Exosomes in the Real World of Medical Aesthetics: A Review.

BACKGROUND: Exosomes are cell-derived nanovesicles that transport proteins, nucleic acids, and lipids and play a significant role in almost every physiological process in the human body. They have generated great interest, especially in the field of tissue regeneration. Studies in the last decade support their great regenerating and rejuvenating potential. However, the lack of standardized procedures, limited knowledge regarding their action mechanism, and little clinical evidence impair their implementation and approval in the medical setting. This review aimed to identify published studies and clinical trials using exosomes in human patients for clinical treatments in aesthetic medicine. MATERIALS AND METHODS: A systematic search was conducted in the PubMed database using the search term "exosomes" and 25 terms related to aesthetic medicine treatments in human patients. Additionally, a search was conducted in the ClinicalTrials.gov database for interventional clinical trials using exosomes for aesthetic treatments in adults 18 to ≥ 65 years of age. RESULTS: Nine articles were selected after debugging the initial list of published articles in which exosomes were related to Aesthetic Medicine (633 articles). Nine studies were identified from the initial search on ClinicalTrial.gov (104 trials with exosomes). CONCLUSIONS: There is no doubt about the scientific basis of exosome regenerative potential and the growing interest in exosomes in Aesthetic Medicine. However, companies must spend more on research to develop standardized and reliable procedures to obtain exosomes for their approval and application in clinical practice. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This review highlights the large amount of published research on exosomes related to aesthetic medicine and, at the same time, the lack of products approved by regulatory agencies. Several issues have been suggested to elucidate a response, such as the need for standardized protocols and more knowledge to ensure safe treatments. It also highlights the few clinical trials conducted to evaluate exosome properties in aesthetic medicine treatments.

The Effect of Photobiomodulation on Human Mesenchymal Cells: A Literature Review.

BACKGROUND: Mesenchymal stem cell-based therapy is known to have the potential to induce angiogenesis. However, there are still some limitations regarding their clinical application. Photomodulation/photobiomodulation is non-invasive and non-toxic phototherapy able to stimulate cell viability, proliferation, differentiation, and migration, when the right irradiation parameters are applied. A review of the published articles on human conditioned-by-photobiomodulation mesenchymal cells in an in vitro set up was carried out. Our aim was to describe the studies' results and identify any possible tendency that might highlight the most suitable procedures. METHODS: A search in English of the PubMed database was carried out with the search criteria: photobiomodulation or photoactivation or photomodulation, and mesenchymal cells. All irradiations applied in vitro, on human mesenchymal cells, with wavelengths ranged from 600 to 1000 nm. RESULTS: The search yielded 42 original articles and five reviews. Finally, 37 articles were selected with a total of 43 procedures. Three procedures (7.0%) from 620 to 625 nm; 26 procedures (60.5%) from 625 to 740 nm; 13 procedures (30.2%) from 740 to 1000 nm; and one procedure (2.3%) with combinations of wavelengths. Of the 43 procedures, 14 assessed cell viability (n = 14/43, 32.6%); 34 cell proliferation (n = 34/43, 79.1%); 19 cell differentiation (n = 19/43, 44.2%); and three cell migration (n = 3/43, 7.0%). CONCLUSIONS: Photobiomodulation is a promising technology that can impact on cell viability, differentiation, proliferation, or migration, leading to enhance its regenerative capacity. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pain and Bruising Levels After Lip Augmentation: A Comparison of Anterograde and Retrograde Techniques Using an Automated Motorized Injection Device. A Blinded, Prospective, Randomized, Parallel Within-Subject Trial.

BACKGROUND: Dermal fillers for lip augmentation can be injected using various techniques. Although all seem to provide acceptable results, it is not clear which technique is safer, less painful, and provides greater patient comfort. OBJECTIVE: To compare patients' self-reported pain intensity during the injection of hyaluronic acid dermal filler for lip augmentation, with 2 different techniques, anterograde versus retrograde. METHODS AND MATERIALS: Prospective, single-center, within-subject, single-blinded, randomized controlled trial. All subjects received injections in the lip with hyaluronic acid-based filler, each side using the anterograde or retrograde injection technique. An automated motorized injection device was used to ensure a homogeneous deposition flow of the product injected and reduce operator bias. Pain intensity was self-assessed using a 100-mm visual analog scale. Presence and severity of bruising were recorded. RESULTS: Forty-four women (mean age 30.3 years) were randomized. Mean self-reported pain score was 53.1% lower with the anterograde technique than with the retrograde (p < .0001). The anterograde technique had lower rates of site reactions, showed a faster recovery time, and 68.2% of patients favored this technique. CONCLUSION: This study demonstrated that the anterograde technique was less painful, and led to fewer bruising and site reactions than the retrograde technique when using an automated device. LEVEL OF EVIDENCE: I.

Miniprobe Endoscopic Sonography for Gastrointestinal Tract Assessment: A Case Series of 1451 Procedures.

Conventional endoscopic sonography has allowed precise diagnostics without disturbances, and miniprobes can be easily introduced through the biopsy channel of the endoscope. Miniprobe endoscopic sonography has many benefits compared with conventional endoscopic sonography. Although there are well-known indications for miniprobe endoscopic sonography in endoscopic digestive tract assessment, there is still a need for this method to be widely spread among physicians and commonly used by most endoscopists. The aim of this series was to describe a multicenter retrospective experience with 1451 procedures using miniprobes, presenting examples and the applicability and usefulness of this technology in the daily activities of an endoscopy department.

Canalization technique to obtain deep tissue biopsy of gastrointestinal subepithelial tumors as an alternative to conventional known techniques.

BACKGROUND AND OBJECTIVES: The most accurate technology to detect and diagnose subepithelial tumors (SETs) is the endoscopic ultrasonography (EUS) combined with puncture techniques, such as the endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) or the endoscopic ultrasonography-guided fine-needle biopsy. Going further in the improvement of the results of tumor samples obtained endoscopically to diagnose the SETs, the canalization technique guided by miniprobes (MPs) to obtain biopsies of SET could be an alternative to EUS-FNA. The objective of this study is to analyze the results of samples obtained by this procedure. MATERIALS AND METHODS: A multicenter, retrospective study of a review of a database of 32 consecutive patients with a SET in the digestive tract, from 2000 to 2015 was conducted. All patients underwent EUS-performed by MP, to define the size, internal echostructure, and layer of origin of tumor. Once the echostructure was defined, it proceeded to the canalization technique to arrive to the tumor tissue. RESULTS: The average diameter of SETs in this series (32 patients) was about 21.6±11 mm (range: 5-41 mm). The diagnostic accuracy was 28/32, 87.50% (Confidence interval 95%: 76.04%-98.99%), and there were no major complications. All procedures were performed on outpatients, none of which required additional hospitalization. The 50% of patients were operated or endoscopically resected and in all cases, the previous pathological diagnosis was confirmed. CONCLUSIONS: This is a feasible, safe, and effective procedure that allows to access to inside of SET to obtain deep biopsies. Tumor samples obtained by deep biopsy, with prior performing of the canalization technique guided by MP, were sufficient for histopathological and immunohistochemical diagnosis and similar to those obtained with other known methods (FNA Trucut, ProCore®, etc.). However, more prospective comparative studies with a larger number of patients and different specialists carrying out the procedure to reach a higher statistical significance are necessary.