Joris A. van Dongen

The fate of research abstracts submitted to a national surgical conference: a cross-sectional study to assess scientific impact

BACKGROUND Conference abstracts often lack rigorous peer review, but potentially influence clinical thinking and practice. To evaluate the quality of abstracts submitted to a large surgical conference, presentation and publication rates were investigated to assess scientific impact. METHODS A Cross-sectional study of abstracts submitted to Dutch Surgical Society meetings from 2007 to 2012 was conducted. Presentation rates, publication rates in MEDLINE-indexed journals using PubMed Central database, and actuarial times to subsequent publication were investigated. RESULTS Of 2,174 submitted abstracts, 1,305 (60%) abstracts were accepted for presentation. Actuarial 1, 3, and 5-year publication rates were 22.4%, 62.2%, and 68.6% for presented abstracts, compared with 20.9%, 50.3%, and 57.7% for rejected abstracts, respectively (log-rank x(2) 23.728, df1, P < .001). Publications resulting from abstracts presented at the conference had a significantly higher mean (±standard error) impact factor (4.4 ± .2 vs 3.4 ± .1, P < .001), compared with publications from previously rejected abstracts. CONCLUSIONS We advocate critical appraisal of the use of findings of scientific abstracts and conference presentations. The 5-year abstract-to-publication ratio is proposed as a novel quality indicator to allow objective comparison between scientific meetings.

The power of fat and its adipose-derived stromal cells: Emerging concepts for fibrotic scar treatment

Lipofilling or lipografting is a novel and promising treatment method for reduction or prevention of dermal scars after injury. Ample anecdotal evidence from case reports supports the scar‐reducing properties of adipose tissue grafts. However, only a few properly controlled and designed clinical trials have been conducted thus far on this topic. Also, the underlying mechanism by which lipofilling improves scar aspect and reduces neuropathic scar pain remains largely undiscovered. Adipose‐derived stromal or stem cells (ADSC) are often described to be responsible for this therapeutic effect of lipofilling. We review the recent literature and discuss anticipated mechanisms that govern anti‐scarring capacity of adipose tissue and its ADSC. Both clinical and animal studies clearly demonstrated that lipofilling and ADSC influence processes associated with wound healing, including extracellular matrix remodelling, angiogenesis and modulation of inflammation in dermal scars. However, randomized clinical trials, providing sufficient level of evidence for lipofilling and/or ADSC as an anti‐scarring treatment, are lacking yet warranted in the near future.

The fractionation of adipose tissue procedure to obtain stromal vascular fractions for regenerative purposes.

Autologous adipose tissue transplantation is clinically used to reduce dermal scarring and to restore volume loss. The therapeutic benefit on tissue damage more likely depends on the stromal vascular fraction of adipose tissue than on the adipocyte fraction. This stromal vascular fraction can be obtained by dissociation of adipose tissue, either enzymatically or mechanical. Enzymatic dissociation procedures are time‐consuming and expensive. Therefore, we developed a new inexpensive mechanical dissociation procedure to obtain the stromal vascular fraction from adipose tissue in a time sparing way, which is directly available for therapeutic injection. This mechanical dissociation procedure is denoted as the fractionation of adipose tissue (FAT) procedure. The FAT procedure was performed in eleven patients. The composition of the FAT‐stromal vascular fraction was characterized by immunohistochemistry. Adipose derived stromal cells isolated from the FAT‐stromal vascular fraction were compared with adipose derived stromal cells isolated from nondissociated adipose tissue (control) for their CD‐surface marker expression, differentiation and colony forming unit capacity. Case reports demonstrated the therapeutic effect of the FAT‐stromal vascular fraction. The FAT‐stromal vascular fraction is an enrichment of extracellular matrix containing a microvasculature and culturable adipose derived stromal cells. Adipose derived stromal cells isolated from FAT‐stromal vascular fraction did not differ from adipose derived stromal cells isolated from the control group in CD‐surface marker expression, differentiation and colony forming unit capacity. The FAT procedure is a rapid effective mechanical dissociation procedure to generate FAT‐stromal vascular fraction ready for injection with all its therapeutic components of adipose tissue: it contains culturable adipose derived stromal cells embedded in their natural supportive extracellular matrix together with the microvasculature.

Comparison of intraoperative procedures for isolation of clinical grade stromal vascular fraction for regenerative purposes : a systematic review

Intraoperative application of the stromal vascular fraction (SVF) of adipose tissue requires a fast and efficient isolation procedure of adipose tissue. This review was performed to systematically assess and compare procedures currently used for the intraoperative isolation of cellular SVF (cSVF) and tissue SVF (tSVF) that still contain the extracellular matrix. Pubmed, EMBASE and the Cochrane central register of controlled trials databases were searched for studies that compare procedures for intraoperative isolation of SVF (searched 28 September 2016). Outcomes of interest were cell yield, viability of cells, composition of SVF, duration, cost and procedure characteristics. Procedures were subdivided into procedures resulting in a cSVF or tSVF. Thirteen out of 3038 studies, evaluating 18 intraoperative isolation procedures, were considered eligible. In general, cSVF and tSVF intraoperative isolation procedures had similar cell yield, cell viability and SVF composition compared to a nonintraoperative (i.e. culture laboratory‐based collagenase protocol) control group within the same studies. The majority of intraoperative isolation procedures are less time consuming than nonintraoperative control groups, however. Intraoperative isolation procedures are less time‐consuming than nonintraoperative control groups with similar cell yield, viability of cells and composition of SVF, and therefore more suitable for use in the clinic. Nevertheless, none of the intraoperative isolation procedures could be designated as the preferred procedure to isolate SVF. Copyright

The rainbow scale: A simple, validated online method to score the outcome of aesthetic treatments

Photographs have become an important integral part of documentation in an aesthetic surgery practice, both for medico-legal as well as scientific purposes.1 Only by evaluating pre- and postoperative photographic documentation are we able to evaluate our success and treatment outcomes in an objective way. Several photographic scales have already been developed for this purpose.2-4 However, an easy online system to evaluate aesthetic outcomes in a validated, fast, reliable, and standardized way is still lacking. We have therefore designed what we call the “Rainbow Scale” method based on the Merz Scales (Merz Pharmaceuticals GmbH, Frankfurt, Germany) (Figure 1).2 In this online system, 6 photographs are presented in a block of two rows of 3 photographs. The photograph of the patient to be evaluated is located in the central position of the lower row. Other photographs show the five grades of severity of the area to be evaluated, with the lowest score left of the photograph to be evaluated, the second score on the upper left side, etc. until the highest score on the lower right side of the photograph. The different scores are thus presented around the patient in a rainbow fashion. …

The Rainbow Scale for Assessing Breast Ptosis: Validation of Three Different Views.

BACKGROUND Photographic scales have become an increasingly used tool in objectively assessing outcomes in aesthetic surgery. However, no online photographic scale for assessing breast ptosis has been developed yet that is readily available. OBJECTIVES This study was designed to validate the online Rainbow Scale for the assessment of breast ptosis for the anterior-posterior (AP), lateral, and oblique views. METHODS For the five grades of the Rainbow Scale format, standardized reference photographs were selected. Six plastic surgeons rated 15 photographs for each view three times. Intra- and inter-observer agreements were calculated by using the weighted kappa coefficient and differences in intra- and inter-observer agreements between the three views were assessed for statistical significance using the Kruskal-Wallis test. RESULTS The mean intra-observer agreements were 0.91 (range, 0.82-0.98) for the AP view, 0.88 (range, 0.77-1.00) for the oblique view, and 0.86 (range, 0.74-0.97) for the lateral view and did not vary significantly between all three views. The mean inter-observer agreements were 0.88 (range, 0.77-0.95) for the AP view, 0.84 (range, 0.72-0.94) for the oblique view, and 0.82 (range, 0.58-0.95) for the lateral view. The mean inter-observer agreements of the AP view varied significantly from the oblique view (P = .012) and the lateral view (P = .001). CONCLUSIONS The Rainbow Scale for breast ptosis has been validated for the AP view, the lateral view, and the oblique view and is reproducible and reliable for the assessment of breast ptosis in three different views in an online setup. LEVEL OF EVIDENCE 4 Diagnostic.

The Addition of Platelet-Rich Plasma to Facial Lipofilling: A Double-Blind, Placebo-Controlled, Randomized Trial

Background: Lipofilling is a treatment modality to restore tissue volume, but it may also rejuvenate the aging skin. Platelet-rich plasma has been reported to augment the efficacy of lipofilling, both on graft take and rejuvenation, by altering the adipose-derived stem cells. The authors hypothesized that addition of platelet-rich plasma would increase the rejuvenating effect and shorten recovery time. Methods: The study conducted was a single-center, double-blind, placebo-controlled, randomized trial (2012 to 2015). In total, a well-defined cohort of 32 healthy female patients enrolled in the study, with 25 completing the follow-up. All patients underwent aesthetic facial lipofilling with either saline or platelet-rich plasma added. Outcome was determined by changes in skin elasticity, volumetric changes of the nasolabial fold, recovery time, and patient satisfaction during follow-up (1 year). Results: Platelet-rich plasma did not improve the outcome of facial lipofilling when looking at skin elasticity improvement, graft volume maintenance in the nasolabial fold. Reversal of the correlation between age and elasticity, however, might suggest a small effect size, and thus might not be significant with our small study population. Conclusions: This randomized, double-blind, placebo-controlled study clearly has shown that platelet-rich plasma significantly reduces postoperative recovery time but does not improve patient outcome when looking at skin elasticity, improvement of the nasolabial fold, or patient satisfaction. The reversal of the correlation between age and elasticity might indicate some effect on skin but requires more power in future studies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Augmentation of Dermal Wound Healing by Adipose Tissue-Derived Stromal Cells (ASC)

The skin is the largest organ of the human body and is the first line of defense against physical and biological damage. Thus, the skin is equipped to self-repair and regenerates after trauma. Skin regeneration after damage comprises a tightly spatial-temporally regulated process of wound healing that involves virtually all cell types in the skin. Wound healing features five partially overlapping stages: homeostasis, inflammation, proliferation, re-epithelization, and finally resolution or fibrosis. Dysreguled wound healing may resolve in dermal scarring. Adipose tissue is long known for its suppressive influence on dermal scarring. Cultured adipose tissue-derived stromal cells (ASCs) secrete a plethora of regenerative growth factors and immune mediators that influence processes during wound healing e.g., angiogenesis, modulation of inflammation and extracellular matrix remodeling. In clinical practice, ASCs are usually administered as part of fractionated adipose tissue i.e., as part of enzymatically isolated SVF (cellular SVF), mechanically isolated SVF (tissue SVF), or as lipograft. Enzymatic isolation of SVF obtained adipose tissue results in suspension of adipocyte-free cells (cSVF) that lack intact intercellular adhesions or connections to extracellular matrix (ECM). Mechanical isolation of SVF from adipose tissue destructs the parenchyma (adipocytes), which results in a tissue SVF (tSVF) with intact connections between cells, as well as matrix. To date, due to a lack of well-designed prospective randomized clinical trials, neither cSVF, tSVF, whole adipose tissue, or cultured ASCs can be indicated as the preferred preparation procedure prior to therapeutic administration. In this review, we present and discuss current literature regarding the different administration options to apply ASCs (i.e., cultured ASCs, cSVF, tSVF, and lipografting) to augment dermal wound healing, as well as the available indications for clinical efficacy.

Use of Stem Cells in Orthopaedics

Mesenchymal stem cells have for some time been gaining interest in the context of their potential applications in the treatment of musculoskeletal disorders. Mesenchymal stem cells (MSCs) are capable of differentiating into one of several mesenchymal phenotypes such as osteoblasts, chondrocytes, myocytes, marrow stromal cells, tendon–ligament fibroblasts and adipocytes [ 1– 4]. Due to the relative ease of obtaining and administering them, compared to the alternative surgical treatment (or in combination with surgical treatment), they offer an attractive therapeutic option, for both physicians and patients alike, and find an increasing range of applications in orthopaedics. According to the most recent thinking on mesenchymal stem cell physiology, these cells are actually pericytes, that is, perivascular cells which are activated in response to trauma or local inflammation, and act to repair the damage using various types of chemotactic factors [ 5]. These secreted bioactive factors suppress the local immune system, inhibit fibrosis (scar formation) and apoptosis, enhance angiogenesis and stimulate mitosis and differentiation of tissue-intrinsic reparative or stem cells [ 6]. It has been proposed that the pericyte is released from its position on a vascular tube in the case of a focal injury, and, as such, it functions as an immunomodulatory and trophic MSC [ 7]. MSC-induced immune modulation turns off T-cell supervision of the injured area and blocks autoimmunological reactions. Its trophic activity limits the field of damage so that scarring does not occur and that tissue-intrinsic progenitors replace the expired cells.