without sacrificing muscle that may be critical for long-term function. Comparative studies between myocutaneous flap (MF) reconstruction, the accepted standard reconstructive technique, and AFF/ADM remain under-reported. The aim of this study was to evaluate the safety and efficacy of myelomeningocele reconstruction using muscle sparing AFF/ADM versus MF.
METHODS
A retrospective comparison was conducted on consecutive myelomeningocele patients reconstructed with MF or AFF/ADM over an 84-month period. Data analyzed included: basic demographics, defect size, reconstructive technique, complications, and length of follow-up. A supplemental meta-analysis based on systematic review of literature was performed to compare alternative reconstructive options.
RESULTS
Twelve patients were identified who met inclusion criteria. Median age, weight, and defect size at reconstruction in the AFF/ADM group (n = 6) was 37.5 weeks, 3.25 kg, and 20.0 cm, respectively, and in the MF group (n = 6) was 37 weeks, 3.6 kg, and 22.5 cm (P > 0.5). For the AFF/ADM versus MF groups, median follow-up was 33.8 versus 22.6 months, reoperation rate was 0% versus 17% (P = 1.0), and complex skin flap closure rate was 17% versus 100% (P = 0.015). No cerebrospinal fluid leaks or surgical site infections occurred in either group. Meta-analysis of the literature revealed no statistically significant difference in complications rates between muscle and nonmuscle flap reconstruction (P > 0.5); potential long-term sequelae of muscle flap harvest were not included.
CONCLUSIONS
Muscle sparing AFF with ADM is a safe and effective surgical alternative to muscle flaps for lumbar myelomeningocele reconstruction.
Topics: Acellular Dermis; Fascia; Female; Follow-Up Studies; Humans; Infant; Lumbar Vertebrae; Male; Meningomyelocele; Muscle, Skeletal; Myocutaneous Flap; Organ Sparing Treatments; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Subcutaneous Fat
PubMed: 29750727
DOI: 10.1097/SCS.0000000000004598 -
Annals of Plastic Surgery Feb 2015Conflict of interest (COI) and disclosure of financial relationships have received increased attention recently owing in part to the passage of the Physician Payments... (Review)
Review
INTRODUCTION
Conflict of interest (COI) and disclosure of financial relationships have received increased attention recently owing in part to the passage of the Physician Payments Sunshine Act, which requires manufacturers of drugs, medical devices, and biological to record payments to physicians and health care systems. The impact of financial relationships with industry sponsorship and COI reporting on surgical outcomes of abdominal wall reconstruction with acellular dermal matrices (ADMs) has not been previously explored.
METHODS
A systematic review of the literature for studies that evaluated surgical outcomes in abdominal wall reconstruction using ADM was conducted. The level of evidence of these studies was evaluated; and data concerning the type of industry, government, or national society sponsorship, primary outcome, complications, and statistical results were collected. The overall favorability of the study with respect to ADM use was systematically assessed. Comparisons between type of sponsorship and significant results were analyzed using the Pearson χ2 test.
RESULTS
A total of 204 studies were identified, of which 124 fulfilled our inclusion criteria. Sixty-four (52%) studies had a disclosure statement present. Conflict of interest was reported in 39 (61%) of these studies. Taken collectively, studies that report no COI are more likely to be unfunded (P<0.001). Studies with a reported COI are more likely to report a favorable outcome with respect to infection (P<0.01), wound complications (P<0.01), and overall morbidity (P<0.07) and mortality (P<0.05).
CONCLUSIONS
Industry sponsorship and COI are common in abdominal wall reconstruction studies with ADM. Studies authored by groups disclosing an industry conflict that report clinical outcomes are significantly associated with reporting lower postoperative complications, and consequently describing positive research findings.
Topics: Abdominal Wall; Acellular Dermis; Conflict of Interest; Herniorrhaphy; Humans; Outcome Assessment, Health Care; Surgical Mesh
PubMed: 25590252
DOI: 10.1097/SAP.0000000000000372 -
Plastic and Reconstructive Surgery Mar 2016Capsular contracture is a complication of breast augmentation that frequently requires revision surgery. "Capsulectomy, site change, and implant exchange" has been... (Review)
Review
BACKGROUND
Capsular contracture is a complication of breast augmentation that frequently requires revision surgery. "Capsulectomy, site change, and implant exchange" has been referred to as the gold standard treatment of clinically significant contractures. However, the actual clinical evidence behind this algorithm remains elusive at best. A systematic review of the literature was performed to clarify the true evidence behind the surgical management of capsular contracture.
METHODS
A search of the MEDLINE database was performed for clinical studies involving the surgical treatment of capsular contracture following breast augmentation. Resulting articles were reviewed using a priori criteria.
RESULTS
The systematic review was performed in April of 2015. The primary search for "breast augmentation" yielded 9490 articles. When filtered for "treatment of capsular contracture," 461 articles resulted. Review of these articles and pertinent references using a priori criteria yielded 24 final articles. No controlled trials met final inclusion criteria.
CONCLUSIONS
There is limited clinical evidence behind the surgical management of capsular contracture. Site change and implant exchange are associated with reduced contracture recurrence rates and likely play a beneficial role in treating capsular contracture. The data on capsulectomy are less conclusive. Acellular dermal matrix may be a useful adjunct but still requires long-term data.
Topics: Acellular Dermis; Breast Implants; Esthetics; Female; Follow-Up Studies; Humans; Implant Capsular Contracture; Mammaplasty; Prosthesis Failure; Reoperation; Risk Assessment; Skin Transplantation; Treatment Outcome; Wound Healing
PubMed: 26910663
DOI: 10.1097/01.prs.0000480095.23356.ae -
Odontology Apr 2024The aim of this systematic review (SR) compared the effect of xenogeneic collagen matrix (XCM) vs. connective tissue graft (CTG) for the treatment of multiple gingival... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review (SR) compared the effect of xenogeneic collagen matrix (XCM) vs. connective tissue graft (CTG) for the treatment of multiple gingival recession (MGR) Miller Class I and II or Cairo type I. Five databases were searched up to August 2022 for randomized clinical trials (RCTs) comparing the clinical effects of XCM vs. CTG in the treatment of MGR. The random effects model of mean differences was used to determine reduction of gingival recession (GR), gain in keratinized tissue width (KTW), gain in gingival thickness (GT) and gain in clinical attachment level (CAL). The risk ratio was used to complete root coverage (CRC) at 6 and 12 months. 10 RCTs, representing 1095 and 649 GR at 6 and 12 months, respectively, were included in this SR. The meta-analysis showed no statistically significant difference in GR reduction, KTW gain GT gain or CAL gain between groups at 6 months. However, at 12 months of follow-up, differences favoring the control group were observed (p < 0.05). CRC was significantly higher in the CTG group at 6 and 12 months. Regarding dentine hypersensitivity (DH), no statistically significant differences were found between groups at 6 and 12 months of follow-up (p < 0.05). At 12 months, CTG showed significantly superior clinical results in the treatment of MGR: however, this difference was not observed in the decrease of DH.
Topics: Humans; Gingival Recession; Treatment Outcome; Surgical Flaps; Tooth Root; Collagen; Connective Tissue; Gingiva
PubMed: 37898589
DOI: 10.1007/s10266-023-00863-4 -
The Cochrane Database of Systematic... 2000Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also... (Review)
Review
BACKGROUND
Suburethral slings are surgical operations used to treat women with urinary incontinence. They were originally designed for recurrent stress incontinence, but have also been used recently for primary cases.
OBJECTIVES
To determine the effects of suburethral slings on stress or mixed urinary incontinence in comparison with other management options.
SEARCH STRATEGY
We searched the Cochrane Incontinence Group's trials register, The National Research Register and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 1999, inclusive. Date of most recent search: January 2000.
SELECTION CRITERIA
Randomised or quasi-randomised trials that included suburethral slings for the treatment of urinary incontinence.
DATA COLLECTION AND ANALYSIS
Both reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data.
MAIN RESULTS
Five trials were identified including 206 women - 126 treated with suburethral slings and 80 with other procedures. Three compared suburethral slings with open abdominal retropubic suspensions (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In the fifth trial, different types of suburethral sling were compared with each other. Six types of slings were included (Teflon, polytetrafluoroethylene, Goretex, porcine dermis, lyophilized dura mater and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections, artificial sphincters or conservative management. There is one ongoing trial with Tension-free Vaginal Tape (TVT) versus Burch colposuspension, results expected in August 2000. For each outcome data were available only from individual trials. There were no detectable differences in terms of voiding dysfunction, urge incontinence or detrusor instability between suburethral slings and abdominal or needle suspensions, but the data were few and the confidence intervals wide. More peri-operative complications were reported after suburethral slings than after needle suspension (9/10 vs 2/10; RR 4.5, 95% CI 1.3 to 15.8), and length of stay was longer after sling operations than after abdominal or needle suspension. In the trial which compared autologous (rectus fascia) with synthetic (Goretex) slings, 11/32 vs 2/16 women had not improved after a year (RR 2.75, 95% CI 0.69 to 10.95), but fewer had complications (0/32 vs 5/16; RR 0.05, 95% CI 0 to 0.8). Two women in the second group had late sling erosion of the urethra requiring removal of the Goretex, although their incontinence remained cured.
REVIEWER'S CONCLUSIONS
There were few data available to compare suburethral sling operations with other surgical management (abdominal and needle suspension, or different types of slings). In general, the quality of trials was poor with no clear method of randomisation, small numbers of women studied, short follow-up and scanty information on outcome measures. There is not enough evidence on which to judge whether suburethral slings are better or worse than other surgical or non surgical managements.
Topics: Female; Humans; Polytetrafluoroethylene; Randomized Controlled Trials as Topic; Urethra; Urinary Incontinence; Urologic Surgical Procedures
PubMed: 10908509
DOI: 10.1002/14651858.CD001754 -
Clinical and Experimental Dermatology Nov 2002'Nonablative laser resurfacing' is a new treatment for photoaged skin, the aim of which is to wound the upper dermis in order to induce dermal fibrosis and improve the... (Review)
Review
'Nonablative laser resurfacing' is a new treatment for photoaged skin, the aim of which is to wound the upper dermis in order to induce dermal fibrosis and improve the clinical appearance. Unlike conventional laser resurfacing or dermabrasion, the epidermis is protected and retained to avoid the problems associated with open wounds and reepithelialization. A number of lasers and light sources have been developed or adapted for this purpose.
Topics: Dermabrasion; Humans; Laser Therapy; Phototherapy; Plastic Surgery Procedures; Regeneration; Skin Aging; Skin Physiological Phenomena
PubMed: 12472533
DOI: 10.1046/j.1365-2230.2002.01157.x -
Journal of Indian Society of... 2017The aim of this systematic review was to evaluate whether patients with gingival recession would benefit from an acellular dermal matrix graft (ADMG) in ways that are...
BACKGROUND
The aim of this systematic review was to evaluate whether patients with gingival recession would benefit from an acellular dermal matrix graft (ADMG) in ways that are comparable to the gold standard of the subepithelial connective tissue graft (SCTG).
MATERIALS AND METHODS
A systematic review and meta-analysis comparing ADMG to SCTG for the treatment of Miller Class I and II recession defects was conducted according to PRISMA guidelines. PubMed, Excerpta Medica Database, and Cochrane Central Register of Controlled Trials databases were searched up to March 2016 for controlled trials with minimum 6 months duration. The primary outcome was root coverage; secondary outcomes included attachment level change, keratinized tissue (KT) change, and patient-based outcomes. Both authors independently assessed the quality of each included trial and extracted the relevant data.
RESULTS
From 158 potential titles, 17 controlled trials were included in the meta-analysis. There were no differences between ADMG and SCTG for mean root coverage, percent root coverage, and clinical attachment level gain. ADMG was statistically better than SCTG for gain in width of KT (-0.43 mm; 95% confidence interval: -0.72, -0.15). Only one study compared patient-based outcomes.
CONCLUSION
This review found that an ADMG would be a suitable root coverage substitute for an SCTG when avoidance of the second surgical site is preferred.
PubMed: 29551861
DOI: 10.4103/jisp.jisp_222_17