Evolución de la técnica follicular unit extraction (FUE) / Evolution of the follicular unit extraction (FUE) technique

El microtrasplante capilar, método FUE, es la cirugía para la recuperación capilar que consta en la extracción de unidades foliculares con punches de distintos diámetros y longitudes, desde una zona llamada dadora, generalmente occipital y/o temporal aunque pueden utilizarse otras partes del cuerpo como barba, tórax, abdomen y pubis, para luego de seleccionarse y conservarse en forma adecuada ser implantadas en la llamada zona receptora. Tanto los avances en la técnica como en el uso de instrumental de última generación generan resultados mejores y más naturales, con una recuperación más rápida y menor daño de sus zonas dadoras.

Hair transplant, FUE method, is surgery for hair recovery that consists of the extraction of follicular units with punches of different diameters and lengths, from an area called the donor; usually occipital and/or temporal; although they can be used on other parts of the body such as beard, thorax, abdomen and pubes. After being appropriately selected and preserved, they are implanted in the so-called receiving area. Both advances in technique and in the use of cutting-edge instruments generate better and more natural results, with faster recovery and less damage to the donor areas

Pedaço arrancado de mim: mulheres com alopecia por quimioterapia antineoplásica / Pieza rotada de mí: mujeres con alopecia mediante quimioterapia antineoplástica / Piece torn from me: women with alopecia through antineoplastic chemotherapy

Objetivo: Conhecer as percepções de mulheres sobre a autoimagem alterada após alopecia por quimioterapia antineoplásica. Método: Estudo descritivo, qualitativo, realizado em um hospital oncológico no Pará. Participaram 30 mulheres com alopecia por quimioterapia antineoplásica. Os dados foram produzidos no período de julho a agosto de 2021, por meio de entrevistas semiestruturadas. Analisaram-se os dados sob os preceitos da Análise de conteúdo associada com o software IRAMUTEQ. Resultados: Identificaram-se 17 mulheres com idade entre 44 e 56 anos (56,66%), com parceiro fixo (66,66%); católica (89,99%); com renda damiliar menor que um e até dois salários mínimos (63,33%). Dentre as cinco classes geradas pelo IRAMUTEQ, duas serão analisadas neste artigo: a percepção da mulher sobre a perda do cabelo e o cabelo como significado de feminilidade. Conclusão: As mulheres com autoimagens alteradas após a alopecia são protagonistas de enfrentamentos físicos e psicológicos que pode impactar negativamente as percepções sobre a aparência

Objective: To know the perceptions of women about the altered self-image after alopecia by antineoplastic chemotherapy. Method: Descriptive, qualitative study carried out in an oncology hospital in the state of Pará. Thirty women with alopecia from antineoplastic chemotherapy participated.Data were produced from July to August 2021, through individual interviews with a semi-structured script. Data were analyzed under the precepts of Content Analysis associated with the IRAMUTEQ software. Results: We identified 17 women aged between 44 and 56 years (56.66%), with a steady partner (66.66%); Catholic (89.99%); with household income below one and up to two minimum wages (63.33%). Among the five classes generated by IRAMUTEQ, two will be analyzed in this article "the woman's perception of hair loss" and "the hair as a meaning of femininity". Conclusion: Women with altered self-images after alopecia are protagonists of physical and psychological confrontations that can negatively impact perceptions about appearance.

Objetivo: Conocer las percepciones de las mujeres sobre la autoimagen alterada tras la alopecia por quimioterapia antineoplásica. Método: Estudio cualitativo descriptivo realizado en un hospital de oncología en el estado de Pará. Participaron 30 mujeres con alopecia por quimioterapia antineoplásica. Los datos fueron producidos de julio a agosto de 2021, a través de entrevistas individuales con guión semiestructurado. Los datos fueron analizados bajo los preceptos de Análisis de Contenido asociados al software IRAMUTEQ. Resultados: Se identificaron 17 mujeres con edad entre 44 y 56 años (56,66%), con pareja estable (66,66%); católica (89,99%); con renta familiar inferior a uno y hasta dos salarios mínimos (63,33%). De las cinco clases generadas por IRAMUTEQ, dos serán analizadas en este artículo "la percepción de la caída del cabello por parte de la mujer" y "el cabello como significado de la feminidad". Conclusión: Las mujeres con autoimagen alterada tras la alopecia son protagonistas de enfrentamientos físicos y psicológicos que pueden impactar negativamente en las percepciones sobre la apariencia. Descriptores: Alopecia; Neoplasias; Oncología; Salud de la mujer.

Manifestaciones dermatológicas en pacientes oncológicos pediátricos en un hospital de tercer nivel de Honduras / Dermatological manifestations in pediatric oncology patients in a tertiary hospital in Honduras

Antecedentes: Los pacientes oncológicos pediátricos pueden desarrollar lesiones dermatológicas secundario a terapia antineoplásica, afectando piel, cabello y uñas. Objetivo: Describir las manifestaciones dermatológicas en los pacientes oncológicos pediátricos hospitalizados. Métodos: Estudio descriptivo transversal llevado a cabo en sala de Hemato- Oncología Pediátrica, Hospital Escuela, período enero-junio 2022. Fueron incluidos 86 pacientes que presentaron manifestaciones dermatológicas durante el período del estudio. Para el análisis se generaron resultados como frecuencias, porcentajes y estadística descriptiva. La proporción de pacientes con manifestaciones dermatológicas se determinó como número total de pacientes con diagnósticos dermatológicos en el período del estudio/número total de pacientes hospitalizados en la sala de Hemato-Oncología Pediátrica multiplicado por 100. Resultados: La edad media fue 9.4 años (DS +/-5.0; rango: 5 meses-18 años). Predominó sexo masculino 62.8% (54/86), procedencia de Francisco Morazán 41.9% (36/86) y ambiente rural 53.5% (46/86). El diagnóstico oncológico fue leucemia linfoblástica aguda 60.5% (52/86), la clasificación fue malignidades hematológicas 67.4% (58/86). El principal fármaco oncológico administrado fue Vincristina 76.7% (76/86). El principal agente antineoplásico administrado fue alcaloides vegetales 75.6% (65/86). El tipo de lesión eritema 38.5% (34/86); la localización de la lesión fue en piel 47.6% (41/86). El diagnóstico dermatológico fue alopecia y mucositis 36.0% (31/86) respectivamente. La proporción de lesiones dermatológicas fue de 65.1% (86/132) y fueron clasificadas como secundarias al tratamiento oncológico 82.6% (71/86). Discusión: La proporción de lesiones dermatológicas fue 65%, siendo las principales manifestaciones alopecia y mucositis, posiblemente secundario a la administración de terapia antineoplásica específicamente alcaloides vegetales, similar a lo reportado en la literatura...(AU)

Procedimentos estéticos com ênfase na queda capilar / Aesthetic procedures with emphasis on hair loss / Procedimientos estéticos con énfasis en la caída del cabello

A beleza está diretamente ligada ao aspecto dos cabelos, em todos os tempos e todas as culturas. O cabelo ao longo da vida é sujeito a vários tipos de mudanças, sejam elas naturais ou artificiais, conduzidas por uma vontade de mudar, muitas vezes, seja por representar uma nova fase, como também é símbolo de autocuidado, vaidade, sucesso, possuem significativa importância na aparência e autoestima das pessoas e, por isso, a queda capilar pode atingir a qualidade de vida do indivíduo. Neste sentido, o objetivo deste estudo foi avaliar procedimentos estéticos minimamente invasivos e não cirúrgicos com ênfase na queda capilar. Para tanto, foi realizada uma revisão bibliográfica integrativa, de caráter descritivo nas principais bases de dados em saúde: SciELO, Google Acadêmico, PubMed e livros de medicina, nos idiomas português, inglês e espanhol, considerando o período de 2007 a 2022. De acordo com o último censo da Sociedade Brasileira de Dermatologia, a queixa de alopecia está entre as dez mais frequentes nos consultórios dermatológicos. As doenças capilares mais importantes estão divididas em dois grupos, as cicatriciais quando a perda de cabelo é acompanhada por cicatrizes resultando em calvície permanente, e as não cicatriciais onde a calvície não é permanente levando a diminuição e o afinamento gradual do cabelo. A alopecia não cicatricial é a mais frequente e as mais comuns entre elas são a alopecia androgenética e o eflúvio telógeno. Muitos pacientes procuram tratamento para melhorar a aparência e a autoestima, que podem estar relacionados a quadros de ansiedade e depressão. Esses tratamentos devem ser individualizados, onde se deve avaliar as características individuais de cada paciente. Os tratamentos capilares estéticos podem contribuir de forma significativa para a redução da baixa autoestima, contribuindo para recuperação da autoconfiança através do crescimento capilar proporcionado pela estética. Sendo assim, conclui-se que os resultados coletados na revisão de literatura foram satisfatórios, de forma onde mostra que os medicamentos, suplementos e tratamentos estéticos na queda capilar vem evoluindo cada vez mais. Contudo, mais estudos acerca do assunto são necessários.

Beauty is directly linked to the appearance of hair, in all times and all cultures. Hair throughout life is subject to various types of changes, whether natural or artificial, driven by a desire to change, often because it represents a new phase, as it is also a symbol of self-care, vanity, success, they have significant importance in people's appearance and self-esteem and, therefore, hair loss can affect the individual's quality of life. In this sense, the objective of this study was to evaluate minimally invasive and non- surgical aesthetic procedures with an emphasis on hair loss. To this end, an integrative bibliographic review was carried out, of a descriptive nature, in the main health databases: SciELO, Google Scholar, PubMed and medical books, in Portuguese, English and Spanish, considering the period from 2007 to 2022. According to the latest census by the Brazilian Society of Dermatology, the complaint of alopecia is among the ten most frequent complaints in dermatological offices. The most important hair diseases are divided into two groups, scarring when hair loss is accompanied by scars resulting in permanent baldness, and non-scarring where baldness is not permanent leading to gradual thinning and thinning of the hair. Non-scarring alopecia is the most frequent and the most common among them are androgenetic alopecia and telogen effluvium. Many patients seek treatment to improve their appearance and self-esteem, which may be related to anxiety and depression. These treatments must be individualized, where the individual characteristics of each patient must be evaluated. Aesthetic hair treatments can contribute significantly to reducing low self-esteem, contributing to the recovery of self-confidence through hair growth provided by aesthetics. Therefore, it is concluded that the results collected in the literature review were satisfactory, in a way that shows that medicines, supplements and aesthetic treatments in hair loss have been evolving more and more. However, more studies on the subject are needed.

La belleza está directamente ligada al aspecto del cabello, en todos los tiempos y en todas las culturas. El cabello a lo largo de la vida está sujeto a diversos tipos de cambios, ya sean naturales o artificiales, impulsados por un deseo de cambio, a menudo, ya sea para representar una nueva etapa, como también es un símbolo de auto- cuidado, la vanidad, el éxito, tienen una importancia significativa en la apariencia y la autoestima de las personas y, por lo tanto, la pérdida del cabello puede afectar la calidad de vida del individuo. En este sentido, el objetivo de este estudio fue evaluar los procedimientos estéticos mínimamente invasivos y no quirúrgicos con énfasis en la pérdida de cabello. Para ello, se realizó una revisión bibliográfica descriptiva integradora en las principales bases de datos de salud: SciELO, Google Scholar, PubMed y libros de medicina, en portugués, inglés y español, considerando el período de 2007 a 2022. Según el último censo de la Sociedad Brasileña de Dermatología, la queja de alopecia está entre las diez más frecuentes en las consultas de dermatología. Las enfermedades capilares más importantes se dividen en dos grupos, las cicatriciales, cuando la caída del cabello va acompañada de cicatrices que dan lugar a una calvicie permanente, y las no cicatriciales, cuando la calvicie no es permanente, dando lugar a un adelgazamiento y reducción gradual del cabello. Las alopecias no cicatriciales son las más frecuentes y entre ellas destacan la alopecia androgenética y el efluvio telógeno. Muchos pacientes buscan tratamiento para mejorar su aspecto y autoestima, que pueden estar relacionados con la ansiedad y la depresión. Estos tratamientos deben ser individualizados, donde se deben evaluar las características individuales de cada paciente. Los tratamientos capilares estéticos pueden contribuir significativamente a la reducción de la baja autoestima, contribuyendo a la recuperación de la confianza en uno mismo gracias al crecimiento del cabello que proporciona la estética. Por lo tanto, se concluye que los resultados recogidos en la revisión bibliográfica fueron satisfactorios, mostrando que los medicamentos, suplementos y tratamientos estéticos para la caída del cabello están evolucionando cada vez más. Sin embargo, son necesarios más estudios sobre el tema.

Single-cell profiling reveals a potent role of quercetin in promoting hair regeneration

Hair loss affects millions of people at some time in their life, and safe and efficient treatments for hair loss are a significant unmet medical need. We report that topical delivery of quercetin (Que) stimulates resting hair follicles to grow with rapid follicular keratinocyte proliferation and replenishes perifollicular microvasculature in mice. We construct dynamic single-cell transcriptome landscape over the course of hair regrowth and find that Que treatment stimulates the differentiation trajectory in the hair follicles and induces an angiogenic signature in dermal endothelial cells by activating HIF-1α in endothelial cells. Skin administration of a HIF-1α agonist partially recapitulates the pro-angiogenesis and hair-growing effects of Que. Together, these findings provide a molecular understanding for the efficacy of Que in hair regrowth, which underscores the translational potential of targeting the hair follicle niche as a strategy for regenerative medicine, and suggest a route of pharmacological intervention that may promote hair regrowth.

Effect study of Sonic hedgehog overexpressed hair follicle stem cells in hair follicle regeneration / 中国修复重建外科杂志

OBJECTIVE@#To determine the expression level of Sonic hedgehog (Shh) in the passage of hair follicle stem cells (HFSCs), analyze the effect of Shh overexpression on the proliferation activity of HFSCs, and explore the survival of HFSCs after Shh overexpression and its effect on hair follicle regeneration.@*METHODS@#Hair follicles from the normal area (H1 group) and alopecia area (H2 group) of the scalp donated by 20 female alopecia patients aged 40-50 years old were taken, and the middle part of the hair follicle was cut under the microscope to culture, and the primary HFSCs were obtained and passaged; the positive markers (CD29, CD71) and negative marker (CD34) on the surface of the fourth generation HFSCs were identified by flow cytometry. The two groups of HFSCs were transfected with Shh-overexpressed lentivirus. Flow cytometry and cell counting kit 8 assay were used to detect the cell cycle changes and cell proliferation of HFSCs before and after transfection, respectively. Then the HFSCs transfected with Shh lentivirus were transplanted subcutaneously into the back of nude mice as the experimental group, and the same amount of saline was injected as the control group. At 5 weeks after cell transplantation, the expression of Shh protein in the back skin tissue of nude mice was detected by Western blot. HE staining and immunofluorescence staining were used to compare the number of hair follicles and the survival of HFSCs between groups.@*RESULTS@#The isolated and cultured cells were fusiform and firmly attached to the wall; flow cytometry showed that CD29 and CD71 were highly expressed on the surface of the cells, while CD34 was lowly expressed, suggesting that the cultured cells were HFSCs. The results of real-time fluorescence quantitative PCR and Western blot showed that the expression levels of Shh protein and gene in the 4th, 7th, and 10th passages of cells in H1 and H2 groups decreased gradually with the prolongation of culture time in vitro. After overexpression of Shh, the proliferation activity of HFSCs in the two groups was significantly higher than that in the blank group (not transfected with lentivirus) and the negative control group (transfected with negative control lentivirus), and the proliferation activity of HFSCs in H1 group was significantly higher than that in H2 group before and after transfection, showing significant differences ( P<0.05). At 5 weeks after cell transplantation, Shh protein was stably expressed in the dorsal skin of each experimental group; the number of hair follicles and the expression levels of HFSCs markers (CD71, cytokeratin 15) in each experimental group were significantly higher than those in the control group, and the number of hair follicles and the expression levels of HFSCs markers in H1 group were significantly higher than those in H2 group, and the differences were significant ( P<0.05).@*CONCLUSION@#Lentivirus-mediated Shh can be successfully transfected into HFSCs, the proliferation activity of HFSCs significantly increase after overexpression of Shh, which can secrete and express Shh continuously and stably, and promote hair follicle regeneration by combining the advantages of stem cells and Shh.

Sífilis secundaria en un paciente con VIH / Secondary Syphilis in a Patient with HIV

Introducción: La sífilis y la infección por virus de inmunodeficiencia humana comparten los mismos grupos de alto riesgo y formas de transmisión, por lo que la coinfección es común. La historia natural y las manifestaciones clínicas de la sífilis pueden modificarse por la infección concomitante por VIH, que puede progresar rápidamente desde la sífilis primaria a la sífilis terciaria. Objetivo: Describir las manifestaciones clínicas, análisis de laboratorio y tratamiento de un paciente que vive con el virus de inmunodeficiencia humana con coinfección de sífilis secundaria, una condición infrecuente. Caso clínico: Paciente de 30 años quien acude a consulta en el contexto de alopecia sifilítica a nivel del cuero cabelludo, cejas y pestañas, hipocromía en zona escrotal y perineal; la sífilis es considerada la gran simuladora, lo cual dificulta el diagnóstico y tratamiento. Se confirma el diagnóstico de sífilis secundaria. Conclusiones: Mediante un caso clínico de un paciente que vive con el virus de inmunodeficiencia humana y con coinfección de sífilis, se describe la afectación de manifestaciones clínicas poco habituales como la alopecia sifilítica en región del cuero cabelludo, cejas y pestañas, entre otras(AU)

Introduction: Syphilis and human immunodeficiency virus infection share the same high-risk groups and transmission ways; therefore, coinfection is common. The natural history and clinical manifestations of syphilis can be modified by concomitant HIV infection, which can rapidly progress from primary to tertiary syphilis. Objective: To describe the clinical manifestations, laboratory tests and treatment of a patient living with human immunodeficiency virus and co-infected with secondary syphilis, being such a rare condition. Clinical case: A 30-year-old patient attended consultation for presenting of syphilitic alopecia of the scalp, eyebrows and eyelashes, as well as hypochromia in the scrotal and perineal area; syphilis is considered as the great simulator, which makes diagnosis and treatment difficult. The diagnosis of secondary syphilis is confirmed. Conclusions: Through the clinical case of a patient living with human immunodeficiency virus and syphilis coinfection, the condition is described of unusual clinical manifestations such as syphilitic alopecia in the scalp, eyebrows and the eyelashes region, among others(AU)

Telogen Effluvium and COVID-19: a case and a brief review of literature / Eflúvio Telógeno e COVID-19: um caso e uma breve revisão de literatura

COVID-19 is a new disease that has brought a great impact on global morbidity and mortality. There have been increasingly frequent reports of persistent symptoms and/or clinical manifestations attributed to COVID-19 after the acute phase of the disease. In this article, we present a case of post-COVID-19 telogen effluvium in a 39-year-old hypertensive and obese patient who looked for medical attention due to massive hair loss. Previous history of moderate COVID-19 4 months ago. After investigation and exclusion of other possible causes of telogen effluvium well established in the literature, the condition was attributed to the previous episode of COVID-19. Persistent fever, the cytokine storm, and the entire immunological cascade of COVID-19 can lead to apoptosis of the keratinocytes of the hair follicles, initiating the catagen phase early followed by the telogen phase with a consequent capillary release. Late symptoms possibly secondary to COVID-19 should receive attention and interest from the medical and scientific community. As it is a new disease, whose late consequences are not yet fully known/elucidated, careful observation and careful clinical follow-up of these patients are recommended (AU)

A COVID-19 é uma doença nova que vem provocando grande impacto na morbimortalidade mundial. Relatos de persistência de sintomas e/ou manifestações clínicas atribuídas à COVID-19 após a fase aguda da doença tem sido cada vez mais frequentes. Neste artigo, apresentamos um caso de eflúvio telógeno pós COVID-19 em um paciente de 39 anos, hipertenso e obeso, que procurou atendimento médico devido à queda volumosa de cabelos. Histórico prévio de COVID-19 moderada há 4 meses. Após investigação e exclusão de outras possíveis causas de eflúvio telógeno bem estabelecidas na literatura o quadro foi atribuído ao episódio prévio de COVID-19. É possível que a febre persistente, a tempestade de citocinas e toda a cascata imunológica da COVID-19 possam levar à apoptose dos queratinócitos dos folículos capilares, iniciando, assim, precocemente a fase catágena seguida pela fase telógena com consequente liberação capilar. Sintomas tardios possivelmente secundários à COVID-19 devem ser alvo de atenção e interesse da comunidade médica e científica. Por se tratar de uma doença nova, cujas consequências tardias ainda não se encontram completamente conhecidas/ elucidadas, recomenda-se a observação atenta e o seguimento clínico criterioso desses pacientes (AU)

Fenómeno infrecuente la co-localización de alopecia frontal fibrosante y vitiligo en un varón: informe de un caso / Infrequent phenomenon the co-localization of fibrosing frontal alopecia and vitiligo in a male: case repor

La alopecia frontal fibrosante es una alopecia cicatricial que se caracteriza por la recesión de la línea de implantación frontotemporal que afecta principalmente a mujeres caucásicas en edad posmenopáusica y rara vez a hombres. Actualmente los mecanismos específicos de desarrollo continúan en estudio; sin embargo hay varias hipótesis sobre la asociación de la alopecia frontal fibrosante con otros trastornos autoinmunitarios. Se comunica el caso de un paciente masculino de 58 años con alopecia frontal fibrosante en áreas comprometidas por vitiligo. (AU)

Frontal fibrosing alopecia is a cicatricial alopecic characterized by progressive regression of the frontotemporal hairline. It usually affects postmenopausal caucasian women, and rarely men. Currently the specific mechanisms of development remain unknown, however there are several hypotheses about the association of frontal fibrosing alopecia with other autoimmune disorders. The case of a 58-year-old male patient with frontal fibrosing alopecia in areas affected by vitiligo. (AU)

Reporte de Caso: efluvio telógeno agudo post COVID-19 asociado a receptores androgénicos / Case Report: acute telogen effluvium post COVID-19 associated with androgen receptors

Antecedentes: El efluvio telógeno puede ser definido como una pérdida de cabello difusa y sin cicatrices que ocurre alrededor de 2-3 meses después de un evento desencadenante y usualmente autolimitado. En la actualidad, la infección por COVID-19 se ha relacionado con manifestaciones dermatológicas, entre las cuales se encuentra el efluvio telógeno. Descripción del caso clínico: Se presenta el caso de una paciente femenina, de 48 años quien acudió a consulta refiriendo una pérdida brusca y masiva de cabello de aproximadamente 30-40% de las unidades foliculares, de dos semanas de evolución. Sin antecedentes familiares de pérdida de cabello, neumonía en la infancia, con antecedentes de alopecia androgénica por parte de su padre, con infección previa por COVID-19 confirmada por laboratorio. Al realizar la exploración física se observó prueba Pull positivo, aspecto macroscópico fino y deshidratado y pérdida de densidad generalizada sin alteraciones dérmicas. La tricoscopía mostró folículos vacíos y más del 20% en fase telógena. Se diagnosticó Efluvio telógeno post COVID-19 y alopecia androgénica de base (subclínica). Conclusiones: Con un número creciente de pacientes en recuperación de COVID-19, el riesgo de desarrollar esta manifestación dermatológica física y emocionalmente angustiante probablemente continuará en ascenso. Gracias a la implementación de pruebas genéticas específicas (Tricológico) se identificó a la paciente en fase temprana de alopecia androgénica femenina (FAGA), una patología pobremente diagnosticada en este sexo...(AU)

Efluvio telógeno y Covid-19 / Telogen effluvium and Covid-19

The first case of infection by the virus SARS-CoV-2 was reported in China in the late 2019. The disease caused by this virus was called COVID-19 and was declared as a global pandemic by World Health Organization in March 2020. Among the consequences caused by the virus, some dermatological pathologies have been reported, such as Telogen effluvium (TE). In this review we will address the relation between Telogen effluvium and COVID-19. Material and methods: All literature related to Telogen effluvium and COVID-19 was searched in PubMed. Results: Since the beginning of the pandemic, the number of patients diagnosed with TE has increased. This is explained on one hand by the infection itself of the virus, generating a proinflammatory and procoagulant answer that lead to TE. On the other hand, it can be explained due to the stress caused by the lockdowns and the psychological consequences of a global pandemic. Also, the therapies used to treat the infection may increase the severity of the TE. The relation between TE and Covid-19 is not totally clear yet, but it is important due to the great impact that generates in the lives of the patients. (AU)

Clinical effects of autologous follicular unit extraction transplantation in the treatment of small area secondary cicatricial alopecia after burns / 中华烧伤杂志

Objective: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of small area secondary cicatricial alopecia (hereinafter referred to as cicatricial alopecia) after burns. Methods: A retrospective observational study was carried out. According to the adopted treatment methods, 18 patients (12 males and 6 females, aged (29±6) years) who received autologous FUE transplantation for small area cicatricial alopecia after burns from March 2017 to November 2019 in the First Affiliated Hospital of Air Force Medical University were included in FUE transplantation group, and 18 patients (13 males and 5 females, aged (33±5) years) who were treated with expanded flap transplantation for small area cicatricial alopecia after burns by the same surgery team during the same period in the same hospital were included in expanded flap transplantation group. All the patients were followed up for more than 1 year. At the last follow-up, the follicular unit density in the transplanted area was measured by Folliscope hair detection system and the hair survival rate was calculated; the visual analogue scale (VAS) method was adopted to evaluate the treatment effect; patients were asked their satisfaction with the treatment effect and the occurrence of complications during follow-up; the hair growth and the scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area were recorded. Data were statistically analyzed with Fisher's exact probability test and independent sample t test. Results: At the last follow-up, the follicular unit density in the transplanted area of patients in FUE transplantation group was (46.8±2.0)/cm2, which was significantly higher than (42.5±4.3)/cm2 in expanded flap transplantation group (t=3.84, P<0.01); the hair survival rates of patients were similar between the two groups (P>0.05). At the last follow-up, VAS scores evaluating the treatment effect of patients were similar between the two groups (P>0.05); the satisfaction score of patients toward the treatment effect in FUE transplantation group was 8.6±1.1, which was significantly higher than 7.6±0.8 in expanded flap transplantation group (t=2.89, P<0.01). During the follow-up, no inflammation or infection occurred in patients of the two groups, but only 2 patients in expanded flap transplantation group had postoperative pain. At the last follow-up, the transplanted area of patients in the two groups was covered with new hair, and the hair growth direction was basically consistent with the surrounding normal hair; scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area of patients were similar between the two groups (P>0.05). Conclusions: Autologous FUE transplantation has better long-term follicular unit density and patients' satisfaction than expanded flap transplantation in the treatment of small area cicatricial alopecia after burns, showing better postoperative effect and a good prospect of clinical application.

Up-regulation of androgen receptor by heat shock protein 27 and miR-1 induces pathogenesis of androgenic alopecia / 中南大学学报(医学版)

OBJECTIVES@#The pathogenesis of androgenetic alopecia (AGA) is related to the level of androgen and its metabolic pathways. The binding of androgen and androgen receptor (AR) depends on the assistance of heat shock protein 27 (HSP27). HSP27 combined with microRNAs (miR)-1 can regulate AR levels. However, it is not clear whether HSP27 and miR-1 jointly participate in the pathogenesis of AGA. This study aims to investigate the role of AR up-regulation in the pathogenesis of AGA and underlying mechanisms.@*METHODS@#A total of 46 male AGA patients (AGA group), who admitted to the First Affiliated Hospital of Guangzhou Medical University from September 2019 to February 2020, and 52 healthy controls admitted to the same period were enrolled in this study. Serum levels of dihydrotestosterone (DHT) and HSP27 in patients and healthy controls were measured by ELISA. Western blotting was used to detect the protein expression of HSP27 and AR in scalp tissues of patients and the healthy controls. The levels of HSP27, AR, and miR-1 were analyzed using real-time PCR. Human dermal papilla cells were transfected with HSP27 siRNA to inhibit the expression of HSP27. MiR-1 and miR-1 inhibitors were transfected simultaneously or separately into cells and then the changes in AR protein expression were detected.@*RESULTS@#The levels of DHT and HSP27 in the AGA group were (361.4±187.7) pg/mL and (89.4±21.8) ng/mL, respectively, which were higher than those in the control group [(281.8±176.6) pg/mL and (41.2±13.7) ng/mL, both P<0.05]. However, there was no significant difference in serum HSP27 and AR levels among AGA patients with different degrees of hair loss (P>0.05). Correlation analysis showed that there was a positive correlation between HSP27 level and DHT level in the AGA patients (P<0.05). The level of HSP27 mRNA in scalp tissue was negatively correlated with that of miR-1 mRNA (P<0.05). Compared with the control group, the levels of HSP27 protein, AR protein, HSP27 mRNA, and AR mRNA in scalp tissues of AGA group were significantly increased (P<0.05). The up-regulation of HSP27 in scalp tissues of AGA patients was closely related to the increased levels of AR. However, the level of miR-1 in scalp tissues of AGA patients was significantly down-regulated, contrary to the expression of AR (P<0.05). Further in cell studies showed that inhibition of HSP27 or miR-1 expression in human dermal papilla cells could inhibit the expression of AR, and inhibition of both HSP27 and miR-1 expression was found to have an accumulative effect on AR, with statistically significant differences (all P<0.05).@*CONCLUSIONS@#HSP27 could combine with miR-1 to up-regulate AR levels, which is closely related to the development of AGA.

Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database / 中华胃肠外科杂志

Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.

Characteristics of telogen effluvium in COVID-19 in western Iran (2020)

Abstract Background: Although COVID-19 pandemic significantly induces mortality, many of the patients who recovered present other medical problems such as alopecias. Telogen effluvium is a common alopecia that is usually related to previous events such as acute febrile diseases, including COVID-19. Objective: To evaluate the characteristics of telogen effluvium in COVID-19. Method: This cross-sectional study was carried out on 526 patients with documented telogen effluvium that recovered from COVID-19. Demographic data, concurrent alopecia, associated diseases, and COVID-19 severity were recorded. Data were analyzed by appropriate statistical methods. Results: The mean age of the 526 patients (410 females, 116 males) was 30.97±9.592 years, with 7.65 ± 1.739 weeks of mean time of alopecia onset. Vitamin D deficiency (24.3%), androgenetic alopecia (78.2%), and grade III COVID-19 severity were the most common findings. Alopecia onset was significantly earlier in the younger age group, females, in hypothyroidism, and more severe coronavirus infection. Higher grade coronavirus infection was significantly seen in males, higher ages, earlier onset, and androgenic alopecia. Study limitations: Performing a single-center study and considering limited variables. Conclusion: Although Coronavirus 2 infection can be an important factor in telogen effluvium induction, other factors such as associated diseases, drug intake and emotional stress may also be involved. In the cases of early onset of alopecia, concomitant diseases such as hypothyroidism and severe coronavirus infection can occur, thus, the presence of various factors in telogen effluvium induction should be considered.

Acute telogen effluvium triad after resolution

Abstract Five cases of telogen effluvium undergoing resolution are shown, with the presence of frontal, bitemporal, and occipital hair regrowth. Diagnosing acute telogen effluvium after the end of the active phase can be challenging, especially when the pull test is negative. The differential diagnosis includes alopecia areata and traction alopecia. Clinical signs of hair regrowth after telogen effluvium can help in the diagnosis. The frontal and temporal areas have more telogen hairs and are more affected. On the occipital area, hairs seem to have the same behavior. The acute telogen effluvium triad during resolution is proposed: frontal fringe, temporal recess and occipital fringe.

Moniletrix of the scalp from almost normal aspect to total alopecia: variable intrafamilial expressiveness

Abstract Monilethrix is a rare defect of the hair shaft, with most cases showing an autosomal dominant pattern of inheritance and variable clinical expression. It is characterized by hypotrichosis secondary to hair fragility. The diagnosis is made through trichoscopy, detecting typical findings such as periodic narrowing at regular intervals, giving the hair the appearance of beads in a rosary. This article reports the case of six members of a family diagnosed with monilethrix with alopecia of varying degrees.