Soft-tissue augmentation with dermal fillers is a popular, minimally invasive aesthetic procedure. In 2012, in the USA, most non-surgical augmentation treatments performed with a dermal filler used a product based on hyaluronic acid (HA), with the second most popular type being the calcium hydroxylapatite (CaHA)-based filler, Radiesse® (Merz Pharmaceuticals GmbH, Frankfurt, Germany), hereafter referred to as CaHA gel matrix.
This document provides an overview of careers in drug discovery and development. It discusses the multi-stage process of discovering new drugs, from identifying drug targets through clinical trials and regulatory approval. The document notes that drug development is a highly time-intensive and costly process involving many disciplines. It also aims to dispel common myths about careers in the pharmaceutical industry, emphasizing that industry scientists have opportunities for publication, innovation, and interesting work.
This document provides a synopsis for a Master's thesis project titled "Formulation and Evaluation of Fast Dissolving Films of Lisinopril". The project aims to develop fast dissolving films of the hypertension drug Lisinopril to improve patient compliance. Literature on fast dissolving drug delivery systems and films has been reviewed. The planned work involves preparing Lisinopril films using natural and synthetic polymers through various techniques and evaluating the films for properties like drug content, dissolution, and pharmacodynamics. If successful, the fast dissolving Lisinopril films could provide quick action and ease of administration benefits for hypertension patients.
Formulation and evaluation of multipurpos e herbal cream KiranRajput38
This document summarizes the formulation and evaluation of a multipurpose herbal cream. It describes extracting aloe vera gel, neem leaves, and tulsi leaves. The cream was formulated by heating the oil phase of liquid paraffin and beeswax, and the aqueous phase of borax and methylparaben in water. The herbal extracts were then added to the emulsion and fragrance was included. The formulated cream was stable at room temperature and showed significant activities from the herbal ingredients to provide multiple skin benefits.
This document provides an overview of liposomes, including their definition as concentric spheres of lipid bilayers separated by aqueous compartments, classifications, components, preparation methods, applications, and marketed preparations. It discusses how liposomes are formed and characterized, and lists their advantages in controlled drug delivery and stabilization of compounds as well as disadvantages like short shelf life. Preparation techniques covered are mechanical dispersion, solvent dispersion, and freeze-thaw sonication methods. The document serves as a reference for the structure, production, and uses of liposome drug delivery vehicles.
in this slide contains introduction, types, classification, review team, requirement of protocol and process of Investigated New Drug Application (IND).
Presented by: RAVI SHANKAR D (Department of pharmaceutical analysis and quality assurance),
RIPER, anantapur.
The document is a seminar presentation on the use of nuclear magnetic resonance (NMR) spectroscopy in preformulation studies. It contains an introduction to NMR and preformulations. The key uses of NMR in preformulations discussed are identifying chemical structures, detecting drug-excipient interactions, distinguishing polymorphs, differentiating amorphous and crystalline forms, determining properties of molecules and polymers like number of molecules in the asymmetric unit, solubility characteristics, and polymerization. Examples are provided for each application through NMR spectra figures and their explanations.
Challenges In Formulating Herbal Cosmetics by Darshan PawarDarshanPawar56
PPT pressentation on the Challenges In Formulating
Herbal Cosmetics
Cosmetics:
"Any article intended to be rubbed, poured, sprinkled, sprayed, introduced to or applied to any part of human body for cleansing, beautifying, promoting attractiveness or altering the appearances of human body are cosmetics.
This document provides an overview of careers in drug discovery and development. It discusses the multi-stage process of discovering new drugs, from identifying drug targets through clinical trials and regulatory approval. The document notes that drug development is a highly time-intensive and costly process involving many disciplines. It also aims to dispel common myths about careers in the pharmaceutical industry, emphasizing that industry scientists have opportunities for publication, innovation, and interesting work.
This document provides a synopsis for a Master's thesis project titled "Formulation and Evaluation of Fast Dissolving Films of Lisinopril". The project aims to develop fast dissolving films of the hypertension drug Lisinopril to improve patient compliance. Literature on fast dissolving drug delivery systems and films has been reviewed. The planned work involves preparing Lisinopril films using natural and synthetic polymers through various techniques and evaluating the films for properties like drug content, dissolution, and pharmacodynamics. If successful, the fast dissolving Lisinopril films could provide quick action and ease of administration benefits for hypertension patients.
Formulation and evaluation of multipurpos e herbal cream KiranRajput38
This document summarizes the formulation and evaluation of a multipurpose herbal cream. It describes extracting aloe vera gel, neem leaves, and tulsi leaves. The cream was formulated by heating the oil phase of liquid paraffin and beeswax, and the aqueous phase of borax and methylparaben in water. The herbal extracts were then added to the emulsion and fragrance was included. The formulated cream was stable at room temperature and showed significant activities from the herbal ingredients to provide multiple skin benefits.
This document provides an overview of liposomes, including their definition as concentric spheres of lipid bilayers separated by aqueous compartments, classifications, components, preparation methods, applications, and marketed preparations. It discusses how liposomes are formed and characterized, and lists their advantages in controlled drug delivery and stabilization of compounds as well as disadvantages like short shelf life. Preparation techniques covered are mechanical dispersion, solvent dispersion, and freeze-thaw sonication methods. The document serves as a reference for the structure, production, and uses of liposome drug delivery vehicles.
in this slide contains introduction, types, classification, review team, requirement of protocol and process of Investigated New Drug Application (IND).
Presented by: RAVI SHANKAR D (Department of pharmaceutical analysis and quality assurance),
RIPER, anantapur.
The document is a seminar presentation on the use of nuclear magnetic resonance (NMR) spectroscopy in preformulation studies. It contains an introduction to NMR and preformulations. The key uses of NMR in preformulations discussed are identifying chemical structures, detecting drug-excipient interactions, distinguishing polymorphs, differentiating amorphous and crystalline forms, determining properties of molecules and polymers like number of molecules in the asymmetric unit, solubility characteristics, and polymerization. Examples are provided for each application through NMR spectra figures and their explanations.
Challenges In Formulating Herbal Cosmetics by Darshan PawarDarshanPawar56
PPT pressentation on the Challenges In Formulating
Herbal Cosmetics
Cosmetics:
"Any article intended to be rubbed, poured, sprinkled, sprayed, introduced to or applied to any part of human body for cleansing, beautifying, promoting attractiveness or altering the appearances of human body are cosmetics.
Cancer-related cachexia causes devastating changes to facial structure such as muscle wasting and fat loss. While pharmaceuticals and nutrition have addressed total body mass loss, little research was done on restoring facial aesthetics. The author describes using a combination approach called the DUBLiN Lift to treat a cachexic cancer patient, combining hyaluronic acid fillers, platelet-rich plasma growth factors, dermal needling, fractional CO2 resurfacing, and red light therapy to address volume loss, poor skin texture, and sagging caused by long-term cachexia. This multiprocedure approach aimed to stimulate collagen production through multiple established techniques and appeared to successfully restore the patient's facial volume and quality of life.
Dr Patrick Treacy explains how the use of a combination of
restorative dermal techniques allowed him to address the
poor skin texture and facial sagging in a patient with cancer
related cachexia
Calcium Hydroxylapatite Over a Decade of Clinical Experiencekpyu
Background: Calcium hydroxylapatite is one of the most well-studied dermal fillers worldwide and has been
extensively used for the correction of moderate-to-severe facial lines and folds and to replenish lost volume.
This document describes the development of a novel biodegradable porous scaffold for skin regeneration using tissue engineering techniques. The scaffold was made of collagen, hyaluronic acid, and gelatin cross-linked with EDC. It had a porous structure with an average pore size of 132.5 μm. In vitro tests showed the scaffold supported growth of keratinocytes, melanocytes, and fibroblasts. In a rat model, wounds treated with the scaffold healed faster and showed less inflammation compared to untreated wounds. Histological analysis confirmed the scaffold facilitated skin repair.
This study evaluated a fluorinated methacrylamide chitosan (MACF) hydrogel for its ability to supply oxygen to tissues and improve wound healing. MACF hydrogels were able to load oxygen and maintain elevated oxygen levels in culture media for over 48 hours. In vitro tests on human skin cells showed that MACF improved cell migration, metabolism, proliferation and ATP levels under hypoxic conditions, suggesting it can enhance wound healing processes in low-oxygen environments like chronic wounds. The results demonstrate MACF hydrogels have potential as a treatment for chronic wounds by locally supplying oxygen to accelerate healing.
A 22-year-old woman presented with hypotrophic labia majora and a protruding clitoral hood after undergoing surgical reduction of the labia minora. She was treated with injections of diluted calcium hydroxylapatite (CaHA) in two sessions, 6 weeks apart, to augment the labia majora and mons pubis. At the 3-month follow-up, a significant improvement in the appearance of the external genitalia was observed with no serious side effects. The results lasted beyond 12 months. The author describes CaHA as a valuable, well-tolerated treatment option for aesthetic improvement of the female genitalia due to its ability to stimulate collagen production and correct volume deficiency with minimal downt
Results of a calcium hydroxylapatitie (Radiesse) study performed on 27 patients with moderate to severe atrophic acne scarring for a period of 12 months. The results show a favorable and possible cheap alternative to laser resurfacing. A comparative HA study (hyaluronic acid) with 13 patients showed this product was of little therapeutic benefit.
Synthetic fillers for facial rejuvenationNhat Nguyen
This document discusses synthetic fillers used for facial rejuvenation. It begins by providing statistics on the popularity and growth of soft tissue filler procedures. It then discusses several synthetic fillers - calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), polymethyl methacrylate (PMMA), and silicone. Specifically, it outlines the composition, FDA approval history, injection techniques, and benefits of CaHA and PLLA, which provide long-lasting volume replacement through biostimulation of collagen production. Complications are rare but can include nodules, which can be treated through massage or injection of other substances.
Background: Many new brands of Hyaluronic acid (HA) fillers are being produced, and the longevity and safety are always major concern about HA fillers.
Objective: To evaluate the efficacy, tolerability, and safety of touch-up treatment of a HA filler, Elravie® deep line which is used for correcting nasolabial folds (NLFs).
Methods: The rheological property values of HA fillers were measured using a rheometer.A total of 50 subjects with visible NLFs were enrolled in this clinical study and were divided into test and control groups. All subjects were injected with same amount of HA in both NLFs and only the test group had touch-up treatment after 9 months of first injection. All participants were then reassessed for cosmetic changes using Wrinkle Severity Rating Scale (WSRS) and Global aesthetic improvement scale (GAIS).
Background: Many new brands of Hyaluronic acid (HA) fillers are being produced, and the longevity and safety are always major
concern about HA fillers.
Objective: To evaluate the efficacy, tolerability, and safety of touch-up treatment of a HA filler, Elravie® deep line which is used for correcting nasolabial folds (NLFs).
Methods: The rheological property values of HA fillers were measured using a rheometer.A total of 50 subjects with visible NLFs were enrolled in this clinical study and were divided into test and control groups. All subjects were injected with same amount of HA in both NLFs and only the test group had touch-up treatment after 9 months of first injection. All participants were then reassessed for cosmetic changes using Wrinkle Severity Rating Scale (WSRS) and Global aesthetic improvement scale (GAIS).
Results: By month 9, the mean improvement in the WSRS of test group compared to control was not statistically significant. But on month 12, 15 and 18, the mean WSRS of test group compared to control were remarkably improved. GAIS of test group showed also significant high score since month 12, compared to control. The touch-up treatments of filler were well-tolerated and adverse reactions were mild and transient in most cases.
Conclusion:The touch-up of HA filler, which is performed before injected filler was not fully disappeared, is safe, effective and more satisfactory treatment for correcting NLFs.
Radiesse and Ellanse are considered biostimulant dermal fillers as they stimulate collagen production in addition to providing immediate volume restoration. Radiesse contains calcium hydroxylapatite microspheres suspended in a gel carrier that provide both immediate correction and induce new collagen formation over time. Ellanse contains polycaprolactone microspheres that degrade slowly and stimulate collagen production. Both fillers have been shown to effectively treat areas such as the cheeks and folds with natural results and high patient satisfaction.
This study developed a novel biodegradable porous scaffold for skin regeneration composed of collagen, hyaluronic acid, and gelatin. The scaffold was tested in vitro by culturing human keratinocytes, melanocytes, and fibroblasts, which all proliferated normally. In vivo tests on rats found the scaffold treated wounds healed faster than untreated wounds, with over 50% closure within 7 days versus only 60% for untreated wounds. Histological analysis further supported the scaffold's ability to facilitate more rapid wound healing and regeneration of skin tissue.
journal club - scar revision with laser and narrowband intensed pulsed lightMalaM67
The document summarizes a study assessing the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single light IPL treatment with a 3 month follow up. Results showed that the combined CO2-IPL treatment was more effective at improving scar characteristics according to POSAS scores. 100% of patients treated with CO2-IPL expressed satisfaction with outcomes compared to 84% for single light IPL. The study concludes that combined CO2-IPL therapy provides significant improvement in scar assessment and is a safe alternative for multi-photoelectric scar treatment.
The document describes a novel biodegradable porous scaffold composed of collagen, hyaluronic acid, and gelatin for skin regeneration. The scaffold was tested in vitro and in vivo. In vitro tests showed the scaffold had an appropriate pore size and water absorption for human skin cell growth. When seeded with keratinocytes, melanocytes, and fibroblasts, the cells proliferated normally within the scaffold. In a rat model, wounds treated with the scaffold healed faster than untreated wounds, with over 50% closure within 7 days and reduced neutrophil infiltration. The scaffold facilitated improved skin repair.
EWMA 2014 - EP425 COMPARATIVE STUDY OF HUMAN FULL THICKNESS SKIN GRAFT SURVIV...EWMA
This study compared the effect of applying human adipose-derived stem cells (ADSCs) by different methods on the survival of human full-thickness skin grafts in nude mice. ADSCs were applied either by intrafascial injection under the skin graft or by topical application on the skin graft. The results showed that intrafascial injection of ADSCs led to the highest skin graft survival rate of 100% and shortest time for engraftment of 7 days. Topical application of ADSCs also improved graft survival to 75% and time to engraftment compared to the control group. Histological and molecular analysis revealed that intrafascial injection of ADSCs promoted the most angiogenesis, collagen formation
This prospective clinical trial evaluated the use of autologous adipose-derived regenerative cell (ADRC)-enriched fat grafting for reconstruction of partial mastectomy defects in 71 women. Fat tissue was harvested from patients and processed to isolate ADRC's and prepare an ADRC-enriched fat graft for re-implantation during the same surgical procedure. The graft was injected in a fan-shaped pattern. 50 out of 67 patients reported satisfaction with results at 12 months and investigators reported satisfaction with 57 patients. MRI assessment found improved breast contour in 54 out of 65 patients. There were no serious adverse events or cancer recurrences reported. This trial demonstrates the safety and efficacy of using ADRC-enriched fat grafts
This document summarizes a study that fabricated and evaluated chitosan/gelatin/PVA hydrogels incorporating different concentrations of honey for wound healing applications. The hydrogels were characterized through SEM imaging, mechanical testing, degradation testing, antibacterial evaluation, and cell proliferation assays. An in vivo study on rats found that hydrogels with 10% and 20% honey accelerated wound closure and maintained a well-structured epidermis containing collagen compared to controls. Overall, the addition of honey improved the hydrogels' antibacterial properties and biocompatibility while degrading sufficiently for wound repair.
jc scar and laser.pptx journal club scar treatmentMalaM67
This study assessed the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single IPL treatment over 10-14 week intervals. Clinical assessment using the POSAS scale found that the combined CO2-IPL treatment resulted in significantly lower POSAS scores compared to single IPL, indicating greater improvement in scar characteristics. 100% of patients treated with CO2-IPL expressed satisfaction with results compared to 84% for single IPL. The combination of CO2-IPL was found to be a safe and effective alternative for treatment of hypertrophic sc
The Indo-American Journal of Agricultural and Veterinary Sciences it appears to be a scholarly journal focused on publishing research within the fields of agriculture and veterinary sciences of the jou.rnalism research paper
This randomized, double-blind, placebo-controlled study investigated the effects of oral intake of 1000 mg per day of low-molecular-weight collagen peptide (LMWCP) for 12 weeks in 64 women aged 40-60 with photoaged skin. The study found that LMWCP significantly improved skin hydration, elasticity, and wrinkling compared to the placebo. No safety issues were reported. The study demonstrates that LMWCP is a safe and effective ingredient for improving signs of skin photoaging when taken orally. However, the study had some limitations, including a narrow age range and focusing only on women, and future studies are recommended with a larger sample size and exploring other outcomes.
Воспаление как составная часть инъекционных косметологических манипуляцийkpyu
В статье подробно обсуждаются теоретические аспекты воспаления в коже и мягких тканях в ответ на имплантацию инородного тела. Рассматриваются различные варианты осложнений и лечебная тактика при каждом из них с конкретными препаратами и дозами. Также уделено внимание биопленкам — современной проблеме, которая сопровождает инвазивную манипуляцию.
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Cancer-related cachexia causes devastating changes to facial structure such as muscle wasting and fat loss. While pharmaceuticals and nutrition have addressed total body mass loss, little research was done on restoring facial aesthetics. The author describes using a combination approach called the DUBLiN Lift to treat a cachexic cancer patient, combining hyaluronic acid fillers, platelet-rich plasma growth factors, dermal needling, fractional CO2 resurfacing, and red light therapy to address volume loss, poor skin texture, and sagging caused by long-term cachexia. This multiprocedure approach aimed to stimulate collagen production through multiple established techniques and appeared to successfully restore the patient's facial volume and quality of life.
Dr Patrick Treacy explains how the use of a combination of
restorative dermal techniques allowed him to address the
poor skin texture and facial sagging in a patient with cancer
related cachexia
Calcium Hydroxylapatite Over a Decade of Clinical Experiencekpyu
Background: Calcium hydroxylapatite is one of the most well-studied dermal fillers worldwide and has been
extensively used for the correction of moderate-to-severe facial lines and folds and to replenish lost volume.
This document describes the development of a novel biodegradable porous scaffold for skin regeneration using tissue engineering techniques. The scaffold was made of collagen, hyaluronic acid, and gelatin cross-linked with EDC. It had a porous structure with an average pore size of 132.5 μm. In vitro tests showed the scaffold supported growth of keratinocytes, melanocytes, and fibroblasts. In a rat model, wounds treated with the scaffold healed faster and showed less inflammation compared to untreated wounds. Histological analysis confirmed the scaffold facilitated skin repair.
This study evaluated a fluorinated methacrylamide chitosan (MACF) hydrogel for its ability to supply oxygen to tissues and improve wound healing. MACF hydrogels were able to load oxygen and maintain elevated oxygen levels in culture media for over 48 hours. In vitro tests on human skin cells showed that MACF improved cell migration, metabolism, proliferation and ATP levels under hypoxic conditions, suggesting it can enhance wound healing processes in low-oxygen environments like chronic wounds. The results demonstrate MACF hydrogels have potential as a treatment for chronic wounds by locally supplying oxygen to accelerate healing.
A 22-year-old woman presented with hypotrophic labia majora and a protruding clitoral hood after undergoing surgical reduction of the labia minora. She was treated with injections of diluted calcium hydroxylapatite (CaHA) in two sessions, 6 weeks apart, to augment the labia majora and mons pubis. At the 3-month follow-up, a significant improvement in the appearance of the external genitalia was observed with no serious side effects. The results lasted beyond 12 months. The author describes CaHA as a valuable, well-tolerated treatment option for aesthetic improvement of the female genitalia due to its ability to stimulate collagen production and correct volume deficiency with minimal downt
Results of a calcium hydroxylapatitie (Radiesse) study performed on 27 patients with moderate to severe atrophic acne scarring for a period of 12 months. The results show a favorable and possible cheap alternative to laser resurfacing. A comparative HA study (hyaluronic acid) with 13 patients showed this product was of little therapeutic benefit.
Synthetic fillers for facial rejuvenationNhat Nguyen
This document discusses synthetic fillers used for facial rejuvenation. It begins by providing statistics on the popularity and growth of soft tissue filler procedures. It then discusses several synthetic fillers - calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), polymethyl methacrylate (PMMA), and silicone. Specifically, it outlines the composition, FDA approval history, injection techniques, and benefits of CaHA and PLLA, which provide long-lasting volume replacement through biostimulation of collagen production. Complications are rare but can include nodules, which can be treated through massage or injection of other substances.
Background: Many new brands of Hyaluronic acid (HA) fillers are being produced, and the longevity and safety are always major concern about HA fillers.
Objective: To evaluate the efficacy, tolerability, and safety of touch-up treatment of a HA filler, Elravie® deep line which is used for correcting nasolabial folds (NLFs).
Methods: The rheological property values of HA fillers were measured using a rheometer.A total of 50 subjects with visible NLFs were enrolled in this clinical study and were divided into test and control groups. All subjects were injected with same amount of HA in both NLFs and only the test group had touch-up treatment after 9 months of first injection. All participants were then reassessed for cosmetic changes using Wrinkle Severity Rating Scale (WSRS) and Global aesthetic improvement scale (GAIS).
Background: Many new brands of Hyaluronic acid (HA) fillers are being produced, and the longevity and safety are always major
concern about HA fillers.
Objective: To evaluate the efficacy, tolerability, and safety of touch-up treatment of a HA filler, Elravie® deep line which is used for correcting nasolabial folds (NLFs).
Methods: The rheological property values of HA fillers were measured using a rheometer.A total of 50 subjects with visible NLFs were enrolled in this clinical study and were divided into test and control groups. All subjects were injected with same amount of HA in both NLFs and only the test group had touch-up treatment after 9 months of first injection. All participants were then reassessed for cosmetic changes using Wrinkle Severity Rating Scale (WSRS) and Global aesthetic improvement scale (GAIS).
Results: By month 9, the mean improvement in the WSRS of test group compared to control was not statistically significant. But on month 12, 15 and 18, the mean WSRS of test group compared to control were remarkably improved. GAIS of test group showed also significant high score since month 12, compared to control. The touch-up treatments of filler were well-tolerated and adverse reactions were mild and transient in most cases.
Conclusion:The touch-up of HA filler, which is performed before injected filler was not fully disappeared, is safe, effective and more satisfactory treatment for correcting NLFs.
Radiesse and Ellanse are considered biostimulant dermal fillers as they stimulate collagen production in addition to providing immediate volume restoration. Radiesse contains calcium hydroxylapatite microspheres suspended in a gel carrier that provide both immediate correction and induce new collagen formation over time. Ellanse contains polycaprolactone microspheres that degrade slowly and stimulate collagen production. Both fillers have been shown to effectively treat areas such as the cheeks and folds with natural results and high patient satisfaction.
This study developed a novel biodegradable porous scaffold for skin regeneration composed of collagen, hyaluronic acid, and gelatin. The scaffold was tested in vitro by culturing human keratinocytes, melanocytes, and fibroblasts, which all proliferated normally. In vivo tests on rats found the scaffold treated wounds healed faster than untreated wounds, with over 50% closure within 7 days versus only 60% for untreated wounds. Histological analysis further supported the scaffold's ability to facilitate more rapid wound healing and regeneration of skin tissue.
journal club - scar revision with laser and narrowband intensed pulsed lightMalaM67
The document summarizes a study assessing the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single light IPL treatment with a 3 month follow up. Results showed that the combined CO2-IPL treatment was more effective at improving scar characteristics according to POSAS scores. 100% of patients treated with CO2-IPL expressed satisfaction with outcomes compared to 84% for single light IPL. The study concludes that combined CO2-IPL therapy provides significant improvement in scar assessment and is a safe alternative for multi-photoelectric scar treatment.
The document describes a novel biodegradable porous scaffold composed of collagen, hyaluronic acid, and gelatin for skin regeneration. The scaffold was tested in vitro and in vivo. In vitro tests showed the scaffold had an appropriate pore size and water absorption for human skin cell growth. When seeded with keratinocytes, melanocytes, and fibroblasts, the cells proliferated normally within the scaffold. In a rat model, wounds treated with the scaffold healed faster than untreated wounds, with over 50% closure within 7 days and reduced neutrophil infiltration. The scaffold facilitated improved skin repair.
EWMA 2014 - EP425 COMPARATIVE STUDY OF HUMAN FULL THICKNESS SKIN GRAFT SURVIV...EWMA
This study compared the effect of applying human adipose-derived stem cells (ADSCs) by different methods on the survival of human full-thickness skin grafts in nude mice. ADSCs were applied either by intrafascial injection under the skin graft or by topical application on the skin graft. The results showed that intrafascial injection of ADSCs led to the highest skin graft survival rate of 100% and shortest time for engraftment of 7 days. Topical application of ADSCs also improved graft survival to 75% and time to engraftment compared to the control group. Histological and molecular analysis revealed that intrafascial injection of ADSCs promoted the most angiogenesis, collagen formation
This prospective clinical trial evaluated the use of autologous adipose-derived regenerative cell (ADRC)-enriched fat grafting for reconstruction of partial mastectomy defects in 71 women. Fat tissue was harvested from patients and processed to isolate ADRC's and prepare an ADRC-enriched fat graft for re-implantation during the same surgical procedure. The graft was injected in a fan-shaped pattern. 50 out of 67 patients reported satisfaction with results at 12 months and investigators reported satisfaction with 57 patients. MRI assessment found improved breast contour in 54 out of 65 patients. There were no serious adverse events or cancer recurrences reported. This trial demonstrates the safety and efficacy of using ADRC-enriched fat grafts
This document summarizes a study that fabricated and evaluated chitosan/gelatin/PVA hydrogels incorporating different concentrations of honey for wound healing applications. The hydrogels were characterized through SEM imaging, mechanical testing, degradation testing, antibacterial evaluation, and cell proliferation assays. An in vivo study on rats found that hydrogels with 10% and 20% honey accelerated wound closure and maintained a well-structured epidermis containing collagen compared to controls. Overall, the addition of honey improved the hydrogels' antibacterial properties and biocompatibility while degrading sufficiently for wound repair.
jc scar and laser.pptx journal club scar treatmentMalaM67
This study assessed the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single IPL treatment over 10-14 week intervals. Clinical assessment using the POSAS scale found that the combined CO2-IPL treatment resulted in significantly lower POSAS scores compared to single IPL, indicating greater improvement in scar characteristics. 100% of patients treated with CO2-IPL expressed satisfaction with results compared to 84% for single IPL. The combination of CO2-IPL was found to be a safe and effective alternative for treatment of hypertrophic sc
The Indo-American Journal of Agricultural and Veterinary Sciences it appears to be a scholarly journal focused on publishing research within the fields of agriculture and veterinary sciences of the jou.rnalism research paper
This randomized, double-blind, placebo-controlled study investigated the effects of oral intake of 1000 mg per day of low-molecular-weight collagen peptide (LMWCP) for 12 weeks in 64 women aged 40-60 with photoaged skin. The study found that LMWCP significantly improved skin hydration, elasticity, and wrinkling compared to the placebo. No safety issues were reported. The study demonstrates that LMWCP is a safe and effective ingredient for improving signs of skin photoaging when taken orally. However, the study had some limitations, including a narrow age range and focusing only on women, and future studies are recommended with a larger sample size and exploring other outcomes.
Similar to A Randomized, Split-Face, Histomorphologic Study Comparing a Volumetric Calcium Hydroxylapatite and a Hyaluronic Acid-Based Dermal Filler (20)
Воспаление как составная часть инъекционных косметологических манипуляцийkpyu
В статье подробно обсуждаются теоретические аспекты воспаления в коже и мягких тканях в ответ на имплантацию инородного тела. Рассматриваются различные варианты осложнений и лечебная тактика при каждом из них с конкретными препаратами и дозами. Также уделено внимание биопленкам — современной проблеме, которая сопровождает инвазивную манипуляцию.
Практический пример работы с пациенткой с типом старения «усталое лицо»kpyu
Возрастные изменения у данной пациентки относятся к типу «Усталое лицо». Такой тип характерен для славянских лиц и часто в более старшем возрасте сочетается с деформационным типом старения. Предполагает склонность к пастозности, задержание жидкости в тканях. Протекает с постепенным перемещением мягких тканей лица вниз, согласно воздействию гравитации. Видимые признаки хроно- и фотостарения кожи соответствуют биологическому возрасту в 39-40 лет, что старше биологического на 3-4 года.
Новое направление медицинской науки и практикиkpyu
Формирование в современной России новых направлений медицинской науки и практики возможно только при качественно новом подходе к пониманию либеральности человеческой жизни и одновременной модернизации системы здравоохранения. Одним из наиболее перспективных направлений, безусловно, является сексуальной здоровье человека.
выбор лечения возрастных изменений кожи кистей в зависимости от клинической с...kpyu
Руки, так же как лицо, шея, декольте, относятся к открытым частям тела, поэтому методы профилактики и коррекции, их грамотное сочетание и особенно выбор, с учетом индивидуальных признаков старения кожи, всегда актуальны.
Клинические случаи нежелательных явлений в практике врача-косметологаkpyu
К сожалению, без вероятности возникновения нежелательных последствий не обходится ни одно вмешательство в человеческий организм. Косметологи, практикующие контурную пластику и химические пилинги, с нежелательными проявлениями дело имеют довольно часто. Но прежде чем кидаться
«тушить пожар», нужно уметь четко разбираться, с чем мы имеем дело: с нежелательным явлением или с осложнением. Приведем несколько клинических случаев.
B последние годы все большей популярностью в эстетической медицине пользуются процедуры введения дермальных филлеров на основе гиалуроновой кислоты, гидросиапатита кальция, поли-L-молочной кислоты и т.д. Цель - коррекции морщин, складок и состояния мягких тканей. Однако увеличение числа показаний и процедур ведет к росту количества осложнений. Одним из таких осложнений в практике врача-косметолога является воспаление.
Клинический опыт применения ER:YAG-лазера и PRP в терапии постакнеkpyu
В статье описан вариант терапии симптомокомплекса постакне у 16-летнего пациента с применением Er:YAG-лазера (2 940 нм) и плазмы,
обогащенной тромбоцитами (PRP). Особенностью является использование Er:YAG-лазера в абляционном и неабляционном режимах в комбинации
с инъекционной формой PRP.
Прогнозирование результатов ботулинотерапии (препарат Диспорт) в верхней трет...kpyu
Человеку свойственно испытывать и выражать множество разнообразных эмоций – радоваться, печалится, любить и ненавидеть, проявлять силу или слабость характера.
Косметические проблемы у женщин разного возраста: взгляд дерматолога и космет...kpyu
Постменопаузальный дефицит эстрогенов оказывает влияние на структурное и функциональное состояние кожи. Наиболее эффективным методом терапии менопаузальных нарушений является заместительная гормональная терапия.
Терапия акне в зависимости от степени тяжести заболевания: клинический опытkpyu
В статье рассматриваются общие принципы терапии акне в зависимости от степени тяжести.
Дана классификация, описание различных степеней тяжести заболевания, современные подходы
в терапии акне. Представлен опыт лечения акне и ухода за кожей. На основе анализа
литературы и собственного опыта обсуждается применение системных изотретиноинов
(препарата «Акнекутан») в терапии различных форм акне.
Коррекция круговой мышцы глаза с применением препарата Диспортkpyu
В статье рассматриваются общие принципы ботулинотерапии круговой мышцы глаза в зависимости от ее строения и гипертонуса. Описано строение круговой мышцы глаза, а также возможные варианты гипертонуса. На основе анализа литература и собственного опыта обсуждается применение препарата Диспорт® для коррекции различных вариантов гипертонуса круговой мышцы глаза.
Терапия кожи с признаками хронологического старения препаратом Meso-Wharton P...kpyu
Эффективность косметологической терапии, направленной на улучшение качества кожи, обычно оценивается по ряду визуальных признаков, в первую очередь на основании субъективного восприятия внешности врачом и пациентом.
По прогнозам ВОЗ ожидается, что к 2015 году 46% женщин будут в возрасте старше 45 лет. Следствием изменения демографической ситуации в современном обществе в последние годы стало заметное возрастание числа больных с дистрофическими заболеваниями вульвы, в том числе женщин репродуктивного возраста и детей.
Коррекция средней трети лица: профилактика формирования носогубной бороздыkpyu
Использование ботулинического токсина типа А (БТА) в клинической медицине и косметологии в течение последних 30 лет показало, что ботулинотерапия является высокоэффективным методом коррекции возрастных изменений внешности.
Консенсус по применению инкоботулотоксина А в практике специалиста эстетическ...kpyu
Выработка консенсуса по ботулинотерапии (БТ) в эстетической медицине продиктована рядом актуальных вопросов. Во-первых, на сегодняшний день отсутствует литература сравнительного анализа по БТ.
Консенсус по применению инкоботулотоксина А в практике специалиста эстетическ...kpyu
Выработка консенсуса по ботулинотерапии (БТ) в эстетической медицине продиктована рядом актуальных вопросов. Во-первых, на сегодняшний день отсутствует литература сравнительного анализа по БТ.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
“Environmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the public”.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
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Study Treatment
Participants received injections of both CaHA gel matrix and HA gel. The CaHA gel matrix injections were given in a single dose (maximum 0.1 mL) by supraperiostal administration to the postauricular area on the left side. HA gel injections were also given in a single dose (maximum 0.1 mL), administered to the same area on the right side.
Visits and Assessments
Treatment was performed at visit 1 (day 1). There were two subsequent evaluation visits at months 4 (±2 weeks) and 9 (±2 weeks) after treatment. At both visits, punch biopsies of the postauricular area (3–4 mm diameter) were obtained for histomorphologic and immunohistochemical analysis of collagen types I and III, elastin, and also Ki-67 and angiogenesis (morphometry data: for fibers,
%/mm2; for cells, number of positive cells/mm2). Microphotography was performed using an Olympus BX41 microscope (Olympus America Inc., Melville, NY). Ultrasound scanning was performed at a frequency of 45 MHz using a SkinScanner DUB 22–75 MHz (taberna pro medicum GmbH, Lüneburg, Germany).
Punch biopsies (96 biopsies from 24 participants) were fixed in 10% neutral formalin and embedded in paraffin according to standard protocols. Serial 4 μm paraffin sections were prepared and stained with hematoxylin-eosin (H&E). Tissue samples
extracted through punch biopsies at months 4 and 9 after treatment were analyzed by both qualitative and quantitative measures for collagen types I and III and elastin expression. Qualitative and quantitative measures of Ki-67, lymphohistiocytic infiltration and angiogenesis were also taken at these timepoints.
For immunohistochemistry, sections were stained after antigen unmasking in retriever solution, according to standard protocols. Monoclonal antibodies against collagen type I (Sigma- Aldrich Corporation, St. Louis, MO; used at 1:4000 dilution), collagen type III (Sigma Aldrich Corporation; used at 1:8000 dilution), elastin (Novacastra Leica Biosystems, Newcastle upon Tyne, UK; used at 1:200 dilution) and Ki-67 (RTU DaKo, Glostrup, Denmark; used at 1:100 dilution) were used.
A semi-quantitative method was used to analyze the immunohistochemistry results, with 10 fields of vision studied at high magnification (x400) in two sections, according to the standard scale. Staining intensity was scored as weak (2 points), moderate (4 points), strong (6 points) or hyperexpression (8 points). Epidermal expression of Ki-67 was evaluated by the mean percentage of positively-stained cell nuclei among a sample of 300 epithelial cells. Angiogenesis was measured by counting the number of capillary-type vessels per 10 fields of vision in dermal tissue slides stained with H&E, viewed at high magnification (x400). The sign- rank test of Wilcoxon was used for the comparison of the CaHA gel matrix and HA gel collagen type I, collagen type III, and Ki-67 quantification and the elastin data in this paired design.
to participate in the process of ECM remodeling.16,17 Indeed, as the most abundant structural protein in the dermal ECM, type I collagen has a pivotal role in providing the skin with strength and resilience.18 In contrast, elastin is a distinct protein characterized by long-range extensibility, giving skin elasticity.16 During the ageing process there is a progressive loss of dermal collagen and elastin fibers19 that contributes to the formation of wrinkles by altering the biomechanic properties of the skin.20 As such, the potential of treatments such as CaHA gel matrix to stimulate production of these important ECM components represents an interesting line of investigation, particularly in the context of previous work indicating that CaHA gel matrix can stimulate neocollagenesis (the production of new collagen type I).15
A further role for dermal fillers in maintaining the structural integrity of the dermal ECM has been documented through the positive impact of HA on dermal cell proliferation, as shown through
increased Ki-67 (a marker of cell proliferation and, therefore, an index of ECM remodeling in the injected skin) immunostaining.21
The aim of this study was to compare the CaHA gel matrix with HA gel for their ability to stimulate neocollagenesis following single-dose administration, as determined by qualitative and quantitative histomorphologic/immunohistochemical analysis at 4 and 9 months after treatment. An additional aim was to examine the effects of both fillers on levels of dermal elastin, lymphohistiocytic infiltration (a measure of inflammatory response in the injected region) and Ki-67. To the authors’ knowledge, this is the first head-to-head study of the histomorphologic effects of two dermal fillers on neocollagenesis and elastin production in the region of the implant, while it is also the first to extend follow-up to 9 months.
METHODS
Study Design
This was a randomized, split-face, comparative, clinical study and immunohistochemical investigation in healthy female volunteers, 35–45 years of age. Recruitment of participants occurred from one site in Moscow between November 2012 and February 2013. Written informed consent from all participants and ethical approval for the study were obtained. The study was conducted in accordance with the ethical principles laid down in the Declaration of Helsinki.
Participants
Participants in the study had symmetric NLF as an indicator of facial symmetry, and scored 3–4 on the validated Merz 5-point scale for NLF at rest.22 Participants were excluded if they were pregnant or breastfeeding, had significant facial asymmetry, had applied any resorbable and permanent fillers, HAs or botulinum toxin type A to the face in the previous 12 months (any previous administration of permanent materials in the lower third of the face, including polylactic acid, polymethyl methacrylate and silicone) or had a history of facial nerve palsy.
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months 4 and 9 after treatment with CaHA gel matrix compared with HA gel (P<0.0002 and P<0.0001, respectively; Figure 4). Grade of lymphohistiocytic infiltration was significantly lower with CaHA gel matrix at months 4 and 9 after treatment compared with HA gel (P=0.0108 and P<0.0001, respectively) and grade of mucoid edema was significantly lower with CaHA gel matrix compared with HA gel at month 4 (P<0.0001). By month 9, the grades were negligible for both treatments (Figure 4).
Effect on Epidermal and Dermal Structure
Ultrasound scanning (a routine method for assessing dermal structure in the practice of cosmetology) showed that, prior to treatment with CaHA gel matrix, the structure of the epidermis was neither homogenous nor clearly separated from the dermis. The dermis was not structurally uniform; fibers in the superficial layer were arranged densely and linearly, while the
Safety
Safety and tolerability were monitored throughout the study and for a further month after study completion. Safety information was gathered from questionnaires given to participants and from face-to-face interviews prior to treatment. At each visit, subjects were asked about adverse events (AEs) and serious AEs, and details of concomitant medications were recorded.
RESULTS
Participant Demographics
A total of 24 healthy women (age range, 35–45 years) took part in this study.
Analysis of Collagen Expression at Month 4
At month 4, collagen type I formation was found to be higher with CaHA (mean staining intensity: 4.0±1.44) than with HA gel (mean staining intensity: 3.65±1.65), nearing a level of statistical significance (P=0.0679). At this timepoint, the mean staining
intensity of collagen type III was significantly greater with CaHA gel matrix than HA gel (5.2±1.67 vs 4.2±1.44, respectively; P=0.0052).
Analysis of Collagen Expression at Month 9
At month 9, the mean staining intensity for collagen type I was significantly greater after treatment with CaHA gel matrix than with HA gel (6.58±1.1 vs 4.8±1.86, respectively; P=0.0135;
Figure 1). This difference in staining intensity was also demonstrated by the more widespread brown staining (indicating collagen type I expression) seen with CaHA gel matrix vs HA gel, (Figure 2). The staining intensity for collagen type III was significantly lower at month 9 after treatment with CaHA gel matrix compared with HA gel (3.7±1.09 vs 6.02±0.82, respectively; P=0.0019). This difference in staining intensity was also supported by the less intense brown staining (indicating collagen type III expression) seen with CaHA gel matrix vs HA gel at month 9.
Analysis of Elastin Expression, Ki-67 Staining, Angiogenesis, Lymphohistiocytic Infiltration, and Mucoid Edema
Elastin staining intensity was significantly higher after treatment with CaHA gel matrix vs HA gel, both at month 4 (2.8±2.3 vs 1.0±1.15, respectively; P=0.0004) and month 9 (5.2±1.22 vs 4.33±1.27; P=0.0186) (Figure 3). The pattern of elastin staining was also very different with CaHA gel matrix compared with HA gel; preserved perivascular elastin fibers were evident at
9 months after treatment with the former, but fragmentation of elastin fibers was observed at the same timepoint after treatment with HA gel (Figure 3). Ki-67 staining was similar with the CaHA gel matrix and HA gel at month 4 (3.4%±2.08% vs 3.3%±2.4%, respectively; P=0.2013) but was significantly greater with the CaHA gel than HA gel at month 9 after treatment (6.2%±2.2% vs 4.5%±1.79%, respectively; P=0.0011). Significantly more angiogenesis was evident in the dermis from H&E-stained sections at
FIGURE 1. Mean scores for collagen type I staining intensity (staining index; weak=2, hyperexpression=8) 9 months after treatment with CaHA gel matrix or HA gel.
FIGURE 2. Microphotographs showing collagen type I expression, as indicated by the brown staining, at month 9 after treatment with a) CaHA gel matrix and b) HA gel. Deposition of collagen type I is indicated with the red arrows. Magnification x600. JDD PROOFS
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duction of collagen type III and then collagen type I, which
replaces the former. This was demonstrated by the reversal in
the differential levels of staining for the two collagen types at
the timepoints investigated here.
Collagen types I and III play independent roles in the neocol-lagenesis
associated with ECM remodeling after tissue injury.
Neocollagenesis under physiologic conditions is dependent
on collagen type I gradually replacing the collagen type III
that is formed as part of the early response to tissue injury.17
This results in tissue with a high tensile strength.17 Our results
indicate that, relative to HA gel, the CaHA gel matrix may
evoke ECM remodeling more consistent with this two-step
process whereby collagen type III is gradually replaced by col-lagen
type I. At the initial assessment (4 months), the staining
for collagen type III was significantly greater with CaHA gel
matrix than with HA gel. By month 9, collagen type I staining
was higher following CaHA gel matrix treatment than HA gel
treatment, whereas collagen type III was significantly lower
following CaHA gel matrix treatment than HA gel treatment
at this timepoint. Our findings are consistent with a previous
FIGURE 3. Mean score for elastin staining intensity (staining index; weak=2, hyperexpression=8) at a) month 4 and b) month 9 after treatment
with CaHA gel matrix and HA gel; c) elastin expression, indicated by the brown staining at month 9 after injection of CaHA gel matrix, showing
preserved perivascular elastin fibers in dermal tissue and d) expression of elastin at month 9 after injection of HA gel, showing fragmentation of
elastin fibers in dermal tissue. Magnification x600.
c)
d)
deeper layers were organized linearly but sparsely. After treat-ment
with CaHA gel matrix, a more homogeneous epidermal
structure was seen, with clear separation from the dermis. A
more uniform dermal structure was also seen, with a more lin-ear
and dense arrangement of superficial and deep-layer fibers.
At month 4 after injection of HA gel, the filler was visualized in
the dermis with fixed-area hyperechogenicity and edema of the
papillary dermis, though the epidermis and hypodermis were
unchanged. At month 9 there was no swelling of the dermis;
dilated dermal vessels could be seen, and the collagen fibers of
the dermis were linear, not compact.
Safety
There were no AEs reported during the study.
DISCUSSION
This study evaluated collagen production following a single-dose
administration of a CaHA gel matrix and a HA gel-based
dermal filler. The results indicate that at the timepoints evalu-ated
here, CaHA stimulates a process more consistent with
the two-step physiologic neocollagenesis than HA ie, pro-
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study that found that at 6 months post-treatment with CaHA
gel matrix, collagen type I infiltration and deposition were
stimulated.15 However, the previous study by Berlin et al only
used a single timepoint at 6 months and, therefore, did not
observe the change in infiltration pattern shown here.
The dominance of collagen type III at the later timepoint evalu-ated
here, 9 months following HA gel administration, may
be of concern owing to the involvement of collagen type III
in fibrosis; it has been observed that the scar tissue that can
persist after wound healing contains a higher concentration of
collagen type III than is found in normal adult dermal tissue.23
However, it would be interesting to investigate whether the pro-cess
of ECM remodeling is delayed following HA gel treatment
compared with CaHA treatment and if the levels of collagens
are more similar between the two products at later timepoints.
CaHA gel matrix also stimulated cell proliferation signifi-cantly
more than HA gel, as reflected by a relative increase in
Ki-67 staining with the former at month 9, which may support
the observed increase in collagen production by stimulating
proliferation of collagen-producing cells. This is consistent
with previous work showing the presence of fibroblasts and
macrophages 6 months after injection of CaHA gel matrix.5,15
Treatment with CaHA gel matrix also stimulated neoangio-genesis
at both 4 and 9 months, suggesting that blood flow
and, therefore, nutrient delivery to the skin was improved
with CaHA gel matrix compared with HA gel. Moreover, the
increase in angiogenesis correlates with, and may result in,
the early synthesis of collagen type III.
This study was the first known examination of the effect of der-mal
fillers on elastin levels. It found that CaHA gel matrix also
stimulated remodeling of the ECM by increasing elastin levels
to a significantly greater extent than HA gel. Elastin provides
skin with the ability to recoil after deforming stresses have been
applied. Therefore, unlike HA gel, the CaHA gel matrix appears
to have the potential to improve not only the structural strength
of skin via collagen remodeling, but also its elasticity, proper-ties
that are known to decline in ageing skin in parallel with the
loss of both collagen and elastin fibers.19,20
Lymphohistiocytic infiltration is suggestive of inflamma-tory
changes in the tissue. Observations at both timepoints
showed that HA caused significantly more lymphohistiocytic
infiltration, suggesting that it has a more pronounced effect
on the inflammatory process than CaHA gel matrix. In addi-tion,
the lymphohistiocytic infiltration may result in elastin
lysis and fragmentation; this could account for the significant-ly
lower levels of elastin following HA gel injection compared
with CaHA gel matrix.
There were a number of limitations to this study that merit
discussion. First, the study was performed in a relatively
small number of participants. While the area chosen for treat-ment
was the postauricular region rather than areas such as
NLF, which are typically treated with dermal fillers, it was
felt that this was a suitable sample point given the similarity
between the skin of the postauricular region and areas that
are commonly injected with dermal fillers. Furthermore,
treating the postauricular region means that any temporary
unsightliness caused by the biopsy can be easily hidden. Only
two post-treatment timepoints were evaluated in the present
study as this was deemed appropriate to show the process
of neocollagenesis being stimulated. However, as mentioned
above, we cannot rule out further changes in terms of colla-gen
or elastin staining by either product beyond the 9-month
timepoint and, thus, longer term monitoring of these pro-cesses
should be the subject of further study.
In conclusion, CaHA gel matrix produced an instant volume
enhancement, but with a longer reconstructive process
brought about through collagen neogenesis. At the timepoints
evaluated here, CaHA gel matrix treatment resulted in a pro-cess
indicative of more active, physiologic remodeling of the
ECM in comparison with HA gel. The CaHA gel matrix stimu-lated
the production of collagen type III and type I in a two-step
process whereby collagen type I gradually replaced collagen
type III, consistent with the process of remodeling and collagen
FIGURE 4. Histomorphologic characteristics at (a) month 4 and (b)
month 9 after treatment with CaHA gel matrix and HA gel.
JDD PROOFS
6. 52
Journal of Drugs in Dermatology
September 2014 • Volume 13 • Issue 9
Y. Yutskovskaya, E. Kogan, E. Leshunov
production under physiologic conditions. The increase in elastin
fibers stimulated by CaHA gel matrix treatment also indicates
active remodeling; indeed, by reconstituting tissue homeosta-sis
without inducing inflammation. Taken together, the results
indicate that CaHA gel matrix evokes a process consistent
with physiologic remodeling of the ECM and thus displays fa-vorable
properties for a dermal filler.
ACKNOWLEDGMENTS
Financial and scientific support was provided by Merz Pharmaceu-ticals
GmbH. Editorial assistance, funded by Merz Pharmaceuticals
GmbH, was provided by Ogilvy 4D, Oxford, UK.
DISCLOSURES
Yana Yutskovskaya has no conflicts of interest to disclose.
Evgenjia Kogan has no conflicts of interest to disclose. Eugene
Leshunov has no conflicts of interest to disclose. This study
was supported by Merz Pharmaceuticals GmbH, Frankfurt, Ger-many.
All authors had full access to all the data in the study
and had final responsibility for the decision to submit for pub-lication.
Editorial assistance, funded by Merz Pharmaceuticals
GmbH, was provided by Ogilvy 4D, Oxford, UK.
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AUTHOR CORRESPONDENCE
Yana Yutskovskaya MD
E-mail:................…….................................................. yutsk@mail.ru
JDD PROOFS