Daily Cosmetic Research Analysis
Analyzed 26 papers and selected 3 impactful papers.
Summary
A multicenter RCT with integrated multi-omics shows tretinoin (ATRA) prevents hypertrophic scarring by reprogramming fibroblast glucose metabolism via RARα–HIC1–PCK1/2. Two surgery-focused meta-analyses refine cosmetic practice: laparoendoscopic single-site donor nephrectomy offers no perioperative advantage over conventional laparoscopy, while transvaginal specimen extraction improves pain, complications, length of stay, and cosmetic satisfaction versus mini-laparotomy.
Research Themes
- Metabolic reprogramming as an antifibrotic strategy in scar prevention
- Evidence-based appraisal of minimally invasive surgical techniques and cosmetic outcomes
- Translation of randomized evidence to procedural selection and patient counseling
Selected Articles
1. From RCT to mechanistic study: ATRA reverses myofibroblast activation by reprogramming glucose metabolism via HIC1 and PCK1/2 to attenuate hypertrophic scar formation.
A multicenter, double-blind RCT found tretinoin cream non-inferior to silicone gel for preventing hypertrophic scars, reducing scar thickness without delaying wound healing. Mechanistically, ATRA activates RARα to upregulate HIC1 and PCK1/2, suppressing aerobic glycolysis, promoting gluconeogenesis, and inhibiting myofibroblast phenotypes; fibroblast-specific overexpression of these targets reduced scarring in vivo.
Impact: This study bridges randomized clinical evidence with mechanistic validation, identifying a metabolic pathway (RARα–HIC1–PCK1/2) as a druggable axis for scar prevention. It elevates tretinoin from empirical use to mechanistically guided therapy.
Clinical Implications: Topical tretinoin can be considered for hypertrophic scar prevention, with a mechanistic rationale to target glucose metabolism in fibroblasts. Metabolic modulators of RARα–HIC1–PCK1/2 may represent future antifibrotic interventions.
Key Findings
- Tretinoin was non-inferior to silicone gel for hypertrophic scar prevention with an absolute risk difference of −8.65% (90% CI −23.03 to 5.74).
- Scar thickness decreased more with tretinoin without impairing wound healing in both mouse and rabbit models.
- ATRA activated RARα to upregulate HIC1, PCK1, and PCK2, suppressing aerobic glycolysis and promoting gluconeogenesis in hypertrophic scar fibroblasts.
- Fibroblast-specific overexpression of HIC1, PCK1, or PCK2 reduced myofibroblast activation and hypertrophic scarring in vivo.
Methodological Strengths
- Multicenter, double-blind randomized controlled trial with registered protocol (ChiCTR2500097242).
- Integrated multi-omics, functional metabolic assays, animal models, and genetic overexpression for mechanistic validation.
Limitations
- Sample size and detailed RCT endpoints are not fully reported in the abstract.
- Long-term durability, dosing optimization, and comparative effectiveness across skin types were not addressed.
Future Directions: Conduct adequately powered multicenter RCTs with long-term cosmetic/functional outcomes, dose–response studies, and evaluation across diverse skin types; explore pharmacologic modulation of the RARα–HIC1–PCK axis.
BACKGROUND: Abnormal glucose metabolism often contributes to myofibroblast activation and the pathogenesis of skin fibrotic diseases. All-trans retinoic acid (ATRA), the active component of tretinoin cream, can regulate glucose metabolism and activate myofibroblasts. Importantly, investigating the potential of ATRA to inhibit myofibroblast activation by modulating glucose metabolism could reveal the translational significance of ATRA in attenuating hypertrophic scar (HS) formation. METHODS: We first conducted a multicenter, double-blind, randomized controlled trial (RCT) to compare the effects of tretinoin cream with those of the first-line medication, silicone gel. In the mechanistic study, the characteristics of glucose metabolic reprogramming and the activation of hypertrophic scar fibroblasts (HSFs) after ATRA treatment were identified through multi-omics profiling, complemented by glucose metabolism assays and functional validations. Besides, genetic overexpression targeting the potential downstream molecules of ATRA, including hypermethylated in cancer 1 (HIC1), phosphoenolpyruvate carboxykinase (PCK)1, and PCK2, was conducted RESULTS: Our RCT demonstrated that tretinoin cream is non-inferior to silicone gel in preventing HS formation, with the absolute risk difference of incidence rates [-8.65% 90% two-sided confidence interval (CI) -23.03 to 5.74] and in decreasing scar thickness [(2856.20±211.83) μm vs. (1664.57±273.50) μm], attributing to the reduction in HSF proliferation and the proportion of myofibroblasts. Moreover, tretinoin cream effectively mitigated HS formation in both mice and rabbits without impeding normal wound healing. Mechanistically, HSFs underwent glucose reprogramming, characterized by increased aerobic glycolysis, which facilitated the transition of HSFs to myofibroblasts and their proliferation. However, ATRA upregulated HIC1, PCK1, and PCK2 expression through retinoic acid receptor alpha (RARα) activation, thereby inhibiting the fibrotic phenotypes of HSFs by suppressing aerobic glycolysis and facilitating gluconeogenesis. The fibroblast-specific overexpression of HIC1, PCK1, or PCK2 in Col1a2-CreER mice significantly reduced myofibroblast activation and hypertrophic scarring. CONCLUSIONS: Our study not only substantiated that topical tretinoin cream could serve as an effective strategy to prevent HSs in clinical settings, but also established ATRA as a regulator of glucose metabolism. Importantly, ATRA/RARα-mediated glucose reprogramming was identified as a potential therapeutic target for attenuating HS formation. TRIAL REGISTRATION: ChiCTR, ChiCTR2500097242. Registered on 14 Feb, 2025. Available from https://www.chictr.org.cn/bin/project/edit?pid=220146.
2. Laparoendoscopic single-site versus conventional laparoscopic living donor nephrectomy: a systematic review and meta-analysis of randomized controlled trials.
Across four RCTs (n=274 donors), LESS donor nephrectomy showed no significant perioperative differences versus conventional laparoscopy in operative time, warm ischemia, blood loss, length of stay, extraction time, or complication rates. The authors call for larger multicenter RCTs to assess pain, recovery, and cosmetic satisfaction.
Impact: Provides randomized evidence that challenges presumed perioperative advantages of LESS in living donors, discouraging adoption based on unproven benefits.
Clinical Implications: Technique selection should prioritize surgeon expertise and donor safety rather than presumed perioperative or cosmetic gains; patient counseling should reflect the absence of proven perioperative benefits.
Key Findings
- Meta-analysis of four RCTs (n=274) found no significant differences between LESS-DN and CLDN in operative time and warm ischemia time.
- No significant differences in estimated blood loss, length of hospital stay, or time to extraction.
- Overall complication rates were comparable between LESS-DN and CLDN.
Methodological Strengths
- Inclusion limited to randomized controlled trials with formal Cochrane RoB 1.0 bias assessment.
- Standardized meta-analytic approach using RevMan 5.4.1.
Limitations
- Small aggregate sample size (n=274) limits power to detect modest differences.
- Lack of patient-reported outcomes including pain, recovery, and cosmetic satisfaction.
Future Directions: Conduct adequately powered, multicenter RCTs incorporating patient-reported outcomes (pain, recovery) and standardized cosmetic satisfaction metrics.
BACKGROUND: Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs). METHODS: PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software. RESULTS: Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates. CONCLUSIONS: Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials-particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction-are warranted.
3. Transvaginal versus transabdominal extraction techniques in laparoscopic surgery: a systematic review and meta-analysis.
Across 25 studies (n=2751), transvaginal specimen extraction reduced postoperative pain, rescue analgesia, complications, and hospital stay and improved cosmetic satisfaction, particularly versus mini-laparotomy, without increasing dyspareunia. Benefits were smaller when compared with simple port-site enlargement.
Impact: Synthesizes cross-specialty evidence showing TVSE can preserve minimally invasive benefits and cosmetic outcomes while maintaining safety, guiding procedural choice where feasible.
Clinical Implications: When expertise is available, consider TVSE instead of mini-laparotomy for specimen retrieval to reduce pain, complications, and length of stay and to improve cosmetic satisfaction; counsel that dyspareunia risk appears unchanged.
Key Findings
- TVSE lowered postoperative pain (MD −0.98, 95% CI −1.30 to −0.66) and reduced rescue analgesia use (OR 0.38, 95% CI 0.28 to 0.51).
- TVSE decreased postoperative complications (OR 0.55, 95% CI 0.34 to 0.89) and shortened hospital stay (MD −1.04 days, 95% CI −1.77 to −0.30).
- Cosmetic satisfaction was higher with TVSE (MD 0.91, 95% CI 0.46 to 1.35), with the greatest benefit versus mini-laparotomy; blood loss, intraoperative complications, and dyspareunia were similar.
Methodological Strengths
- Comprehensive multi-database search with stratification by design, specialty, and extraction method.
- Quantitative synthesis with exploration of heterogeneity across subgroups.
Limitations
- Predominantly non-randomized studies increase risk of bias and confounding.
- Heterogeneity in procedures and outcome definitions; limited standardized cosmetic metrics.
Future Directions: Prospective randomized trials comparing TVSE to mini-laparotomy and port-site enlargement with standardized pain, recovery, sexual function, and cosmetic outcome measures.
BACKGROUND: In laparoscopic surgery, specimen retrieval can require enlarging abdominal incisions, reducing the minimally invasive benefits. Transvaginal specimen extraction (TVSE) can offer a safer, more cosmetic alternative for women. This systematic review and meta-analysis evaluated the safety and outcomes of TVSE compared with transabdominal extraction, regardless of surgical indication. METHODS: EMBASE, Scopus, PubMed, MEDLINE, Web of Science, and the Cochrane Library were searched from inception to April 2025. Studies were grouped by design, surgical specialty, and extraction method (port enlargement versus mini-laparotomy) to explore heterogeneity. RESULTS: Twenty-five studies were included for 2751 patients (1144 TVSE, 1607 transabdominal extraction) in general, urologic, or gynecologic surgery. TVSE was associated with lower postoperative pain (mean difference -0.98, 95%CI -1.30 to -0.66), rescue analgesia use (OR 0.38, 95%CI 0.28 to 0.51), postoperative complications (OR 0.55, 95%CI 0.34 to 0.89), shorter hospital stays (mean difference -1.04, 95%CI -1.77 to -0.30), and higher cosmetic satisfaction (mean difference 0.91, 95% CI 0.46 to 1.35), especially versus mini-laparotomy. Blood loss, intraoperative complications, and dyspareunia did not differ. CONCLUSION: TVSE is associated with improved postoperative outcomes when it replaces mini-laparotomy, whereas less benefit is observed versus laparoscopic port-site enlargement. Further randomized controlled trials are needed to confirm these findings.