Diana Crisan

Expression of advanced glycation end-products on sun-exposed and non-exposed cutaneous sites during the ageing process in humans.

The glycation process is involved in both the intrinsic (individual, genetic) and extrinsic (ultraviolet light, polution and lifestyle) aging processes, and can be quantified at the epidermal or dermal level by histological, immunohistochemical (IHC), or imagistic methods. Our study is focused on a histological and immunohistological comparison of sun-protected regions versus sun-exposed regions from different age groups of skin phototype III subjects, related to the aging process. Skin samples collected from non-protected and UV protected regions of four experimental groups with different ages, were studied using histology and IHC methods for AGE-CML [N(epsilon)-(carboxymethyl)lysine]. A semi-quantitative assessment of the CML expression in the microvascular endothelium and dermal fibroblasts was performed. The Pearson one-way ANOVA was used to compare data between the groups. In the dermis of sun-exposed skin, the number and the intensity of CML positive cells in both fibroblasts and endothelial cells (p<0.05) was higher compared to sun-protected skin, and was significantly increased in older patients. The sun-exposed areas had a more than 10% higher AGE-CML score than the protected areas. No statistically significant correlation was observed between the histological score and the IHC expression of CML. We concluded that in healthy integument, the accumulation of final glycation products increases with age and is amplified by ultraviolet exposure. The study provides new knowledge on differences of AGE-CML between age groups and protected and unprotected areas and emphasizes that endothelium and perivascular area are most affected, justifying combined topical and systemic therapies.

The role of vitamin C in pushing back the boundaries of skin aging: an ultrasonographic approach.

Background Imagistic methods stand as modern, non-invasive, and objective means of assessing the impact of topical cutaneous therapies. Objective This study focuses on the evaluation, by high-frequency ultrasound, of the cutaneous changes induced by topical use of a vitamin C complex at facial level. Methods A vitamin C-based solution/Placebo moisturizer cream was applied at facial level of 60 healthy female subjects according to a predetermined protocol. Ultrasonographic images (Dermascan C, 20 MHz) were taken from zygomatic level initially, at 40 and 60 days after therapy. The following parameters were assessed for every subject: thickness of the epidermis and dermis (mm), the number of low (LEP), medium (MEP), high echogenic pixels (HEP), and the number of LEP in the upper dermis/lower dermis (LEPs/LEPi). Results LEP decreased significantly in all age categories during and after therapy, but especially in the first 2 age intervals, up to the age of 50 (P=0.0001). MEP and HEP, pixel categories that quantify protein synthesis also had an age-dependent evolution in the study, increasing significantly in all age categories but most of all in the first age interval (P=0.002). Our ultrasonographic data suggest that collagen synthesis increased significantly after topical vitamin C therapy, and is responsible for the increase in MEP and HEP and consequent decrease of the LEP. Conclusion Our study shows that topically applied vitamin C is highly efficient as a rejuvenation therapy, inducing significant collagen synthesis in all age groups with minimal side effects.

Modelling cutaneous senescence process

During the last years, skin aging has become an area of increasing research interest. High frequency ultrasound allows the “in vivo” appreciation of certain histological parameters and offers new characteristic markers, which may quantify the severity of the cutaneous senescence process. This paper focuses on measuring the changes in skin thickness and dermis echogenicity , as part of the complex ageing process, on different intervals of age. In particular by using a multiscale approach we will compute some parameters which are connected with complexity (fractal structure) of skin ageing.

Ultrasonographic assessment of the cutaneous changes induced by topical flavonoid therapy

Ultrasonography allows the quantification of dermal density and echogenicity changes during the physiological senescence process. Some active ingredients are able to slow down the tissular degeneration and disorganization process. The purpose of this study was to assess the cutaneous changes induced by the topical use of products containing Viniferol® as active ingredient, using high-frequency ultrasound. The study was performed over 12 weeks and included 80 healthy Caucasian female subjects, aged 22–75 years, divided into two groups: the study group and the control group. The product was applied according to a predetermined protocol. The measurements performed for each subject were: the thickness of the epidermis and dermis (mm), the number of low, medium, and high echogenic pixels, and the number of low echogenic pixels in the upper dermis/number of low echogenic pixels in the lower dermis. All the parameters showed a significant improvement. Ultrasound measurements showed an increase of the mean thickness of the epidermis (P < 0.0001) and dermis (P < 0.0001) following the application of the Viniferol product as compared to the control group. The changes in the dermal echogenicity confirm the efficacy and direct action of Viniferol upon the cutaneous fibroblasts. No side effects related to the treatment were recorded. The study proves the efficacy of this active ingredient in the cutaneous senescence process as well, as the fact that anti-aging prophylaxis should be initiated in the 20–40 year critical age group. This interval involves specific changes in dermal echogenicity that quantify intense molecular, biochemical and structural changes, being thus mostly and highly responsive to the anti-aging therapy.

Surgical treatment of melanoma in pregnancy: a practical guideline.

A tumor primarily requiring surgical treatment, newly diagnosed or preexisting melanoma during pregnancy is a clinical rarity. In such cases, the surgeon faces the challenge of having to decide on the appropriate therapeutic course of action. Based on our clinical experience and a review of the literature, we herein provide a guideline on how to practically deal with this rare clinical conundrum. In our experience, pregnant melanoma patients require thorough counseling with respect to their therapeutic options. They naturally tend to put their unborn child first, and are hesitant to consent to necessary surgery despite a potentially life‐threatening diagnosis. It is therefore crucial to clearly inform these patients that – based on existing medical experience – pregnancy by itself is no reason to hold off on any type of necessary melanoma surgery. However, various parameters such as preoperative imaging procedures, positioning on the operating table, monitoring, anesthesia, and perioperative medication require certain adjustments in order to comply with this special situation.

A Novel S100A8/A9 Induced Fingerprint of Mesenchymal Stem Cells associated with Enhanced Wound Healing

We here investigated whether the unique capacity of mesenchymal stem cells (MSCs) to re-establish tissue homeostasis depends on their potential to sense danger associated molecular pattern (DAMP) and to mount an adaptive response in the interest of tissue repair. Unexpectedly, after injection of MSCs which had been pretreated with the calcium-binding DAMP protein S100A8/A9 into murine full-thickness wounds, we observed a significant acceleration of healing even exceeding that of non-treated MSCs. This correlates with a fundamental reprogramming of the transcriptome in S100A8/A9 treated MSCs as deduced from RNA-seq analysis and its validation. A network of genes involved in proteolysis, macrophage phagocytosis, and inflammation control profoundly contribute to the clean-up of the wound site. In parallel, miR582-5p and genes boosting energy and encoding specific extracellular matrix proteins are reminiscent of scar-reduced tissue repair. This unprecedented finding holds substantial promise to refine current MSC-based therapies for difficult-to-treat wounds and fibrotic conditions.

Langsam wachsender exophytischer hyperpigmentierter Knoten an der Wade

eines pigmentierten Flecks aufgetreten und hatte sich in Folge zu einem blutenden Tumor entwickelt. Bei der klinischen Untersuchung wurde eine hyperpigmentierte, ulzerierte, gestielte Läsion (3 × 3,5 cm) auf einem bräunlichen Fleck festgestellt. In Tumornähe gab es mehrere blass-violettfarbene knotenförmige Läsionen, die druckunempfi ndlich waren (Abbildung 1 ). Eine regionale Lymphadenopathie lag nicht vor. Es gab keine familiäre Prädisposition für Hautkrebs und der Patient selbst wies lediglich eine leichte Niereninsuffi zienz auf. Bei der Dermatoskopie beobachtete man eine bläulich-braune Verfärbung mit kleinen braunen Globuli. Die Läsionen dazwischen bestanden aus homogenen, lividen subepidermalen Knoten. In der Ultraschalluntersuchung des Tumors stellte man eine feste, heterogene, gut abgegrenzte echoarme ovale Struktur fest. Bei der Duplexsonographie wurde eine intraläsionale Vaskulisierung mit vaskulären Stielen am unteren Pol beobachtet. Die Sono-Elastographie wies eine erhöhte Steifi gkeit in 90% der Läsionen nach. Die Satellitenherde zeigten sich als gut abgegrenztes, subepidermales echoarmes Gewebe mit peripherem Blutfl uss und verringerter Elastizität (Abbildung 2 a, b). Die Histologie des Haupttumors ergab Abbildung 1 Exophytischer hyperpigmentierter Knoten an der Wade. Die umliegenden Satellitenläsionen treten in Form von subkutanen violettfarbenen Knoten verschiedener Größe auf.

Surgical management of skin cancer and trauma involving the middle third of the auricle: Reconstruction techniques of midhelix-antihelix defects

The main causes of acquired auricular defects are surgical treatment of skin tumors and trauma. Due to the complex anatomy of the external ear, surgical reconstruction of defects in this area is challenging for surgeons, especially in case of midhelix‐antihelix involvement with significant loss of soft tissue and cartilage.

A neurofibroma-like tumor in a giant congenital nevus

Giant congenital melanocytic nevi are rare entities (incidence of < 1 : 500,000 newborns), characterized by their size (> 20 cm) and their potential transformation into malignant melanomas [ 1 ] . Associations with neurocutaneous melanocytosis, spina bifi da, meningocele, neurofi bromas, lipomas, arachnoid cysts or Chiary Type 1 malformations have been described [ 2 ] . We report a case of a young man who developed a giant neurofi broma-like tumor on his back, resulting in complex surgical management. The 20-year-old man presented with a giant confl uent, pigmented, hairy patch covering his trunk, as well as multiple pigmented, hairy lesions on his limbs. A fast growing, soft, non-tender, non-pulsatile tumor approximately 30 × 15 cm in size had recently developed on the left aspect of his back (Figure 1 ). MRI of the brain excluded neurocutaneous meningeosis; MRI of the spine showed a large subcutaneous mass at the cervicothoracic level. The results of neurological examination and ophthalmological assessment were normal, while café-au-lait macules and axillary freckling (characteristic of neurofi bromatosis type 1) were absent. With suspicion of a large neurofi broma and the patients signifi cant psychological impairment, we decided to remove the tumor completely.

Chirurgische Versorgung von Hautkrebs und Trauma im mittleren Drittel der Ohrmuschel: Rekonstruktionstechniken bei Defekten der mittleren Helix-Anthelix

Die Hauptursachen erworbener Ohrmuscheldefekte sind chirurgische Behandlung von Hauttumoren und Traumata. Wegen der komplexen Anatomie des Außenohrs ist die chirurgische Rekonstruktion von Defekten in dieser Region für Operateure herausfordernd, insbesondere wenn die mittlere Helix und Anthelix von größeren Weichteil– und Knorpelverlusten betroffen sind.