Lifting frontal apoyado en malla de polipropileno Brow lift supported on polypropylen mesh

La región frontorbitaria tiene una especial significación en el contexto del envejecimiento facial. La literatura cuenta con numerosa bibliografía que trata sobre este problema. Se considera como una unidad diagnóstico-terapéutica en los últimos tiempos y la evolución de la cirugía hace que se vaya hacia soluciones cada vez más fisiológicas y mínimamente invasivas. Nuestro trabajo queremos que sea un paso más en esa dirección. Sobre una muestra de 25 pacientes en los que se trató la región frontorbitaraia con diferentes procedimientos, y que además mostraban un descenso de la altura de las cejas, se presenta una técnica de suspensión frontorbitaria con mínima incisión, apoyada en una malla de polipropileno anclada en el músculo frontal y galea en el extremo inferior y en el periostio y la galea en su extremo superior en el plano supraperióstico y sin resección cutánea. Se emplea un sistema de medición de resultados basado en puntos del esqueleto facial. Los resultados han sido satisfactorios subjetiva y objetivamente, y comparables a los de otras técnicas más complejas y de mayor coste económico. Las complicaciones desarrolladas han sido leves y pasajeras. Se valora porqué se decidió utilizar la malla de polipropileno, así como porqué se eligió un gramaje concreto. También se analizan las características que aportan el material y su uso en esta técnica como comportamiento ante la infección, tolerancia tisular, retracción cicatricial y adhesividad. Asímismo se justifica el plano de disección y colocación elegido, y se valora el sistema de medición para el control objetivo de los resultados. La aportación de este trabajo consiste en desarrollar una alternativa dentro de las técnicas mínimamente invasivas para le reposición de la región frontorbitaria, sin resección de piel y con buenos resultados en la corrección de las arrugas frontales, comparables a los de otras técnicas de mayor complejidad y elevado coste económico.The fronto-orbital region is of particular significance in the context of facial ageing. There is a considerable amount of research on the nature of this problem. This area has recently come to be considered as a therapeutic- diagnostic unit and surgical developments mean that focus is switching more towards less invasive physiological solutions. Our study aims to take another step in this direction. Taking a sample of 25 patients, all of them undergoing different procedures on the fronto-orbital region and with a lowering of the eyebrows, a suspension technique was introduced with minimum incisions supported by a polypropylene mesh attached to the frontal muscle and galea in the inferior extreme and to the periosteum and galea in the superior extreme in the supra-periosteum plane and without skin removal. A measuring system based on points of the facial skeleton was used. The results were subjectively and objectively satisfactory compared to those from more complicated and expensive techniques. Complications were of a slight and temporary nature. This section carries out an assessment of the reasons for selecting a polypropylene mesh and specific grammage. In addition, the properties of the material are analysed and its use in this context of preventing infection, tissue tolerance, scar reduction and adhesiveness. Justification of the site of dissection and the choice of positioning, and an assessment of the course of medication given in order to produce a set of controlled and objective results, will also be carried out. The aim of this work is to develop an alternative within minimally invasive techniques for the restructuring of the fronto-orbital region without skin removal and with good results in the correction of facial wrinkles compared to other more complicated and expensive techniques

Can magnetic resonance imaging enhance the assessment of potential new treatments for cognitive impairment in mood disorders? A systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force

Background: Developing treatments for cognitive impairment is key to improving the functioning of people with mood disorders. Neuroimaging may assist in identifying brain-based efficacy markers. This systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force examines the evidence from neuroimaging studies of pro-cognitive interventions. Methods: We included magnetic resonance imaging (MRI) studies of candidate interventions in people with mood disorders or healthy individuals, following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE, Cochrane Library, and Clinicaltrials.gov from inception to 30th April 2021. Two independent authors reviewed the studies using the National Heart, Lung, Blood Institutes of Health Quality Assessment Tool for Controlled Intervention Studies and the quality of neuroimaging methodology assessment checklist. Results: We identified 26 studies (N = 702). Six investigated cognitive remediation or pharmacological treatments in mood disorders (N = 190). In healthy individuals, 14 studies investigated pharmacological interventions (N = 319), 2 cognitive training (N = 73) and 4 neuromodulatory treatments (N = 120). Methodologies were mostly rated as ‘fair’. 77% of studies investigated effects with task-based fMRI. Findings varied but most consistently involved treatment-associated cognitive control network (CCN) activity increases with cognitive improvements, or CCN activity decreases with no cognitive change, and increased functional connectivity. In mood disorders, treatment-related default mode network suppression occurred. Conclusions: Modulation of CCN and DMN activity is a putative efficacy biomarker. Methodological recommendations are to pre-declare intended analyses and use task-based fMRI, paradigms probing the CCN, longitudinal assessments, mock scanning, and out-of-scanner tests