Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix

BACKGROUND Frey syndrome,also known as ototemporal nerve syndrome or gustatory sweating syndrome,is one of the most common complications of parotid gland surgery.This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes,visual stimuli,or eating.AIM To investigate the preventive effect of acellular dermal matrix(ADM)on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.METHODS Retrospective data from 82 patients were analyzed to assess the correlation between sex,age,resection sample size,operation time,operation mode,ADM usage,and occurrence of postoperative Frey syndrome.RESULTS Among the 82 patients,the incidence of Frey syndrome was 56.1%.There were no significant differences in sex,age,or operation time between the two groups(P>0.05).However,there was a significant difference between ADM implantation and occurrence of Frey syndrome(P<0.05).ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.CONCLUSION ADM can effectively prevent Frey syndrome and delay its onset.

The Combined Effect of Lumenato and Ceramide in the Protection of Collagen Damage Induced by Neutrophils in Normal Human Dermal Fibroblasts

Introduction: Collagen is the primary structural protein fibroblasts produce in the skin’s extracellular matrix. Infiltration of neutrophils into the epidermis and dermis by exposure to UV causes collagen damage and contributes to photoaging. Methods: To study the combined effect of Lumenato and ceramide in preventing collagen-1 damage induced by phagocytes, we used co-cultures of normal human dermal fibroblasts (fibroblasts) and activated human neutrophils. The present study aimed to determine the protective effect of the combination of Lumenato and ceramide on fibroblast collagen-1 damage induced by neutrophils. Results: Lumenato (in the range of 6.5 - 208 μg/ml) or ceramide (in the range of 0.1 - 50 μM) inhibited the production of superoxides and MPO by TNFα-stimulated neutrophils, as well as the production of NO by LPS-stimulated macrophages in a dose-dependent manner. The combinations of Lumenato and ceramide, in low concentrations, caused synergistic prevention of fibroblasts’ collagen-1 damage induced by TNFα-activated neutrophils, detected by fluorescence immunostaining and WB analysis. MPO activity in the supernatants of the co-cultures was also synergistically inhibited. Adding Lumenato or ceramide singly or in combinations in these low concentrations to the fibroblast cultures did not affect the expression of collagen-1. The combinations of Lumenato or ceramide in these concentrations also caused a synergistic inhibition of NO production by activated macrophages. Conclusions: The results suggest that combining low concentrations of Lumenato and ceramide results in synergistic protection against fibroblasts’ collagen-1 damage induced by neutrophils, thus indicating their possible potential for enhanced skin health.

Clear Cell Pleomorphic Dermal Sarcoma: A Case Report and Literature Review

Introduction: Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are one spectrum of rare cutaneous neoplasms that typically arise in sun-exposed skin of older population. AFX/PDS is essentially diagnosis of exclusion requiring Immunohistochemical work-up to exclude other types of tumors. Case Report: We present a case involving an ulcerated solitary lesion on the scalp of an elderly man. Histological examination revealed that the dermal tumor was composed of large pleomorphic, epithelioid, and spindle cells with clear cytoplasm. These cells were negative for cytokeratins, melanocytes and smooth muscle markers, but positive for CD10. These findings are consistent with a diagnosis of clear cell (CC) PDS. Conclusion: PDS is a low-grade malignancy that can recur locally and metastasize, which is distinguished from AFX by its larger size and the presence of aggressive histopathologic features including deeper invasion into the subcutaneous tissue, tumor necrosis, and lymphovascular and/or perineural involvement. Among several histopathologic variants, the CC variant is extremely rare with only two cases of PDS reported in the literature to date.

Flavonoids in safflower extract reduce cisplatin-induced damage to human follicle dermal papilla cells by inhibiting DNA damage and Rad17/Chk1/Cdc25C signaling

Background:Cisplatin is a chemotherapeutic agent commonly used clinically for the treatment of various human cancers.Patients often reduce the use of cisplatin due to its side effects,which in turn affects its treatment.This study explored the mechanism of action of safflower extract as an adjuvant traditional Chinese medicine for chemotherapy.Methods:Primary human follicle dermal papilla cells(HFDPCs)were used as target cells for cisplatininduced damage to hair cells.Western blotting was used to investigate the molecular targets of cisplatin and safflower extract in causing HFDPCs damage.Cell survival and cell cycle were analyzed by mitochondrial staining reagent WST-1 and propidium iodide.Results:Cisplatin could reduce the viability of HFDPCs without causing cell death.Cisplatin increased the level of phospho-Rad17 in HFDPCs and activated the Chk1/Cdc25C signaling to reduce the expression of Cdc2 protein,thereby arresting the cells in the G2/M phase.The combination of safflower extract and the flavonoids could effectively inhibit the signal transduction of Rad17/Chk1/Cdc25 in cisplatin-treated cells and reduce the cell population in the G2/M phase.Finally,we also confirmed that safflower extract could effectively inhibit the damage to HFDPCs caused by cisplatin,mainly at the level of reducing the DNA damage caused by cisplatin.Conclusions:Safflower extract can be used as an adjuvant Chinese medicine for chemotherapy to reduce the damage caused by chemotherapy to normal hair follicle cells.

Management of Complex Wounds with Dermal Substitute Assisted by a Negative Pressure System

Introduction: The standard treatment for complex wound care is autografting. The advent of dermal substitutes has provided a novel tool for the preparation of the bed to be grafted. However, most types of dermal matrices require the application of a skin graft a second time. Currently, other strategies have been developed to improve the vascularization process, such as negative pressure wound therapy (NPWT), which has been reported to reduce the time required for vascular growth and dermal matrix integration and thus achieve a shorter waiting period for autologous graft application. The present study aims to evaluate the effectiveness and safety of dermal matrix management associated with NPWT in the treatment of complex wounds. Methods: Seven patients with a diagnosis of complex wounds were enrolled in this study between July 1, 2015, and June 31, 2016. After debridement and having an adequate wound bed, patients who met the criteria for the application of combined therapy were treated with dermal substitutes and a negative pressure system. The percentage of graft integration into the wound bed, complications, length of hospital stay, and duration of therapy were analyzed. Results: The mean age was 42.5 ± 16 (39 - 54) years old;three women and four men were included in the study. The approximate size of skin loss was 120.7 ± 75 cm2 (25 - 250 cm2). The combined therapy of dermal matrix plus NPWT was instituted in all cases for a period of 14 days. There were no complications, with 100% graft integration in 6 of 7 cases. Patients were discharged after a mean hospital stay of 5.4 days. Conclusions: This study demonstrates that the utilization of combined dermal matrix plus NPWT therapy can be performed safely and effectively in patients with complex wounds with low complication rates and a short hospital stay.

<i>In Vitro</i>Analysis of VEGF and HGF Production by Fibroblast in Cultured Dermal Substitute Combined with EGF-Incorporating Top Dressing

This study aimed to investigate the potential of cultured dermal substitute (CDS) to release angiogenic growth factors when laminated with a membrane containing epidermal growth factor (EGF) as a top dressing. Membranes were prepared by air-drying a solution of hyaluronic acid (HA) and collagen (Col) with or without EGF. Membranes were designed to contain EGF at concentrations of 0, 0.1, 0.2 or 0.5 μg/cm2. CDS was prepared by incorporating fibroblasts into a collagen gel combined with a cross-linked HA spongy matrix, followed by culturing for 5 days. CDS was designed to contain fibroblasts at a density of 2 × 105 (Group I) or 4 × 105 cells/cm2> (Group II). CDS was elevated at the interface between air and culture medium, on the top of which each membrane was placed. This culture system was employed as a wound surface model. Metabolic activity of the fibroblasts in the CDS cultured for 7 days on a wound surface model was measured by MTT assay. The amounts of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) after 7 days of cultivation were measured by using ELISA. Membranes containing EGF ranging from 0.1 to 0.5 μg/cm2> facilitated production of both VEGF and HGF, as compared with control membranes without EGF. However, a membrane containing EGF at a concentration of 0.5 μg/cm2> failed to facilitate fibroblast cytokine production in Group I. These results demonstrated that the EGF-incorporating membrane was able to stimulate fibroblasts in the CDS to synthesize an increased amount of VEGF and HGF in a dose-dependent manner.

Epidermal stem cells and skin tissue engineering in hair follicle regeneration

The reconstitution of a fully organized and functional hair follicle from dissociated cells propagated under defined tissue culture conditions is a challenge stillpending in tissue engineering. The loss of hair follicles caused by injuries or pathologies such as alopecia not only affects the patients' psychological well-being, but also endangers certain inherent functions of the skin. It is then of great interest to find different strategies aiming to regenerate or neogenerate the hair follicle under conditions proper of an adult individual. Based upon current knowledge on the epithelial and dermal cells and their interactions during the embryonic hair generation and adult hair cycling, many researchers have tried to obtain mature hair follicles using different strategies and approaches depending on the causes of hair loss. This review summarizes current advances in the different experimental strategies to regenerate or neogenerate hair follicles, with emphasis on those involving neogenesis of hair follicles in adult individuals using isolated cells and tissue engineering. Most of these experiments were performed using rodent cells, particularly from embryonic or newborn origin. However, no successful strategy to generate human hair follicles from adult cells has yet been reported. This review identifies several issues that should be considered to achieve this objective. Perhaps the most important challenge is to provide threedimensional culture conditions mimicking the structure of living tissue. Improving culture conditions that allow the expansion of specific cells while protecting their inductive properties, as well as methods for selecting populations of epithelial stem cells, should give us the necessary tools to overcome the difficulties that constrain human hair follicle neogenesis. An analysis of patent trends shows that the number of patent applications aimed at hair follicle regeneration and neogenesis has been increasing during the last decade. This field is attractive not only to academic researchers but also to the companies that own almost half of the patents in this field.

Randomized controlled trial of minimally invasive surgery using acellular dermal matrix for complex anorectal fistula

AIM: To compare the efficacy and safety of acellular dermal matrix (ADM) bioprosthetic material and endorectal advancement flap (ERAF) in treatment of complex anorectal fistula. METHODS: Ninety consecutive patients with complex anorectal fistulae admitted to Anorectal Surgical Department of First Affi liated Hospital, Xinjiang Medical University from March 2008 to July 2009, were enrolled in this study. Complex anorectal fistula was diagnosed following its clinical, radiographic, or endoscopic diagnostic criteria. Under spinal anesthesia, patients underwent identification and irrigation of the fistula tracts using hydrogen peroxide. ADM was securely sutured at the secondary opening to the primary opening using absorbable suture. Outcomes of ADM and ERAF closure werecompared in terms of success rate, fecal incontinence rate, anorectal deformity rate, postoperative pain time, closure time and life quality score. Success was defined as closure of all external openings, absence of drainage without further intervention, and absence of abscess formation. Follow-up examination was performed 2 d, 2, 4, 6, 12 wk, and 5 mo after surgery, respectively. RESULTS: No patient was lost to follow-up. The overall success rate was 82.22% (37/45) 5.7 mo after surgery. ADM dislodgement occured in 5 patients (11.11%), abscess formation was found in 1 patient, and fistula recurred in 2 patients. Of the 13 patients with recurrent fistula using ERAF, 5 (11.11%) received surgical drainage because of abscess formation. The success rate, postoperative pain time and closure time of ADM were significantly higher than those of ERAF (P < 0.05). However, no difference was observed in fecal incontinence rate and anorectal deformity rate after treatment with ADM and ERAF. CONCLUSION: Closure of fistula tract opening with ADM is an effective procedure for complex anorectal fistula. ADM should be considered a first line treatment for patients with complex anorectal fistula.

A novel porcine acellular dermal matrix scaffold used in periodontal regeneration

Regeneration of periodontal tissue is the most promising method for restoring periodontal structures.To find a suitable bioactive three- dimensional scaffold promoting cell proliferation and differentiation is critical in periodontal tissue engineering.The objective of this study was to evaluate the biocompatibility of a novel porcine acellular dermal matrix as periodontal tissue scaffolds both in vitro and in vivo.The scaffolds in this study were purified porcine acellular dermal matrix(PADM) and hydroxyapatite-treated PADM(HA-PADM). The biodegradation patterns of the scaffolds were evaluated in vitro.The biocompatibility of the scaffolds in vivo was assessed by implanting them into the sacrospinal muscle of 20 New Zealand white rabbits.The hPDL cells were cultured with PADM or HA-PADM scaffolds for 3,7,14,21 and 28 days.Cell viability assay,scanning electron microscopy(SEM),hematoxylin and eosin(H&E) staining, immunohistochemistry and confocal microscopy were used to evaluate the biocompatibility of the scaffolds.In vitro,both PADM and HA-PADM scaffolds displayed appropriate biodegradation pattern,and also,demonstrated favorable tissue compatibility without tissue necrosis,fibrosis and other abnormal response.The absorbance readings of the WST-1 assay were increased with the time course, suggesting the cell proliferation in the scaffolds.The hPDL cells attaching,spreading and morphology on the surface of the scaffold were visualized by SEM,H&E staining,immnuohjstochemistry and confocal microscopy,demonstrated that hPDL cells were able to grow into the HA-PADM scaffolds and the amount of cells were growing up in the course of time.This study proved that HA-PADM scaffold had good biocompatibility in animals in vivo and appropriate biodegrading characteristics in vitro.The hPDL cells were able to proliferate and migrate into the scaffold.These observations may suggest that HA-PADM scaffold is a potential cell carrier for periodontal tissue regeneration.

Differentiation of mesenchymal stem cells into neuronal cells on fetal bovine acellular dermal matrix as a tissue engineered nerve scaffold

The purpose of this study was to assess fetal bovine acellular dermal matrix as a scaffold for supporting the differentiation of bone marrow mesenchymal stem cells into neural cells fol-lowing induction with neural differentiation medium. We performed long-term, continuous observation of cell morphology, growth, differentiation, and neuronal development using several microscopy techniques in conjunction with immunohistochemistry. We examined speciifc neu-ronal proteins and Nissl bodies involved in the differentiation process in order to determine the neuronal differentiation of bone marrow mesenchymal stem cells. The results show that bone marrow mesenchymal stem cells that differentiate on fetal bovine acellular dermal matrix display neuronal morphology with unipolar and bi/multipolar neurite elongations that express neuro-nal-speciifc proteins, includingβIII tubulin. The bone marrow mesenchymal stem cells grown on fetal bovine acellular dermal matrix and induced for long periods of time with neural differen-tiation medium differentiated into a multilayered neural network-like structure with long nerve ifbers that was composed of several parallel microifbers and neuronal cells, forming a complete neural circuit with dendrite-dendrite to axon-dendrite to dendrite-axon synapses. In addition, growth cones with filopodia were observed using scanning electron microscopy. Paraffin sec-tioning showed differentiated bone marrow mesenchymal stem cells with the typical features of neuronal phenotype, such as a large, round nucleus and a cytoplasm full of Nissl bodies. The data suggest that the biological scaffold fetal bovine acellular dermal matrix is capable of supporting human bone marrow mesenchymal stem cell differentiation into functional neurons and the subsequent formation of tissue engineered nerve.

Effect of Dermal Exposure to Paraphenylenediamine and Linear Alkylbenzene Sulphonate in Guinea Pigs

To study the effects of paraphenylenediamine （PPD） and linear alkylbenzene sulphonate （LAS） alone and in combination on the skin. Methods Forty-eight guinea pigs were divided equally into 4 groups and exposed to PPD （4 mg/kg）, LAS （12 mg/kg） and PPD （4 mg/kg） plus LAS （12 mg/kg） for 30 days. The biochemical parameters such as acid phosphatase, gtutathione-s-transferase, glutathione peroxidase, glutathione, lipid peroxidafion and histamine contents in exposed skin were estimated. The histopathological examination of the exposed skin was also carried out. Results The skin enzymes, lipid peroxidation, and histamine increased while glutathione decreased in skin. The simultaneously exposed group showed additive toxic effects. The histopathological examination showed severe hyperkeratosis, thickening of collagen fibres and vacuolisation of epidermal cells in PPD plus LAS exposed skin. Conclusion The findings of the present study suggest that simultaneous exposure to PPD and LAS has additive toxic effects.

Chicken collagen hydrolysates differentially mediate anti-inflammatory activity and type I collagen synthesis on human dermal fibroblasts

Collagen is a major extracellular matrix protein.Given the potential anti-inflammatory and antioxidant profiles of these bioactive compounds,there has been increasing interest in using collagen derived peptides and peptide-rich collagen hydrolysates for skin health,due to their immunomodulatory,antioxidant and proliferative effects on dermal fibroblasts.However,all hydrolysates are not equally effective in exerting the beneficial effects;hence,further research is needed to determine the factors that improve the therapeutic applicability of such preparations.We used different enzymatic conditions to generate a number of different collagen hydrolysates with distinct peptide profiles.We found that the use of two rather than one enzyme for hydrolysis generates a greater abundance of low molecular weight peptides with consequent improvement in bioactive properties.Testing these hydrolysates on human dermal fibroblasts showed distinct actions on inflammatory changes,oxidative stress,type I collagen synthesis and cellular proliferation.Our findings suggest that different enzymatic conditions affect the peptide profile of hydrolysates and differentially regulate their biological activities and potential protective responses on dermal fibroblasts.

The Versatility of Acellular Fetal Bovine Dermal Matrix for Head and Neck Surgical Reconstruction in Children

Objectives: To describe the versatility of acellular fetal bovine dermal matrix as an alternative to human cadaveric allograft for head and neck reconstructive procedures in children. Study Design: Case series with chart review. Methods: A database of pediatric operative procedures was queried for the use of acellular fetal bovine dermal matrix over a 16-month period. Indications for reconstruction were assessed and initial parental and surgeon satisfaction with the product were noted. Results: During the time period of 3/2012 and 7/2013 a total of 8 reconstructive procedures were performed on pediatric patients using acellular fetal bovine dermal matrix. Indications for use varied and included open and transnasal endoscopic repair of encephaloceles and soft tissue reconstructions including lateral pharyngeal wall repair, cleft palate repair, and facial recontouring operations. Acellular fetal bovine dermal matrix had a subjectively increased ease of use as compared to the surgeon’s prior experience with human cadaveric acellular dermis. Every parent vocalized a greater comfort level with the use of a bovine product over the alternative of human cadaveric tissue. The cost of acellular fetal bovine dermal matrix is slightly lower than the cost of human cadaveric acellular dermis. Conclusions: Acellular fetal bovine dermal matrix appears to be an acceptable alternative to human cadaveric acellular dermis for various forms of head and neck soft tissue reconstruction in children. Further prospective studies are warranted to assess for any differences in the long-term efficacy of this product as compared to other forms of allograft reconstruction.

Visceral leishmaniasis: An immunological viewpoint on asymptomatic infections and post kala azar dermal leishmaniasis

Elimination of visceral leishmaniasis is a priority programme in Indian subcontinent.The World Health Organization has set a new target to eliminate kala-azar by the year 2020 as previous target elimination year(2015) has passed.The elimination programme has successfully curbed the rate of infection in endemic regions; however, there are still few challenges in its route.The current drug control regime is extremely limited and comprises only two(amphotericin B and miltefosine) drugs, which are also susceptible for parasites resistance.Moreover, these drugs do not produce sterile cure, and cured patients may develop post kala-azar dermal leishmaniasis even after a decade of cure leaving behind a potent source of parasitic reservoirs for further disease transmission.A significant proportion of endemic population remain seropositive but aymptomatic for many years without any clinical symptom that serve as latent parasitic reservoirs.The lack of tools to identify live parasites in asymptomatic infections and there association in disease transmission, parameters of sterile cure along with post kala-azar dermal leishmaniasis progression remain a major threat in its elimination.In this review, we discuss the potential of host immune inhibitory mechanisms to identify immune correlates of protective immunity to understand the mystery of asymptomatic infections, sterile cure and post kala azar dermal leishmaniasis.

Application of acellular dermal matrix for intestinal elongation in animal models

AIM:To investigate the eff icacy of acellular dermal matrix(ADM) for intestinal elongation in animal models.METHODS:Japanese white big-ear rabbits(n = 9) and Wuzhishan miniature pigs(n = 5) were used in the study.Home-made and commercial ADM materials were used as grafts,respectively.A 3-cm long graft was interposed in continuity with the small bowel and a sideto-side anastomosis,distal to the graft about 3-4 cm,was performed.The animals were sacrificed at 2 wk,4 wk,8 wk and 3 mo after surgery and the histological changes were evaluated under light microscope and electron microscope.RESULTS:The animals survived after the operation with no evidence of peritonitis and sepsis.Severe ad-hesions were found between the graft and surrounding intestine.The grafts were completely absorbed within postoper ative two or three months except one.Histological observ ation showed inflammation in the grafts with fibrinoid necroses,infiltration of a large amount of neutrophils and leukomonocytes,and the degree varied in different stages.The neointestine with wellformed structures was not observed in the study.CONCLUSION:It is not suitable to use acellular dermal matrix alone as a scaffold for the intestinal elongation in animal models.

A study on the activity of dermal multipotent stem cells in initiation of wound repair

Background: Wound healing is a process of cell-cell interaction and cell-extracellular matrix interaction. Dermal multipotent stem cells (dMSCs) have the abilities to promote survival and wound healing, but the potential function of dMSCs in wound healing, particularly in the initiation of wound repair, has not been fully understood. Methods: dMSCs and fibroblasts were isolated from neonatal rat dermis and were further purified and expanded. The cell cycles were determined with flow cytometry, while the radiosensitivity was measured by MTT assay. Rats were wounded with a 7-cm incision on the back skin and the wound fluids were collected by inserting two pieces of sterile polyvinyl alcohol sponge (1 cmin diameter and0.4 cmin thickness) subcutaneously into the dorsum of each rat through the midline of incision on the 1st, 2nd, 3rd and 4th day after incision. The effects of wound fluids on the proliferation of dMSCs and fibroblasts were measured with MTT assays. dMSC’s abilities of adhesion and attachment and its migration in response to wound fluids collected on the 1st day after incision were explored by measuring the percentage of floating cells and the cells migrated into wounding area in vitro, respectively. Results: The isolated dMSCs were morphologically homogenous and highly proliferative. Most of the cultured dMSCs were quiescent with few apoptotic cells. Compared with fibroblasts, dMSCs were more sensitive to radiation and more proliferative in response to wound fluids, especially to the wound fluids collected on the 1st day after wounding. Moreover, their abilities to attach, adhere and migrate were significantly enhanced with the early-phase wound fluids. Conclusions: As primitive stem cells, dMSCs are very responsive to wound fluids, which suggests dMSCs’ important role in wound healing, especially in initiating wound repair.

Reconstruction of massive skin avulsion of the scrota and penis by combined application of dermal regeneration template(Pelnac) and split-thickness skin graft with vacuum-assisted closure: A case report

BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.

Establishment and molecular characterization of human dermal mesenchymal-like stem cells derived from human scalp biopsy of androgenetic alopecia patient

Development of Dermal cell line has great scope in the field of skin related diseases and regenerative medicine. Alopecia leads to a skin disorder causing balding and its mechanism is not yet understood. In the present study, we have developed and characterized a heterogeneous population of human dermal mesenchymal-like stem cell line from scalp biopsy of androgenetic alopecia patient with a view to isolate cells from the bulge region of the hair follicle. Our study showed that the dermal cells isolated from dermis of skin showed epithelial-like cells expressing CD34 and Keratin 18, which are characteristic of bulge hair follicle cells. These cells also expressed mesenchymal phenotypes and pluripotency markers such as Oct4, Nanog and SOX2. These cells were designated as “Human Dermal Mesenchymal-like Stem Cells (hDMSCs)”. To confirm their epithelial phenotypes, we have grown these cells at low serum concentration and it was observed that 3% serum concentration provided optimum conditions for their growth and maintenance of characteristics. The hDMSCs cells are presently at passage 10. This study reports the establishment of human dermal mesenchymal-like cell line from the dermis of Alopecia patient, which may be used as an in vitro model system to study the mechanism of Alopecia and other related skin disorders.

High-Dose Intra-Dermal Hepatitis B Vaccine in a Liver Transplant Patient Who Failed Prior Intramuscular Vaccination: A Brief Case Report

Hepatitis B virus (HBV) chronic infection represents a significant cause of morbidity and mortality worldwide. While traditional intramuscular (IM) HBV vaccination is an excellent method for robust and sustained seroconversion in healthy individuals, its efficacy in chronic liver disease is sub-optimal and scant data exists in the post-liver transplant state. Importantly, HBV complications are even more severe in these same immunocompromised populations. Intra-dermal (ID) vaccination has shown initial promise as a successful alternative to achieving HBV seroconversion in patients refractory to standard vaccination protocols. Herein is a case report of a 61 year-old female who underwent liver transplantation for chronic HBV infection and achieved HBsAg seroconversion with a robust HSsAb titer with ID vaccination after having failed both standard and double dose IM vaccination.

Two Crossed Dermal Flaps for Prevention of Bottoming out after Breast Reduction

Introduction: Breast reduction is one of the most prevalent plastic surgery procedures in Syria and the world, bottoming out on the other hand is one of the most happened disadvantages after breast reduction with inferior pedicle technique. Different techniques were used to prevent this deformity after inferior pedicle. In this study we tried to prevent bottoming out by using two crossed dermal flaps suspending the inferior pedicle to the periosteum of the 2nd rib. Methods and materials: 32 patients had breast reduction surgery using inferior pedicle technique at Almowassat University Hospital in Damascus. We divide them into 2 groups, 16 patients each. First group we used crossed dermal flaps with the inferior pedicle and the second group was without these flaps, the dermal flaps had a base on the side of the inferior pedicle base, crossed anterior to it in the middle point between the lower edge of the areola and the IMF and then sutured to the periosteum of the 2nd rib on each side. Results: Preoperatively, the average distance between the inframammary fold and areola was 14.5 cm (range, 11 - 18 cm) in the first group without dermal flaps and 14 cm in the second group with dermal flaps. The average amount of breast parenchymal resection was 790 g (range, 140 - 1600 g). The average distance between the inframammary fold and the lower border of the areola was 8.5 cm (range, 7.5 - 9 cm) on the postoperative first-year measurements in the group with flaps and 10.2 cm (8.6 - 11.4 cm) in the other group. Conclusion: Inferior pedicle suspension using crossed dermal flaps has a real role in preventing bottoming out, without using any allogenic or alloplastic materials, making it one of the considered ways in preventing bottoming after breast reduction.