摘要：BACKGROUND? There is growing evidence of improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments. Retention of biologic fluids over the wound prevents desiccation of denuded dermis or deeper tissues and allows faster and unimpeded migration of keratinocytes over the wound surface. It allows also the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and re-epithelialization. Despite all of these documented benefits, applying the moist healing principles to large surface areas, in particular to large burns, is hindered by the major technical handicap of creating and maintaining a sealed moist environment over these areas. METHODS? From January to September 2001, healing of partial-thickness skin graft donor sites was studied in a prospective comparative study of two types of moist dressings, Tegaderm (3M Health Care, St. Paul, MN), a semipermeable membrane occlusive dressing, and moist exposed burn ointment (MEBO) (Julphar; Gulf Pharmaceutical Industries, United Arab of Emirates), an ointment that can provide a moist environment without the need of an overlying occlusive dressing. Healing was assessed both clinically and with serial measurements of transepidermal water loss (TEWL) and moisture. Following healing, scar quality was evaluated by two members of the team separately using a visual analog scale. Results were statistically analyzed. RESULTS? Faster healing was observed clinically with MEBO application. Physiologic healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality, demonstrating a positive relationship between function and cosmetic appearance. Moreover, the ointment is definitely easier to apply than the occlusive self-adhesive membrane, which requires some degree of dexterity and expertise. CONCLUSION? MEBO application is an effective and valid alternative to conventional occlusive dressings. Moreover, the observed improved anatomic and physiologic healing indicates that MEBO may have a positive effect on healing more that the mere fact of passive moisture retention.

摘要：Conventional management of partial-thickness burn wounds includes the use of paraffin gauze dressing, frequently with topical silver-based antibacterial creams. Some creams form an overlying slough that renders wound assessment difficult and are painful upon application. An alternative to conventional management, moist exposed burn ointment (MEBO), has been proposed as a topical agent that may accelerate wound healing and have antibacterial and analgesic properties. One hundred fifteen patients with partial-thickness burns were randomly assigned to conventional (n = 58) or MEBO treatment (n = 57). A verbal numerical rating score of pain was made in the morning, after burn dressing, and some 8 hours later. Patient pain profiles were summarized by locally weighted regression smoothing technique curves and the difference between treatments estimated using multilevel regression techniques. Mean verbal numerical rating scale pain levels (cm) in week 1 for all patients were highest at 3.2 for the after dressing assessment, lowest in the evening at 2.6, and intermediate in the morning at 3.0. This pattern continued at similar levels in week 2 and then declined by a mean of 0.5 in all groups in week 3. There was little evidence to suggest a difference in pain levels by treatment group with the exception of the postdressing pain levels in the first week when those receiving MEBO had a mean level of 0.7 cm (95% confidence interval, 0.2 to 1.1) lower than those on conventional therapy. MEBO appeared to bring greater pain relief for the postdressing assessment during the first week after burns. This initial relief, together with comparable pain levels experienced on other occasions, indicates that MEBO could be an alternative to conventional burns management.

摘要：Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.

摘要：New hopes in cell therapies have steadily arisen with ongoing progress in stem cell research, and innumerable conditions could be now treated and cured, from musculoskeletal injuries to diabetes to cardiac failure, to cite but a few, with the appropriate stem cells available. Arguably, the ideal therapeutic stem cells are those that naturally heal, repair, and replenish the target tissue in life, and research from the last decades has uncovered the presence of such committed, specialized stem cells in most organs. However, these cell lineage-specific regenerative cells are rare, difficult to identify and purify, and virtually impossible to culture for amplification as functionally intact, undifferentiated units. For this reason, and with the notable exception of hematopoietic stem cells, these are not presently amenable to clinical utilization.From the 1980's, Prof. Rongxiang Xu developed the theory that some of the pluripotent stem cells that build the embryo in early development also establish through adult life a minor subset of cells which, although seemingly terminally differentiated, retain strong multi-lineage developmental potential. He called these "potential regenerative cells" (PRCs), proposing these can be recruited into tissue repair and regeneration when no other progenitor cells are available (1). Although this hypothesis could not be fully tested experimentally at the time, it later turned out as strikingly visionary: on the one hand, it was demonstrated that mature cells can be reprogrammed into stem cells in culture, a discovery rewarded by attribution of the Nobel Prize in Medicine or Physiology in 2012 (2). Hence, transition from a functional, specialized cell back into a naïve, unbiased stem cell is, biologically, feasible and might explain the persistence of Rongxiang Xu's PRCs in adult organs. Another example in support of PRC existence refers to mesenchymal stem cells. MSCs are multipotent cells that can differentiate in culture into bone, cartilage, fat, tendon, muscle, and indirectly support, via growth factor secretion, the regeneration of multiple other tissues (3). This extraordinary potential has stimulated the use of MSCs in over 2000 clinical trials in attempts to treat multiple conditions in cardiology, orthopaedics, cancerology, nephrology, and many other specialties including medical immunology, since MSCs are also immunosuppressive (see clinicaltrials.gov). Despite such a popularity, progress in MSC science has long been hindered by the unknown identity of native, tissueresident mesenchymal stem cells, since these cells appear and expand in extended cultures of total, unselected cell populations dissociated from bone marrow, adipose tissue, umbilical cord, or other organs. Put in other words, MSCs are normally produced in vitro from elusive, rare ancestor cells that have long resisted description. This changed when multicolour, stringent flow cytometry cell sorting and sensitive differentiation assays were used for MSC prospective identification. In full support of the PRC concept proposed by Rongxiang Xu, innate tissue resident mesenchymal stem cells turned out to be differentiated perivascular cells of documented function. Pericytes, which enwrap capillaries and microvessels, regulate blood pressure and control angiogenesis. Equivalent cells populate the tunica adventitia at the periphery of larger blood vessels. Both purified pericytes and adventicytes give rise to bona fide mesenchymal stem cells when cultured in vitro (4,5). The use of transgenic reporter mice, in which cell lineages can be tracked dynamically, has confirmed the progenitor cell potential of perivascular cells in vivo (6). In aggregate, all these results have confirmed that differentiated cells can be reprogrammed into regenerative cells in culture and in the living organism, thus supporting Dr Xu's hypothesis on the existence of PRCs in adult organs.Professor Rongxiang Xu contributed to the development of formulations, mostly inspired by traditional Chinese medicine, for stem cell (PRC) stimulation in situ and in culture. Such a supplement, for instance, named GIC, was claimed to regenerate the gastrointestinal mucosa, as well as nerves, in culture. More recently, the LifeRegen Inc. company developed a line of products inspired by Dr Xu's research and patents were issued for a proprietary blend of natural ingredients produced via an original manufacturing process. All LifeRegen protocols rely on the infusion of combined black sesame oil, skullcap root, and beeswax. These products are considered GRAS (generally recognized as safe) by the FDA, and represent a scientific breakthrough merging ancient Chinese medicine recipes and Rongxiang Xu's groundbreaking results that are, moreover, being supported and extended by ongoing current research. More precisely, GI Balance and Juvenate Skincare are LifeRegen's proprietary formulations developed to nurture and renew the gut lining and create a cellular, rejuvenation promoting protective barrier for the skin, respectively.The insightful Prof. Rongxiang Xu predicted that some of the cells that constitute developed organs retain stem potential, and hence can be qualified as "potentially regenerative cells", and devised formulations that can stimulate such cells into tissue regeneration. He left us a rich legacy of centers at prestigious institutions, such as the Rongxiang Xu Center for Regenerative Therapeutics at Beth Israel Deaconess Medical Center in Boston, the Rongxiang Xu Center for Regenerative Life Science at the University of Southern California, and the Rongxiang Xu College of Health and Human Services at Cal state LA.The LifeRegen company has resumed and considerably amplified and diversified Dr Xu's approach to regenerative medicine, and is now sponsoring clinical studies for the GI Balance supplement that in previous published research enabled regeneration and rejuvenation of the entire gut mucosa within 6 months. In a more fundamental investigation perspective, PRCs have been prospectively identified and characterized in depth, for instance as pericytes and other perivascular elements, and can be purified to homogeneity and in large numbers from multiple organs (3). This opens unforeseen possibilities in regenerative medicine research whereby such well-characterized potential regenerative cells can be selected from the bone marrow, pancreas, skin, adipose tissue and other organs and treated with natural supplements for enhanced proliferation, migration, and differentiation. Such protocols should be initialized in culture and further developed in vivo by transplantation into relevant animal hosts. In perspective are novel biomolecular manoeuvres to drive the improved healing and replenishment of, for instance but not exclusively, cardiovascular, musculoskeletal, and epithelial tissues.