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Objective: After injury, humans and other mammals heal by forming fibrotic scar tissue with diminished function, and this healing process involves the dynamic interplay between resident cells withi...

Background and objectives Both artesunate and fractional CO2 laser have been proved effective in the treatment of hypertrophic scars, yet little data are available for the efficacy of artesunate combined with fractional CO2 laser. In order to assess the pre-clinical significance and the underlying mechanism of this combined treatment profile, we attempted to observe the effectiveness of this therapy in rabbit models through determining the expression of BMP-7 and Fas. Materials and methods Twenty-Four New Zealand white rabbits with established hypertrophic scar samples were randomly divided into control group and three treatment groups. Artesunate (20 μl/cm2) was injected into the rat’s scar of artesunate and combination groups, while fractional CO2 laser (Combo mode, deep energy:10 mJ, super energy: 50 mJ) was applied to rats in fractional CO2 laser and combination groups at week 4 after model establishment. All rabbits underwent a total of 3 sessions of treatment once every 2 weeks. Histological and immunohistochemistry study, Western blot assay, cell viability, ELISA and RT-QPCR were performed at week 10 to observe the aspects of hypertrophic scar sample changes and expression of BMP-7 and Fas in the scar tissues. Results Compared with control group, hypertrophic scars and the collagen fibers were significantly inhibited after treatment, and higher inhibition was seen in the samples in combination group compared to that in artesunate and fractional CO2 laser groups (P Conclusions Artesunate combined with fractional CO2 laser is effective in hypertrophic scarring in this rabbit model. Our findings can serve as a potential alternative strategy to treatment of hypertrophic scar in clinical practice.

Keloids are disfiguring pathological scars that could cause pain and pruritus. The conventional treatments, such as bolus injection of drugs or surgery, are invasive and require a personal visit to clinic. Microneedle (MN) technology has great potential to offer a self-administered and minimally invasive treatment of keloids. However, drugs delivered using MNs suffer from limited penetration in keloid tissue. This study demonstrates enhanced drug penetration in human keloid scar tissue by combining MN and sonophoresis.

The U.S. Transuranium and Uranium Registries whole-body tissue donor Case 0407 had an acute intake of ‘high-fired’ plutonium oxide resulting from a glove-box fire in a fabrication plant at a nuclear defence facility. The respiratory tract of this individual was dissected into five regions (larynx, bronchi, bronchioles, alveolar-interstitial, and thoracic lymph nodes) and analysed for plutonium content. The activities in certain compartments of the respiratory tract were found to be higher than expected from the default models described in publications of the International Commission on Radiological Protection. Because of the extremely slow rate of dissolution of the material inhaled, the presence of bound fraction is incapable of explaining the higher-than-expected retention. A plausible hypothesis—encapsulation of plutonium in scar tissues—is supported by the review of literature. Therefore, scar-tissue compartments corresponding to the larynx, bronchi, bronchioles and alveolar-interstitial regions were added to the existing human respiratory tract model structure. The transfer rates between these compartments were determined using Markov Chain Monte Carlo analysis of data on urinary excretion, lung counts and post-mortem measurements of the liver, skeleton and regional retention in the respiratory tract. Modelling of the data showed that approximately 30% of plutonium activity in the lung was sequestered in scar tissues. The dose consequence of such sequestration is qualitatively compared against that of chemical binding.

Introduction Vertical ridge augmentation (VRA) is one of the most challenging procedures. This is the first case report to show 2-5 mm VRA after two unsuccessful GBRs around previously placed dental implants, with the use of an exposed d-PTFE membrane. Case presentation A 79-year-old ASA II Caucasian male presented after two previous GBR procedures on the LLQ. The second attempt left the site with two exposed implants, scar tissue, no keratinized tissue and lack of vestibular depth. VRA was attempted with the use of cortical perforations, tenting screws, dense PTFE membrane and a 50:50 mixture of anorganic bovine bone matrix and mineralized allograft. The site was left to heal in a secondary intention, leaving the d-PTFE membrane exposed. The membrane was removed 4 weeks postoperatively. The healing abutments were placed, the tenting screws were removed, and the site was allowed to heal for more than seven months. Radiographically, VRA was achieved ranging from 2 to 5 mm. A vestibuloplasty was performed using a diode laser and subsequent flap dissection. Four months after the vestibuloplasty, the tissue surrounding the implants showed adequate keratinization, and an elongated vestibular depth. In addition, in both implants, the emergence profile buccal and lingual was more than 3 mm and the patient was referred to his prosthodontist for the fabrication of the final restorations. Conclusions VRA around dental implants was achieved with the use of a nonresorbable dense PTFE membrane, which was left exposed to heal in a secondary intention, tenting screws and a combination grafting technique to correct two previously failed GBRs.

Scars usually do not show strong contrast under standard skin examination relying on dermoscopes. They usually develop after skin injury when the body repairs the damaged tissue. In general, scars cause multiple types of distress such as movement restrictions, pain, itchiness and the psychological impact of the associated cosmetic disfigurement with no universally successful treatment option available at the moment. Scar treatment has significant economic impact as well. Mueller matrix polarimetry with integrated autofocus and automatic data registration can potentially improve scar assessment by the dermatologist and help to make the evaluation of the treatment outcome objective. Polarimetry can provide new physical parameters for an objective treatment evaluation. We show that Mueller matrix polarimetry can enable strong contrast for in vivo scar imaging. Additionally, our results indicate that the polarization stain images obtained form there could be a useful tool for dermatology. Furthermore, we demonstrate that polarimetry can be used to monitor wound healing, which may help prevent scarring altogether.

The respiratory tract tissues of four former nuclear workers with plutonium intakes were radiochemically analyzed post mortem by the United States Transuranium and Uranium Registries. Plutonium activities in the upper respiratory tract of these individuals were found to be higher than those predicted using the most recent biokinetic models described in publications of the International Commission on Radiological Protection. Modification of the model parameters, including the bound fraction, was not able to explain the data in one of the four individuals who had inhaled insoluble form of plutonium. Literature review points to the presence of—and a significant retention of—plutonium in the scar tissues of the lungs. Accordingly, an alternate model with scar-tissue compartments corresponding to larynx, bronchi, bronchioles, alveolar-interstitium and thoracic lymph nodes was proposed. The rates of transfer to the scar tissue compartments were determined using Markov Chain Monte Carlo analysis of data on urinary excretion, lung counts and post-mortem measurements of liver, skeleton and individual respiratory tract compartments, as available. The posterior models predicted that 20–100%—depending on the solubility of the material inhaled—of the activities retained in the respiratory tract were sequestered in the scar tissues.

It is well known that collagen tissue, especially the collagen structure, plays an important role in wound healing. However, most research on collagen has been qualitative and morphological, based on sections, and cannot be used for real-time monitoring and clinical prediction. There are no standardized methods of quantitative analysis based on the whole skin sample in three dimensions (3-D). In order to explore a 3-D quantitative analysis, we developed a method that was derived from that of material science and physics, combined with our previous technique, X-ray scattering (SAXS). We hypothesized that the dermis might be analysed by fractal dimensions. To test this hypothesis, we performed the analysis in different pathological conditions, such as scar tissue, different time points after wounding, skin in different degrees of burns and skin in diabetes. The results showed that fractal dimension analysis could detect differences in different locations of the scar tissue, at different time points after wounding, and at a different extent of the severity of skin in diabetes. The research demonstrated that fractal dimension analysis can describe the 3-D structure of the collagen tissue of the skin, which will be beneficial for studying wound healing and finding new clinical treatments.

BACKGROUND Ventricular scars due to myocardial infarction provide a substrate for ventricular arrhythmias, and cardiac magnetic resonance (CMR) is the golden standard for the quantification of scar tissue magnitude. CMR has still limitations with patients with ICD despite ICD's becoming MR-compatible. We investigated the association between calibrated integrated backscatter (cIBS) and arrhythmia frequency in patients with ICD. METHODS Thirty-two ischemic dilated cardiomyopathy (ICM) patients with VVI-ICD (mean age 66.56 ± 9.05, 28 male, and four female) were divided into three groups according to their arrhythmia frequency (ventricular arrhythmia-[VA -], VA + [VA +], and arrhythmia storm [AS]). Then with transthoracic echocardiography (TTE), all patients' cIBS values were calculated and these values were compared with the patients' arrhythmia frequency. RESULTS cIBS values of patients with VA + and AS were significantly higher in the apical-septal (0.66 ± 0.11 vs. 0.50 ± 0.16, p = .008) and apical-lateral (0.62 ± 0.19 vs. 0.46 ± 0.18, p = .041) segments compared to those of patients with VA -. The cIBS values of apical-septal (0.50 ± 0.16 vs. 0.65 ± 0.08 vs. 0.66 ± 0.13 respectively, p = .032) and apical-anterior (0.53 ± 0.22 vs. 0.48 ± 0.17 vs. 0.79 ± 0.23 respectively, p = .03) segments were significantly different between the groups. Furthermore, in the post hoc analysis, the difference was significantly higher in VA + than VA - in the apical-septal segment and higher in AS than VA + in apical-anterior segments. CONCLUSION Our findings suggest an association between the cIBS values and arrhythmia frequency in the study group.

The aim of the study was to observe the effect of allogeneic acellular dermal matrix (ADM) combined with autologous razor‐thin graft on the appearance and function of hands in patients with extremely large area burns combined with deep hand burns. Sixty‐four patients with severe burn combined with deep burn of the hand in our hospital from August 2015 to August 2019 were selected as the study subjects. All patients were randomly divided into the study group (32 cases, given allogeneic ADM combined with autologous razor‐thin graft) and the control group (32 cases, given autologous scar tissue combined with autologous razor‐thin graft). Hand appearance, wound healing, wound contraction, hand function, and quality of life were compared between the two groups at 3 and 6 months after treatment. The vascular distribution, skin thickness, and flexibility scores of the two groups 6 months post operation were lower than those of the 3 months post operation (P

To date, treatment of atrophic acne scars remains a therapeutic challenge for dermatologists, yet there is no standard option on the most effective treatment. Microneedling (MN) is a minimally invasive technology that involves repetitive skin puncture using sterile microneedles to disrupt dermal collagen that connects the scar tissue. Recent studies have demonstrated the potency of MN, such as dermaroller and fractionated microneedle radiofrequency, in the treatment of atrophic scars. The objective of this review is to evaluate systematically the current literature on MN for atrophic acne scars. A systematic search of literature was performed from PubMed, Medline, Cochrane Central, and Google Scholar databases for articles published during the last 20 years. Only randomised controlled trials (RCTs) with full‐text version of the manuscript available were included in our study. Nine RCTs were included in this review. All treatment modalities demonstrated consistent results that MN was efficacious in treating atrophic acne scars as a monotherapy or in combination with other treatments. Moreover, no serious adverse effects were reported in all studies after MN treatment. MN is a well‐tolerated and effective therapeutic modality in treating atrophic acne scars. Further research is required to validate the efficacy of MN with a larger sample size and lengthy follow‐up.

Objective Caesarean rates have increased rapidly for various reasons recently. One of the important reasons among these is medicolegal problems. Our aim with this study was to preoperatively predict abdominal adhesion density by combining the scar tissue morphology formed in the post-caesarean Pfannenstiel incision line and the skin color scoring of the patients. Material and methods Patients who had undergone one caesarean section previously, completed their terms (37−39 weeks) and were under 35 years old were included in the study. Skin color scoring of the patients was performed using the Fitzpatrick skin color scale. Intra-abdominal adhesion scoring of the participant patients was performed using Nair’s adhesion scoring system. Results The change in abdominal adhesion scores was evaluated based on the Fitzpatrick color scale. Adhesion scores per the Nair intra-abdominal adhesion scoring system were found to be 0.04±0.209 in the FP1 group, 0.35±0.662 in the FP2 group, 1.58±0.923 in the FP3 group, and 2.33±0.577 in the FP4 group (p Conclusion The aim of this study was to increase the prediction rates by adding the skin color scoring to the scar tissue characteristics, which have been used in previous studies. The results of this study indicate that the combination of these two parameters may be more effective in predicting intra-abdominal adhesions. Nevertheless, there is a need for studies with a much higher number of patients and multiple parameters to be able to predict intra-abdominal adhesion density preoperatively with greater accuracy.

Although many invasive and noninvasive approaches exist, management of keloids and hypertrophic scars remains challenging. By better understanding patient expectations regarding scar treatments, dermatologists can provide higher quality and more satisfying care. Survey patients age 18 to 80 years with a history of hypertrophic, keloid, or disfiguring scars. Overall, 187 participants completed the 25-question survey. Expectations and willingness were measured on a 1-5 Likert scale. Results were analyzed overall and by patient demographics. Older respondents more often expected scar reduction, while younger patients expected scar removal. Compared with Caucasians, Asian respondents were more symptomatic, more likely to have seen a physician, and more willing to undergo invasive therapies. Respondent willingness for treatment and their perceived efficacy significantly differed across gender, age, and race. This study explores a gap in the literature of what role patient expectations play in electing specific treatments. Although patient expectations are complex and context dependent, gaining more understanding of what therapies patients are willing to attempt, and their expectations from those therapies could help guide counseling with the goal setting realistic expectations to improve patient compliance and satisfaction.

Introduction: Children aged 0–6 years with Chiari malformation (CM) often present with atypical symptoms and require revision surgery more often than older children. We studied characteristics and outcomes of CM patients in this age-group who underwent one or more revision surgeries to assess how often revision surgery is necessary and successful in this age-group. Methods: We retrospectively reviewed patients who were diagnosed with CM 1 or CM 1.5 and surgically treated with posterior fossa decompression (PFD) with or without duraplasty before their 7th birthday. Basic demographics, preoperative presentation, operative details, and postoperative outcomes were analyzed. Results: Forty patients (mean age 3.2 ± 1.7 years, 35% female) were reviewed. The most common presenting symptoms were headache, dysphagia, and respiratory problems. Eight patients required one or more revision surgeries 11.6 ± 7.6 months on average after their initial surgery. Comparing the revision and no revision groups, dysautonomia was significantly more common prior to initial surgery in the children requiring revision (37.5 vs. 3.1%, p = 0.02). The revision group also trended toward more dysphagia (75.0 vs. 46.9%, p = 0.24) and respiratory problems (75.0 vs. 40.6%, p = 0.12). The most frequent reasons for reoperation were symptom recurrence (6/8), residual posterior fossa compression (3/8), significant scar tissue formation (2/8), ventral brainstem compression (1/8), and suspected craniocervical instability (1/8). Of the 8 children undergoing reoperation, surgery achieved symptom resolution or improvement in 5, while 3 had unchanged symptoms. Two patients underwent a third surgery, after which 1 showed improvement and the other did not. This last patient showed short-term improvement after a fourth surgery but had symptom recurrence 12 months later. Discussion/Conclusion: Oropharyngeal and respiratory problems are particularly common in children aged 0–6 years with CM. Presentation with dysautonomia or other signs of brainstem compression will often predict an additional surgery will be needed after an initial PFD. Symptom recurrence is the most frequent reason for reoperation, and revision surgeries lead to improved clinical outcomes in the majority but not all of these young patients. Surgery in very young children is successful, but reoperation should be integrated into an up-front discussion algorithm particularly in children with severe symptoms.

Most patients with neurogenic thoracic outlet syndrome (NTOS) have a history of trauma. Scar tissue formation within the scalene muscle and around the nerves after injury cause arm and hand symptoms. We report that supraclavicular scalenotomy followed by external neurolysis without rib resection is very effective as the surgical treatment.Consecutive case series. Our aim was to evaluate the outcomes of patients who underwent supraclavicular scalenotomy followed by external neurolysis without rib resection for post-traumatic NTOS. Neurogenic thoracic outlet syndrome (NTOS) comprises over 95% of all TOS patients, and most patients with NTOS have a history of trauma before the onset of their symptoms. Patients treated with supraclavicular scalenotomy and neurolysis without rib resection from September 2014 to December 2019 were retrospectively reviewed by using the medical records and operative notes. Patient's characteristics, clinical symptoms before treatment, operative findings, and short- and long-term outcomes were assessed. To assess clinical outcomes at 2 months after surgery (short-term outcomes) and 12 months later (long-term outcomes), we used a 4-grade categorization (Excellent, Good, Fair, and Poor) of patients’ subjective evaluations after surgery on the basis of modified Odom's criteria. Excellent and Good were defined as a successful outcome. Ninety-six supraclavicular scalenotomies without rib resection were performed on patients with post-traumatic NTOS. The most common intraoperative observation was the fibrous bands within the anterior scalene muscle in 86 cases (89.6%). The short-term outcome with patients’ subjective evaluation in 96 operations at 2 months after surgery showed a 96.9% success rate (Excellent + Good). In 85 cases followed for more than 12 months after surgery, the success rate based on patients’ subjective evaluation at the last clinic follow-up appointment as a long-term outcome was 74.1%. In post-traumatic NTOS, it has been reported the arm and hand symptoms are due to pressure on the brachial plexus, which can stem from the swollen muscle following injuries and later from tightness of the scarred muscle. Considering this mechanism and our results, we concluded that supraclavicular scalenotomy and external neurolysis without rib resection made sense, as they were very effective and adequate to improve symptoms of NTOS. Level of Evidence: 5.

Tendons are specialized matrix-rich connective tissues that transmit forces from muscle to bone and are essential for movement. As tissues that frequently transfer large mechanical loads, tendons are commonly injured in patients of all ages. Following injury, mammalian tendons heal poorly through a slow process that forms disorganized fibrotic scar tissue with inferior biomechanical function. Current treatments are limited and patients can be left with a weaker tendon that is likely to re-rupture and an increased chance of developing degenerative conditions. More effective, alternative treatments are needed. However, our current understanding of tendon biology remains limited. Here, we emphasize why expanding our knowledge of tendon development, healing, and regeneration is imperative for advancing tendon regenerative medicine. We provide a comprehensive review of the current mechanisms governing tendon development and healing and further highlight recent work in regenerative tendon models including the neonatal mouse and zebrafish. Importantly, we discuss how present and future discoveries can be applied to both augment current treatments and design novel strategies to treat tendon injuries. This article is protected by copyright. All rights reserved.

Patients with congenital heart disease (CHD) are prone to develop atrial and ventricular arrhythmias. Multiple factors throughout life contribute to arrhythmogenicity substrate such as (i) (longstanding) volume and/or pressure overload, (ii) scar tissue, (iii) ageing-related structural remodelling, (iv) cardiovascular risk factors and (v) tachycardia-induced remodelling. At present, it is unknown whether, and to what extent, paediatric patients with CHD have atrial or ventricular conduction disorders early in life and whether there is a correlation between duration of volume/pressure overload and extensiveness of conduction disorders. To investigate this, we initiated high-resolution intraoperative epicardial mapping in paediatric patients with CHD undergoing primary open-heart surgery.

Reconstruction of auricular deformities and facial scars after burns is a challenging undertaking for surgeons. Excessive scar tissue, a poor blood supply and the paucity of available skin are all substantial difficulties that should be considered before the operation. Expanded neck flaps provide comparatively larger and thinner flaps for the simultaneous treatment of auricular deformities and facial scars in burn patients. In this article, the authors introduced the use of an expanded neck flap as coverage tissue for ear reconstruction and face resurfacing in 2 burn patients. The operation consisted of 3 stages. In the first stage, the expander was implanted subcutaneously under the skin of the neck to create adequate skin and soft tissue. In the second stage, the expander was removed, and the expanded flap was transferred to cover defects on the auricle and face. The third operation to repair the reconstructed ear and thick flap could be performed according the willingness of the patients and surgeons. Esthetically satisfactory results were achieved in both of the patients. The flaps survived completely, and the skin color, texture, and flexibility were well matched to those of the peripheral tissue. Six months postoperatively, the flaps did not shrink, and subsequent contractures did not recur. Both of the patients experienced high satisfaction, and no adverse effects were detected.

Ischaemic heart disease is among the most frequent causes of death. Early detection of myocardial pathologies can increase the benefit of therapy and reduce the number of lethal cases. Presence of myocardial scar is an indicator for developing ischaemic heart disease and can be detected with high diagnostic precision by magnetic resonance imaging. However, magnetic resonance imaging scanners are expensive and of limited availability. It is known that presence of myocardial scar has an impact on the well-established, reasonably low cost, and almost ubiquitously available electrocardiogram. However, this impact is non-specific and often hard to detect by a physician. We present an artificial intelligence based approach — namely a deep learning model — for the prediction of myocardial scar based on an electrocardiogram and additional clinical parameters. The model was trained and evaluated by applying 6-fold cross-validation to a dataset of 12-lead electrocardiogram time series together with clinical parameters. The proposed model for predicting the presence of scar tissue achieved an area under the curve score, sensitivity, specificity, and accuracy of 0.89, 70.0, 84.3, and 78.0%, respectively. This promisingly high diagnostic precision of our electrocardiogram-based deep learning models for myocardial scar detection may support a novel, comprehensible screening method.

To compare the clinical and radiologic outcomes and arthroscopic findings of proximal tibial osteotomy (PTO) alone versus PTO combined with medial meniscal posterior root repair (MMPRR).Between October 2010 and September 2016, patients who underwent PTO and second-look arthroscopy at a minimum of 24 months postoperatively were reviewed. Patients were divided into group I (isolated PTO), group P (PTO with MMPRR using the pull-out technique), and group F (PTO and MMPRR using the side-to-side repair method). The subjective knee scores were assessed. Radiologic evaluation was based on the Kellgren-Lawrence grade. Healing of medial meniscal posterior root tears (good/loose/scar tissue/failed) and cartilage regeneration (excellent/good/poor) were assessed by arthroscopic examination.Mean clinical follow-up duration of group I (n = 22), P (n = 25), and F (n = 24) was 28.5 ± 5.7, 27.9 ± 6.2, and 26.3 ± 5.3 months, respectively. At final follow-up, Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale significantly improved in all groups (P.001), and subjective scores did not differ among the groups. The Kellgren-Lawrence grade progression showed no significant differences among 3 groups (P = .461). Good healing of medial meniscal posterior root tears was found in 24% and 12.5% of patients in groups P and F, respectively, and 0 in group I; there were significant differences between groups I and P (P.001) and groups I and F (P.001). Excellent cartilage regeneration in the medial femoral condyle and medial tibial plateau was found in 13.6% and 9.1% in group I, 24% and 12% in group P, and 16.7% and 8.3% in group F, respectively, without significant differences.Concurrent MMPRR during PTO appears to improve the arthroscopic appearance (healing of MMRPTs and cartilage regeneration) during second-look arthroscopy. However, concurrent MMPRR does not significantly improve clinical and radiologic outcomes at short-term follow-up.Level III, retrospective comparative study.

Introduction: Phonomicrolaryngeal surgery involves the surgical treatment of benign disorders of the vocal folds. Postoperative scar tissue in vocal fold mucosa is undesired because mucosal hypodynamia may lead to prolonged impairment in voice quality. This study aims to present and share the outcomes of a new endolaryngeal suture technique. Methods: This study consists of patients who underwent vocal fold surgery followed by endolaryngeal microscopic suturation with a technique that we call the “mini-microsuture technique” between January 2018-December 2019. Videolaryngoscopic images were examined to observe the tissue healing process (suture elimination time, mucosal scar status, and wave pattern) at the first and the fourth week postoperatively. Results: A retrospective analysis was made in 144 (57 males (39.5%) and 87 females (60.5%)) patients who underwent phonomicrosurgery with “Mini-microsuture technique.” Mean age was 40.61 ± 13.54 (10-78) years. There were multiple pathological lesions in 41.66% (n: 60) of our patients, and 58.33% (n: 84) of them had single-lesion. 63.88% (n: 92) of the patients had bilateral vocal fold lesions where 36.22% (n: 52) of the patients had pathology in one vocal fold. Conclusions: The “mini-microsuture technique” is an easy and functional procedure that can be performed by a single surgeon under microscopy, which minimizes tissue trauma, prevents mucosal hypodynamia, and provides a better anatomical structure postoperatively for a symmetrical vibration. The technique does not significantly prolong operation time when mastered and is a cost-effective method in which surgery which can be concluded using a single suture material.

Scar tissues have been important factors in determining the progression of myocardial diseases and the development of adverse cardiac failure outcomes. Accurate segmentation of the scar tissues can be helpful to the clinicians for risk prediction and better evaluation of cardiovascular diseases. Our goal is to apply topology data analysis toward machine learning algorithms to confirm the geometry of scar tissue, in addition to gaining better visualization and quantification of the scar tissue present. We have introduced architecture for integrating geometry in the form of topology toward machine learning. Morphological image processing was carried out to define the regions of the endocardial wall. We implemented convolutional neural networks on delayed enhancement cardiac computed tomography images for the recognition of scar tissue. Segmented two-dimensional images were stacked up to build the geometry of the scar area for visualization purposes. Mathematical calculations were executed for the validation of the scar tissue in addition to performing morphological image processing and marking the scar tissue present on the endocardial wall of the left ventricular. We applied convolutional neural network over convolution and pooling the layers with small sizes; we achieved 89.23% accuracy, 91.11% sensitivity, and 87.75% specificity, and found the dissimilarity distance between the normal endocardial tissue distances to be 9.37. This new concept in this study contributes toward a better understanding of scar structure and transmural variation of the endocardial wall of the left ventricular.

Revision hammertoe surgery can be extremely challenging for the foot and ankle surgeon given the scar tissue and available osseous and soft tissue. Although not a common procedure, lesser metatarsophalangeal joint arthrodesis is an option for the patient especially in lieu of an amputation. This article describes the current literature and the surgical technique for a lesser metatarsophalangeal joint arthrodesis.

Background: Image evaluation of scar tissue plays a significant role in the diagnosis of cardiovascular diseases. Segmentation of the scar tissue is the first step towards evaluating the morphology of the scar tissue. Then, with the use of CT images, the deep learning approach can be applied to identify possible scar tissue in the left ventricular endocardial wall. Objective: To develop an automated method for detecting the endocardial scar tissue in the left ventricular using Deep learning approach. Method: Pixel values of the endocardial wall for each image in the sequence were extracted. Morphological operations, including defining regions of the endocardial wall of the LV where scar tissue could predominate, were performed. Convolutional Neural Networks (CNN) is a deep learning application, which allowed choosing appropriate features from delayed enhancement cardiac CT images to distinguish between endocardial scar and healthy tissues of the LV by applying pixel value-based concepts. Result: We achieved 89.23% accuracy, 91.11% sensitivity, and 87.75% specificity in the detection of endocardial scars using the CNN-based method. Conclusion: Our findings reveal that the CNN-based method yielded robust accuracies in LV endocardial scar detection, which is currently the most extensively used pixel-based method of deep learning. This study provides a new direction for the assessment of scar tissue in imaging modalities and provides a potential avenue for clinical adaptations of these algorithms. Additionally this methodology, in comparison with those in the literature, provides specific advantages in its translational ability to clinical use.

Scar tissue formation after synovectomy limits range of motion and causes muscle atrophy. The functional results for patients who underwent total open knee synovectomy often included questionnaires, and assessment of muscle strength was lacking in the literature. Therefore, we aimed to identify the strength and range of motion outcomes for patients who underwent total open synovectomy and to compare the results with the contralateral limb and healthy individuals. Knee range of motion and muscle strength were assessed in fourteen patients that underwent total (anterior and posterior) open knee synovectomy and were compared with the contralateral limb and with 14 healthy individuals matched by sex, age, height, and weight. The range of motion of flexion decreased 8.4% compared with the contralateral limb (95% CI − 18.9 to − 4.7, p = 0.002) and 9.9% compared with the control group (95% CI 3.9–14.9, p

Background: Median arcuate ligament (MAL) syndrome is a rare cause of chronic abdominal pain in adults and children. Release of the MAL has traditionally been performed open or laparoscopically. There have not been any published cases to our knowledge of robotic-assisted MAL release in pediatric patients. Patients and Methods: Two adolescent patients, aged 12 and 15 years, at our institution underwent robotic-assisted MAL release. The procedure involved dissecting the MAL muscle fibers and overlying scar tissue. Patients stayed inpatient postoperatively overnight and with an average outpatient follow-up of 10 months. Results: Both patients had immediate pain relief postoperatively and at 10-month follow-up had no recurrent symptoms. No complications were associated with the procedure. Conclusion: The increasing role of robotic surgery as a new surgical technique is gaining momentum for many procedures. This new approach for MAL release in the pediatric population was explored by our institution. It was found to be successful, safe, and reproducible for future patients.

Purpose Recurrent lumbar disc herniation is the most common complication after discectomy. Due to the altered anatomy with the presence of scar tissue, the surgical revision of already operated patients could be a surgical challenge. Methods We describe the microsurgical revision technique step by step with the evaluation of our own clinical results in comparison with primary lumbar disc surgeries. The clinical data are based on a clinical register with 2576 recorded primary surgeries (PD) and 592 cases of revisions (RD) with 12- and 24-month follow-up (FU). The intraoperative dura lesion rates of the surgeries between 2016 and 2018 were recorded retrospectively. Data from 894 primary disc surgeries and 117 revisions were evaluated. Results The ODI and the VAS for leg and back pain improved in both groups significantly with slightly inferior outcome of the revision group. The ODI improved from 46.3 (PD) and 45.9 (RD), respectively, to 12.6 (PD) and 22.9 (RD) at the 24-month FU. The VAS dropped down as well in both group [VAS back: 47.8 (PD) and 43.9 (RD) to 19.9 and 32.2 at the 24-month FU; VAS leg: 62.9 (PD) and 65.5 (RD) to 15.6 and 26.8 at the 24-month FU]. During the primary interventions, we observed 1.5% (11/894) and during revisions 7.7% (9/117) of dura lesions. Conclusions There is no clear guideline for the surgical treatment of recurrent disc herniations. In most cases, a pure re-discectomy is sufficient and can be performed safely and effectively with the help of a microscope. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Burns and scalds are relatively common injuries in children. Formation of hypertrophic scars or keloids is feared complications. A 2-year-old girl who spilled a cup of hot coffee onto herself developed widespread hypertrophic scars and beginning keloids on her upper chest, despite application of pressure garments and daily massage with silicone gel. Herein, we describe instructions for use of prolonged continuous 24-hour occlusive application of self-adherent silicone sheets to help mitigate the formation of scar tissue.

The definition of a cesarean scar pregnancy (CSP) is the localization of the gestational sac (GS) in the cicatrix tissue, which is created in the front wall of the uterus after a previous cesarean section (CS). The worldwide prevalence of CSP has been growing rapidly. However, there are no general recommendations regarding prophylaxis and treatment of the abnormalities of the anterior wall of the uterus discovered in a non-pregnant myometrium, or how to deal with existing cases of CSP. We present the latest knowledge, a holistic approach to the biology, histology, imaging, and management concerning post-CS scars based on our cases, which were treated in the Department of Pregnancy and Pathology of Pregnancy in the Medical University of Lublin, Poland. In our study, we present images of tissue samples of areas with a cicatrix in the uterus, and ultrasound and MRI images of CSP. We discuss the advances in the biology of the post-CS scar tissue, the prevention techniques used to repair the scar defect (niche) before the pregnancy, and the treatment of different complications of CSP, such as the rupture of the gravid uterus or the dehiscence of the myometrium.

“Ghosts” are fibrinous remnants that become visible during transvenous lead extraction (TLE). Methods: Data from transoesophageal echocardiography-guided TLE procedures performed in 1103 patients were analysed to identify predisposing risk factors for the development of so-called disappearing ghosts—flying ghosts (FG), or attached to the cardiovascular wall—stable ghosts (SG), and to find out whether the presence of ghosts affected patient prognosis after TLE. Results: Ghosts were detected in 44.67% of patients (FG 15.5%, SG 29.2%). The occurrence of ghosts was associated with patient age at first system implantation [FG (OR = 0.984; p = 0.019), SG (OR = 0.989; p = 0.030)], scar tissue around the lead (s) [FG (OR = 7.106; p < 0.001, OR = 1.372; p = 0.011), SG (OR = 1.940; p < 0.001)], adherence of the lead to the cardiovascular wall [FG (OR = 0.517; p = 0.034)] and the number of leads [SG (OR = 1.450; p < 0.002). The presence of ghosts had no impact on long-term survival after TLE in the whole study group [FG HR = 0.927, 95% CI (0.742–1.159); p = 0.505; SG HR = 0.845, 95% CI (0.638–1.132); p = 0.265]. Conclusions: The degree of growth and maturation of scar tissue surrounding the lead was the strongest factor leading to the development of both types of ghosts. The presence of either form of ghost did not affect long-term survival even after TLE indicated for infection.

Introduction Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue. Case report We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed. Conclusions Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

A certain cell type can be isolated from different organs in the adult body that can differentiate into ectoderm, mesoderm, and endoderm, providing significant support for the existence of a certain type of small, vascular-associated, pluripotent stem cell ubiquitously distributed in all organs in the adult body (vaPS cells). These vaPS cells fundamentally differ from embryonic stem cells and induced pluripotent stem cells in that the latter possess the necessary genetic guidance that makes them intrinsically pluripotent. In contrast, vaPS cells do not have this intrinsic genetic guidance, but are able to differentiate into somatic cells of all three lineages under guidance of the microenvironment they are located in, independent from the original tissue or organ where they had resided. These vaPS cells are of high relevance for clinical application because they are contained in unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs). The latter can be obtained from and re-applied to the same patient at the point of care, without the need for further processing, manipulation, and culturing. These findings as well as various clinical examples presented in this paper demonstrate the potential of UA-ADRCs for enabling an entirely new generation of medicine for the benefit of patients and healthcare systems.

Rectovaginal fistula (RVF) is a type of anastomotic leakage that may occur after low anterior resection for rectal cancer. The repair of RVF can be challenging because of the scar tissue stenosis and incomplete obstruction. Two patients presented in our department with vaginal faecal discharge almost 7 months after the radical resection of rectal cancer. On vaginal examination, titanium nails related to the rectal surgery were found in the vaginal wall. The patients were diagnosed with RVF. Considering that RVF positions in the patients were high and might adhere to the pelvic tissue, a combined transabdominal–transanal resection and vaginal repair surgery was performed. About 3 months after surgery, both patients underwent colonic closure surgery, with consequent good recovery. A combined transabdominal–transanal approach may provide distinct advantages in surgical repair of difficult cases of RVF.

Background:Muscle strain injury leads to a high risk of recurrent injury in sports and can cause long-term symptoms such as weakness and pain. Scar tissue formation after strain injuries has been described, yet what ultrastructural changes might occur in the chronic phase of this injury have not. It is also unknown if persistent symptoms and morphological abnormalities of the tissue can be mitigated by strength training.Purpose:To investigate if heavy resistance training improves symptoms and structural abnormalities after strain injuries.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 30 participants with long-term weakness and/or pain after a strain injury of the thigh or calf muscles were randomized to eccentric heavy resistance training of the injured region or control exercises of the back and abdominal muscle. Isokinetic (hamstring) or isometric (calf) muscle strength was determined, muscle cross-sectional area measured, and pain and function evaluated. Scar tissue ultrastructure was determined from biopsy specimens taken from the injured area before and after the training intervention.Results:Heavy resistance training over 3 months improved pain and function, normalized muscle strength deficits, and increased muscle cross-sectional area in the previously injured region. No systematic effect of training was found upon pathologic infiltration of fat and blood vessels into the previously injured area. Control exercises had no effect on strength, cross-sectional area, or scar tissue but a positive effect on patient-related outcome measures, such as pain and functional scores.Conclusion:Short-term strength training can improve sequelae symptoms and optimize muscle function even many years after a strain injury, but it does not seem to influence the overall structural abnormalities of the area with scar tissue.Registration:NCT02152098 (ClinicalTrials.gov identifier).

Cases We present 3 patients who underwent ulnar nerve transposition and wrapping of the nerve with human amniotic membrane (HAM). All 3 patients subsequently required a reoperation for the original pathologic condition (not for ulnar nerve symptoms), necessitating the exploration and dissection of the transposed ulnar nerve. We demonstrate the lack of scar formation and ease of separation between nerve and surrounding tissue, as well as histology in one case taken from the perineural tissues (previous amniotic membrane), demonstrating no inflammatory cells or absence of scar tissue formation. Conclusion Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis.

Scar tissue presents a barrier to regeneration in the central nervous system (CNS). Although the glial scar has been extensively studied, recent evidence suggests that non-glial components are also involved. In a recent paper, Dias, Kalkitsas, and colleagues uncovered a subset of pericytes as a contributor to fibrotic scarring that is conserved across diverse CNS lesions.

The purpose of this study was to investigate three-dimensional facial soft tissue changes after bimaxillary orthognathic surgery (BOGS) in patients with cleft lip and palate. The samples consisted of 34 Korean young adult patients with skeletal class III malocclusion who underwent BOGS for maxillary advancement/posterior impaction and mandibular setback. They were divided into cleft-class III (C-CIII) group (n = 18) and noncleft-class III (NC-CIII) group (n = 16). Three-dimensional computed tomography images were taken 1 month before (T1) and 3 months after (T2) surgery. After 34 hard/soft tissue landmarks were automatically identified using software, the amount and direction of change in landmarks and the amount of change in 16 soft tissue variables during T1-T2 were calculated. Then, statistical analysis was performed. Compared to NC-CIII group, C-CIII group showed more posteriorly-positioned hard/soft tissue landmarks, larger alar width, alar base width and philtrum width, and more obtuse nasal tip angle at both T1 and T2 stages. C-CIII group exhibited higher soft-to-hard tissue movement ratios at the bottom of the nose (ΔSn/ΔANS, 1.08 versus 0.81) and the upper part of the upper lip (ΔPoint A'/ΔPoint A, 1.08 versus 0.91), but a lower ratio at the lower part of the upper lip (ΔLs'/ΔIs, 0.72 versus 1.01) than NC-CIII group. The number of hard-soft tissue landmarks with high correlation (>0.90) was smaller in C-CIII group than in NC-CIII group (2 versus 6). Scar tissues and abnormal muscles in the nose and upper lip might elicit different responses in the nasolabial soft tissues to BOGS between C-CIII and NC-CIII patients.

Return to play (RTP) criteria after hamstring strain injuries (HSIs) help clinicians in deciding whether an athlete is ready to safely resume previous sport activities. Today, functional and sport-specific training tests are the gold standard in the decision-making process. These criteria lead to an average RTP time between 11 and 25 days after a grade 1 or 2 HSI. However, the high re-injury rates indicate a possible inadequacy of the current RTP criteria. A possible explanation for this could be the neglect of biological healing time. The present review shows that studies indicating time as a possible factor within the RTP-decision are very scarce. However, studies on biological muscle healing showed immature scar tissue and incomplete muscle healing at the average moment of RTP. Twenty-five percent of the re-injuries occur in the first week after RTP and at the exact same location as the index injury. This review supports the statement that functional recovery precedes the biological healing of the muscle. Based on basic science studies on biological muscle healing, we recommend a minimum period of 4 weeks before RTP after a grade 1 or 2 HSI. In conclusion, we advise a comprehensive RTP functional test battery with respect for the natural healing process. Before deciding RTP readiness, clinicians should reflect whether or not it is biologically possible for the injured tissue to have regained enough strength to withstand the sport-specific forces. In an attempt to reduce the detrimental injury-reinjury cycle, it is time to start considering (biological healing) time.

Endometriomas are typically an advanced form of endometriosis that leads to the formation of scar tissue, adhesions, and an inflammatory reaction. There is no certain serum marker for the diagnosis of endometriosis. This study aims to research the correlation between the amount of peaks corresponding to proteins and lipids with the volume of endometrioma and determine the chemical structure of blood serum collected from women suffering from endometriosis patients with endometrioma and healthy subjects using Fourier Transform Infrared (FTIR) spectroscopy. FTIR spectroscopy is used as a non-invasive diagnostic technique for the discrimination of endometriosis women with endometrioma and control blood sera. The FTIR spectra of 100 serum samples acquired from 50 patients and 50 healthy individuals were used for this study. For this purpose, multivariate analyses such as Principal Component Analysis (PCA), Partial Last Square analysis (PLS) with Variables Importance in Projection (VIP), and probability models, were performed. Our results showed that FTIR range 1500 cm-1 and 1700 cm-1 and around 2700 cm-1 - 3000 cm-1, regions may be used for the diagnosis of endometriosis. Also, we find that proteins and lipids fraction increase with the volume of endometrioma. Moreover, PLS and VIP analysis suggested that lipids could be helpful in the diagnosis of endometriosis women with endometrioma. WOS:000701842600018 34371315 Q1

BACKGROUND Parathyroid carcinoma (PC) is a rare malignancy that is difficult to eradicate completely after recurrence. We assessed the efficiency of extended en bloc resection (EEBR) in the management of recurrent or persistent PC. METHODS In this observational cohort study, 31 patients who underwent reoperations for recurrent or persistent PC were enrolled after 2-9 surgeries by other medical teams. EEBRs, which provided the oncologic resection by removing all possible tumor-bearing scar tissues, were adopted in 25 patients. The other 6 with gross infiltration into the upper aerodigestive tract (UAT) underwent less radical procedures for unwillingness to sacrifice laryngeal function. RESULTS The 5-year overall survival (OS) rate after EEBR was 59.6% compared with 16.7% after less radical procedures, with an improved median expected survival time of 90.0 months compared with 13.0 months after local excision. EEBR exhibited a favorable local control of relapses in 84.0% of patients after a median follow-up period of 27.0 months, 40.0% even achieved disease-free survival, although 56.0% had subsequent distant metastases (DMs) and suffered a worse 5-year OS of 36.7% in contrast with 100.0% in the absence of DM (p = 0.011). UAT invasion, rather than age, number of previous operations, or preoperative PTH levels, was the unique independent factor associated with both DM (HR = 5.466, p = 0.006) and mortality (HR = 7.606, p = 0.011). CONCLUSION EEBRs provide better outcomes than other conventional surgical approaches and might offer a second chance of cure for patients with recurrent or persistent PC in the absence of DM.

The scope of physical methods for correcting the pathological skin scars is rapidly growing but the results of their use are often unsatisfactory. An inadequate approach to therapy without taking into account the assessment of their effectiveness leads to relapses, increased growth of scar tissue or the absence of a clinically significant effect which requires strict scientific evidence in the course of benign scientific studies.Scientometric analysis of evidence-based studies on the use of therapeutic physical factors in the correction of post-acne scars.The analysis of evidence-based studies in electronic databases (PEDro, PubMed, eLibrary) and in databases of systematic reviews (Cochrane database) for the period from 2015 to 2020 was carried out. The following terms in Russian and English were taken as key words: acne scars (acne scarring), physical therapy (physical therapy). The final assessment of physical methods of correction included mainly data from foreign systematic reviews, meta-analyzes of RCTs, data from individual RCTs in English and/or Russian and tests rated at 4 points or higher on the PEDro scale.The clinical effects and supposed mechanisms of action of the currently proven therapeutic physical factors in the treatment of patients with post-acne scars are considered in detail. The most studied physical methods are technologies of high-intensity laser therapy (44.2%), fractional radiofrequency therapy (17%), combined methods of exposure (high-intensity laser therapy or micro-needling in combination with peels, fillers, PRP injection) (25%), micro-needling as monotherapy (5.8%) and microdermabrasion (4.5%) causing the most significant clinical changes and pronounced remodeling of the extracellular matrix of the skin in the area of scars.There is a need for regular synthesis and analysis of existing evidence-based studies, as well as the implementation of new high-quality randomized controlled clinical trials to study the effect of physical correction methods on post-acne scars which serve as the basis for the development of clinical guidelines.Арсенал физических методов коррекции патологических рубцов кожи быстро пополняется, однако результаты их использования зачастую неудовлетворительны. Неадекватный подход к терапии без учета оценки их эффективности приводит к рецидивам, усиленному росту рубцовой ткани или отсутствию клинически значимого эффекта, что требует строгих научных доказательств в ходе доброкачественных научных исследований.Наукометрический анализ доказательных исследований по применению лечебных физических факторов в коррекции рубцов постакне.Выполнен анализ доказательных исследований в электронных базах данных (PEDro, PubMed, eLIBRARY) и в базах данных систематических обзоров (Cochrane database) за период с 2015 по 2020 г. В качестве ключевых слов были приняты следующие термины на русском и английских языках: рубцы постакне (acne scarring), физиотерапия (physical therapy). В итоговую оценку физических методов коррекции включали преимущественно данные зарубежных систематических обзоров, метаанализы РКИ, данные отдельных РКИ на английском и/или русском языках и испытания, оцененные на 4 балла и выше по шкале PEDro.Детально рассмотрены клинические эффекты и предполагаемые механизмы действия доказанных на сегодняшний день лечебных физических факторов в терапии пациентов с рубцами постакне. Наиболее изученными из физических методов являются технологии высокоинтенсивной лазеротерапии (44,2%), фракционной радиочастотной терапии (17%), комбинированных методик воздействия (высокоинтенсивная лазеротерапия или микронидлинг в сочетании с пилингами, филлерами, введением PRP) (25%), микронидлинг в качестве монотерапии (5,8%) и микродермабразия (4,5%), вызывающие наиболее значимые клинические изменения и выраженное ремоделирование внеклеточного матрикса кожи в области рубцов.Необходимы регулярное обобщение и анализ существующих доказательных исследований, а также выполнение новых качественных рандомизированных контролируемых клинических испытаний по изучению воздействия физических методов коррекции на рубцы постакне, которые служат базой для разработки клинических рекомендаций.

Chronic Achilles tendon ruptures typically are treated with surgical intervention except in low-demand patients or patients who are unable to tolerate surgery. Although several treatment strategies are described, most literature is case reports and case series. There is no widely accepted algorithm or gold standard for surgical treatment of chronic Achilles tendon ruptures. Treatment strategy depends on the size of the tendon gap after excision of nonviable tissue and scar tissue. Smaller gaps can be treated with direct end-to-end repair. Medium-sized gaps can be treated with tendon-lengthening procedures. Tendon transfers, autograft, allograft, xenograft, and synthetic grafting are described for the reconstruction of large defects.

The term "self-myofascial release" is ubiquitous in the rehabilitation and training literature and purports that the use of foam rollers and other similar devices release myofascial constrictions accumulated from scar tissue, ischaemia-induced muscle spasms and other pathologies. Myofascial tone can be modulated with rollers by changes in thixotropic properties, blood flow, and fascial hydration affecting tissue stiffness. While rollers are commonly used as a treatment for myofascial trigger points, the identification of trigger points is reported to not be highly reliable. Rolling mechanisms underlying their effect on pain suppression are not well elucidated. Other rolling-induced mechanisms to increase range of motion or reduce pain include the activation of cutaneous and fascial mechanoreceptors and interstitial type III and IV afferents that modulate sympathetic/parasympathetic activation as well as the activation of global pain modulatory systems and reflex-induced reductions in muscle and myofascial tone. This review submits that there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions and thus the term "self-myofascial release" devices is misleading.

Summary An increase in left ventricular volume after a myocardial infarction is a key component of the adverse remodelling process leading to chamber dysfunction, heart failure and an unfavourable outcome. Hence, the therapeutic strategies have been designed to reverse the remodelling process by medical therapy, devices or surgical strategies. Surgical ventricular reconstruction primarily combined with myocardial revascularization has been introduced as an optional intervention aimed to reduce the left ventricle through resection of the scar tissue and is recommended in selected patients with predominant heart failure symptoms, and with myocardial scarring and moderate left ventricular remodelling. This review outlines the rationale and the technique for reconstructing the left ventricle and the possible indications for using that technique, based on experiences from the centre with the largest international experience. The major contributions in the literature are briefly discussed.

In this study, we aimed to investigate the predictive value of early systolic lengthening duration in differentiating myocardial ischemia from scar tissue in patients with chronic coronary total occlusion. A total of 69 patients were included in the study. The participating patients were divided into two groups as 35 patients with ischemia and 34 patients with scar tissue based on the results of the myocardial perfusion scintigraphy. In the scar group compared to the ischemia group; LVEF, GLS, SRS', and the duration of early systolic lengthening were significantly lower; whereas, EDV, ESV, and WMSI were significantly higher in the scar group compared to the ischemia group. In the multivariate logistic regression test, LVEF (OR 1.150, 95% CI 1.044-1.268, p = 0.005) and duration of early systolic lengthening (OR 1.021, 95% CI 1.004-1.039, p = 0.016) were determined as independent predictive parameters for ischemia detected by myocardial perfusion scintigraphy. Duration of early systolic lengthening obtained by speckle tracking echocardiography in patients with chronic total occlusion lesions may be useful in differentiating ischemia from scar tissue detected in myocardial perfusion scintigraphy. Prolonged duration of early systolic lengthening in patients with chronic total occlusion lesions was related to the presence of ischemia detected by myocardial perfusion scintigraphy.

Summary Aim To evaluate the symmetry of facial expression in surgically managed UCLP patients. Materials and methods The study was conducted on 13 four-year-old children. Facial images were captured at rest and at maximum smile using stereophotogrammetry. A generic mesh, which is a mathematical facial mask consisting of a fixed number of indexed vertices, was utilised for the assessment of facial asymmetry. This was quantified by measuring the disparity between the left- and right-hand sides of the face after superimposing the original 3D images on their mirror copies. Results Residual asymmetries at rest were identified at the vermillion of the upper lip and at the nares with a deviation of the philtrum towards the scar tissue. Vertical and anteroposterior asymmetries were identified on the cleft side. At maximum smile, the asymmetry increased noticeably at the vermillion of the upper lip and at the alar base. In the mediolateral direction, the philtrum deviated towards the cleft side with a significant increase of the asymmetry scores. Discussion Asymmetry of the upper lip has significantly increased at maximum smile as a result of the upward forces of all perioral lifting muscles, which affected the lip directly. Conclusions The innovation of this study is the measurement of facial asymmetry for the objective outcome measure of the surgical repair of UCLP. The philtrum was the main site of residual asymmetry, which indicates the need for refining the primary repair of the cleft lip. Further corrective surgery may be required.

Excessive fibrosis is the topmost factor for the defeat of surgical glaucoma drainage device (GDD) implantation. Adjuvant drug approaches are promising to help reduce the scar formation and excessive fibrosis. Opal shale (OS), as a natural state and noncrystalline silica substance with poriferous nature and strong adsorbability, is highly likely to undertake drug loading and delivery. Here, we employed OS microparticles (MPs) by ultrasound and centrifugation and presented an innovative and improved GDD coated with OS MPs, which were loaded with mitomycin C (MMC). MMC-loaded OS MPs were physically absorbed on the Ahmed glaucoma valve surface through OS' adsorbability. About 5.51 μg of MMC was loaded on the modified Ahmed glaucoma valve and can be released for 18 days in vitro. MMC-loaded OS MPs inhibited fibroblast proliferation and showed low toxicity to primary Tenon's fibroblasts. The ameliorated drainage device was well tolerated and effective in reducing the fibrous reaction in vivo. Hence, our study constructed an improved Ahmed glaucoma valve using OS MPs without disturbing aqueous humor drainage pattern over the valve surface. The modified Ahmed glaucoma valve successfully alleviated scar tissue formation after GDD implantation surgery.

Necrosis in heart muscles can permanently hinder the natural healthy rhythm of heart pumping mechanism. The damaged muscular tissues are replaced by scar tissues and burdens the healthy muscles resulting in further attenuated functioning of heart. Since, human heart muscles cannot regenerate naturally or it has been thought so, pharmacological procedures such as using a heart assist device are followed to restore the lost function of heart. Stem cell engineering and cardiac patches offers promising prospects with their cutting edge research reports. Cardiac patches offers a viable solution as they can also function as an implant to assist in offering the mechanical support the damaged muscles were capable of. Designing cardiac patches to suit multiple functions is not only challenging but also perilous due to the target organ with which it will be interfaced. Sensor based, electrically active, miniaturized circuitry etc., poses a huge threat to the individual in whom the device/patch is implanted. In this paper, we propose a hypothesis on choosing β-PVDF based nanocomposites as the inimitable material for designing implantable cardiac patches. β-PVDF based nanocomposite materials is expected to exhibit piezoelectric effect and contribute to the adherence, proliferation and maturation of stem cells. Physico-chemical characterizations followed by in vitro cell line studies were performed in ought to confirm the same. The results revealed that the β-PVDF based nanocomposite material was mechanically stable and supportive in cardiomyocyte adherence and differentiation when compared to standard non piezoelectric scaffolds (control). Hence, an implantable β-PVDF based novel electrospun nanocomposite scaffold is hypothesized to be the hour of need in conjugation with stem cell engineering for repairing damaged heart muscles.

Fibrosis, or the accumulation of extracellular matrix molecules that make up scar tissue, is a common result of chronic tissue injury. Advances in the clinical management of fibrotic diseases have been hampered by the low sensitivity and specificity of non-invasive early diagnostic options, lack of surrogate endpoints for use in clinical trials, and a paucity of non-invasive tools to assess fibrotic disease activity longitudinally. Hence, the development of new methods to image fibrosis and fibrogenesis is a large unmet clinical need. Herein we provide an overview of recent and selected molecular probes for imaging of fibrosis and fibrogenesis by magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT).