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Сергей Гольцов
служу искусству врачебного сомнения
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Parallel worlds

Every device is alive and every discovery has a part of its author’s soul.

The physical nature of a man is the result of his mental activity. Obviously, the things we see around us are just external manifestations of internal personal energies. This means that an inventor deals with the results of the intellectual process leading to some discoveries as well as generates fine energies himself realizing them into actual devices and medications. It is strange that this often happens in parallel, for example, in different countries.

Although Israel is the country which has been at war for several decades, there is a plant here producing the best laser devices for medicine, including aesthetic medicine.

UltraPulse by Lumenis (Israel — USA) — is a unique device which knows no equals among the lasers used for fractional ablation and standard carbon dioxide (CO2) skin resurfacing. By the way it is the most powerful laser among the currently available CO2-lasers and the only device which functions in an UltraPulse mode. What is the reason of its unique character? When I visited the production facilities I understood: it is assembled manually putting one’s heart into every single part – absolute creation of forms while using the cutting-edge technologies and the highest level of quality standards make this state-of-the-art device alive.

Russia has been through a lot for the last thirty years as well. Yet here, justifying the words by M.V. Lomonosov saying that the power of Russia will grow with Siberia, our laboratory of the development and production facility Tyumencryobank has developed a wound healing medication having no equals anywhere in the world.

Cellgel (Цельгель) — the lyophilized extract of chicken embryo cells is used as an active primary material of this wound healing medication. Isn’t this life? Indeed, our research team managed to perform a xenogeneic transfer of biological properties which resulted in the gel creation which stimulates migration and proliferation of fibroblasts, keratinocytes, endothelial and other cells taking an active part in the wound healing process thus contributing to epithelialization and regeneration of the tissue compliance. 

 

 

Collective mind always wins

In the world around us there are information waves as well as energy ones. There is a theory according to which the information waves penetrating through the whole Universe transfer people’s thoughts and feelings thus forming a common information space. A man having access to this information space can get answer to any question which bothers him, but on condition that it is really important for him to know and if his thoughts are utterly sincere. In accordance with this theory a man’s thoughts are material and have direct influence on the people and all living creatures around.

In this regard it should be noted that a discovery is made not by one person. As a rule, it is a result of work of the whole team, and the next noticed parallels clearly demonstrate this fact.

"Lightingthe way to future life-enhancing technologies!" has been the guiding principle at Lumenis since 1996. The company which has been an acknowledged leader in the field of development and production of surgical lasers and technologies based on lasers.

In Latin Lumenis means "light of life" thus stressing the importance of the light which is the basis of technologies aimed at improving the quality of life.

The company’s forward-looking technologies are proved by through clinical tests in all the fields of medical aid.

Just concerning machine cosmetology Lumenis is the pioneer and the global leader in the field of laser resurfacing. The company’s devices obtained a record number of FDA’s approvals and references of leading experts which are not easy to get, as you may see.

"+1 Life" — this was the motto when in 2008 we established our development and production facility

Tyumencryobank to realize research projects in the field of biomedical and cellular technologies. The facility comprises the research laboratory, the production shop, the vivarium and the cryoreservoir for biological material.

As nowadays the increasing attention of scientists and clinicians is paid to the processes of cell-to-cell cooperation then the main object of our studies has become the human skin. Being the largest barrier tissue the skin is ideal as a model for studying the efficiency of applying cellular technologies.

The results of tests on rabbits and volunteers who participated in the clinical tests came to acquisition of the patent by Federal Institute for Industrial Property of the Russian Federation for a wound healing medication Cellgel. The gel application was proved by the test data sheet No 594?12П/7-НТdated December 24, 2012 and the Customs Union declaration of compliance No ТСRU Д-RU. АЛ14. В. 03012 dated December 25, 2012. 

 

 

The most dramatic events happen across research areas

The course of the scientific and technological progress implies the connection of sciences; in our case – the laser device UltraPulse by Lumenis and Cellgel by the development and production facility Tyumencryobank as an example of efficiency of physics and biology parallels in practical medicine to obtain maximum performance in the best interests of a patient.

What does the word "laser" mean? It is the abbreviation of the English expression "Light Amplification by Stimulated Emission of Radiation". Actually it is a device for the energy conversion (electric energy, energy of light, chemical energy and heat energy) into the electromagnetic radiation energy of optical spectrum.

Everything started in 1916 when Albert Einstein predicted the phenomenon of stimulated emission of radiation – the physical basis of any laser. In 1960 Theodore Maiman demonstrated the first optical laser using ruby crystal.

Today UltraPulse possesses excellent advantages of other CO2-lasers due to its unique properties:

• 6 times more powerful than other CO2-lasers;
• 4 times deeper than any other CO2-laser (ablation depth up to 4 mm);
• 2 times faster than the majority of CO2-lasers;
• provides 240 watt of power on tissue and 255 mJ of energy on pulse;
• functions in the ultra pulse mode for optimum correlation of ablation and coagulation;
• obtained 34 approvals by FDA for dermatology, aesthetic medicine and plastic surgery.

The theory of potential xenogeneic stimulation of the skin reparative processes and our 14-year scientific inquiry which started with the research of the animal embryonal tissue followed by a wide range of research which resulted in isolation of the chicken embryo tissue extract which was then adsorbed on hydroxymethyl cellulose. This is how Cellgel appeared being sold today in 27 regions of Russia and the Customs Union countries.

The basis of Cellgel wound healing medication is a 2% solution of hydroxyethyl cellulose which is an aqueous gel. When water is evaporated (moisture is lost) the gel is dried up and if the water is added the gel swells again. The therapeutic concentration of the gel is preserved due to the basis hydrophilic properties; the properties of the active agent do not change as a result of its water solubility. The hydrophilic basis provides a moderate dehydrating effect and decreases sensation of pain. After applying the wound healing gelon the damaged skin a thin elastic film is formed on the skin surface. The film prevents the wound surface from tightening – one of the reasons of coarse cicatrization.

How does the gel influence the wound process? The gel doesn’t fill in the tissue defect but stimulates the proper growth pool in the wound. Contributing to healing of the tissue defect it stimulates the emergence and growth of granulations with subsequent epithelialization exceeding the rates of the connective tissue formation.

During the first phase of wound healing the gel cuts short inflammation and accelerates wound cleansing due to its strong antibacterial effect and inductive influence on necrocytosis. During the second and the third phases the gel stimulates processes of physiological reparative regeneration: the wound epithelialization takes place without formation of the connective scar and with restoration of the damaged skin functions (as evidenced by the hair-covering growth). The substances contained in the extract of chicken embryo cells enhance the oxidative metabolic processes in the cell which suffers from energy deficiency. Under conditions of hypoxia and/or lack of substrate as well as in case of the heavy energy consumption during the process of healing and regeneration it stimulates energy processes of cellular metabolism. 

 

 

If the parallels were not so effective they would not be worth talking about

Since the late XX century the status of aesthetic medicine has been undergoing great changes: right before our very eyes it is turning from the particular applied discipline into a self-sufficient scientifically-based field of medicine. New technologies are being implemented into the field of aesthetic medicine extremely fast using the factors of various levels of aggressiveness influencing the soft tissues. However, the issues concerning preventive treatment of complications are still important, first and foremost, the development of coarse cicatrization while applying invasive procedures, the enhancement of skin restoration and the rehabilitation period reduction. Inotherwords, theissuesofwoundhealing.

Thus, two technologies, two results have met in the context of clinical medicine and subsequent application.

As our time and the time of our youth quickly flies by so the modern technologies develop further increasing their efficiency. In NEO-Clinic the whole family of the Lumenis lasersis employed by the highly skilled doctors to preserve the patients’ health and beauty. However, the significant skin aging, fine lines and deep wrinkles, enlarged pores, hyperpigmentation, scars and cicatrices – these are the problems which cosmetologists constantly face and which are effectively eliminated with the help of the UltraPulse laser due to the ultra-fine and intense pulse. This laser forms narrow and at the same time deep ablation areas in contrast to other lasers. In this case it is referred to the fractional thermolysis the clinical performance of which is based on the mechanism of controlled tissue damage and its subsequent restoration.

The procedure is prescribed to the patients with:

fine lines and deep wrinkles;

significant skin aging;

enlarged pores;

hyperpigmentation;

scars and cicatrices.

The clinical practice convinces that the wound healing remedies which a cosmetologist has at his/her disposal improve the prognosis for the tissue restoration though do not always give the expected result, and sometimes cause the patients’ physical discomfort, restrict their social activities, and frequently result in the restricted duty. It is vital not only to heal the wound quickly, but to do it right from the aesthetic point of view as well as to avoid cicatrization.

Just after the procedure of fractional thermolysis the patients wish to avoid a long-term period of rehabilitation in order to stay in the course of their active social life. The doctors, for their part, consider it important to manage the wound healing process to prevent the skin from cicatrization and infectious complications. That is why after such a serious aesthetic procedure it is vital to use the medication which guarantees scarless wound healing.

Cellgel meets the requirements for the rehabilitation period after the fractional thermolysis effectively reducing inflammation and improving the patients’ quality of life.

To a considerable extent the success of a wound healing process depends on the applied medications of local action. However, they are frequently prescribed in an empirical way, in this case the frequency of complications may reach 70%. This choice is based on the classical dermatological approach to the wound therapy – to close the tissue defect as soon as possible, by all means, including formation of the cicatrical tissue. Following the above statements various kinds of external therapy are applied: bactericidal agents, antiseptic agents, antibacterial agents, corticosteroids and dosage forms of reparative agents. As the basic elements of the wound development are explained from the standpoint of abscure inveterate autoimmune pathology all currently available therapeutic measures are reduced to the immunosuppressive ones, in other words to the application of steroid drugs. In my opinion it is unacceptable as when applying any corticosteroid a constant skin microvascular spasm is formed in the wound focus which results in the tissue metabolism disorder in the damaged area.

A special group is represented by the reparative agents which accelerate the natural processes of epithelialization: the patient’s own epidermis is the best wound cover, and it contributes the most to its healing free of cicatrization. But the epithelialization rates are low when applying reparative agents, in particular it averages 30 days when using Solcoseryl. Thus, the problem of developing new highly-efficient methods of reparation is quite urgent.

What problems should be solved by the medication which provides normal wound healing? With the knowledge of pathogenesis of wound healing and pathological cicatrization it is not difficult to answer this question: such medication should provide acceleration of healing of the damaged area, stimulation of the skin reparative potencies, preventive treatment of recurrent infectious diseases and serious complications connected with cicatrization. It is much more difficult to find this medication, the research is carried out in different fields. Our field of research is directly connected with cellular technologies. In the course of our research we based on the well-known fact: the phase of epithelialization always follows the phase of formation of new granular connective tissue – granulation tissue. This was the start of the working hypothesis on the possible improvement of the wound healing process if the stimulation of the skin reparative capabilities caused by some local damage (foe example, skin care procedures) would be enhanced due to additional application of the substance which predictably influences the mechanism of the granulation tissue formation. When choosing the basis for the medication we proceeded from the assumption that if we take a naturally occurring gel-forming substance as the basis this will help us avoid skin irritation and cicatrical contraction of the wound and reduce sensation of pain.

Thus, Cellgel is the product that meets all the requirements to the wound healing. One layer of the gel should be applied straight after the laser treatment of skin, and then on the laser treated skin area 2-3 times a day during 3-4 days. Before application the skin should be cleaned from the previous layer, dead cells, possible blood and lymph discharge with cotton buds wet with thermal water or soft inert tonic. It is vital not to use tonics containing alcohol, acids and other active agents for cleaning the laser treated skin area. Application of Cellgel is unnecessary during the period of skin scaling.

After the very first application of gel we get the reduction of skin redness and edema. The healing period will be more comfortable and will be reduced by 2-3 times. This will make it possible to avoid cicatrization and infectious complications.

 

And what is more important Cellgel doesn’t have any contraindications, it doesn’t cause complications and allergic response. In exceptional cases there can be a little burning sensation in the area of the gel application, but it means only one thing: the medication is having an active effect and the derma restructuring with an increasing pool of granulations is taking place.

As a result we expect:
• reduction  of the rehabilitation period;
• preventive treatment of infectious complications;
• comfortable conditions for the patient during the healing period;
• reduction of adverse effects of the exudation period (edema, hyperemia);
• sustaining of the skin hydration level;
• skin regeneration without cicatrical tissue formation.

Possible response? The response can and will be the only one – fast skin restoration and healing without scars. In exceptional cases there can be a little burning sensation in the area of the gel application.

How does a specialist work with the laser and Cellgel? Application of Cellgel after fractional thermolysis is carried out in accordance with the elaborated protocol.

What do we actually get:

reduction  of the rehabilitation period;

preventive treatment of infectious complications;

comfortable conditions for the patient during the healing period;

reduction of adverse effects of the exudation period (edema, hyperemia);

sustaining of the skin hydration level;

skin regeneration without cicatrical tissue formation.

Expectationsandresultscoincide. No complications have been observed.

dramatic results — smoothing of fine and deep wrinkles and skin surfacing after one procedure;

the rehabilitation period is reduced by 2-3 times;

the procedure with the UltraPulse laser makes it possible to surface even very deep scars and cicatrices of any origin.

Case management after the procedure is one of the main factors of efficiency of aesthetic correction with the use of methods which provide for the violation of skin integrity, such as laser resurfacing and fractional thermolysis.

In our clinic the wound healing medication Cellgel has been used for 3 years after the procedures of fractional thermolysis, laser removal of the skin new growth and laser resurfacing for patients of different age and skin type. Our experience as well as the experience of our colleagues from other clinics has shown that the application of the wound healing gel at an early rehabilitation period after the cosmetic procedures of various degrees of invasiveness contributes to the reduction of the exudation period, a faster skin restoration and healing without cicatrization. Thiscanbeseenthroughtheexample.

 

Medicalcase

Patient E. applied to the clinic with complaints of the skin irregularity in the area of cheeks, forehead and cheekbones as well as of formed atrophic cicatrices. In the medical history – acne. Objective of the procedure to be held – skin surfacing and smoothing of skin irregularities.

The procedure was held under the following parameters: handpiece Active FX with CPG mode, form/size/density — 3/5/5, pulse energy — 150 mJ, frequency — 175 hertz.

Anesthesia — short-time general anesthesia — Diprivan (intravenously). Got back on track in 7 days.

 

To accelerate the healing process and avoid cicatrization Cellgel was applied with a thin layer on the laser treated skin area straight after the manipulation and further in accordance with the protocol.

Every time before the gel application to the skin it was cleaned from dead cells, blood and lymph discharge and beginning from thesecond procedure – from the previous gel layer. The skin was cleaned with cotton buds wet with thermal water or soft inert tonic.No other medications containing alcohol, acids, manganese or any other active agents were used.

Observations showed that the skin redness and edema reduced within the first 24 hours after the procedure.

After the procedure the patient noticed the considerable smoothing of skin irregularities. Prior to that she got four procedures using the other laser with a less satisfactory result. This time she was pleased with the results.

 

As an alternative to conclusion

Thus, the clinical experience showed the efficiency of a combined application of UltraPulse and Cellgel. The controlled wound healing process accelerates and improves the processes of the damaged skin reparation preventing it from the deep cicatrization and providing a desirable aesthetic effect.