Thesis (M.S. in Mechanical Engineering and Mechanical Engineer)--Naval Postgraduate School, June 1990. / Thesis Advisor(s): Sarpkaya, T. "June 1990." Description based on title page as viewed on October 16, 2009. DTIC Identifier(s): Vortices, Vortex pairs, Interactions, Surface properties, Interfaces, Striations, Trailing vortices, Theses. Author(s) subject terms: Surface disturbances, Scars, Striations, Trailing Vortices, Vortex Dynamics. Includes bibliographical references (p. 120-122). Also available in print.

Introduction Keloids are formed by the excessive production of scar tissue, which extends beyond the margins of the original injury, often resulting in lesions of grotesque dimensions. Keloids present a major dilemma to surgeons because of the high recurrence rate with recurrent growth often larger than the original keloid. The high recurrence rate and the poor response of keloids to therapy present a great challenge to surgeons. The numerous therapeutic regimens demonstrate that to date there is no single therapy that is absolutely successful. Therefore, it is necessary to comprehensively establish the pathology of keloids and to determine the aetiopathogenesis of the lesion in order to eventually provide unfailing specific effective treatment and to better understand the mechanisms regulating fibrosis in various fibroproliferative diseases. Aim To evaluate the pathology and aetiopathogenesis of keloid formation. Methods The research protocol for the study was approved by the Nelson R Mandela Faculty of Medicine Ethics Committee. Informed consent was obtained before the biopsies were taken. Keloid and non-lesional skin biopsies were obtained from thirty two patients who had multiple lesions in various locations, bringing the total number of keloids and apparently normal skin biopsies processed and examined to fifty eight. The biopsied specimens were processed for paraffin wax embedment and routine haematoxylin and eosin, differential and immunocytochemical staining. Sections were scrupulously examined using the Olympus BH-2 microscope; features pertinent to the study were photographed with the Olympus DP 10 microscope digital camera system. The stored images were studied, using the Camedia graphics processing programme. Results The results of the study showed that keloids comprise many distinct regions categorized as: the zone of hyalinising collagen bundles, fine fibrous areas, areas of inflammation, zone of dense regular connective tissue, nodular fibrous area and area of angiogenesis. Fibroblastic phenotypes present ranged from spindle, fibrohistiocytic, epitheloid, elongated flattened condensed fibroblastic cells to few wavy, fuzzy, polygonal and atrophic cell types. Immunocytochemically these cells were vimentin-positive and actin- and desmin-negative. Few myofibroblastic phenotypes were also identified and these were vimentin- and alpha smooth muscle actin-positive and desmin-negative. The fibroblastic and myofibroblastic phenotypes were in proliferative or degenerative stages and pathological features exhibited were the presence of vesicular, degenerate or calcified nuclei; nuclear and plasma membrane damage; cytoplasmic and nucleoplasmic clearing; atrophy, pyknosis and swelling. Severe, moderate to mild paravascular inflammation was observed around the microvessels of the sub-papillary plexus and within the keloid. There was compression and occlusion of small blood vessels, coagulation necrosis and dissolution of mural cells of small blood vessels and small peripheral nerves. Also present in keloids were oedematous areas, disorganised and hyalinised connective tissue fibres and increased numbers of degranulated and degranulating mast cells. Elastic fibres in keloids were minimal or absent whereas at the border of keloids there was an increase.Discussion Degenerate, occluded and compressed microvessels were a widespread pathological feature in keloids. This resulted in impaired vascular supply to each of the keloid regions which impacted directly on the pathology of keloids where degeneration and necrosis, manifesting the lack of nutrients and oxygen to tissue, were found throughout the keloid. The vascular supply was impaired because of the chronic inflammatory destruction of the microvessels and the elevated stress within keloids. Factors contributing to increased intrinsic stress were: 1) the lack of elastic fibres in keloids which decreased the elastic limit, leading to effects of excessive deformational force which were compression and stiffening of tissue; 2) the high tension skin covering keloid prone areas had low stretch and a low elastic modulus; 3). protruding hard connective tissue such as bony prominences or cartilage into the dermis of keloid prone skin; 4) contractile forces exerted by wound healing fibroblastic cells; and 5) external forces. Compression and occlusion of blood vessels induced ischaemic and reperfusion tissue injury. During the reperfusion phase blood rich in growth factors returned to tissue stimulating tissue growth. Tissue growth was also promoted by elevated internal stress which stimulated increasing levels of gene expression, collagen synthesis and mitotic activity. All these growth promoting effects resulted in keloid formation. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

Thesis (Ph.D.) - University of Queensland, 2005. / Includes bibliography.

The skin acts as a protective barrier, is crucial for thermoregulation and also forms part of the sensory, immunological and endocrine system. Therefore skin preservation is paramount to preserving life. The loss of skin homeostasis, through injury, initiates the wound healing process where the final outcome is the formation of a scar. Scar treatment remains a challenge, despite a plethora of treatments, resulting in a poor outcome and sub-optimal response to existing therapies. Photodynamic therapy (PDT) has been used to treat oncologic conditions affecting the skin. Its action depends on a photosensitiser and a specific light source. Aminolevolinic acid (5ALA) and its methyl ester (MALA) are commonly used pro-drugs of the photosensitiser protoporphyrin IX (PpIX), which in combination with red light produces reactive oxygen species (ROS). ROS will cause different responses such as cell death and tissue destruction. There is limited clinical evidence emerging for the use of PDT in treating wound healing and pathological skin scarring. For this reason, further investigations are required to better understand the role of PDT in adult human skin wound healing and skin scarring. The aim of this investigation was to evaluate the accumulation of PpIX after exposure to 5ALA or MALA, phototoxicity of red light arrengment, citotoxicity, cell death inducction, ROS generation and a gene related analysis post-PDT in keloid fibroblasts compared to normal skin fibroblasts. Optimization of a wound healing organ culture (WHOC) model and evaluation of re-epithelialization, cell death, proliferation, extracellular matrix arreangment (ECM) and a related gene analysis after 5ALA-PDT ex vivo. General histology, cell death, proliferation, ECM rearrengment and a gene related analysis after PDT in skin scarring ex vivo. This investigation found PpIX accumulation higher with MALA compared to 5ALA. Phototoxicity and cytotoxicity was site specific within the lesion and increased proportionately to fluence rates. ROS generation leads to the decrease of cytoproliferation and increased apoptosis and necrotic cell death, COLI, COLIII an HSP70 were found down-regualted. Ex vivo wound geometry, system of support and growth media were optimized in a human wound healing organ culture (WHOC). WHOCs treated with 5ALA-PDT (20 J/cm2), showed an advancing re-epithelialization tongue 3.5 folds longer, which were highly proliferative, showing increased CK14 and p16 levels. The neo-epidermis was fully differentiated and neo-collagen was present. PCNA, p16, COLI, COLIII, MMP3, MMP19 and alpha-SMA were significantly more expressed in the dermis. MALA/5ALA-PDT (40 J/cm2) applied to striae alba, fine line, hypertrophic and keloid scars ex vivo coused an increased of apoptosis while proliferation decreased, matrix components were found to be re-organised, both according to the severity of the scar. COLI and COLIII genetic expression decreased while MMP3 and tropoelastin increased significantly. However, no statistically significant difference was observed between 5ALA and MALA-PDT treatments. In conclusion, this thesis shows that cytotoxicity post-PDT in KD fibroblasts is dependent on the lesional site within the scar, a precursor of intracellular photosensitiser and fluence. PDT in wound healing ex vivo shows increased re-epithelialization and ECM reconstruction and remodelling. Finally, in dermal fibrosis morphological and cellular effects of the application of PDT correlate with the degree and severity of dermal fibrosis. In view of this, PDT may be ideal for treating abnormal skin scarring and improving human cutaneous wound healing.

Human skin colour has significant aesthetic and cultural implications. Cutaneous injuries can result in dys-pigmented scars which are more noticeable, aesthetically unpleasant, and can lead to patient distress and social isolation. Management of dys-pigmented scars has been challenging with variable success. There is a limited understanding of the timing, progression and mechanisms of skin re-pigmentation following wounding. This thesis is a detailed sequential study, which describes and quantifies scar colour changes in pigs of different pigmented strains.The first result chapter describes the observational pigmentary changes in scars of four different pigmented pig strains (Hampshire, Yucatan, Tamworth and Duroc) over time. Two scar re-pigmentation progression patterns, specific to the darkly and the lightly pigmented pigs, are identified and all scar photographs of all pigs at all time-points are scored during non-invasive wound/ scar monitoring using a semi-quantitative scale. In the second result chapter, histo-chemical (DOPA-oxidase) staining was combined with immuno-histochemistry (HMB45) to establish the spatial and temporal distribution and activities of melanocytes in the regenerated epithelium of darkly pigmented pig strains. Results suggest a rise in both inactive and active melanocyte numbers in re-pigmenting scars at early time-points and by late time-points, scars achieved ‘complete re-pigmentation’ and melanocyte numbers were lowest. Late melanocyte proliferation was observed in two scars from two different pigs; one of which manifested this as hyper-pigmentation, macroscopically. In addition, histological analysis of the epidermal melanin staining (Warkel-Luna-Helwig) pattern showed good correlation with the macroscopic appearance of the scars. The effect of changes in scar basement membrane undulation on melanocyte packing density was investigated: changes were small and unlikely to impact melanocyte packing density; hence macroscopic scar colour. Macroscopic and microscopic observations of the pattern of re-pigmentation following creation of partial thickness wounds across the white and black belts of three Hampshire pigs were investigated.The final result chapter describes how colour changes were quantified for scars and normal skin of each pig, at all time-points during non-invasive scar monitoring; using a reflectance spectrophotometer. In addition, the sensitivity of objective colour measurements was investigated. Results using two statistical clustering techniques suggest that colour measurements differentiate scars from the surrounding normal skin and the tristimulus L*a*b* values of scars correlate well with their macroscopic colour appearances. Time-dependent colour changes in scars and normal skin were quantified independently, using polynomial analysis. The results suggest systematic colour changes in most scars of all pig groups, except Yucatans’, which on the other hand, showed systematic colour changes to their normal skin. These findings highlight the importance of independent analysis of scar and normal skin colour measurements with time post wounding. In conclusion, this thesis has investigated timing and progression patterns of scar re-pigmentation in pigs of different pigmented strains.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / According to research, continuing symptoms of pain, instability, crepitus, weakness, stiffness (Pellow and Brantingham, 2001) and swelling (Patel and Warren, 1999:332) commonly follow an acute ankle sprain. The cause of these symptoms is often attributed to the development of a tight sensitive scar (Reid, 1992:251) within the injured ligament. The treatment options available include scar tissue debridement (Bassewitz and Shapiro, 1997), manipulation (Edmond, 1993:164), mobilization, (Hockenbury and Sammarco, 2001) and ultrasound (Thomson, Skinner & Piercy, 1991:43-44). Transverse friction massage could also be used to reduce adhesions (Kessler, 1990:85) and improve mobility of the tissues (Kessler, 1990:140). The Graston Technique Instrument Assisted Soft Tissue Mobilization (GTIASTM) comprises a set of stainless steel instruments (Carey 2003:2) designed to detect and reduce scar tissue and adhesions (Carey 2003:7) by bringing about an area of controlled microtrauma (Hammer, 2003(b):1) and inflammation (Carey 2003:32) through a mechanism similar to that of friction massage. / M

We report on the potential for developing long-term fire histories from chir pine (Pinus roxburghii Sarg.) forests in the Western Himalayan foothills based on a preliminary study from a stand located in the state of Uttarakhand in northern India. Rings from trees collected to develop a master skeleton plot chronology were generally complacent with false rings present during most years, but were crossdatable with only minor difficulty. The oldest tree confidently crossdated back to 1886, with good sample depth (5 trees) from 1911, which helped date the fire scars in cross-sections collected from three trees. Fire frequency as determined from fire-scar dates was high, with mean and median fire intervals of 3 years from 1938 to 2006. Fires were likely from human ignitions given the prevalence of human land use in the site. Fire scars were generally recorded at false-ring boundaries and likely represent burning during the hot, dry period in May or early June before the onset of monsoon rainfall beginning in mid-June. Although only three fire-scarred trees were sampled, this preliminary assessment shows there is a potential for additional samples from other stands to develop longer-term fire histories to better understand the role of fire in the ecology and management of chir pine throughout its range in the Himalaya region.

It is a commonly held belief that a repeat caesarean section through a low vertical scar provides easier access and fewer complications than an operation through a previous Pfannenstiel incision. To test this hypothesis the records of one hundred and twenty one repeat caesarean sections were retrospectively reviewed by the author. These records were reviewed at the two large teaching hospitals of the University of the Witwatersrand, Chris Hani Baragwanath and Johannesburg General Hospital. Statistically significant findings were that older women were more likely to have had an initial midline incision. Incision to delivery times were faster via the midline (4 min) than the Pfannenstiel incision (5.5 min). Total operating times did not differ significantly. The findings do show that repeat midline incisions are faster (1.5 min) to deliver, but do not address the patient’s need for a cosmetically pleasing wound scar.

Aims and objectives The aim of this study is to investigate the impact of bullying of educators by learners they teach, thereby make an effort to improve the methods of dealing with bullying in our schools by introducing a pastoral counselling approach to our schools. The objectives of the study were the following: • To journey with the bullied educators through method of positive deconstruction, so as to give a supportive system and to cease their pain of being shamed and belittled. • To develop a pastoral model to help bullying victims and perpetrators. • To avail to the educators another possible effective method to deal with bullying in our schools, "A formation of pastoral model". • To combat the acts of violence in our society • To create awareness of bullying in our society. This qualitative study endeavoured to answer the following research questions: What is the impact of bullying on the educator? The other forms of bullying like verbal bullying, teasing and threats found hard to investigate, as at times it is the victim's word against the perpetrator's word. The research found that it's not easy to get witnesses, especially from learners. Cases of the bully acts normally get neglected, unless, they ended up being physical. Findings and recommendations The study, presented findings and recommendations. These were to be piloted in one school with the aim to get to buy in of the Department of Education, so to have this approach implemented in all schools and be incorporated in the already existing policies and programmes of intervention. The author aimed at assisting our Department of Education and schools with an alternative method that can improve interventions. The study was feasible, as it was easy to find former educators and learners for interviews and study cases. Not much information was found from schools due to protocol, red tape and right procedure given our schools by the Government as far as information related to learners in our schools. It would have been difficult to complete this study on time if the author was to wait for authorization. Financially the author had to rely on his congregational and diocesan support. The author being a former educator was able therefore to work with adults who are no longer at school but have experienced bullying as former learners and educators. The following points are in the authors mind, as he seeks to research on the bullied, the bullies and the bystander: • Physical bullying is the most feared form of bullying and educators felt it a challenge as they can't retaliate due to policy. • Cyber bullying is the most difficult form of bullying that is highly perpetuated against educators and caused internal wounds and scars that take very long to heal. • Sexual bullying is one of the causes of high pregnancy amongst girls in our school. • Drugs and alcohol are a catalyst to many boys who bully their educators / Dissertation (MA (Theology))--University of Pretoria, 2016. / Practical Theology / MA (Theology) / Unrestricted

Faculty of Health Science Degree of Master of Science in Human Genetics 9809684w / Lipoid proteinosis (LP) (OMIM 247100) is a rare autosomal recessive disorder that is caused by mutations within the extracellular matrix protein 1 gene (ECM1). The ECM1 gene has been shown to play a role in angiogenesis and connective tissue matrix generation, especially in skin and bone. The role of ECM1 in normal skin development and maintenance is further highlighted by its role in LP and in lichen sclerosis where autoantibodies are raised against ECM1. LP usually presents in the first year of life with a faint or hoarse cry and is due to a hyaline-like material deposited in the mucous membranes of the vocal cords. Gradually (over years) there is diffuse skin infiltration and general skin thickening with a yellow, waxy appearance. There is excessive scarring with scars often appearing at sites of minor injury or stress. In many cases, the eyelids show typical beaded papules. In some cases, calcification of certain aspects of the temporal lobes have been observed, and may or may not be associated with variable neurological, psychiatric and neuropsychological sequelae. Although the prevalence of LP in South Africa is unknown, the disproportionately high number of case reports originating from South Africa indicates that LP is unusually common in certain South African populations, most notably the Coloured population of Namaqualand and the Afrikaans-speaking White population. This may be due to a possible LP founder effect that occurred early during the European colonisation of South Africa. The founder effect was investigated in the South African LP patients by conducting ECM1 mutation and linked marker analysis. The data supported a LP founder effect as the Q276X mutation in exon seven of ECM1 was present in the homozygous state in all LP patients investigated. In addition, the Q276X mutation was associated with a single founder haplotype of 19-12-23-22 (ND1-D1S2343-D1S305-D1S2624). These markers were in significant linkage disequilibrium with each other and with the Q276X mutation. VI As variation within ECM1 may alter properties of skin such as healing and scar formation, ECM1 exons two through five and the first part of exon six were investigated for nucleotide variation using denaturing high performance liquid chromatography (dHPLC) and direct DNA sequencing in three different South African populations. Eight nucleotide variants were identified, of which six were cytosine to thymine transitions. Seven of the eight variants identified were either intronic or synonymous, with one variant being a missense variant, changing a methionine residue to a threonine residue (T130M).