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Smoking affects collagen synthesis and extracellular matrix turnover in human skin
Abstract
Smoking is associated with premature facial wrinkling and aberrant wound healing, but the underlying mechanisms of skin injury are poorly understood.
To compare the in vivo collagen synthesis and degradation in the skin of smokers and non-smokers.
The study population consisted of 47 current smokers and 51 individuals who had never smoked from northern Finland. Suction blisters were induced in the sun-protected upper inner arm of the study subjects, after which suction blister fluid (SBF) was collected for analyses of the levels of aminoterminal procollagen propeptides of type I and III collagens (PINP and PIIINP, respectively), matrix metalloproteinase (MMP)-8 and tissue inhibitor of MMP (TIMP)-1. PINP, PIIINP and TIMP-1 were also determined from serum samples. The levels of active and pro MMP-1 were assessed from deep-frozen skin biopsies by Western blotting.
The synthesis rates of type I and III collagens were lower by 18% and 22%, respectively, in the SBF of the smokers compared with the non-smokers. The levels of MMP-8 were higher by 100% in the SBF of the smokers. The levels of MMP-1 in the skin biopsies did not differ significantly between the groups. The levels of TIMP-1 in SBF were 14% lower in the smokers than in the non-smokers, whereas the serum concentrations of TIMP-1 did not differ between the groups.
Smoking decreases the synthesis rates of type I and III collagens in skin in vivo and alters the balance of extracellular matrix turnover in skin.
... Knuutinen and colleagues [41], failed to identify significant changes in the distribution of elastic fibres in the photoprotected skin of smokers using histological methodologies. However, studies employing the immunohistological identification of elastin have found significant increases in both the number and total area attributable to elastin-positive fibres in the reticular and deeper dermis of the photoprotected skin of smokers [27,29]. ...
... The role of MMPs in the pathogenesis of wrinkle formation in the skin of smokers may be more important for the collagenous rather than the elastic fibre network. It has been shown previously that smoking decreases the synthesis of type I and III collagens in skin in vivo [41] and alters the balance of dermal extracellular matrix (ECM) turnover [41,45]. However, there are conflicting opinions on precisely which MMPs are responsible for the remodelling of collagen, with both MMP-1 [45] and MMP-8 [41] suggested as likely candidates. ...
... The role of MMPs in the pathogenesis of wrinkle formation in the skin of smokers may be more important for the collagenous rather than the elastic fibre network. It has been shown previously that smoking decreases the synthesis of type I and III collagens in skin in vivo [41] and alters the balance of dermal extracellular matrix (ECM) turnover [41,45]. However, there are conflicting opinions on precisely which MMPs are responsible for the remodelling of collagen, with both MMP-1 [45] and MMP-8 [41] suggested as likely candidates. ...
One of the major functions of human skin is to provide protection from the environment. Whilst we cannot entirely avoid, for example, sun‐exposure, it is likely that exposure to other environmental factors could impact cutaneous function. A number of studies have identified smoking as one such factor that leads to both facial wrinkle formation and a decline in skin function. In addition to the direct physical effects of tobacco smoke on skin, its inhalation has additional profound systemic effects for the smoker. The adverse effects on the respiratory and cardiovascular systems from smoking are well known. Central to the pathological changes associated with smoking is the elastic fibre, a key component of the extracellular matrices of lungs. In this study we examined the systemic effect of chronic smoking (>40 cigarettes/day; >5 years) on the histology of the cutaneous elastic fibre system, the nanostructure and mechanics of one of its key components, the fibrillin‐rich microfibril, and the micromechanical stiffness of the dermis and epidermis. We show that photoprotected skin of chronic smokers exhibits significant remodelling of the elastic fibre network (both elastin and fibrillin‐rich microfibrils) as compared to the skin of age‐ and sex‐matched non‐smokers. This remodelling is not associated with increased gelatinase activity (as identified by in situ zymography). Histological remodelling is accompanied by significant ultrastructural changes to extracted fibrillin‐rich microfibrils. Finally, using scanning acoustic microscopy, we demonstrated that chronic smoking significantly increases the stiffness of both the dermis and the epidermis. Taken together, these data suggest an unappreciated systemic effect of chronic inhalation of tobacco smoke on the cutaneous elastic fibre network. Such changes may in part underlie the skin wrinkling and loss of skin elasticity associated with smoking.
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... Smoking status was determined by four categories: daily smoker, non-daily smoker, former smoker (smoked in the past but currently quitted), and never smoker (individuals who had smoked fewer than 100 cigarettes in their lifetime). Dependent variables were IPSS grade {mild: IPSS total [0-7], moderate [8][9][10][11][12][13][14][15][16][17][18][19], severe [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]}, IPSS voiding [sum of IPSS Q1 (incomplete emptying), Q3 (intermittency), Q5 (weak stream), Q6 (straining); 5 or higher score categorized as having symptoms], IPSS storage [sum of IPSS Q2 (frequency), Q4 (urgency), Q7 (nocturia); 4 or higher score categorized as having symptoms], and nocturia (IPSS Q7; 1 or higher score categorized as having symptoms). Socio-demographic factors and comorbidities were considered as covariates. ...
... The possible mechanism for the effect of cigarette smoking on LUTS has been investigated in many experimental studies. These studies have suggested that cigarette smoking could increase androgen level (16,17), increase the sympathetic tone activity by nicotine receptor (18,19), and cause imbalance in hormone and nutrient between muscle and collagen (20). Other studies support that the negative effect of cigarette smoking on nocturia is especially related to metabolic syndrome (21). ...
Background:
Although there have been several studies about the relationship between alcohol or smoking and lower urinary tracts symptoms (LUTS). This study aimed to investigate the association between alcohol or smoking and severity of LUTS in men, as alcohol intake and cigarette smoking is important modifiable lifestyle factors for LUTS.
Methods:
A cross-sectional analysis has been performed and a total of 86,707 participants in Korean Community Health Survey were included for final analysis. The adjusted odds ratio (OR) or coefficient with 95% confidence interval (CI) estimates were described to show the association between alcohol consumption or cigarette smoking and LUTS.
Results:
Among the total subjects, 77,398 (89.3%), 7,532 (8.7%), and 1,777 (2.0%) had mild, moderate, and severe symptoms, respectively, according to International Prostate Symptom Score (IPSS) grade. Those who drank alcohol at least once per month were significantly associated with decreased risk of having the worst IPSS grade (OR: 0.80, 95% CI: 0.68 to 0.93). Those who smoked in the past but currently quitted and those who were daily smokers showed significantly increased risk of having the worst IPSS grade (past smoker, OR: 1.26, 95% CI: 1.14 to 1.39; daily smoker, OR: 1.21, 95% CI: 1.10 to 1.34). For nocturia, daily smoking showed positive effect (OR: 0.79, 95% CI: 0.75 to 0.84) whereas heavy alcohol drinking showed negative effect (OR: 1.22, 95% CI: 1.14 to 1.32).
Conclusions:
Alcohol showed positive effect on LUTS except nocturia whereas cigarette smoking had negative effect on LUTS except nocturia. Daily smoking showed positive effect on nocturia whereas heavy alcohol drinking showed negative effect on nocturia.
... Possible theories include disruption of collagen synthesis, altered expression of matrix metalloproteinases (MMPs), and oxidative stress. 22 Hypertension is generally considered to be a risk factor for AA, and elevated mean blood pressure is considered to be an independent risk factor for aneurysm rupture, reflecting the ongoing hemodynamic burden on the aortic wall, which leads to wall weakness. 23 In experimental animal models, hypertension accelerates the progression of experimental aneurysms by upregulating nuclear factor kappa-B (NF-κB) and erythroblast transformation specific (ETS). ...
Aortic aneurysm is a chronic aortic disease affected by many factors. Although it is generally asymptomatic, it poses a significant threat to human life due to a high risk of rupture. Because of its strong concealment, it is difficult to diagnose the disease in the early stage. At present, there are no effective drugs for the treatment of aneurysms. Surgical intervention and endovascular treatment are the only therapies. Although current studies have discovered that inflammatory responses as well as the production and activation of various proteases promote aortic aneurysm, the specific mechanisms remain unclear. Researchers are further exploring the pathogenesis of aneurysms to find new targets for diagnosis and treatment. To better understand aortic aneurysm, this review elaborates on the discovery history of aortic aneurysm, main classification and clinical manifestations, related molecular mechanisms, clinical cohort studies and animal models, with the ultimate goal of providing insights into the treatment of this devastating disease. The underlying problem with aneurysm disease is weakening of the aortic wall, leading to progressive dilation. If not treated in time, the aortic aneurysm eventually ruptures. An aortic aneurysm is a local enlargement of an artery caused by a weakening of the aortic wall. The disease is usually asymptomatic but leads to high mortality due to the risk of artery rupture.
... This family of enzymes is recognized as a key factor in lung ECM turnover and the members of the family, including MMP-9 and MMP-12, seem to be involved in an imbalance in protease and antiprotease activity, leading to the development of emphysema [19][20][21]. On the contrary, in smokers' skin, decreased levels of collagen I and collagen III were observed, and this finding may be a result of the imbalance (decreased collagen biosynthesis and/or increased degradation) related to the overexpression of MMPs [14,22,23]. Interestingly, all enzymes seem to be induced by tobacco smoke and other air pollution, factors involved in both processes of skin quality impairment and lung emphysema. ...
The aim of this study was to investigate facial wrinkling in COPD patients, its relationship with lung function parameters, and the differences in wrinkling between COPD patients and smokers without COPD. The study included 56 patients with COPD with smoking history and 84 controls. Wrinkle intensity was measured and classified using Daniell’s grading system, and the total length of wrinkles was also estimated. The predominant grades of Daniell’s scale were IV–V for COPD patients (89.3% of current and 75.0% of former smokers), III–V for controls who currently smoke (89.2%), and II–III for former (92.9%) and never smokers (100%) controls. These distributions were statistically significantly different, but current and former smokers with COPD and COPD former smokers and control current smokers did not differ. In terms of the total length of wrinkles, the COPD patients possessed significantly longer wrinkles than the control subgroups (all p-values were <0.004). Negative correlations between wrinkle length and lung parameters were found. This phenomenon seems to be independent of smoking, but the length of wrinkles is related to lung function parameters. It seems that not only smoking but also COPD damages skin beauty and quality.
... In addition, smoking could cause nutritional imbalance, which may affect bladder and collagen synthesis [50]. It may also affect bladder wall strength and detrusor instability [51]. ...
Background
Obesity (waist circumference, body mass index (BMI)) and lifestyle factors (dietary habits, smoking, alcohol drinking, Sedentary behavior) have been associated with risk of benign prostatic hyperplasia (BPH) in observational studies, but whether these associations are causal is unclear.
Methods
We performed a univariable and multivariable Mendelian randomization study to evaluate these associations. Genetic instruments associated with exposures at the genome-wide significance level (P < 5 × 10–8) were selected from corresponding genome-wide associations studies (n = 216,590 to 1,232,091 individuals). Summary-level data for BPH were obtained from the UK Biobank (14,126 cases and 169,762 non-cases) and FinnGen consortium (13,118 cases and 72,799 non-cases). Results from UK Biobank and FinnGen consortium were combined using fixed-effect meta-analysis.
Results
The combined odds ratios (ORs) of BPH were 1.24 (95% confidence interval (CI), 1.07–1.43, P = 0.0045), 1.08 (95% CI 1.01–1.17, P = 0.0175), 0.94 (95% CI 0.67–1.30, P = 0.6891), 1.29 (95% CI 0.88–1.89, P = 0.1922), 1.23 (95% CI 0.85–1.78, P = 0.2623), and 1.04 (95% CI 0.76–1.42, P = 0.8165) for one standard deviation (SD) increase in waist circumference, BMI, and relative carbohydrate, fat, protein and sugar intake, 1.05 (95% CI 0.92–1.20, P = 0.4581) for one SD increase in prevalence of smoking initiation, 1.10 (95% CI 0.96–1.26, P = 0.1725) and 0.84 (95% CI 0.69–1.02, P = 0.0741) for one SD increase of log-transformed smoking per day and drinks per week, and 1.31 (95% CI 1.08–1.58, P = 0.0051) for one SD increase in sedentary behavior. Genetically predicted waist circumference (OR = 1.26, 95% CI 1.11–1.43, P = 0.0004) and sedentary behavior (OR = 1.14, 95% CI 1.05–1.23, P = 0.0021) were associated with BPH after the adjustment of BMI.
Conclusion
This study supports independent causal roles of high waist circumference, BMI and sedentary behavior in BPH.
... TIMPs are natural inhibitors of MMPs, and the interaction between MMPs and TIMPs determines the deposition and degradation of the ECM, which is essential for neovascularization during healing [66]. It has been suggested that disturbed expression of TIMPs and MMPs may delay wound healing [67], and this phenomenon can be clearly observed in the serum of smokers [68]. In our study, we observed that 100 µA MC corrected the expression of MMPs and TIMPs that were downregulated by 3% CSE, and CSE-injured HaCaT cells showed a higher magnitude of upregulation of MMPs compared to TIMPs after MC exposure, suggesting a therapeutic role of MC in enhancing matrix remodeling potential, which is beneficial for angiogenesis. ...
Cigarette smoking (CS) leads to several adverse health effects, including diseases, disabilities, and even death. Post-operative and trauma patients who smoke have an increased risk for complications, such as delayed bone or wound healing. In clinical trials, microcurrent (MC) has been shown to be a safe, non-invasive, and effective way to accelerate wound healing. Our study aimed to investigate if MC with the strength of 100 μA may be beneficial in treating CS-related healing impairment, especially in regard to angiogenesis. In this study, we investigated the effect of human keratinocyte cells (HaCaT) on angiogenesis after 72 h of cigarette smoke extract (CSE) exposure in the presence or absence of 100 μA MC. Cell viability and proliferation were evaluated by resazurin conversion, Sulforhodamine B, and Calcein-AM/Hoechst 33342 staining; the pro-angiogenic potential of HaCaT cells was evaluated by tube formation assay and angiogenesis array assay; signaling pathway alterations were investigated using Western blot. Constant exposure for 72 h to a 100 μA MC enhanced the angiogenic ability of HaCaT cells, which was mediated through the PI3K-Akt signaling pathway. In conclusion, the current data indicate that 100 μA MC may support wound healing in smoking patients by enhancing angiogenesis.
... Cell-ECM attachment and spreading are the main steps in cell migration, and these are known to require the activation of Rho Guanosine-5 ′ -triphosphatases (GTPase) (Ridley et al., 2003). Knuutinen et al. reported that the synthesis rates of type I and III collagens in extracellular matrix were altered and the levels of MMP-8 were higher among smokers compared to non-smokers (Knuutinen et al., 2002). ...
Objectives: The aims of this study were to investigate the efficacy of Histatin-1 in wound closure as well as effects
on gene expression of nicotine-treated human Periodontal Ligament Fibroblast cells (HPDL) in vitro.
Design: HPDL grown in 2.5% culture medium treated with 10 ng/ml Histatin − 1 in the presence/absence of 0.5
µM nicotine were subjected to wound assay and migration was studied at 0 h, 6 h, 12 h and 24 h. Cells grown in
2.5% medium served as control. Cell migration was studied by wound gap and transwell migration assays. The
effect of Histatin-1 on expression of matrix metalloproteinase 8 (MMP-8), insulin-like growth factor 1 (IGF-1),
transforming growth factor beta (TGF-β), collagen type I (COL1) and plasminogen activator inhibitor 1 (PAI-1)
were studied.
Results: Histatin-1 treatment significantly decreased percentage wound gap at 12 h (62.96 ± 3.22 vs 79.23 ±
1.73; p < 0.05) and at 24 h (38.78 ± 7.59 vs 75.21 ± 4.94; p < 0.001) compared with controls. In nicotine+Histatin-1 treated cells, wound gap decreased to 70.2 ± 2.9% (p < 0.01) at 24 h compared to nicotine
alone in which 82 ± 1.64% of wound gap was retained. Transwell migration assays showed significant migration
of HPDL with Histatin-1 (p < 0.05). Gene expression demonstrated significant upregulation for IGF-1, TGF β,
COL1 and PAI-1 with Histatin-1.
Conclusion: Histatin-1 significantly mitigated the effect of nicotine in wound healing assay involving HPDL
fibroblast cells at 24 h. Histatin-1 aided wound closure is attributed to the upregulation of IGF-1, TGF β, COL1,
and PAI-1 genes.
... Cell-ECM attachment and spreading are the main steps in cell migration, and these are known to require the activation of Rho Guanosine-5'-triphosphatases (GTPase) (Ridley et al., 2003). Knuutinen et al reported that the synthesis rates of type I and III collagens in extracellular matrix were altered and the levels of MMP-8 were higher among smokers compared to non-smokers (Knuutinen et al., 2002). Smoking damages cell matrix and does not allow appropriate cell migration activity. ...
Objectives: The aims of this study were to investigate the efficacy of Histatin-1 in wound closure as well as effects on gene expression of nicotine-treated human Periodontal Ligament Fibroblast cells (HPDL) in vitro. Design: HPDL grown in 2.5% culture medium treated with 10ng/ml Histatin-1 in the presence/absence of 0.5µM nicotine were subjected to wound assay and migration was studied at 0h, 6h, 12h and 24h. Cells grown in 2.5% medium served as control. Cell migration was studied by wound gap and transwell migration assays. The effect of Histatin-1 on expression of matrix metalloproteinase 8 (MMP-8), insulin-like growth factor 1 (IGF-1), transforming growth factor beta (TGF-β), collagen type I (COL1) and plasminogen activator inhibitor 1 (PAI-1) were studied. Results: Histatin-1 treatment significantly decreased percentage wound gap at 12 h (62.96 ± 3.22 vs 79.23 ± 1.73; p 0.05) and at 24h (38.78 ± 7.59 vs 75.21 ± 4.94; p 0.001) compared with controls. In nicotine+Histatin-1 treated cells, wound gap decreased to 70.2 ± 2.9 % (p 0.01) at 24 h compared to nicotine alone in which 82 ± 1.64 % of wound gap was retained. Transwell migration assays showed significant migration of HPDL with Histatin-1 (p 0.05). Gene expression demonstrated significant upregulation for IGF-1, TGF β, COL1 and PAI-1 with Histatin-1. Conclusion: Histatin-1 significantly mitigated the effect of nicotine in wound healing assay involving HPDL fibroblast cells at 24h. Histatin-1 aided wound closure is attributed to the upregulation of IGF-1, TGF β, COL1, and PAI-1 genes. J o u r n a l P r e-p r o o f
... From early adulthood, fibroblasts become less active and collagen production declines by about 1.0%-1.5% a year [13,14] . This can also be aggravated by certain lifestyle choices like smoking and external factors like sun exposure [15] . Ongoing sunlight and pollution exposure and reduced efficiency in eliminating free radical chemicals add to the damage. ...
Collagen-based supplements have become a keystone in the management of the ageing process, with proven ability to repair skin damage, bestowing a youthful and healthy appearance sought in the pursuit of beauty. Collagen is an essential scaffold protein that gives smoothness and elasticity to skin, but its production declines with age. Finding ways to tackle this problem is now strongly promoted as an effective way to transform skin and hair, repairing age-related deterioration. A growing number of scientific studies show exciting evidence that it is possible to rejuvenate ageing or damaged skin, improve function of worn joints, and support personal wellbeing and vitality. In recent times, research on the mechanisms which impact the production of collagen in skin and the ideal organization into functional fibres which give skin its characteristic elasticity and firmness has provided new insights into how this bio-scaffold can support cells, tissues and organs. The factors which influence collagen production over a lifetime (e.g., puberty, pregnancy, menopause, andropause), intrinsic factors (e.g., genetics, age, ethnicity) and extrinsic factors (e.g., UV-radiation, pollution, smoking) and the potential for new technologies, ingredients and devices to restore collagen and matrix components to their optimal condition are improving the ability to deliver anti-aging strategies with unprecedented results. This paper will review skin collagen production, structure and function throughout the lifestages, emphasizing its relationship with health, appearance and beauty.
... Smoking has a multifactorial detrimental effect on wound healing due to its reduction of oxygen tension levels in the blood and tissue, disruption of microvasculature, and alteration in surgical site collagen deposition [29][30][31] . VHR and AWR involve several components that may compromise wound healing and promote infection such as undermined skin flaps, myofascial advancement flaps, mesh products, reduction of chronically incarcerated hernia contents, and other concurrent gastrointestinal operations such as fistula take-downs. ...
Prehabilitation for abdominal wall procedures provides an opportunity to further modify patient risk factors for surgical complications. It includes interventions that optimize nutrition, glycemic control, functional status, and utilization of the patient’s microbiome pre-, intra-, and postoperatively. Through a multidisciplinary and anticipatory approach to patients’ existing co-morbidities, the physiological stress of surgery may be attenuated to ultimately minimize perioperative morbidity in the elective setting. With increasing data to support the efficacy of prehabilitation in optimizing surgical outcomes and decreasing hospital length of stay, it is incumbent on the surgeon to employ these practices in elective abdominal wall reconstruction. Further research on the effects of prehabilitation interventions will help to shape and inform protocols that may be implemented beyond abdominal wall procedures in an effort to continually improve best practices in surgical care.
... Among other factors, empirical evidence suggests associations between blistering time and age 15 or smoking status. 39,40 Therefore, the parameter "blistering time" reflects the strength of the dermo-epidermal adhesion and may be regarded as a clinically relevant parameter reflecting the mechanical integrity and resistance of the DEJ. 10,15 However, this proposed outcome has never been used in clinical research so far even though there is evidence supporting its usefulness. ...
Skin ageing is associated with various structural alterations including a decreased strength of the dermo‐epidermal adhesion increasing the risk for shear type injuries (skin tears). Topical applications of basic skin care products seem to reduce skin tear incidence. The suction blister method leads to the artificial and controlled separation of dermis and epidermis. Therefore, time to blister formation may be used as outcome measuring the strength of dermo‐epidermal adhesion. We conducted an exploratory, randomised, controlled trial with a split‐body design on forearms in healthy female subjects (n = 12; mean age 70.3 [SD 2.1] years). Forearms assigned to the intervention were treated twice daily with petrolatum for 8 weeks. Suction blisters were induced on forearms after 4 and 8 weeks and time to blister formation was measured. Stratum corneum and epidermal hydration were measured and epidermal thickness was assessed via optical coherence tomography. Time to blistering was longer and stratum corneum as well as epidermal hydration was consistently higher in intervention skin areas. We conclude that topical application of basic skin care products may improve mechanical adhesion of the dermo‐epidermal junction and that the parameter “time to blistering” is a suitable outcome to measure dermo‐epidermal adhesion strength in clinical research.
... Although the estimated half-life in vivo of collagen fibrils ranges from 15 to 95 years, 25 some factors such as aging, diseases, exposures to UV radiation and smoking, can accelerate its degradation process. [61][62][63][64] Inevitably, synthesis and degradation of collagen occur in the ECM. However, extreme levels of collagenolysis (i.e., collagen degradation) have been demonstrated to be the cause of several human diseases, such as arthritis, cancer, and atherosclerosis. ...
Collagen is an insoluble fibrous protein that composes the extracellular matrix in animals. Although collagen has been used as a biomaterial since 1881, the properties and the complex structure of collagen are still extensive study subjects worldwide. In this article, several topics of importance for understanding collagen research are reviewed starting from its historical milestones, followed by the description of the collagen superfamily and its complex structures, with a focus on type I collagen. Subsequently, some of the superior properties of collagen‐based biomaterials, such as biocompatibility, biodegradability, mechanical properties, and cell activities, are pinpointed. These properties make collagen applicable in biomedicine, such as wound healing, tissue engineering, surface coating of medical devices, and skin supplementation. Moreover, some antimicrobial strategies and the general host tissue responses regarding collagen as a biomaterial are presented. Finally, the current status and clinical application of the three‐dimensional (3D) printing techniques for the fabrication of collagen‐based scaffolds and the reconstruction of the human heart's constituents, such as capillary structures or even the entire organ, are discussed. Besides, an overall outlook for the future of this unique biomaterial is provided.
... The characteristic pattern of cigarette-related facial aging includes deep periorbital and perioral wrinkling, accompanied by orange skin discoloration, and occasionally large comedones [109]. The detrimental effect of smoking is driven by massive oxidative stress generation, antioxidant mechanisms impairment, and upregulation of matrix metalloproteinases [110,111]. So far, there are only indirect evidence for sirtuin 1 regulation of skin changes related to air pollutants. ...
Skin, as the outermost organ of the body, is constantly exposed to both intrinsic and extrinsic causative factors of aging. Intrinsic aging is related to compromised cellular proliferative capacity, and may be accelerated by harmful environmental influences with the greatest significance of ultraviolet radiation exposure, contributing not only to premature aging, but also to skin carcinogenesis. The overall skin cancer burden and steadily increasing global antiaging market provide an incentive for searching novel targets to improve skin resistance against external injury. Sirtuin 1, initially linked to extension of yeast and rodent lifespan, plays a key role in epigenetic modification of proteins, histones, and chromatin by which regulates the expression of genes implicated in the oxidative stress response and apoptosis. The spectrum of cellular pathways regulated by sirtuin 1 suggests its beneficial impact on skin aging. However, the data on its role in carcinogenesis remains controversial. The aim of this review was to discuss the relevance of sirtuin 1 in skin aging, in the context of intrinsic factors, related to genetic premature aging syndromes, as well as extrinsic modifiable ones, with the assessment of its future application. PubMed were searched from inception to 4 January 2021 for relevant papers with further search carried out on ClinicalTrials.gov. The systematic review included 46 eligible original articles. The evidence from numerous studies proves sirtuin 1 significance in both chronological and premature aging as well as its dual role in cancer development. Several botanical compounds hold the potential to improve skin aging symptoms.
... On the other hand, when the environment is disrupted by aging or other factors, there is aberrant compression, stiffness, extracellular tension, elasticity and topography of the tissue. Thence the alteration of the ECM physical structures and stereochemistry induce either directly or indirectly modification [97]. In addition, there are physical effects whereby the microand nano-scale particulate matter may interact act with dynamic mechanical forces on polymers, such as collagen [98]. ...
Appropriate mechanical forces on cells are vital for normal cell behaviour and this review discusses the possibility that tumour initiation depends partly on the disruption of the normal physical architecture of the extracellular matrix (ECM) around a cell. The alterations that occur thence promote oncogene expression. Some questions, that are not answered with certainty by current consensus mechanisms of tumourigenesis, are elegantly explained by the triggering of tumours being a property of the physical characteristics of the ECM, which is operative following loading of the tumour initiation process with a relevant gene variant. Clinical observations are consistent with this alternative hypothesis which is derived from studies that have, together, accumulated an extensive variety of data incorporating biochemical, genetic and clinical findings. Thus, this review provides support for the view that the ECM may have an executive function in induction of a tumour. Overall, reported observations suggest that either restoring an ECM associated with homeostasis or targeting the related signal transduction mechanisms may possibly be utilised to modify or control the early progression of cancers. The review provides a coherent template for discussing the notion, in the context of contemporary knowledge, that tumourigenesis is an alliance of biochemistry, genetics and biophysics, in which the physical architecture of the ECM may be a fundamental component. For more definitive clarification of the concept there needs to be a phalanx of experiments conceived around direct questions that are raised by this paper.
... On the other hand, when the environment is disrupted by aging or other factors, there is aberrant compression, stiffness, extracellular tension, elasticity and topography of the tissue. Thence the alteration of the ECM physical structures and stereochemistry induce either directly or indirectly modification [97]. In addition, there are physical effects whereby the microand nano-scale particulate matter may interact act with dynamic mechanical forces on polymers, such as collagen [98]. ...
Appropriate mechanical forces on cells are vital for normal cell behaviour and this review discusses the possibility that tumour initiation depends partly on the disruption of the normal physical architecture of the extracellular matrix (ECM) around a cell. The alterations that occur thence promote oncogene expression. Some questions, that are not answered with certainty by current consensus mechanisms of tumourigenesis, are elegantly explained by the triggering of tumours being a property of the physical characteristics of the ECM, which is operative following loading of the tumour initiation process with a relevant gene variant. Clinical observations are consistent with this alternative hypothesis which is derived from studies that have, together, accumulated an extensive variety of data incorporating biochemical, genetic and clinical findings. Thus, this review provides support for the view that the ECM may have an executive function in induction of a tumour. Overall, reported observations suggest that either restoring an ECM associated with homeostasis or targeting the related signal transduction mechanisms may possibly be utilised to modify or control the early progression of cancers. The review provides a coherent template for discussing the notion, in the context of contemporary knowledge, that tumourigenesis is an alliance of biochemistry, genetics and biophysics, in which the physical architecture of the ECM may be a fundamental component. For more definitive clarification of the concept there needs to be a phalanx of experiments conceived around direct questions that are raised by this paper.
... They said that it was due to hypoxia and impairment of collagen biyosynthesis (39). The study by Knuutinen et al. showed impaired collagen biosynthesis and turnover of extracellular matrix (40). Whereas, the studies by Sayın et al. and Kara et al. found no significant difference in CCT. ...
... Los mecanismos a través de los cuales el tabaco desencadenaría la formación del AAA son aún desconocidos. Se baraja la implicación de la inhibición en la síntesis de colágeno, la alteración en la expresión de metaloproteinasas y la posible relación con el estrés oxidativo 28 ; y estudios recientes en modelos de AAA asocian la exposición al tabaco con una alteración de la función de las células inflamatorias 29 . ...
Resumen
El aneurisma de aorta abdominal (AAA) es una patología vascular con una elevada tasa de morbimortalidad y una prevalencia que, en varones de más de 65 años, puede alcanzar el 8%. En esta enfermedad, habitualmente asintomática, se produce una dilatación progresiva de la pared vascular que puede llevar a su rotura, un fenómeno mortal en más de un 80% de los casos. El tratamiento de los pacientes con aneurismas asintomáticos se limita al seguimiento periódico con pruebas de imagen, el control de los factores de riesgo cardiovascular y un tratamiento con terapia antiagregante y estatinas, si bien actualmente no existe ningún tratamiento farmacológico efectivo capaz de limitar su progresión o evitar su rotura. En la actualidad el diámetro aórtico es el único marcador de riesgo de rotura y determina la necesidad de reparación quirúrgica cuando alcanza valores superiores a 5,5 cm. En esta revisión se tratan los principales aspectos relacionados con la epidemiología, los factores de riesgo, el diagnóstico y el manejo terapéutico del AAA, se exponen las dificultades para disponer de buenos biomarcadores de esta enfermedad y se describen las estrategias para la identificación de nuevas dianas terapéuticas y biomarcadores en el AAA.
... Also malnutrition, obesity, smoking and collagen disease are playing an important role in incidence of ventral hernia [6] [7]. Also there are many factors related to surgical technique as types of incision; for examples midline vertical incisions have a tendency to burst, which is higher than those, which are transverse [8] and type of closure can play a role as predisposing factor for ventral hernia incidence; layered closures may be followed by higher incidence of post operative hernias than wounds closed by single layer [mass closure technique]. ...
Abstract
Background: Ventral hernia is one of the most common abdominal wall hernias.
Several procedures have been used for hernia repair. During the last few
decades, the open surgical approach has been the standard technique for hernia
repair. During the past 10 years, laparoscopic repair of ventral hernia has
become increasingly established in clinical practice and aimed to be an acceptable
and successful technique. There are many techniques used in laparoscopic
ventral hernia repair and the most commonly used is fixation of
mesh without closing the defect or closing the defect before fixation of mesh.
... Furthermore, smoking increases the expression of small proteoglycans and reduces the synthesis of procollagen. 37 The clinical manifestations of these phenomena are pale and wrinkled skin; DNA mutations also result from oxidative effects or direct toxic damage. 38,39 Smoking is an important independent factor in skin aging, observed in an identical twin study, which concluded that 5-year difference in smoking history is associated with skin changes. ...
Studies assessing the impact of extrinsic factors on skin aging have increased during the last with the increase in life expectancy. Although most of the studies are about the sun radiation impact, many factors should be considered in elderly people, beyond environmental conditions. Lifestyle factors, like diet, sleeping, smoking, should be analyzed carefully, as common age-related conditions (menopause, diabetes, pulmonary diseases, etc.). All these factors could accelerate the natural decline of skin structure and functions, possibly affecting the responses to treatments and drugs. This review demonstrates that growing evidence regarding environmental factors that are associated with lifestyle and comorbidities deserve greater attention from researchers and dermatologists and may require new approaches in the management of skin aging.
... Also malnutrition, obesity, smoking and collagen disease are playing an important role in incidence of ventral hernia [6] [7]. Also there are many factors related to surgical technique as types of incision; for examples midline vertical incisions have a tendency to burst, which is higher than those, which are transverse [8] and type of closure can play a role as predisposing factor for ventral hernia incidence; layered closures may be followed by higher incidence of post operative hernias than wounds closed by single layer [mass closure technique]. ...
... La matrice de réparation tissulaire est alors inappropriée, induisant un retard de cicatrisation(7,361).La nicotine ralentit également l'épithélialisation(362). En effet, elle induit une diminution de la production de collagène(352,363) et va non seulement retarder la cicatrisation mais également induire une modification de la qualité de la cicatrice(364)(365)(366)(367). Enfin, le collagène représente un support à la création de nouveaux vaisseaux. ...
Les troubles de cicatrisation préoccupants en chirurgie plastique, en raison de décollements et d'une vascularisation cutanée fine. Or, le tabagisme est à l'origine de complications, en particulier celle-ci. Ce pourquoi un arrêt de la consommation est actuellement demandé 4 semaines avant et après les abdominoplasties.
En raison d'une sous-estimation des patients de leur consommation, un test de détection urinaire de cotinine est désormais réalisé en pré opératoire.
L'objectif de cette étude était d'évaluer l'efficacité de ce test en terme de réduction de troubles de cicatrisation et de complications chez des patients opérés d'une abdominoplastie.
Matériel et Méthode :
Il s'agissait d'une étude de cohorte historique rétrospective monocentrique, menée en centre hospitalier universitaire, entre janvier 2006 et mars 2016. Les critères d'inclusion étaient les patients opérés d'une abdominoplastie avec transposition de l'ombilic et lipoaspiration. À partir de 2013, un test de détection urinaire de cotinine était réalisé en pré opératoire. En cas de positivité, l'intervention était annulée. Le critère de jugement principal était la survenue d'un retard de cicatrisation. La survenue d'autres complications était secondairement analysée.
Résultats :
235 patients ont été inclus. Le test de détection urinaire de cotinine était un facteur protecteur de survenue d'un retard de cicatrisation, quel que soit son résultat, OR=0,41 ; IC 95% [0,20 - 0,841 (p=0,01) et de survenue de complications, OR=0,44 ; IC 95% [0,21 - 0,941 (p.0,03). Le tabagisme actif ou sevré était un facteur de risque significatif de survenue de complications.
Conclusion :
Le test de détection de cotinine urinaire en pré opératoire d'une abdominoplastie permet une diminution significative des retards de cicatrisation et des complications. Il est un indicateur objectif de la consommation tabagique du patient, simple, rapide à réaliser et non invasif. L'arrêt du tabagisme 4 semaines avant et après l'intervention devrait être systématiquement recommandé, et encadré de façon rigoureuse par le chirurgien, l'anesthésiste, avec une orientation rapide vers les professionnels tabacologues.
This chapter provides an outline of the knowledge and skills required by practitioners caring for patients with the main types of acute and chronic wounds in the field of trauma and orthopaedics. It focuses on the nursing management of wounds. This includes consideration of both surgical and traumatic wounds, an overview of the wound‐healing process and discussion of the current thinking with regards to dressing techniques. The chapter considers issues relating to the prevention and management of pressure ulceration. Traumatic wound care is an integral part of the care of the patient following musculoskeletal trauma as soft tissue wounds are often consistent with the rest of the pattern of injury. Factors affecting wound healing are often referred to as intrinsic or extrinsic. Pressure ulcers are localised areas of tissue damage that result from pressure or a combination of pressure and shear forces.
Genetic factors, androgens, and follicular micro-inflammation play key roles in causing “androgenic” hair loss (see Chaps. 11 and 14, Vol. 1) In order to affect the course and progression of AGA through diet or lifestyle, the only parameter in AGA that could be “manipulated” is the hormonal one, which includes several sub-components:Only the production and transfer steps could be modified through dietary and lifestyle changes, either towards a favorable decrease or an—unwanted—increase in overall androgen availability. The consumption of androgen-containing foods could exacerbate FPHL in some women, but it is unlikely that men would experience any detrimental effects because of high endogenous androgen levels. In the following sections, those lifestyle factors that could impact the course of AGA/FPHL, either by affecting androgen metabolism or by directly influencing the hair follicle physiology, will be examined.
Background
We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery.
Methods
A literature search was performed using the search terms “shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine].” Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges.
Results
Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly ( p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications.
Discussion
Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended.
Level of Evidence
Level III, Systematic Review.
Objectives:
The aims of this study were to investigate the efficacy of Histatin-1 in wound closure as well as effects on gene expression of nicotine-treated human Periodontal Ligament Fibroblast cells (HPDL) in vitro.
Design:
HPDL grown in 2.5% culture medium treated with 10 ng/ml Histatin - 1 in the presence/absence of 0.5 µM nicotine were subjected to wound assay and migration was studied at 0 h, 6 h, 12 h and 24 h. Cells grown in 2.5% medium served as control. Cell migration was studied by wound gap and transwell migration assays. The effect of Histatin-1 on expression of matrix metalloproteinase 8 (MMP-8), insulin-like growth factor 1 (IGF-1), transforming growth factor beta (TGF-β), collagen type I (COL1) and plasminogen activator inhibitor 1 (PAI-1) were studied.
Results:
Histatin-1 treatment significantly decreased percentage wound gap at 12 h (62.96 ± 3.22 vs 79.23 ± 1.73; p < 0.05) and at 24 h (38.78 ± 7.59 vs 75.21 ± 4.94; p < 0.001) compared with controls. In nicotine+Histatin-1 treated cells, wound gap decreased to 70.2 ± 2.9% (p < 0.01) at 24 h compared to nicotine alone in which 82 ± 1.64% of wound gap was retained. Transwell migration assays showed significant migration of HPDL with Histatin-1 (p < 0.05). Gene expression demonstrated significant upregulation for IGF-1, TGF β, COL1 and PAI-1 with Histatin-1.
Conclusion:
Histatin-1 significantly mitigated the effect of nicotine in wound healing assay involving HPDL fibroblast cells at 24 h. Histatin-1 aided wound closure is attributed to the upregulation of IGF-1, TGF β, COL1, and PAI-1 genes.
Objective
Smokers are more likely to undergo postoperative complications after plastic surgeries. Our main purpose was to update nicotine's effects after plastic surgeries and assess whether nicotine-replacement therapy and vaping are safe enough to be recommended in peri-operatory circumstances.
Methods
We set up a literature review including 40 documents from 1986 to 2020 available on Pubmed.
Results
Nicotine has undeniable detrimental effects on patients undergoing plastic surgeries like cutaneous necrosis, skin flap failure and surgical site infection. Nevertheless, this toxicity seems to depend on the plasma concentration of nicotine and thus on the way of administration. While smoking is definitely harmful, nicotine replacement therapies (NRT) like patches and gums do not appear to increase postoperative risks based on available studies. The situation is different with the electronic cigarette since the pharmacokinetic parameters are close to those of the traditional cigarette. Even if powerful studies are lacking because the device is recent, preliminary in vitro studies and case reports suggest non-zero surgical risks for e-cigarette users.
Conclusion
It seems more appropriate to suggest stopping all nicotine intake before and after plastic surgery. However, if strict cessation is not achievable, it appears preferable to use nicotine replacement therapies rather than e-cigarettes and most of all tobacco.
The aim of the study was to carry out a systematic review of the literature on the interrelation between the production of endogenous collagen and the mechanisms of human aging. The methods involved Systematic search on the electronic database PubMed and Scopus in order to select published articles on the endogenous synthesis of collagen and the molecular cascades responsible for aging, following the items of the Guidelines for Systematic Reviews and Meta-analysis (PRISMA). As for the results, 885 articles were identified in the searched databases (858 in PUBMED and 27 in SCOPUS). After exclusion by abstract and title, 62 articles were selected for analysis of the full text. At the end, 13 articles were chosen as relevant to compose the qualitative synthesis. The articles pointed out that collagen synthesis occurs in processes of regeneration and formation of embryonic tissue. Regarding the relationship between such production and aging, advancing age reduces the mechanical strength of fibroblasts due to the accumulation of fragments of collagen fibers in the intercellular spaces, as well as being associated with alterations in the proportions of type 1 and type 3 collagen levels. Collagen synthesis may still be susceptible to interference of environmental and genetic factors, such as nutrition, hormone levels, UV radiation and mutations. Finally, hydrolyzed collagen (HC) supplementation was associated mainly with maintaining skin health. Conclusions are that the synthesis and molecular levels of collagen are modified due to aging. In this context, environmental and genetic factors are also active in modifying these levels and production. To mitigate some effects of the skin aging process, hydrolyzed collagen supplementation is being indicated as effective.Keywords: human aging, collagen; endogenous synthesis. Resumo: O objetivo do estudo foi realizar uma revisão sistemática da literatura sobre a inter-relação entre a produção de colágeno endógeno e os mecanismos do envelhecimento humano. Os métodos envolveram busca sistemática na base de dados eletrônica PubMed e Scopus para selecionar artigos publicados sobre a síntese endógena de colágeno e as cascatas moleculares responsáveis pelo envelhecimento, seguindo os itens do Guidelines for Systematic Reviews and Meta-analysis (PRISMA). Quanto aos resultados, foram identificados 885 artigos nas bases de dados pesquisadas (858 na PUBMED e 27 na SCOPUS). Após exclusão por resumo e título, 62 artigos foram selecionados para análise do texto completo. Ao final, 13 artigos foram escolhidos como relevantes para compor a síntese qualitativa. Os artigos apontaram que a síntese de colágeno ocorre em processos de regeneração e formação do tecido embrionário. Quanto à relação entre tal produção e o envelhecimento, o avanço da idade reduz a resistência mecânica dos fibroblastos devido ao acúmulo de fragmentos de fibras colágenas nos espaços intercelulares, além de estar associado a alterações nas proporções dos níveis de colágeno tipo 1 e tipo 3. A síntese de colágeno ainda pode ser suscetível à interferência de fatores ambientais e genéticos, como nutrição, níveis hormonais, radiação UV e mutações. Por fim, a suplementação de colágeno hidrolisado (HC) foi associada principalmente à manutenção da saúde da pele. As conclusões são que a síntese e os níveis moleculares de colágeno são modificados devido ao envelhecimento. Nesse contexto, fatores ambientais e genéticos também atuam na modificação desses níveis e produção. Para mitigar alguns efeitos do processo de envelhecimento da pele, a suplementação de colágeno hidrolisado está sendo indicada como eficaz.Palavras-chave: envelhecimento humano, colágeno; síntese endógena.
Despite of clinical evidence of increased incidence of bone diseases amongst smokers as well as worsening recovery in orthopedic surgeries, it is still unclear which pathological mechanisms are induced by smoking and how these events impair bone turnover. Animal models and in vitro studies have been used to better elucidate these questions and smoking-induced oxidative stress have been pointed as playing crucial role in the worsening of bone cells activities leading bone damage. Oxidative stress is a physiological mechanism characterized by an imbalance between oxidants and antioxidants components. This imbalance leads cell damage and consequent release of inflammatory mediators, resulting in structural changes that impair the functionality of compromised organ. In this review, we summarize findings from clinical, animal models and in vitro studies that have elucidated the importance of the oxidative stress induced by smoking in different bone cells activities, leading bone mineral and organic matrix structural changes.
Given the advances in diagnostic tools and emerging new surgical and endovascular approaches during recent years to treat disorders of the aorta, a brief knowledge of such diseases and new approaches to treat them is mandatory.
This chapter is designed to introduce the basics of the aorta including practical anatomy, histology, and physiology of the aorta as well as pathological pathways that lead to aortic diseases. The most recent approaches to diagnose and treat aortic diseases are also included.
Previously, some of these disorders had been considered as the so-called “No option for treatment.” However, during recent years, by evolving new therapeutic approaches, nearly all of them can be treated by either surgical or endovascular approaches.
Until the last few years, the only way to address clinical conditions associated with lax facial skin such as prominent laugh lines, jowls, and drooping cheeks was through facelift surgery which could include surgery for rejuvenation of the neck and periorbital areas. Fat deposits in the submental area and the cheeks could only be reduced through liposuction, and non-surgical procedures were limited to the use of injectables and resurfacing procedures.
Cigarette and electronic cigarette use are significant public health concerns across the United States. Tobacco use remains the single most preventable cause of morbidity and mortality in the world. Electronic cigarettes initially emerged as a better alternative to conventional cigarettes and for promoting smoking cessation; however, current evidence reveals similar deleterious health implications caused by both products on almost all organ systems, including the skin. Recognition of the cutaneous manifestations associated with cigarette and electronic cigarette use is essential for dermatologists in current clinical practice. Dermatologists play a vital role in educating and counseling patients on smoking cessation. We specifically highlight the cutaneous consequences of conventional cigarette smoking and electronic cigarettes on dermatologic disease.
Modifiable lifestyle-related risk factors are the object of increasing attention, with a view to primary and tertiary prevention, to limit the onset and development of diseases.
Also in the urological field there is accumulating evidence of the relationship between urological diseases and lifestyle-related risk factors that can influence their incidence and prognosis. Risk factors such as nutrition, physical activity, sexual habits, tobacco smoking, or alcohol consumption can be modified to limit morbidity and reduce the social impact and the burdensome costs associated with diagnosis and treatment.
This review synthesizes the current clinical evidence available on this topic, trying to satisfy the need for a summary on the relationships between the most important lifestyle factors and the main benign urological diseases, focusing on benign prostatic hyperplasia (BPH), infections urinary tract (UTI), urinary incontinence (UI), stones, erectile dysfunction, and male infertility.
Smoking is known to increase the risk of peri-operative complications in Orthoplastic surgery by impairing bone and wound healing. The effects of nicotine replacement therapies (NRTs) and electronic cigarettes (e-cigarettes) has been less well established. Previous reviews have examined the relationship between smoking and bone and wound healing separately. This review provides surgeons with a comprehensive and contemporaneous account of how smoking in all forms interacts with all aspects of complex lower limb trauma. We provide a guide for surgeons to refer to during the consent process to enable them to tailor information towards smokers in such a way that the patient may understand the risks involved with their surgical treatment. We update the literature with recently discovered methods of monitoring and treating the troublesome complications that occur more commonly in smokers effected by trauma
Resumo
Introdução: O envelhecimento é inevitável, dentre os diversos órgãos que sofrem com o envelhecimento a pele é um órgão que sofre consideravelmente com fatores externos, o que potencialmente interfere no envelhecimento precoce do órgão. Tal envelhecimento está associado a uma maior probabilidade de desenvolvimento de doenças dermatológicas bem como interfere substancialmente em questões estéticas. Objetivo: Com base no suposto, o objetivo desse estudo foi o de analisar a frequência de exposição de universitários a fatores de risco envolvidos com o envelhecimento da pele Metodologia: Foram convidados a participar do estudo universitários de diversos cursos da área da saúde. Cada voluntário respondeu a um questionário estruturado contendo perguntas relacionadas a exposição a fatores de risco relacionados ao envelhecimento cutâneo, como tabagismo, etilismo, exposição prolongada ao sol, ausência de foto proteção e poucas horas de sono por dia.
Resultados: Ao todo foram entrevistados 298 voluntários de diversos cursos da área da saúde, sendo que a maioria se declarou da etnia branca. Encontramos uma baixa frequência do uso do cigarro (11%), porém frequência mais elevada de indivíduos que ingeriam álcool (42%), e adicionalmente cerca de 33% dos indivíduos relataram exposição ao sol, e cerca de 56% dos entrevistados não faziam uso de fotoproteção. Em relação ao sono, cerca de 56% dos indivíduos descreveram ter menos do que 6 horas de sono diárias.
Conclusão: A população estudada está frequentemente exposta aos principais fatores intrínsecos e extrínsecos envolvidos com o envelhecimento cutâneo.
Background
The purpose of this study was to investigate the association between smoking status and postoperative complications within 30 days of arthroscopic rotator cuff repair (ARCR).
Methods
All patients who underwent ARCR from 2015-2017 were queried from the American College of Surgeons National Surgical Quality Improvement (ACS NSQIP) database. Smokers were defined as patients who reported smoking cigarettes in the year prior to rotator cuff repair. Patients who used chewing tobacco, cigars, or electronic cigarettes were not included in the smoking cohort. Postoperative complications were reported within 30 days of procedure. Multivariate logistic regression was employed to investigate the relationship between smoking status and postoperative complications.
Results
There were 18,594 patients included in this study. 2,834 (15.2%) of these patients were current smokers. Smokers were more likely to be male, below the age of 65, and have a body mass index (BMI) <30. Smokers were also more likely to have chronic obstruction pulmonary disorder (COPD), be functionally dependent, and have an American Society of Anesthesiologists (ASA) class ≥ 3. After adjusting for all significantly associated patient demographics and comorbidities, smoking was identified as a significant predictor of surgical complications (OR 1.955, p=0.022), return to operating room (OR 2.547, p=0.003), readmission (OR 1.570, p=0.014), and sepsis or septic shock (OR 4.737, p=0.021). Smoking was not a significant predictor of medical complications (OR 1.105, p=0.687) or surgical site infections (OR 1.216, p=0.713).
Conclusion
Smoking may be a risk factor for surgical complications, readmission, and sepsis or septic shock within 30 days of arthroscopic rotator cuff repair.
Aim
To compare demographic factors, outcomes, and prognosis of right‐sided versus left‐sided acute colonic diverticulitis
Methods
We searched MEDLINE,CINAHL,EMBASE,CENTRAL,Scopus,and unpublished literature to identify all observational studies comparing demographic factors and outcomes of right‐sided versus left‐sided acute colonic diverticulitis (PROSPERO registration number: CRD42020180075). We used the QUIPS tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data.
Results
Analysis of 2933 patients from nine studies suggests that right‐sided diverticulitis affects younger patients [MD:‐14.16(‐17.19,‐11.14),P<0.00001] and more male patients [OR:1.33(1.04, 1.71,P=0.02] compared with left‐sided diverticulitis. Smoking [OR: 2.23(1.50,3.32),P<0.0001], alcohol consumption [OR:1.85(1.26,2.71),P=0.002) and co‐morbidity [OR:0.21[0.15,0.30],P<0.00001] were more common in patients with right‐sided diverticulitis. The risk of complicated diverticulitis was lower in the right‐sided group [OR:0.21(0.08,0.55),P=0.001]. More patients in the right‐sided diverticulitis group had modified Hinchey stage I disease [OR:10.21( 3.34,31.22),P<0.0001] while more patients in the left‐sided group had stage II [OR: 0.19(0.10, 0.38),P<0.00001], stage III [OR:0.08(0.01,0.54),P=0.009)or stage IV disease [OR:0.02(0.00,0.08),P<0.00001]. Right‐sided diverticulitis was associated with a lower risk of recurrence [OR:0.49( 0.25, 0.98),P=0.04], failure of conservative management [OR:0.14(0.04,0.43),P=0.0006], the need for emergency surgery [OR:0.13(0.05,0.36),P<0.00001) and shorter length of hospital stay [MD:‐1.70(‐3.08,‐0.33),P=0.02].
Conclusions
Right‐sided acute diverticulitis predominantly affects younger male patients compared with left‐sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right‐sided and left‐sided diverticulitis undergoing emergency surgery.
Peri-implantitis is a plaque-associated pathological condition with inflammation in the peri-implant mucosa and progressive loss of supporting bone. Identification of the players involved in development and progression of peri-implantitis continue to be investigated, diabetes and smoking remain the two risk factors that appear to play direct roles in this disease process. Diabetes is a growing disease world-wide that increases the inflammatory response through upregulation of advanced glycated end products (AGEs) and their receptors, delays wound healing by induction of hypoxic conditions and inhibition of cellular chemotaxis, and may also impair osseointegration by affecting osteoblastic differentiation and matrix production. These factors affect both onset and progression of peri-implant disease. Furthermore, tobacco/nicotine smoking mechanistically delays wound healing by inducing local tissue hypoxia and increasing activity of matrix metalloproteases. Local tissue hypoxia can also impair dental implant osseointegration, which can affect onset and progression of peri-implant diseases in susceptible individuals. Thus, treatment of patients with dental implants, systemic conditions and environmental habits must absolutely be discussed with patients when treatment planning dental restorative options, as they can affect both short- and long-term therapeutic outcomes. Specific to peri-implant diseases, controlling diabetic status and promoting smoking cessation are imperative tasks to achieve predictable implant therapeutics.
Enhanced recovery after Surgery (ERAS) protocols focus on several components. A multidisciplinary team works on a multimodal approach to resolve issues that might delay recovery, based, as much as possible on scientific, evidence-based protocols in an attempt to change patient management and improve patient reported outcomes.
Hypothesis:
The purpose of this study was to evaluate the association between smoking and postoperative complications following total shoulder arthroplasty. We hypothesized that active smokers would have significantly greater postoperative medical and surgical complications.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent total shoulder arthroplasties from 2005 through 2016. Patients were stratified based on tobacco use within the past year. Logistic regression was used to assess the relationship between smoking status and postoperative medical and surgical complications. Multivariate logistic regression was used to adjust for demographic and comorbid factors.
Results:
We identified 14,465 patients, of whom 10.5% were active smokers. Smokers were more likely to be younger, to be female patients, and to have a lower body mass index compared with nonsmokers (P < .001). Univariate analysis demonstrated that smoking was not associated with postoperative medical complications (P > .05) but was associated with an increased risk of overall surgical complications (odds ratio [OR], 3.259; 95% confidence interval [CI], 1.861-5.709; P < .001). Multivariate modeling showed that smoking increased the risk of wound complications (adjusted OR, 7.564; 95% CI, 2.128-26.889; P = .002) and surgical-site infections (adjusted OR, 1.927; 95% CI, 1.023-3.630; P = .042).
Discussion and conclusion:
This study demonstrates that smoking is associated with an increased risk of surgical complications following total shoulder arthroplasty. On the basis of our available data, medical complications are not significantly increased. This information can help risk stratify patients prior to their procedures.
The totality of non-genetic, mainly environmental factors a human being is exposed to from conception to death is summarized by the term ‘exposome’. This exposome concept aims to better understand the influence of all external and internal factors, their interaction with each other and with genetic factors on the human body. Skin is a barrier organ and thus research on the skin exposome is of obvious relevance. In this state-of-the-art review, we summarize existing information on the skin exposome by focusing on skin aging as a trait present in healthy skin.
Abdominal aortic aneurysm (AAA) is a vascular pathology with a high rate of morbidity and mortality and a prevalence that, in men over 65 years, can reach around 8%. In this disease, usually asymptomatic, there is a progressive dilatation of the vascular wall that can lead to its rupture, a fatal phenomenon in more than 80% of cases. The treatment of patients with asymptomatic aneurysms is limited to periodic monitoring with imaging tests, control of cardiovascular risk factors and treatment with statins and antiplatelet therapy. There is no effective pharmacological treatment capable of limiting AAA progression or avoiding their rupture. At present, the aortic diameter is the only marker of risk of rupture and determines the need for surgical repair when it reaches values greater than 5.5 cm. This review addresses the main aspects related to epidemiology, risk factors, diagnosis and clinical management of AAA, exposes the difficulties to have good biomarkers of this pathology and describes the strategies for the identification of new therapeutic targets and biomarkers in AAA.
Importance
Smoking, a common lifestyle trait, is considered by many surgeons to be a major risk factor for postoperative complications. However, in the literature on local reconstruction, the association between smoking and the rate of postoperative complications after cutaneous tissue transfer is not well characterized.
Objective
To study the outcomes of flaps and grafts used in Mohs micrographic surgery reconstruction with respect to smoking status and patient-specific and surgery-specific variables.
Design, Setting, and Participants
This retrospective case-control study was conducted at a single tertiary referral center among 1008 patients who underwent Mohs reconstruction repaired by flap or graft between July 1, 2012, and June 30, 2016, and were selected via consecutive sampling. Cases with incomplete records or those in which a single flap or graft was used to repair multiple defects were excluded. Data analysis was performed from September 2017 to January 2018.
Main Outcomes and Measures
Postoperative acute and long-term complications. Acute complications included postsurgical infection, dehiscence, hematoma, uncontrolled bleeding, and tissue necrosis that required medical counseling or intervention. Long-term complications included functional or cosmetic outcomes that prompted the patient to request or the surgeon to offer additional intervention.
Results
Of the 1008 patients included in the study (396 women and 612 men), the median (SD) age was 70 (12) years (range, 21-90 years). A total of 128 patients (12.7%) were current smokers, 385 (38.2%) were former smokers, and 495 (49.1%) were never smokers. On multivariate logistic regression, current smoking (odds ratio [OR], 9.58; 95% CI, 3.63-25.3), former smoking (OR, 3.64; 95% CI, 1.41-9.38), larger defect size (OR, 2.25; 95% CI, 1.58-3.20), and the use of free cartilage graft (OR, 8.19; 95% CI, 2.02-33.1) were associated with increased risks of acute complications. For long-term complications, central face location (OR, 25.4; 95% CI, 6.16-106.5), use of interpolation flap or flap-graft combination (OR, 3.49; 95% CI, 1.81-6.74), larger flap size (OR, 1.42; 95% CI, 1.09-1.87), and basal cell carcinomas or other basaloid tumors (OR, 3.43; 95% CI, 1.03-11.5) were associated with an increased risk, whereas increased age (OR, 0.66 per 10-year interval; 95% CI, 0.54-0.80) was associated with decreased risk.
Conclusions and Relevance
This study suggests that both current and former smokers are at increased risk for acute postsurgical complications but that smoking status is not associated with long-term complications. These findings may allow the surgeon to better quantify the magnitude of risk and provide helpful information for patient counseling.
Level of Evidence
3.
Aims
The aim of our study was to evaluate the relationship between smoking, metabolic syndrome (MetS) and persistence of nocturia in patients with moderate/severe nocturia (nocturia episodes ≥2), lower urinary tract symptoms (LUTSs), and benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP).
Methods
From 2015 onward, a consecutive series of patients with moderate/severe nocturia (nocturia episodes ≥2), LUTS, and BPE undergoing TURP were prospectively enrolled. Medical history, physical examination, and smoking status were recorded. MetS was defined according to Adult Treatment Panel III. Moderate/severe persistent nocturia after TURP was defined as nocturia episodes ≥2. Binary logistic regression analysis was used to evaluate the risk of persisting nocturia.
Results
One hundred two patients were enrolled with a median age of 70 years (interquartile range: 65/73). After TURP, moderate/severe nocturia was reported in 43 of 102 (42%) of the patients. Overall 40 of 102 (39%) patients presented a MetS, and out of them, 23 of 40 (58%) presented a moderate/severe persistent nocturia after TURP ( P = .001). Overall 62 of 102 (61%) patients were smokers, and out of them, 32 of 62 (52%) presented moderate/severe persistent nocturia after TURP ( P = .034). On multivariate analysis, prostate volume, MetS, and smoking were independent risk factors for moderate/severe persistent nocturia after TURP.
Conclusion
In our single‐center study, MetS and smoking increased the risk of moderate/severe persistent nocturia after TURP in patients with LUTS‐BPE. Although these results should be confirmed, and the pathophysiology is yet to be completely understood, counseling smokers and MetS patients about the risk of postoperative persistent nocturia is warranted.
Over the past decade, there has been a surge in demand for minimally invasive treatments for aging skin. Patients seek non-surgical treatments due to reduced procedure-associated risks and faster recovery time compared to traditional surgical methods. One component of aging skin is the appearance of laxity, which is due to thinning of the epidermis, loss of dermal connective tissue and atrophy and/or redistribution of subcutaneous fat, or all of the above. Innovation in energy-based devices has created multiple avenues to address the various factors leading to skin laxity. This chapter will discuss the mechanism of action, efficacy and safety of ablative and non-ablative lasers, infrared light, ultrasound, and microneedling in treatment of skin laxity.
Large or complex ventral hernias remain a challenging endeavor with potential for high rates of morbidity. Minimally invasive surgery (MIS) techniques such as laparoscopic and robotic-assisted repairs provide a way to minimize wound morbidity as well as decrease length of hospitalization. Even with the benefits of MIS repairs, complex hernias still present challenges that can be positively affected by optimizing the patient in the preoperative period and standardizing their postoperative care. In an effort to optimize outcomes, pre- and perioperative management strategies have been developed to reduce patient complications, in addition to reducing hernia recurrence. While technical factors for ventral hernia repair (VHR) such as surgical technique and mesh selection are modifiable factors during the operation itself, optimizing the patient prior to surgery and immediately following VHR can provide substantial benefit to the patient with the ultimate goal of providing a safe and durable hernia repair.
Minimally invasive as opposed to open ventral hernia repair has been proven to reduce surgical site infection and hospital length of stay with similar long-term outcomes. Despite this, less than one-third of all ventral hernias are being repaired with a minimally invasive technique. While not all patients with a ventral hernia will benefit from minimally invasive repair, the majority will. This is because most patients develop ventral incisional hernias due in part to their comorbid conditions (e.g., obesity, poorly controlled diabetes) which increase the risk of surgical site infection and adversely affect wound healing. The slow adoption of minimally invasive ventral hernia repair is related to surgeon skill and experience. The robotic platform can bridge the gap to allow for more surgeons to successfully perform a minimally invasive procedure. In combination with preoperative optimization, minimally invasive surgery provides the best short-term outcomes with equivalent long-term outcomes and the robotic platform can potentially increase the proportion of patients eligible for minimally invasive treatment. Safety, efficacy, and effectiveness randomized controlled trials are needed to validate these assumptions and should be completed prior to widespread adoption of the robotic platform for ventral hernia repair.
Diabetic foot ulceration has been a serious issue over the past decades in Asia, causing economic and social problems. Therefore, it is important to identify and reduce risk factors of diabetic foot. Cigarette smoking has been reported to be associated with diabetes and its macrovascular complications, but the relationship between smoking and diabetic foot ulcers is still unclear. In this review, we summarizes the effects of cigarette smoking on diabetic foot ulcers with respect to peripheral neuropathy, vascular alterations and wound healing. One underlying mechanism of these impacts may be the smoking induced oxidative stress inside the cells. At the end of this review, the current mainstream therapies for smoking cessation are also outlined. We think that it is urgent for all diabetic patients to quit smoking so as to reduce chances of developing foot ulcers and improve prognosis of diabetic foot ulcers.
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Ventral hernia repair with abdominal wall reconstruction can be a challenging endeavor, as patients commonly present not only with complex and recurrent hernias but also often with comorbidities that increase the risk of postoperative complications including wound morbidity and hernia recurrence, among other risks. By optimizing patient comorbidities in the preoperative setting and managing postoperative care in a regimented fashion, enhanced recovery after surgery pathways allow for a systematic approach to reduce complications and speed up recovery following ventral hernia repair.
It is inherently challenging to achieve successful surgical outcomes for ventral hernia repairs. For complex ventral hernias, attempts to reconstruct the abdomen in patients who are overweight, deconditioned, malnourished, chronically infected or inflamed, have previous hernia recurrence, or otherwise carry a number of serious comorbidities affecting their surgical fitness are a major undertaking requiring careful preparation and planning. As the rate of abdominal wall reconstructions rises, so does the complexity of these procedures. One could argue that the prehabilitation of these patients is equally, if not more, important than the surgical technique itself. To achieve desirable outcomes and avoid surgical-site occurrences (SSOs), the surgeon must familiarize him/herself with ways to optimize a patient preoperatively. Understanding and identifying the aforementioned modifiable risk factors for SSOs is crucial. It is also important to recognize the impact that acute changes in the microbiome perioperatively can have on the postoperative success. Familiarizing oneself with the available literature for these patients is imperative. This review presents discussion and guidance for understanding the challenges and best practices for providing hernia surgery and abdominal wall reconstruction and achieving durable outcomes, with minimal SSOs.
Subcutaneous wound-tissue oxygen (PsqO2) tension in eight volunteers fell rapidly and significantly in response to smoking, and remained low for 30 to 50 minutes. Sham "smoking" had no effect. These data suggest that a typical "pack-per-day" smoker experiences tissue hypoxia during a significant portion of each day. The degree of hypoxia found in these subjects has been associated with poor wound healing in animal and human studies. The onset and duration of tissue hypoxia paralleled the well-established plasma pharmacokinetics of nicotine. This suggests that peripheral vasoconstriction, induced by the adrenergic effects of nicotine, may contribute to the observed decrease in PsqO2.
This is an equilibrium-type radioimmunoassay for the amino-terminal propeptide of type III procollagen (PIIINP), which overcomes the problem of nonparallelism between the standard and human serum samples encountered with earlier assays. Proper selection of antiserum and reaction conditions diminishes interference from degradation products of the propeptide in serum. Because a rapid solid-phase-bound second-antibody step is included, the assay takes only 3 h. The intra-assay and the interassay CVs are both about 5%. In infants and children the concentration of PIIINP in serum closely parallels the growth-velocity curve. For 88 presumably healthy adults, the PIIINP concentration was 1.7-4.2 micrograms/L, about a third that measured with the previously available commercial assay. This is because of lack of inhibition by small Col 1 domain-related degradation products.
This study examined the association of smoking status and pack-years of smoking with facial wrinkling in men and women.
We conducted a cross-sectional study of 299 never smokers, 551 former smokers and 286 current smokers, aged 30 through 69 years, drawn from a health maintenance organization. Smoking status, pack-years of smoking, and potential confounding variables were assessed by questionnaire. Facial wrinkle category, a dichotomous variable, and facial wrinkle score, a computed continuous variable, were assessed by blinded standardized visual assessment. Wrinkling was so uncommon among 30- through 39-year-old subjects that analyses were restricted to subjects aged 40 and over (227 never smokers, 456 former smokers, and 228 current smokers).
With age, average sun exposure, and body mass index controlled, the estimated relative risk of moderate/severe wrinkling for current smokers compared to never smokers was 2.3 (95% confidence interval [CI] = 1.2, 4.2) among men and 3.1 (95% CI = 1.6, 5.9) among women. Pack-years was positively associated with facial wrinkle score in women aged 40 through 69 years and in men aged 40 through 59 years. In both groups, the increased risk of wrinkling was equivalent to about 1.4 years of aging.
Our results support earlier findings that risk of facial wrinkling is greater in cigarette smokers than in never smokers.
To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.
Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained.
Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.
Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.
The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.
Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.
Cigarette smoking, the major cause of pulmonary emphysema, is characterized by destruction of alveolar walls. Because tissue destruction represents a balance between injury and repair, we hypothesized that cigarette smoke exposure may contribute to the development of emphysema through the inhibition of tissue contraction during the repair process. To partially evaluate this hypothesis, we investigated the effects of cigarette smoke extract (CSE) on the ability of cultured fibroblasts to mediate collagen gel contraction in vitro: CSE inhibited fibroblast-mediated gel contraction in a concentration-dependent manner (P < 0.01). Production of prostaglandin E2, a known inhibitor of fibroblast contraction, was unchanged by CSE as was cell surface integrin expression. In contrast, fibronectin production by fibroblasts was inhibited (P < 0.01), and addition of exogenous fibronectin partially restored the contractile activity, thus suggesting at least one mechanism to explain inhibition of gel contraction by CSE. When CSE was treated to remove volatile components, it showed less inhibitory activity on fibroblast-mediated gel contraction. Therefore, we also examined the effects of acrolein and acetaldehyde, two volatile components of cigarette smoke. Inhibition of contraction was observed at 5 microM acrolein and at 0.5 mM acetaldehyde. In conclusion, cigarette smoke inhibited fibroblast-mediated gel contraction, and this inhibition was due, at least in part, to the volatile components of cigarette smoke and may be mediated, at least in part, by a decrease in fibroblast fibronectin production. By inhibition of repair, these smoke components may contribute to the development of pulmonary emphysema.
• Subcutaneous wound-tissue oxygen (Psqo2) tension in eight volunteers fell rapidly and significantly in response to smoking, and remained low for 30 to 50 minutes. Sham "smoking" had no effect. These data suggest that a typical "pack-per-day" smoker experiences tissue hypoxia during a significant portion of each day. The degree of hypoxia found in these subjects has been associated with poor wound healing in animal and human studies. The onset and duration of tissue hypoxia paralleled the well-established plasma pharmacokinetics of nicotine. This suggests that peripheral vasoconstriction, induced by the adrenergic effects of nicotine, may contribute to the observed decrease in Psqo2.
(Arch Surg. 1991;126:1131-1134)
Objective.
—To identify and quantify the major external (nongenetic) factors that contribute to death in the United States.Data Sources.
—Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained.Study Selection.
—Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity.Data Extraction.
—Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates.Data Synthesis.
—The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations.Conclusions.
—Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.(JAMA. 1993;270:2207-2212)
Controlled degradation of the extracellular matrix (ECM) is crucial for the growth, invasive capacity, metastasis and angiogenesis of tumours. Matrix metalloproteinases (MMPs), a family of zinc-dependent neutral endopeptidases that are collectively capable of degrading essentially all ECM components, apparently play an important role in all of these aspects of tumour development. In addition, there is recent evidence that MMPs are also important for tumour cell survival. At present, therapeutic intervention on tumour growth and invasion based on the inhibition of MMP activity is under intensive investigation, and several MMP inhibitors are already being used on malignant tumours of various organs in clinical trials. In this review we discuss the role of MMPs and their inhibitors in tumour invasion as a basis for prognostic purposes and for targeted therapeutic intervention in cancer.
Conclusion PINP is a new, reproducible and sensitive tool to assess the rate of bone formation.
Types I and III collagen are the main fibrillar collagens in the skin. Marked changes occur in the biosynthesis of these proteins during treatment with various drugs, upon ageing and in several diseases. Since conventional methods of assessing these changes have several disadvantages, a new method for estimating collagen synthesis in human skin in vivo has recently been developed. In this method suction blisters are induced on intact, and treated or diseased skin and types I and III procollagen propeptides are measured radioimmunologically in suction blister fluid (SBF).
The concentrations of type I and III procollagen propeptides in SBF reflect the corresponding local ongoing skin collagen synthesis. This method offers a new sensitive tool for experimental and clinical dermatology for monitoring skin collagen synthesis. With this method it has been possible, for example, for the first time directly to show in vivo that glucocorticoids rapidly and dramatically decrease human skin collagen synthesis.
Background.- Although skin disorders associated with long-term sun exposure account for high morbidity, only few data on sun-related preclinical skin changes are available in the general population.objective: In the present study we determined reference values for markers of photoaging in French adults, and we evaluated the relationship between photoaging, phototype, and both behavioral and environmental factors.Methods: The SU.VI.MAX trial is a multicenter, national intervention trial on 12,735 adults living in France. A transverse analysis was performed on the inclusion data of the sample of volunteers between 45 and 60 years of age who underwent skin evaluation in 1995: 3057 women and 3606 men. Skin was evaluated by means of the Larnier skin photoaging photographic scale and a sun reactive skin type classification derived from those proposed by Fitzpatrick in 1976 and Césarini in 1977.Results: The prevalence of skin photoaging, assessed as a dichotomous variable (from moderate/severe to very severe), was comparable in men and women in same age groups: in women, age group 45–49 years = 22%, 50–54 years = 36%, and 55–60 years = 42%; in men, age group 45–49 years = 17%, 50–54 years = 38%, and 55–60 years = 45%. After adjusting for body mass index, exposure to tobacco, and sunlight exposure, the only variables found to be related to skin photoaging in women were age (55–60 years age group: adjusted odds ratio [AOR] = 6.0, 95% confidence interval [CI] = 4.4–8.2), phototype IIIa, IIIb, and N (AOR = 0.2, 95% CI = 0.1-0.4; AOR = 0.3, 95% CI = 0.2-0.6; and AOR = 0.4, 95% CI = 0.3-0.8; respectively), menopausal status (AOR = 1.4, 95% CI = 1.1-1.9), and geographic location (Southern France: AOR = 0.7, 95% CI = 0.6-0.9), with a more pronounced effect in lighter phototypes I–II and a protective impact related to southern locations. No relationship was found between the use of oral contraceptives and skin photoaging. The age effect was also found in men (55–60 years age group: AOR = 10.4, 95% CI = 8.3–13.1) and geographic location (Southern France: AOR = 0.8, 95% CI = 0.6-0.9), with a most pronounced effect in darker phototypes (phototypes > IV AOR = 2.8, 95% Cl = 1.4–5.6).Conclusion: Our results suggest that the prevalence of skin photoaging in the adult French population is determined by age, sex, geographic location, and phototype. The continuation of this longitudinal study will allow for the investigation of the relationship between skin photoaging and the risk of the development of skin diseases.
Neutrophil collagenase (matrix metalloproteinase-8 or MMP-8) is regarded as being synthesized exclusively by polymorphonuclear
neutrophils (PMN). However, in vivo MMP-8 expression was observed in mononuclear fibroblast-like cells in the rheumatoid synovial membrane. In addition, we detected
MMP-8 mRNA expression in cultured rheumatoid synovial fibroblasts and human endothelial cells. Up-regulation of MMP-8 was
observed after treatment of the cells with either tumor necrosis factor-α (10 ng/ml) or phorbol 12-myristate 13-acetate (10
nm). Western analysis showed a similar regulation at the protein level. The size of secreted MMP-8 was 50 kDa, which is about
30 kDa smaller than MMP-8 from PMN. Conditioned media from rheumatoid synovial fibroblasts contained both type I and II collagen
degrading activity. However, degradation of type II collagen, but not that of type I collagen, was completely inhibited by
50 μm doxycycline, suggesting specific MMP-8 activity. In addition, doxycycline down-regulated MMP-8 induction, at both the mRNA
and protein levels. Thus MMP-8 exerts markedly wider expression in human cells than had been thought previously, implying
that PMN are not the only source of cartilage degrading activity at arthritic sites. The inhibition of both MMP-8 activity
and synthesis by doxycycline provides an incentive for further studies on the clinical effects of doxycycline in the treatment
of rheumatoid arthritis.
Although skin disorders associated with long-term sun exposure account for high morbidity, only few data on sun-related preclinical skin changes are available in the general population.
In the present study we determined reference values for markers of photoaging in French adults, and we evaluated the relationship between photoaging, phototype, and both behavioral and environmental factors.
The SU.VI.MAX trial is a multicenter, national intervention trial on 12,735 adults living in France. A transverse analysis was performed on the inclusion data of the sample of volunteers between 45 and 60 years of age who underwent skin evaluation in 1995: 3057 women and 3606 men. Skin was evaluated by means of the Larnier skin photoaging photographic scale and a sun reactive skin type classification derived from those proposed by Fitzpatrick in 1976 and Césarini in 1977.
The prevalence of skin photoaging, assessed as a dichotomous variable (from moderate/severe to very severe), was comparable in men and women in same age groups: in women, age group 45-49 years = 22%, 50-54 years = 36%, and 55-60 years = 42%; in men, age group 45-49 years = 17%, 50-54 years = 38%, and 55-60 years = 45%. After adjusting for body mass index, exposure to tobacco, and sunlight exposure, the only variables found to be related to skin photoaging in women were age (55-60 years age group: adjusted odds ratio [AOR] = 6.0, 95% confidence interval [CI] = 4.4-8.2), phototype IIIa, IIIb, and IV (AOR = 0.2, 95% CI = 0.1-0.4; AOR = 0.3, 95% CI = 0.2-0.6; and AOR = 0.4, 95% CI = 0.3-0.8; respectively), menopausal status (AOR = 1.4, 95% CI = 1.1-1.9), and geographic location (Southern France: AOR = 0. 7, 95% CI = 0.6-0.9), with a more pronounced effect in lighter phototypes I-II and a protective impact related to southern locations. No relationship was found between the use of oral contraceptives and skin photoaging. The age effect was also found in men (55-60 years age group: AOR = 10.4, 95% CI = 8.3-13.1) and geographic location (Southern France: AOR = 0.8, 95% CI = 0.6-0.9), with a most pronounced effect in darker phototypes (phototypes > IV: AOR = 2.8, 95% CI = 1.4-5.6).
Our results suggest that the prevalence of skin photoaging in the adult French population is determined by age, sex, geographic location, and phototype. The continuation of this longitudinal study will allow for the investigation of the relationship between skin photoaging and the risk of the development of skin diseases.
An association between smoking and impaired wound healing has been reported in retrospective studies. The smoking status of a surgical patient may be confounded by social and medical parameters. We have evaluated the effect of smoking in a test wound in volunteers, with special reference to a reliable scientific match between smokers and nonsmokers.
In a prospective open study with blinded assessment, 19 smoking (20 cigarettes/day) and 18 nonsmoking healthy volunteers were matched with respect to baseline characteristics. The deposition of total protein and mature collagen (expressed as hydroxyproline) was assessed in an expanded polytetrafluoroethylene wound healing model implanted subcutaneously for 10 days.
The nonsmokers had a 1.8 times higher median amount of hydroxyproline than the smokers (p < 0.01). The deposition of hydroxyproline was negatively correlated with the consumption of tobacco both before (r = -0.44; p < 0.01) and during the study (r = -0.48; p < 0.005). The impairment was specific for the production of collagenous proteins and not other proteins.
The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.
Five ex-cigarette smokers and five primary pipe and cigar smokers each smoked a large cigar. Carboxyhaemoglobin (COHb) and plasma nicotine levels were measured. In the ex-cigarette smokers mean COHb rose from 2.9% to 9.6% and plasma nicotine from 79.0 nmol/l to 281 nmol/l (12.8-45.6 ng/ml). This response was similar to that of cigarette smokers smoking cigarettes, which indicated that the subjects had inhaled and absorbed significant amounts of nicotine. In the primary pipe and cigar smokers the mean COHb rose from 0.8% to 1.0% and the plasma nicotine from 21 nmol/l to 32 nmol/l (3.4-5.2 ng/ml), indicating neither significant inhalation nor significant nicotine absorption.Since ex-cigarette smokers do not seem to lose their habit of inhaling when they change to cigars, measures aimed at persuading smokers to switch to cigars will have little effect on their health. Pipe and cigar smokers who have never smoked cigarettes do not inhale, which probably accounts for their reduced incidence of coronary heart disease and lung cancer. But they also appear not to absorb nicotine, which suggests that nicotine is absorbed largely from the lung and that the buccal mucosa is unimportant. It also raises the interesting question of why primary pipe and cigar smokers do smoke.
Risk factors for infectious eczematoid dermatitis (IED) were analyzed in a study of males aged 19-50 years. The subjects were 43 IED patients and 226 controls with other skin diseases from the dermatological outpatient clinics of three University Hospitals in Finland. The patients' lifestyles were assessed by a self-administered questionnaire pertaining to two specified periods: the period 12 months before the onset of the skin disease and the period 12 months before the examination date. Recalled mean alcohol intake before the onset of the skin disease was 39.2 g/day for the IED patients and 17.1 g/day for the controls (p = 0.04). The average number of cigarettes smoked daily was 17.7 for the IED patients and 10.4 for the control patients (p = 0.001). The IED patients significantly reduced their alcohol intake after the onset of the skin disease. In logistic regression analysis, IED associated with alcohol intake and smoking but not with coffee consumption, life events, age, marital status, or social group. The odds ratio for IED at an alcohol intake of 50 g/day as against no intake, was 1.7 (95% confidence interval 1.03-2.7), and the odds ratio at a tobacco consumption rate of 20 cigarettes/day as against no use of tobacco, was 2.1 (1.2-3.7). We conclude that alcohol intake and smoking appear to be risk factors for infectious eczematoid dermatitis among males.
We have conducted a multicentre case-control study to assess the epidemiological importance of previously suggested risk factors for psoriasis, including family history of the disease, smoking and alcohol consumption. Newly diagnosed psoriatics, with a history of skin manifestations no longer than 2 years were eligible as cases; as controls we selected subjects with newly diagnosed dermatological conditions other than psoriasis. Interviews were performed by trained medical investigators using a structured questionnaire. Two-hundred and fifteen cases, aged 16-65 years (median age 38), and 267 controls, aged 15-65 years (median age 36), were interviewed and included in the analysis. Family history was a risk factor for psoriasis; the multiple logistic regression (MLR) adjusted-odds ratio was 18.8 (95% confidence interval 6.4-54.8) for a history in parents, and 3.2 (95% confidence interval 1.5-6.6) for a history in siblings. The risk of psoriasis was higher for current smokers than for those who had never smoked. The MLR adjusted odds ratio was 2.1 (95% confidence interval 1.1-4.0) for people smoking 15 cigarettes or more per day. The risk of psoriasis was higher for alcohol drinkers: compared with teetotallers the MLR adjusted-odds ratios were 1.3 (95% confidence interval 0.8-2.3) for subjects drinking one or two drinks/day and 1.6 (95% confidence interval 0.9 to 3.0) for those drinking three or more. However, the trend in risk was not statistically significant. Our study confirms the role of family history in psoriasis and provides some evidence of a dose-response relationship for an association between smoking habits and psoriasis.
We have examined smoking habits in 108 patients with psoriasis, including some with palmoplantar distribution, and compared the results with matched controls from the community. There was a significant association between psoriasis, current smoking status (OR = 2.7, 95% CI 1.44-5.42, P less than 0.01) and smoking habits prior to the onset of disease (OR = 3.75, 95% CI 1.68-9.47, P less than 0.001). There was also a marked dose-response relationship; the relative risk of psoriasis in those currently smoking more than 20 cigarettes/day was significantly elevated (OR = 5.3, 95% CI 2.1-13.0, P less than 0.001). Separate analysis of patients without palmoplantar distribution of psoriasis showed a significant association with smoking prior to onset of psoriasis (OR = 3.6, 95% CI 1.5-9.8, P less than 0.001). Smoking may play a role in the aetiology of this common skin disorder.
Collagen is synthesized as procollagen and large extra domains known as propeptides are cleaved off enzymatically. In the present study we have measured the carboxyterminal propeptide of type I collagen (PICP) and the aminoterminal propeptide of type III collagen (PIIINP) in blister fluids of human skin. High concentrations of PICP were found in the spontaneous blisters of patients with bullous pemphigoid, erysipelas, or erytherna multiforme. Detectable amounts were also found in suction blisters induced on healthy skin. Because the concentrations in suction blisters were several times higher than in corresponding serum, most of PICP and PIIINP was derived from the underlying dermis.
This method was used for assessing type I and type III collagen synthesis after topical glucocorticoid treatment. Clobetasol-17-propionate (CP) decreased the concentrations of PICP by 75% after 1 d of treatment, the maximum inhibition (92%) being found after 2 d treatment. PIIINP was also affected. Hydrocortisone and hydrocortisone-17-butyrate also decreased the concentrations of PICP and PIIINP, but less markedly than CP. Partial recovery was seen 3 d after stopping the treatment. Thus measurement of collagen type specific propeptides in suction blisters can be used as an estimate of collagen synthesis in vivo, avoiding both local anesthesia and skin biopsing. With radioimmunoassays for PICP and PIIINP a large number of samples can also be processed simultaneously.
To determine if cigarette smoking is a risk factor for the development of premature facial wrinkling.
Cross-sectional study.
Smoking cessation clinic and community.
Convenience sample of 132 adult smokers and non-smokers in 1988.
A questionnaire was administered to quantify cigarette smoking and to obtain information about possibly confounding factors such as skin pigmentation, sun exposure, age, and sex. Wrinkling was assessed using photographs of the temple region, and a severity score based on predetermined criteria was assigned. A logistic regression model, which controlled for confounding variables, was developed to assess the risk for premature wrinkling in response to pack-years of smoking.
The prevalence of premature wrinkling was independently associated with sun exposure and pack-years of smoking. After controlling for age, sex, and sun exposure, premature wrinkling increased with increased pack-years of smoking. Heavy cigarette smokers (greater than 50 pack-years) were 4.7 times more likely to be wrinkled than nonsmokers (95% CI, 1.0 to 22.6; P value for trend = 0.05). Sun exposure of more than 50,000 lifetime hours also increased the risk of being excessively wrinkled 3.1-fold (CI, 1.2 to 7.1). When excessive sun exposure and cigarette smoking occurred together, the risk for developing excessive wrinkling was multiplicative (prevalence ratio of 12.0; CI, 1.5 to 530).
Cigarette smoking is an independent risk factor for the development of premature wrinkling.
The association between cigarette smoking and necrosis of flaps and full-thickness grafts was analyzed in 220 patients. Review of a series of 916 flaps and full-thickness grafts revealed 44 patients in whom some degree of tissue necrosis occurred. These patients with necrosis were age and gender matched with 176 controls randomly selected from the remaining 872 patients. Current high-level smokers, that is those smoking one or more packs per day, had necrosis develop approximately three times more frequently than never smokers, low-level smokers (less than one pack per day), or former smokers (95% confidence interval, 1.2 to 8.2). Former smokers (relative risk, 1.4; 95% confidence interval, 0.6 to 3.2) and low-level smokers (relative risk, 1.1; 95% confidence interval, 0.2 to 6.1) were at a negligible increased risk for necrosis that was not significantly different from never smokers. Once tissue necrosis developed, the median percent of the visible flap or graft tissue that necrosed was approximately threefold greater among current smokers (regardless of the number of packs per day smoked) than never smokers.
To see if there was any difference in the skin healing of smokers as opposed to non-smokers we studied 120 women admitted consecutively for laparotomy sterilisation. The method of skin suture was standardised. We compared width, length, and colour of the scars, and assessed the overall cosmetic result using a scoring system in 69 smokers and 51 non-smokers. When the incision was in the midline the scars in the smokers measured 7.4 mm averagely as compared with 2.7 mm in non-smokers (p less than 0.02). There was a corresponding tendency in transverse incisions. When the colour was compared, 26% of smokers had light coloured scars compared with 12% of non-smokers (p less than 0.05). There were no differences between the groups when dark coloured scars were assessed. Overall, using the scoring system, smokers had significantly worse cosmetic results than non-smokers.
Possible risk factors for psoriasis were studied among women aged 18-50 years. The series consisted of 55 consecutive psoriatic patients and 108 unmatched controls with other skin diseases, from the university departments of dermatology in Helsinki, Oulu and Tampere. A questionnaire focused on two specified periods of time, 12 months before the onset of the skin disease and 12 months before the examination date. Before the onset of the skin disease, the recalled mean number of cigarettes smoked daily was 8.6 (1.2 SE) for psoriatics and 4.7 (0.7) for controls (P = 0.004). The respective alcohol intake figures (mean +/- SE) were 8.0 (2.2) and 4.7 (0.8) g/day (P = 0.17). In logistic regression analysis, psoriasis was associated significantly with smoking, but not with alcohol intake, marital status or social group. The odds ratio for psoriasis for those smoking 20 cigarettes daily compared with non-smokers was 3.3 (95% confidence limits 1.4-7.9). The odds ratio for psoriasis at an alcohol intake of 20 g/day compared with no intake was 1.8 (1.0-3.3). After the onset of the disease, psoriasis was associated significantly with alcohol intake, smoking, and the occurrence of negative life events. Among psoriatics, skin surface involvement was significantly associated with alcohol intake (P = 0.04), but not with smoking or negative life events. These results suggest that smoking is a risk factor for psoriasis in women, and that alcohol intake worsens their psoriasis. Smoking and negative life events were more common among psoriasis patients than among controls, perhaps as consequences of the disease.
Clinical data, including focal infection and habitual cigarette smoking, were obtained from 203 male patients with pustulosis palmaris et plantaris (PPP) (age: 43.3 +/- 13.4) and 266 female patients (age: 44.0 +/- 13.7) for the 20 years from 1975 through 1994 to evaluate the relationship between the onset or severity of PPP and smoking. Seasonal incidences of onset were also studied. The incidence of onset of PPP symptoms was highest in June, when it is the most humid in Japan, and lowest in December. The most common infectious disease associated with PPP was tonsillitis. The percentages of heavy smoking (more than 20 cigarettes per day) were 74.7% and 32.9% for male and female patients, while those in the normal control population in Japan were 37.2% and 9.8% for males and females. These results suggest that heavy smoking, tonsillitis, and seasonal factors such as high humidity and high temperature may be related to the onset and exacerbation of PPP.
We have developed quantitative immunoassays for the intact, trimeric amino-terminal propeptide of human type I procollagen (PINP) and its Col1 domain. Intact PINP was isolated from the pleural fluids of cancer patients by a combination of ion-exchange, gel-filtration, and reversed-phase chromatographies. The amino-terminal Col1 domain of PINP was isolated after bacterial collagenase treatment of the heat-denatured trimeric propeptide. For the intact PINP assay we used a polyclonal antibody with only 1.2% cross-reaction with the monomeric Col1 domain. In human serum, this assay detects only one peak of PINP antigenicity that has the size of known intact PINP. Under similar conditions, an assay for the Coll domain of PINP recognized two circulating antigens. The biological relevance was further verified in wound fluid. Interassay and intraassay CVs were 3.1-9.3% for values within the reference intervals (mean +/- 2SD) for intact PINP in serum, which were 19-84 microg/L for women and 20-76 microg/L for men.
Although tobacco smoking is known to result in coronary heart disease, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, lung cancer, and other smoking cancers, many surgeons believe that smoking also results in impaired wound healing and poor surgical results. Large clinical experiences in several areas of plastic surgery reinforce this suspicion. Procedures that have been noted to be adversely affected by cigarette smoking include rhytidectomy, abdominoplasty, breast reconstruction, free-tissue transfer, and digital replantation. This article reviews the available data, introduces new clinical data, and hypothesizes about the ways in which some procedures are more affected than others.
Neutrophil collagenase (matrix metalloproteinase-8 or MMP-8) is regarded as being synthesized exclusively by polymorphonuclear neutrophils (PMN). However, in vivo MMP-8 expression was observed in mononuclear fibroblast-like cells in the rheumatoid synovial membrane. In addition, we detected MMP-8 mRNA expression in cultured rheumatoid synovial fibroblasts and human endothelial cells. Up-regulation of MMP-8 was observed after treatment of the cells with either tumor necrosis factor-alpha (10 ng/ml) or phorbol 12-myristate 13-acetate (10 nM). Western analysis showed a similar regulation at the protein level. The size of secreted MMP-8 was 50 kDa, which is about 30 kDa smaller than MMP-8 from PMN. Conditioned media from rheumatoid synovial fibroblasts contained both type I and II collagen degrading activity. However, degradation of type II collagen, but not that of type I collagen, was completely inhibited by 50 microM doxycycline, suggesting specific MMP-8 activity. In addition, doxycycline down-regulated MMP-8 induction, at both the mRNA and protein levels. Thus MMP-8 exerts markedly wider expression in human cells than had been thought previously, implying that PMN are not the only source of cartilage degrading activity at arthritic sites. The inhibition of both MMP-8 activity and synthesis by doxycycline provides an incentive for further studies on the clinical effects of doxycycline in the treatment of rheumatoid arthritis.
Pustulosis palmoplantaris (PPP) is a common chronic skin disease, which is very resistant to treatment. It is not known why the lesions are located in the palms and soles. There are few studies of the disease and in particular studies of the histology. Fifty-nine patients with PPP answered a questionnaire concerning their medical history and 39 of them were clinically examined. Biopsy specimens were taken from involved skin in 22 of the 39 patients and studied immunohistologically for tryptase+ mast cells, EG2+ eosinophils, lipocalin+ neutrophils and CD3+ T lymphocytes. The sweat gland and sweat duct were visualized with AE1/AE3 antibody (cytokeratins 1-8, 10, 14/15, 16, 19). In addition to neutrophils in the pustule and lymphocytes in the upper dermis, there were also large numbers of mast cells and eosinophils in the subpustular area. Numerous eosinophils were present in the pustule. The epidermal part of the eccrine duct was not detectable in any of the specimens from patients with PPP but was present in all of the nine control persons (including two smokers). The results indicate that the acrosyringium is involved in the inflammation and also that mast cells and eosinophils participate in a hitherto unknown way. Of the 39 patients clinically examined, two had previously diagnosed thyroid disease and two had gluten hypersensitivity. Seventeen had one or several abnormal serum concentrations of thyroid-stimulating hormone, thyroxin, antibodies against thyroglobulin or thyroperoxidase and 10 had immunoglobulin (Ig) A antibodies to gliadin. The mean +/- SD for serum IgA and for eosinophil cationic protein was increased. From the questionnaire the most notable finding was that 56 of the 59 patients had been or still were smokers, all of whom had started smoking before the first signs of PPP. We hypothesize that the acrosyringium might be the target for the inflammation and that PPP is linked to autoimmune thyroid disease and smoking.
Connective tissue is normally in a highly controlled balance between degradation of extracellular matrix proteins and synthesis of new matrix compounds. Three major families of proteases, named according to their active center, are involved in this process: serine-, cysteine- and metalloproteinases. These proteases play an important role in normal and disturbed wound healing as well as in tumor invasion and metastasis.
Controlled degradation of the extracellular matrix (ECM) is crucial for the growth, invasive capacity, metastasis and angiogenesis of tumours. Matrix metalloproteinases (MMPs), a family of zinc-dependent neutral endopeptidases that are collectively capable of degrading essentially all ECM components, apparently play an important role in all of these aspects of tumour development. In addition, there is recent evidence that MMPs are also important for tumour cell survival. At present, therapeutic intervention on tumour growth and invasion based on the inhibition of MMP activity is under intensive investigation, and several MMP inhibitors are already being used on malignant tumours of various organs in clinical trials. In this review we discuss the role of MMPs and their inhibitors in tumour invasion as a basis for prognostic purposes and for targeted therapeutic intervention in cancer.
The potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias.
This study was designed to determine if there was increased facial wrinkling in smokers directly associated with tobacco usage after controlling for solar risk behavior.
Eighty-two smokers (> 10 cigarettes per day) and 118 non-smokers (< 100 lifetime cigarettes) were recruited. Caucasian participants completed a questionnaire designed to assess demographic variables and other suspected factors related to wrinkling.
Three dermatologists, blinded to demographic information, reviewed three photographs of each subject and rated the wrinkling on a 100 mm visual analog scale. Stepwise linear regression was performed on all variables which attained a P < 0.1 level of independent significance.
Overall the model accounted for 75.4% (P = 0.0001) of the variance in wrinkling, and predictive variables (P < or = 0.02) included age (partial R2 = 0.69), smoking pack years (R2 = 0.04), hours of outdoor work (R2 = 0.008), freckling (R2 = 0.007), and eye color (R2 = 0.004). A second model was created excluding age which accounted for 37.8% of the variance. The predictive variables in the second model (P < 0.08) included education (partial R2 = 0.08), smoking pack years (R2 = 0.05), hours of outdoor work (R2 = 0.03), weight change (R2 = 0.02), female sex (R2 = 0.02), hours of lifetime sun (R2 = 0.03), tanning bed use (R2 = 0.01), and sunscreen use (R2 = 0.02).
Smoking may significantly contribute to facial wrinkling, but accounts for only 6% of the explained variance. If there is a role for tobacco smoking in causing wrinkling, this role is a minor one.
Epidemiologic studies have indicated the association between tobacco smoking and skin aging, but the exact mechanism of tobacco smoke-induced premature skin aging is currently unknown. In this study, we investigated the alterations of collagen, matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in human fibroblasts treated with tobacco smoke extract. Human fibroblasts were exposed to different concentrations of water-soluble extract from tobacco smoke. Human fibroblasts irradiated with ultraviolet A1 (UVA1) were used as positive controls because the mechanism of UVA1-mediated MMP expression has been well characterized. The expression of MMP and TIMP was analyzed semiquantitatively following reverse transcriptase-polymerase chain reaction. Production of type I and type III collagens was detected by Western blotting and biosynthesis of new collagen was assessed by 3H-proline incorporation. Upon treatment with tobacco smoke extract or UVA1 irradiation, the expression of MMP-1 and MMP-3 mRNA was significantly increased in a dose-dependent manner. Maximum induction was observed with 25 microl/ml tobacco smoke extract. In contrast, the expression of TIMP-1 and TIMP-3 mRNA remained unchanged. Western blotting of the supernatant revealed that type I and type III collagens were decreased as compared with untreated controls. Collagen biosynthesis was significantly reduced by 40.1% following treatment with 25 microl/ml tobacco smoke extract. Sodium azide, L-ascorbic acid and Trolox (a water-soluble vitamin E) prevented both the UVA1- and the tobacco-induced alteration of MMP-1. These observations suggest that the imbalance of connective tissue matrix components might contribute to the molecular basis for premature skin aging in smokers. They also suggest that reactive oxygen species including singlet oxygen mediate this process.
Smokers look older than non-smokers of the same age. We have compared the concentrations of mRNA for matrix metalloproteinase 1 (MMP-1) in the buttock skin of smokers and non-smokers with quantitative real-time polymerase chain reactions. MMP-1 degrades collagen, which accounts for at least 70% of the dry weight of dermis. We report significantly more MMP-1 mRNA in the skin of smokers than non-smokers whereas no difference was seen for the tissue inhibitor of metalloproteinases 1 (TIMP-1) or the housekeeping gene GAPDH (glyceraldehyde-3-phosphate dehydrogenase). We suggest that smoking-induced MMP-1 might be important in the skin-ageing effects of tobacco smoking.
- Jj Jeffrey
- Interstitial Collagenases
Jeffrey JJ. Interstitial collagenases. In: Matrix Metalloproteinases
(Parks WC, Mecham RP, eds). San Diego: Academic Press, 1998;
15–42.