Efficacy and safety of mesotherapy with tranexamic acid versus vitamin C in the treatment of melasma: A meta-analysis and systemic review.

BACKGROUND: The exact pathogenesis of melasma is not yet known, and its treatment remains challenging. Mesotherapy with tranexamic acid (TXA) and vitamin C was both reported to have certain effects on melasma. In spite of that several articles have compared the efficacy and safety of the two drugs on melasma, most of them were clinical study with small sample size. AIMS: To evaluate the efficacy and safety of mesotherapy with TXA versus vitamin C in treating melasma through meta-analysis and systemic review. METHODS: The authors searched PubMed, Web of Science, Springer, and ScienceDirect for studies that compared mesotherapy with TXA versus vitamin C as a treatment for melasma. Primary outcomes were change in melasma area and severity index (MASI) before and after the treatment. RESULTS: Finally, five studies with a total of 127 patients were included in the systematic review. There was no statistic difference in the change in MASI score between the TXA and vitamin C groups (mean difference, 0.16; 95% CI, -0.79 to 1.11). CONCLUSIONS: Mesotherapy with both TXA and vitamin C is safe and effective in the treatment of melasma.

Application of PRP in Chloasma: A Meta-Analysis and Systematic Review.

Background: Chloasma is a common skin pigment disorder. Treatment of chloasma has been challenging, often unsatisfactory, and difficult to avoid recurrence. PRP is a new treatment for chloasma, but there is no consensus on its use. Lingyun Zhao's team recently reported a systematic evaluation and meta-analysis of the efficacy and safety of PRP in the treatment of chloasma, which is consistent with our ideas, but we will elaborate on the application of PRP in chloasma from a deeper and more comprehensive perspective. Before we started this study, we had registered with Prospero as CRD42021233721. Methods: The authors searched the public medical network, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, Scopus, and Science Network. The clinical trials registry ClinicalTrials.gov databases were searched for relevant publications to June 2021. The results showed the area and severity of chloasma (MASI) or revised MASI (mMASI) score. Results: Three RCTs, one nonrandomized controlled study, and four were prospective before and after self-controlled studies met the inclusive criteria. Intradermal PRP injections significantly improved chloasma as indicated by the significant decrease MASI (average balance -6.71, 95% CI -8.99 to -4.33) and mMASI scores (average balance -2.94, 95% CI -4.81 to -1.07). The adverse reactions were mild, and there were no significant long-term adverse events. Conclusive. The data can reflect the effectiveness and safety of PRP therapy for chloasma. RCTs are needed to determine effective treatment parameters, and long-term follow-up should be included to better clarify the efficacy and side effects of PRP in treating chloasma.

Exosomal MicroRNA-21 Promotes Keloid Fibroblast Proliferation and Collagen Production by Inhibiting Smad7.

In keloid fibroblasts, microRNA-21 (miR-21) enhances activation of the TGF-ß-Smad signaling pathway by down-regulating Smad7 expression, thereby promoting keloid fibroblast proliferation and collagen production. However, it is unclear whether miR-21 performs the above-mentioned functions through exosomal transport. Here, we extracted exosomes from the culture supernatants of keloid and normal skin fibroblasts and observed that both types of cells above secrete exosomes; however, keloid fibroblasts secreted significantly more exosomal miR-21 than normal skin fibroblasts (P < .001). Interestingly, we also observed that exosomal miR-21 could enter target keloid fibroblasts. In addition, inhibiting exosomal miR-21 up-regulated Smad7 protein expression and reduced Smad2 and Smad3 protein levels in target keloid fibroblasts. Furthermore, inhibiting exosomal miR-21 down-regulated collagen I and collagen III expression in target keloid fibroblasts, increased the proportion of apoptotic cells, and reduced cell proliferation. Taken together, these results show that exosomal miR-21 promoted proliferation and collagen production in keloid fibroblasts by inhibiting Smad7. Thus, we identified regulatory roles for miR-21 in promoting keloid fibroblast proliferation and participating in keloid formation and development. These findings imply that miR-21 may serve as a novel target for controlling the development of keloids.

Increased sensitivity to TNF-α promotes keloid fibroblast hyperproliferation by activating the NF-κB, JNK and p38 MAPK pathways.

Hyperproliferation of fibroblasts is the main cause of keloid formation. However, the pathogenesis of keloids has yet to be fully elucidated. Tumor necrosis factor (TNF)-α may play an important role in the formation and proliferation of keloids, as it is implicated in the pathogenesis of various fibrous disorders. In the present study, the expression level of TNF-α and its receptors, soluble TNF receptor (sTNFR)1 and sTNFR2, in the peripheral blood and skin tissues was detected by ELISA, reverse transcription-quantitative PCR or immunohistochemistry. There was no statistically significant difference in the expression of TNF-α and sTNFR2 in the peripheral blood and skin tissues between patients with keloids and healthy participants (P>0.05), while the sTNFR1 mRNA level in fibroblasts cultured in vitro and its protein level in keloid skin samples were significantly higher compared with those in normal skin (P<0.05). Subsequently, TNF-α recombinant protein was used to treat keloid-derived and normal skin fibroblasts, and it was observed that TNF-α promoted the proliferation of keloid fibroblasts (KFs), but had little effect on normal skin fibroblasts. Furthermore, it was observed that TNF-α stimulation led to the activation of the nuclear factor (NF)-κB, c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK) pathways in KFs. In conclusion, KFs exhibited increased expression of sTNFR1, which may contribute to the increased sensitivity to TNF-α, resulting in low concentrations of TNF-α activating the NF-κB, JNK and p38 MAPK pathways, thereby promoting the sustained and excessive proliferation of KFs.

Round versus Anatomical Implants in Primary Cosmetic Breast Augmentation: A Meta-Analysis and Systematic Review.

BACKGROUND: Choosing implant shape (round or anatomical) is one of the most essential yet controversial decisions in cosmetic breast augmentation. Many surgeons choose implant shape based on personal experience or expert opinion. This is the first systematic review and meta-analysis comparing the aesthetic effect between anatomical and round implants in primary cosmetic breast augmentation. METHODS: The authors searched the PubMed, MEDLINE, Embase, ScienceDirect, Web of Knowledge, Scopus, and Cochrane Central Register of Controlled Trials databases for studies that compared anatomical and round implants in primary cosmetic breast augmentation. Primary outcomes were postoperative aesthetic effect and correct identification rate of implant shape. Random effects models were used to obtain pooled standardized mean difference and 95 percent confidence intervals. RESULTS: One randomized comparative and four observational comparative studies met the inclusion criteria. No aesthetic superiority was found in the anatomical implant group with regard to overall appearance (standardized mean difference, 0.06; 95 percent CI, -0.40 to 0.53), naturalness (standardized mean difference, 0.18; 95 percent CI, -1.51 to 1.15), projection, upper pole contour, and lower pole contour. Pooled correct identification rate of implant shape by plastic surgeons was 52 percent (95 percent CI, 0.46 to 0.58). CONCLUSIONS: Generally, anatomical implants do not seem to have an aesthetic superiority compared to round implants. Plastic surgeons seemed to be unable to accurately differentiate the two implant shapes in vivo. Further studies should focus on identifying the specific indications for the use of anatomical implants.

Do Breast Implants Influence Breastfeeding? A Meta-Analysis of Comparative Studies.

BACKGROUND: Aesthetic breast implant augmentation surgery is the most popular plastic surgery worldwide. Many women choose to receive breast implants during their reproductive ages, although the long-term effects are still controversial. Research aim: We conducted a meta-analysis to assess the influence of aesthetic breast augmentation on breastfeeding. We also compared the exclusive breastfeeding rates of periareolar versus inframammary incision. METHODS: A systematic search for comparative studies about breast implants and breastfeeding was performed in PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, Scopus, and Web of Science through May 2018. Meta-analysis was conducted with a random-effects model (or fixed effects, if heterogeneity was absent). RESULTS: Four cohorts and one cross-sectional study were included. There was a significant reduction in the exclusive breastfeeding rate for women with breast implants compared with women without implants, pooled relative risk = 0.63, 95% confidence interval [0.46, 0.86], as well as the breastfeeding rate, pooled relative risk = 0.88, 95% confidence interval [0.81, 0.95]. There was no evidence that periareolar incision was associated with a reduction in the exclusive breastfeeding rate, pooled relative risk = 0.84, 95% confidence interval [0.45, 1.58]. CONCLUSION: Participants with breast implants are less likely to establish breastfeeding, especially exclusive breastfeeding. Periareolar incision does not appear to reduce the exclusive breastfeeding rate.

Changes of Subfoveal Choroidal Thickness after Cataract Surgery: A Meta-Analysis.

PURPOSE: To investigate the effect of cataract surgery on subfoveal choroid thickness (SFCT) using enhanced-depth imaging optical coherence tomography (EDI-OCT). MATERIALS AND METHODS: Relevant publications were searched systematically through various databases from inception to March 2018. The unit of choroidal thickness measurements is micrometers. Studies comparing SFCT before and after cataract surgery were retrieved. All qualified articles were analyzed using RevMan 5.3. RESULTS: A total of 13 studies with 802 eyes from 646 patients were identified for inclusion. There was a significant increase of SFCT at 1 week (MD = 6.62, 95% CI: 1.20-12.05, P=0.02, I2 = 0%), 1 month (MD = 8.30, 95% CI: 3.20-13.39, P=0.001, I2 = 0%), and 3 months (MD = 8.28, 95% CI: 1.84-14.73, P=0.01, I2 = 0%) after cataract surgery. In subgroup analysis, SFCT in Asians and patients without nonsteroidal anti-inflammatory drugs (NSAIDs) in postoperative medication was significantly thicker (P < 0.05). No statistically significant increase of SFCT was found in diabetic mellitus (DM) patients for 1 day (P=0.89), 1 week (P=0.59), 1 month (P=0.52), and 3 months (P=0.42) after cataract surgery. CONCLUSIONS: This meta-analysis suggested that SFCT increased since 1 week after the cataract surgery and the increase lasted for at least 3 months. Asians and patients without NSAIDs in postoperative medication were more likely to have a thicker SFCT after cataract surgery, whereas DM patients were less likely to increase in SFCT.