Daily Cosmetic Research Analysis
Analyzed 26 papers and selected 3 impactful papers.
Summary
Analyzed 26 papers and selected 3 impactful articles.
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 and reducing scar thickness. Mechanistic multi-omics showed ATRA activates RARα to upregulate HIC1, PCK1, and PCK2, suppressing aerobic glycolysis and myofibroblast activation; in vivo overexpression of these targets reduced scarring in mice.
Impact: This study unites rigorous clinical evidence with mechanistic validation to identify a targetable metabolic pathway for scar prevention using a widely available topical agent.
Clinical Implications: Topical tretinoin can be considered for hypertrophic scar prophylaxis after wounds or procedures, and the ATRA/RARα–HIC1–PCK1/2 axis offers a mechanistic basis for metabolic antifibrotic strategies.
Key Findings
- In a multicenter double-blind RCT, tretinoin cream was non-inferior to silicone gel for preventing hypertrophic scarring (absolute risk difference −8.65%, 90% CI −23.03 to 5.74).
- ATRA reduced hypertrophic scar formation in mouse and rabbit models without impairing normal wound healing.
- Mechanistically, ATRA via RARα upregulated HIC1, PCK1, and PCK2, suppressing aerobic glycolysis, limiting myofibroblast activation, and reducing fibroblast proliferation.
- Fibroblast-specific overexpression of HIC1, PCK1, or PCK2 in Col1a2-CreER mice significantly attenuated myofibroblast activation and hypertrophic scarring.
Methodological Strengths
- Multicenter, double-blind randomized controlled trial with registered protocol (ChiCTR2500097242).
- Integrated multi-omics, cell assays, genetic perturbation, and in vivo validation across two animal models.
Limitations
- Human sample size and detailed demographics were not specified in the abstract.
- Long-term clinical outcomes and performance across diverse skin types require further study.
Future Directions: Larger, diverse RCTs assessing long-term scar outcomes and patient-reported measures; development of metabolic modulators targeting the RARα–HIC1–PCK1/2 pathway.
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. 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 use, overall complications, and length of stay, and improved cosmetic satisfaction—particularly compared with mini-laparotomy—without increases in blood loss, intraoperative complications, or dyspareunia.
Impact: This synthesis clarifies benefits of natural-orifice extraction on recovery and cosmesis across multiple surgical specialties, guiding incision-sparing strategies.
Clinical Implications: For eligible women, TVSE can be prioritized over mini-laparotomy for specimen retrieval to reduce pain, complications, and hospital stay while enhancing cosmetic satisfaction.
Key Findings
- TVSE lowered postoperative pain (mean difference −0.98, 95% CI −1.30 to −0.66) and reduced rescue analgesia use (OR 0.38, 95% CI 0.28–0.51).
- Overall postoperative complications decreased with TVSE (OR 0.55, 95% CI 0.34–0.89) and length of stay was shorter (MD −1.04 days, 95% CI −1.77 to −0.30).
- Cosmetic satisfaction improved with TVSE (MD 0.91, 95% CI 0.46–1.35), especially versus mini-laparotomy; blood loss, intraoperative complications, and dyspareunia showed no differences.
Methodological Strengths
- Comprehensive multi-database search and stratified analyses by study design, specialty, and extraction method.
- Inclusion of 25 studies with 2751 patients increases precision of pooled estimates.
Limitations
- Mix of study designs with potential heterogeneity despite subgrouping.
- Limited randomized evidence; need for standardized patient-reported and sexual function outcomes.
Future Directions: Adequately powered RCTs comparing TVSE versus port-site enlargement with standardized pain, cosmesis, and sexual function outcomes.
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.
3. Laparoendoscopic single-site versus conventional laparoscopic living donor nephrectomy: a systematic review and meta-analysis of randomized controlled trials.
Across 4 RCTs (n=274), laparoendoscopic single-site donor nephrectomy showed no significant perioperative advantages over conventional laparoscopy for operative metrics or complications. Larger multicenter RCTs with patient-reported and cosmetic outcomes are needed to clarify any benefits.
Impact: Provides RCT-only synthesis clarifying that purported perioperative benefits of single-site donor nephrectomy are unproven, sharpening priorities for future trials to include pain, recovery, and cosmetic endpoints.
Clinical Implications: Routine adoption of single-site donor nephrectomy solely for perioperative gains is not supported; centers should weigh surgeon experience and prioritize comprehensive patient-reported and cosmetic outcomes in decision-making and future studies.
Key Findings
- Meta-analysis of 4 RCTs (n=274) detected no significant differences between LESS-DN and CLDN in operative time, warm ischemia time, blood loss, length of stay, time to extraction, or overall complications.
- Cochrane RoB 1.0 was applied for bias assessment, and pooled analyses used RevMan 5.4.1.
- Authors highlight the need for adequately powered, multicenter RCTs capturing postoperative pain, patient-reported recovery, and cosmetic satisfaction.
Methodological Strengths
- Restriction to randomized controlled trials strengthens internal validity.
- Formal risk-of-bias assessment with Cochrane RoB 1.0.
Limitations
- Only four RCTs with modest sample size may be underpowered to detect small differences.
- Patient-reported and cosmetic outcomes were not consistently captured.
Future Directions: Multicenter RCTs powered for patient-reported pain, recovery trajectories, and cosmetic satisfaction, alongside cost-effectiveness analyses.
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.