A randomized clinical trial assessing the efficacy of single and multiple intralesional collagenase injections for treating contracted scars

Background:Scar contractions caused by trauma or burns can cause secondary physical dysfunction and disfigurement.Many minimally invasive methods for scar contraction have shown limited applicability and efficacy.This study investigated the feasibility and efficacy of intralesional collagenase injections for scar contraction treatment.Methods:Patients with contracted scars who had limited joint movement and physical disfiguration for>1 year were enrolled in this single-blind,randomized clinical trial from July 2017 to February 2018 at Shanghai Ninth People’s Hospital.Collagenase was injected into the firm-contracted scar(15 U/cm^(2))three times at 4-week intervals in the multiple treatment group and once in the single treatment group,and a placebo injection was performed in the control group.Scar length and skin texture were documented at the 4-and 12-week follow-ups.The safety of the collagenase treatment was also evaluated.Results:The contracted scar was significantly elongated after both single and multiple collagenase treatments.The results showed that,compared to a one-time treatment,repeated injections were more effective at 12 weeks,with an average improvement of 26.83(15.79%).At 12 weeks,78.9% of the patients in the multiple group and 52.9%in the single group achieved significant improvement at 12 weeks.No severe adverse events were observed.Conclusion:Intralesional collagenase injection showed promising results in improving scar contraction and provides an alternative treatment for patients.

Concentrated Growth Factor from Autologous Platelet Promotes Hair Growth in Androgenetic Alopecia

Studies have shown that platelet concentrates can induce the proliferation of the dermal papilla and the vascularization of the perifollicular tissue, as well as accelerate the telogen-to-anagen transition, thereby promoting the regrowth of hair improving the appearance of hair loss. Herein, we report on the application of a new, modified form of platelet concentrates, namely, concentrated growth factors (CGFs), in 15 cases of androgenetic alopecia (AGA). 15 cases of androgenetic alopecia were treated with the use of monthly, subcutaneous injections of autologous CGF in the scalp. A total of 3 injections were administered 4 weeks apart, and the patients were followed up for 6 months. Assessments were performed before the treatments and at 4, 8, 12 and 24 weeks after the first treatment. The treatment outcomes were assessed by taking macroscopic photographs and trichoscopic photomicrographs, as well as by using the Global Aesthetic Improvement Scale (GAIS) and the patient satisfaction survey. In order to determine the safety of the treatment, the injection area was observed for signs of infection or mass evaluation. The photographs showed significant improvement in hair appearance after injections of CGF. The hair photomicrographs showed that CGF promoted the regrowth of hair in balding areas, with an increased hair density and an increased ratio of terminal to vellus hair. The GAIS suggested that CGF treatments were effective in treating AGA, and the majority of patients were satisfied with their improvement. In addition, treatments resulted in a faster rate of hair growth and a decrease in the greasy and unpleasant sensation of the hair of the patients. At the last visit, none of the 15 patients reported experiencing side-effects during the follow-up period. To conclude, the application of CGF can be an effective method in the treatment of androgenetic alopecia.

New dating indicates intermittent human occupation of the Nwya Devu Paleolithic site on the high-altitude central Tibetan Plateau during the past 45,000 years

The timing and mechanisms of the human occupation of the demanding high-altitude Tibetan Plateau environment are of great interest.Here,we report on our reinvestigations and dating of the Nwya Devu site,located nearly 4600 meters above sea level on the central Tibetan Plateau.A new microblade techno-complex was identified on a lower lake shore at this site,distinct from the previously reported blade tool assemblage.These two lithic assemblages were dated to 45.6±2.6 and10.3±0.5 ka using optically stimulated luminescence and accelerator mass spectrometry^(14)C methods.They represent,respectively,the earliest known Paleolithic and microlithic sites on the interior Tibetan Plateau,indicating multiple occupation episodes of hunter-gatherers during the past 45 ka.Our studies reveal that relatively stable depositional conditions and a paleoenvironment characterized by a comparatively warm climate facilitated these multiple occupations at Nwya Devu.The contemporaneous occurrence of the Upper Paleolithic blade technology on the Tibetan Plateau and most of Eurasia between 50 and 40 ka indicates rapid,large-scale dispersals of humans that profoundly affected human demography on a large scale.Combining new archaeological evidence and previously reported genetic data,we conclude that the Tibetan Plateau provided a relatively stable habitat for Upper Paleolithic hunter-gatherers,which may have contributed to the complex and multiple-origin gene pool of present-day Tibetans.

Efficacy and safety of modified medium-chain triglyceride ketogenic diet in patients with drug-resistant epilepsy

Background Medium-chain triglyceride ketogenic diet(MCTKD)is previously less commonly used in China.This study was aimed to assess the efficacy and safety of the modified MCTKD in the treatment of drug-resistant epilepsy in Chinese patients.Methods Patients with drug-resistant epilepsy were enrolled to receive treatment with modified MCTKD in Guangdong Sanjiu Brain Hospital during December 2020 and September 2022.The modified MCTKD contained fat that provided 50–70%of the total energy,as well as proteins and carbohydrates that provided 20–30%and 20%of energy,respectively.The fat component was composed of 20–30%medium-chain triglycerides(MCTs)and 30–40%long-chain triglycerides.The efficacy and safety of the diet were assessed at 1,3 and 6 months.Results A total of 123 patients aged 2.5 to 65 years,were included in this study.The response rates at 1,3 and 6 months were 49.6%,43.1%,and 30.9%,respectively.The seizure freedom rates at 1,3 and 6 months were 12.2%,10.6%,and 6.5%,respectively.The retention rates at 1,3 and 6 months were 98.4%,65.0%and 33.3%respectively.Side effects occurred in 21.14%of patients,which were predominantly gastrointestinal symptoms such as abdominal pain,diarrhea,vomiting,and constipation,and most of them resolved after dietary adjustments.A total of 82 patients(66.7%)discontinued the treatment with the reason of refusing to eat(8.1%),poor efficacy(35.0%),poor compliance(4.9%),and inability to follow-up(9.8%).Only 4 patients(3.3%)withdrew the diet due to side effects.Conclusions The modified MCTKD with MCTs providing 20–30%of energy has a good safety in patients with drug-resistant epilepsy,but its effectiveness needs to be enhanced.Further modifications of MCTKD with an optimal energy ratio are required to achieve a better efficacy and safety.

Ultrasound-assisted isolation:A new method to isolate stromal vascular fraction

Background:The stromal vascular fraction(SVF),a cluster of stem and progenitor cells isolated from adipose tissue,holds significant promise for application in regenerative medicine.However,the existing methods for SVF isolation are time-consuming and expensive.Thus,in this study,we explored a new method of SVF extrac-tion-ultrasound-assisted SVF isolation(USASI)-and compared the viability and characteristics of SVF isolated using different methods.Methods:SVF extraction methods using different combinations of ultrasound power,ultrasound time,collagenase dosage,and collagenase digestion time were compared with those of the control group(collagenase digestion method).The cell yield and vitality of the SVF were evaluated via cell counting and trypan blue staining.The cell components and immunophenotypes of freshly isolated SVF were analyzed using flow cytometry.The prolifer-ative capacity and differentiation potential of the SVF were also identified.Results:Ultrasonication at 95 W-20 kHz for 30 s followed by digestion with 0.15%collagenase for 30 min was identified as the most suitable parameter for the USASI method in isolating SVF,as recommended based on the evaluation of various tested conditions.The USASI method significantly reduced the collagenase dosage and shortened the digestion time.Compared to the collagenase digestion method,the USASI method had a higher cell yield and cell viability,with no adverse effects on cell components,proliferative capacity,or multipotential differentiation capacity.Conclusion:With reduced processing time,lower collagenase dosage,and increased cell yield without impairing the viability and characteristics of SVF,USASI holds the potential to emerge as a time-saving and cost-effective method for future clinical applications.

早期现代人向青藏高原腹地的扩散之路

人类扩散至青藏高原腹地的时间可追溯至深海氧同位素3阶段晚期,目前我们对该历史过程知之甚少,西藏尼阿底遗址为探讨古代人群向高原扩散的行为模式提供了重要线索.石器技术分析与文化对比研究结果表明,尼阿底独特的石叶遗存为典型旧石器时代晚期石叶技术,由于高原上缺少更早或同时期的相关遗址,其来源指向低海拔地区.现有考古学证据表明,尼阿底与中国宁夏水洞沟和亚洲北部的考古遗址具有密切联系,是早期现代人迁徙和文化互动的结果.GIS最低成本路径分析提示,高原腹地与平原地区石叶技术人群的交流存在两条可能性较大的路线:一是西伯利亚和蒙古国北部横穿戈壁,经水洞沟连接高原腹地;二是北亚地区绕戈壁边缘经中国东北连通水洞沟及青藏高原.