3D wide-field multispectral photoacoustic imaging of human melanomas in vivo: a pilot study.

BACKGROUND: The Breslow depth is an important parameter to determine the excision margin and prognosis of melanoma. However, it is difficult to accurately determine the actual Breslow depth before surgery using the existing ocular micrometer and biopsy technique. OBJECTIVES: To evaluate the use of 3D wide-field multispectral photoacoustic imaging to non-invasively measure depth and outline the boundary of melanomas for optimal surgical margin selection. METHODS: Six melanoma patients were examined in vivo using the 3D multispectral photoacoustic imaging system. For five cases of melanomas (one in situ, three nodular, and one acral lentiginous type melanoma), the spectrally unmixed photoacoustic depths were calculated and compared against histopathological depths. RESULTS: Spectrally unmixed photoacoustic depths and histopathological depths match well within a mean absolute error of 0.36 mm. In particular, the measured minimum and maximum depths in the in situ and nodular type of melanoma were 0.6 and 9.1 mm, respectively. In the 3D photoacoustic image of one metastatic melanoma, feeding vessels were visualized in the melanoma, suggesting the neovascularization around the tumour. CONCLUSIONS: The 3D multispectral photoacoustic imaging not only provides well-measured depth and sizes of various types of melanomas, it also visualizes the metastatic type of melanoma. Obtaining accurate depth and boundary information of melanoma before surgery would play a useful role in the complete excision of melanoma during surgery.

Randomised controlled clinical trial for autologous fibroblast-hyaluronic acid complex in treating diabetic foot ulcers.

OBJECTIVE: Diabetic foot ulcers (DFUs) often pose a treatment problem. Bioengineered skin substitutes have been reported to result in accelerated diabetic wound healing. The purpose of this clinical trial was to evaluate the efficacy and safety of the autologous fibroblast-hyaluronic acid complex for treating DFUs. METHOD: A stratified, randomised, controlled, multicentre study was carried out. Patients with DFUs were allocated to either a treatment group with grafting of an autologous fibroblast-hyaluronic acid complex or a control group with non-adherent foam dressing. Except for application of the fibroblast complex, treatment of the study ulcers was identical for patients in both groups. The maximum follow-up period for each patient was 12 weeks. RESULTS: Complete ulcer healing was achieved in 84% (26/31 patients) of the treatment group and 34% (11/32 patients) of the control group (p<0.05). The times required for complete healing were 36.4 ± 17.6 and 48.4 ± 13.1 days in the treatment and control groups, respectively (p<0.05). No adverse events related to treatment occurred. CONCLUSION: These results indicate that autologous fibroblast-hyaluronic acid complex may offer a safe and effective treatment for DFUs.

Treatment of necrotising fasciitis using glycerol-preserved skin allografts for temporary wound coverage.

Allografts of human skin have been used for both temporary and permanent wound coverage. They are useful as temporary bridges for the critically ill patient who is not allowed to receive definite wound coverage, or for wound bed preparation before permanent grafting. Glycerol-preserved skin allografts have several benefits including good adherence to the wound bed, water vapour transport, antimicrobial characteristics, low toxicity and antigenicity, ease of application and removal, a long shelf-life, and minimal storage requirements. We achieved lower limb salvage using a glycerol-preserved skin allograft for temporary wound coverage in the treatment of necrotising fasciitis.

Prospective RCT comparing two hydrocolloid dressings in acute trauma wounds in South Korea.

OBJECTIVE: To compare the efficacy of two hydrocolloid dressings (Medifoam H; Genewel Co. Ltd. and DuoDERM; ConvaTec Inc.) for the management of lacerations, abrasions, and minor operation incisions. METHOD: Patients with lacerations, abrasions, and minor operation incisions were randomly allocated to receive either Medifoam H or DuoDERM. Data collected included wound assessment (amount of exudate, wound infection, rate of wound closure, and the percentage of necrotic, sloughy, fibrous,granulation, and epithelial tissue present in the wound bed) and patient evaluation of itching, burning,leakage of exudate, pain and discomfort incurred from dressing and dressing change. RESULTS: In total, 66 patients were included in the study. No significant difference in wound assessment or in patient evaluation was detected between two groups. CONCLUSION: The data collected from this study gave no evidence for any difference in efficacy between Medifoam H and DuoDERM for minor, acute trauma wound management.

Versatility of right gastroepiploic and gastroduodenal arteries for arterial reconstruction in adult living donor liver transplantation.

BACKGROUND: In cases where there is severe intimal dissection in the recipient hepatic artery (HA), or if the HA has been used already and additional operations are needed due to graft rejection or arterial occlusion, an alternative is necessary. In the present study, we have reported the feasibility of using the right gastroepiploic artery (RGEA) and gastroduodenal artery (GDA) in various situations where the HA is not a feasible option. METHODS: Among 463 patients who underwent primary adult-to-adult living donor liver transplantation from January 2002 to July 2010, eight subjects required alternative vessels. Four recipients displayed severe intimal injury associated with previous transarterial chemoembolization (TACE); two, required a salvage operation due to hepatic artery thrombosis (HAT); and two, retransplantations due to chronic rejection. The RGEA was used in five and the GDA in three patients. RESULTS: Postoperative Doppler ultrasonography and three-dimensional computed tomography showed patent arterial flow in all patients. However, HAT recurred in one patient who underwent a salvage operation with the RGEA; she died 2 months later. Two other patients died due to wound infection and respiratory failure within 3 months despite intact hepatic arterial flow. Four patients had no further complications during follow-up (mean = 33 months). CONCLUSION: Although there was a discrepancy in the diameter of the HA and the RGEA (or GDA), there was no problem with mobilization and microanastomosis. We therefore believe that these vessels can be good alternatives when the hepatic artery is unavailable.

Platelet supernatant promotes proliferation of auricular chondrocytes and formation of chondrocyte mass.

Recently proposed procedures for in vitro generation of new cartilage may be difficult to perform in humans because so many chondrocytes are needed for tissue engineering. In this study the authors investigated new, efficient, low-cost techniques for the isolation and culture of chondrocytes from the ear cartilage of the rabbit. They performed a low-density monolayer culture with a low concentration (0.5%, 1%) of human platelet supernatant and observed cell proliferation (seeding efficiency, deoxyribonucleic acid synthesis), matrix synthesis (glycosaminoglycan synthesis), and the expression of type I and type II collagen (reverse transcriptase polymerase chain reaction). Seeding efficiency was increased in 1% of platelet supernatant-treated cultures by two to three times compared with untreated controls. One percent platelet supernatant had increased the incorporation of [3H]-thymidine by 1.9 to 2.5 times at 72 hours compared with controls. Glycosaminoglycan synthesis was increased in platelet supernatant-treated chondrocytes at 96 hours compared with controls. Chondrocytes treated with 1% platelet supernatant showed a decreased expression of the type II collagen gene. Supplementation with a high concentration (10%) of the platelet supernatant provided the conditions for in vitro chondrocyte mass formation. These results indicate that proliferation and matrix synthesis of auricular chondrocytes is stimulated by a low concentration of platelet supernatant. On the other hand, chondrocytes were immobilized by a high concentration of platelet supernatant. Platelet supernatant may be useful as an inexpensive autologous source of multiple growth factors to enhance chondrocyte proliferation, and also may play the role of scaffold for chondrocytes. Additional investigation is underway to generate culture conditions that promote the differentiation as well as the proliferation of chondrocytes.

Efficient in vitro model for immunotoxicologic assessment of mammary silicone implants.

In clinical and experimental studies, silicone gel has been assumed to cause immune alterations that may be related to macrophage activation of silicone implants. However, it has not been proven that the immunotoxicities are caused by the direct contact of macrophages and silicone gel because there has not been an adequate experimental model. In the present study, silicone gel was loaded directly onto Petri dishes and was distributed uniformly to the bottom by centrifugation. Peritoneal macrophages and splenic lymphocytes were cultured either on the silicone-coated plates or on the conventional, normal plates, and their functions were compared with each other. The experiments were repeated three times. The cytotoxic activities of peritoneal macrophages on cancer cells were markedly augmented by cultivation on silicone gel, and the primary T-dependent immunoglobulin M response in which macrophages participated as antigen presenting cells was also enhanced by incubation on silicone gel. However, macrophage-unrelated functions mediated by B and T lymphocytes were not affected by the silicone gel treatment. It was proven that the direct contact of macrophages with silicone gel was a primary cause of acute immune activation that was related to foreign body reaction. In addition, the present in vitro model exhibited similar silicone-induced immunotoxicities in previous animal and clinical studies.