Development and Application of New Methods for Magnetic Resonance Elastography of the Brain

Accurate mechanical properties of the intact, living brain are essential for modeling traumatic brain injury (TBI). However, the properties of brain tissue in vivo have traditionally been measured in ex vivo samples. Magnetic resonance elastography (MRE) can be used to measure motion and estimate material properties of soft tissues in vivo, but MRE typically assumes tissue isotropy and homogeneity. The objective of this thesis is to improve MRE of soft tissue, like the brain, by developing and evaluating methods for in vivo estimation of heterogeneous, anisotropic properties. This was achieved through pursuit of the following aims: (1) quantifying the differences between in vivo and ex vivo brain tissue, thereby clarifying the need for in vivo measurements; (2) introducing and applying a new approach to anisotropic MRE, using data obtained during external actuation of the porcine brain in vivo, which highlighted the need for new actuation methods; and (3) developing and evaluating a method for anisotropic property estimation using MRE with actuation by harmonic focused ultrasound (FUS). This research has led to new methods for anisotropic MRE, and improved material property estimates of the brain and other soft tissues

Objective evaluation of an occlusive overnight intensive patch containing onion extract and allantoin for hypertrophic scars

Background Patients suffering from hypertrophic scars often describe esthetic, functional, and psychological impairments. While current guidelines for the treatment of pathologic scarring recommend the use of onion extract containing gels and sheets, hard evidence for its efficacy remains scarce due to inconsistent data. Onion extract and allantoin containing occlusive overnight intensive patches (OIP) were introduced as a recent option for noninvasive scar management. However, objective data demonstrating their efficacy are missing. Aims This study is the first to objectively evaluate the benefit and safety of an OIP for hypertrophic scars using a three‐dimensional imaging device and a standardized scar scale. Methods Twelve patients with untreated, three to twelve months old hypertrophic scars received an OIP for 3 months. The assessment was performed using PRIMOS®pico, a three‐dimensional imaging device and POSAS, a standardized scar questionnaire at baseline, one and 3 months after the last treatment. Results Objective evaluation at three months follow‐up (FU) showed a significant decrease in scar height of 28.8% (baseline mean: 2.08 ± 0.68 mm, three months FU mean: 1.48 ± 0.52 mm) and a reduction in scar volume of 31.9% (baseline mean: 454.33 ± 265.53 mm3, 3 months FU mean: 309.58 ± 224.28 mm3). Pain and pruritus subsided under treatment. There were no negative side effects. Conclusion Overnight intensive patches is a convenient, painless, safe, affordable and effective prevention and treatment option for hypertrophic scars. Treatment should be performed at least for 3 months for visible effects

Treatment of keloids using 5‐fluorouracil in combination with crystalline triamcinolone acetonide suspension: evaluating therapeutic effects by using non‐invasive objective measures

Background Intralesional 5‐fluorouracil (5‐FU) in combination with triamcinolone acetonide (TAC) has been recommended as a promising alternative for keloids not responding to silicone‐based products, cryotherapy or intralesional corticosteroids alone. Although numerous studies support the efficacy of this regime, there is a lack of objective data. Objectives In this study, we evaluate the therapeutic effect of four courses of intralesional 5‐FU in combination with TAC (3 : 1) utilizing 3D analysis (PRIMOS®pico), ultrasound and scar scales such as the Patient and Observer Scar Assessment Scales (POSAS) and the Dermatology Life Quality Index (DLQI). Methods Twenty‐five patients with keloids were treated using 5‐FU and TAC every 4 weeks. Objective assessments were performed and the scar scales administered at baseline, as well as during consecutive visits at 1‐ and 12‐month follow‐up (FU). Routine laboratory tests were performed at baseline and at 1‐month FU. Results 3D PRIMOS and ultrasound measurements revealed highly significant and stable reductions in height (baseline mean score: 4.0 ± 1.7 mm, 1‐month FU mean score: 1.5 ± 0.8 mm, 12‐month FU mean score: 1.8 ± 0.9 mm, P = <0.0001), volume (baseline mean score: 1,105 ± 911.5 mm3, 1‐month FU mean score: 416.1 ± 218.1 mm3, 12‐month FU mean sore: 431.2 ± 253.6 mm3, P = <0.0001, respectively) and penetration depth of keloids (relative reduction between baseline and 12‐month FU of 74.4%, P = <0.0001). The POSAS and DLQI scales confirmed significant objective and subjective improvements in scar appearance in all categories. The life quality associated with keloid appearance improved from a ‘moderate effect’ to a ‘small effect’ throughout the course of the study. Conclusions Results of this study confirm the efficacy and safety of the combination of 5‐FU and TAC in keloids. Treatments were well tolerated and demonstrated stable results at 12‐month FU

Efficacy and safety results of micellar water, cream and serum for rosacea in comparison to a control group

Background: Rosacea is a common inflammatory skin disorder with centrofacial erythema, flushing, telangiectasia, papules/pustules, and possible ocular or phymatous manifestation. Patients' skin is particularly sensitive to chemical and physical stimuli leading to burning, stinging, dryness, and skin tightness. Objective: Dermatological evaluation of the efficacy and safety of skin care products designed for centrofacial erythema in rosacea patients, in comparison with a control group using objective measurements. Rosacea symptoms (itching, tension, warmth, burning, dryness) and quality of life were examined. Methods Sixty Caucasians with centrofacial erythema were enrolled in an 8-week prospective study, fifty of them exclusively using the study products (micellar water, cream, and serum) with ten participants randomly assigned to a control group. Patients were evaluated at baseline (V0), at 4 weeks (V1), and at 8 weeks (V2). Three-dimensional objective measurements (VECTRA(R)) as well as standardized questionnaires were used. Results: Results were compared with the control group. A significant reduction of 16% in skin redness as indicated by VECTRA(R)analysis was seen in the intervention group comparing V0-V2. Furthermore, rosacea-associated symptoms diminished by 57.1%, while life quality of affected patients within the intervention group improved by 54.5% comparing V0-V2, respectively. Conclusions: A skin care regime suitable for sensitive and redness-prone skin led to an enhanced clinical appearance, to a decrease of associated symptoms in rosacea patients, and to an improved life quality

Onset of occupational hand eczema among healthcare workers during the SARS‐CoV‐2 pandemic: Comparing a single surgical site with a COVID‐19 intensive care unit

Background As a result of the COVID‐19 outbreak, hygiene regulations have been revised and hand sanitation has been intensified. Objective To investigate the onset of hand eczema during the COVID‐19 pandemic in healthcare workers (HCWs) directly involved in intensive care of COVID‐19 patients and HCWs without direct contact with COVID‐19 patients. Hereby, we aim at increasing awareness about occupational hand eczema and preventive measures that can be adopted. Method A survey was distributed amongst 114 HCWs at a single surgical centre and at a COVID‐19 intensive care unit of the university hospital Ludwig Maximilian University Munich, Germany. Participants were questioned about the daily frequency of hand hygiene prior to and during the pandemic. Participants self‐reported the onset of hand eczema and associated symptoms. Results Our study revealed a significant increase in hand washing, disinfection, and use of hand cream across all participants (P‐value <.001), regardless of having direct contact with COVID‐19 patients. A high prevalence of symptoms associated with acute hand dermatitis of 90.4% was found across all HCWs, whereas hand eczema itself was underreported (14.9%). Conclusion The increase in hand sanitation during the COVID‐19 pandemic impairs the skin of the hands across all HCWs, independent of direct intensive care of affected patients

Line‐field confocal optical coherence tomography, a novel non‐invasive tool for the diagnosis of onychomycosis

Background and objectives Onychomycosis is common and important to distinguish from other nail diseases. Rapid and accurate diagnosis is necessary for optimal patient treatment and outcome. Non-invasive diagnostic tools have increasing potential for nail diseases including onychomycosis. This study evaluated line-field confocal optical coherence tomography (LC-OCT) as a rapid non-invasive tool for diagnosing onychomycosis as compared to confocal laser scanning microscopy (CLSM), optical coherence tomography (OCT), and conventional methods. Patients and Methods In this prospective study 86 patients with clinically suspected onychomycosis and 14 controls were examined using LC-OCT, OCT, and CLSM. KOH-preparation, fungal culture, PCR, and histopathology were used as comparative conventional methods. Results LC-OCT had the highest sensitivity and negative predictive value of all methods used, closely followed by PCR and OCT. Specificity and positive predictive value of LC-OCT were as high as with CLSM, while OCT scored much lower. The gold standard technique, fungal culture, showed the lowest sensitivity and negative predictive value. Only PCR and culture allowed species differentiation. Conclusions LC-OCT enables quick and non-invasive detection of onychomycosis, with advantages over CLSM and OCT, and similar diagnostic accuracy to PCR but lacking species differentiation. For accurate nail examination, LC-OCT requires well-trained and experienced operators

App-Based Addiction Prevention at German Vocational Schools: Implementation and Reach for a Cluster-Randomized Controlled Trial

This article examines the implementation, participation rates, and potential determinants of participation in the digital addiction prevention program “ready4life.” A two-arm cluster-randomized trial recruited German vocational students via class-based strategies. Intervention group received 16 weeks of in-app coaching; the control group received health behavior information, with coaching offered after 12 months. Potential determinants of participation were analyzed based on class and individual characteristics. Out of 525 contacted schools, 35 participated, enrolling 376 classes. Implementation during the pandemic required flexible adjustments, with 49.7% of introductions conducted in person, 43.1% digitally via online streaming, and 7.2% received a video link via email. Despite challenges, 72.3% of the vocational students downloaded the app, and 46.7% gave informed consent. Participation rates were highest among (associate) professionals, vocational grammar school classes, classes introduced by females, younger individuals, members of the project team, and classes introduced face-to-face. Female gender, lower social competencies, lifetime cannabis use, higher problematic internet use, and higher perceived stress were associated with higher individual participation. The study highlights the importance of proactive outreach and personalized interventions for addiction prevention programs in vocational schools. While reached students aligned with the aims of the app, tailored recruitment strategies could enhance engagement among under-represented groups

Lichen Planus Pigmentosus Inversus: A Rare Subvariant of Lichen Planus Pigmentosus

Lichen planus pigmentosus inversus (LPPI) is a rare subvariant of Lichen planus pigmentosus (LPP), presenting with sharply defined brown to gray macules, papules, and plaques limited to the intertriginous areas, with only a few cases reported in the medical literature so far. While LPP mostly affects patients with Fitzpatrick skin type III-IV in sun-exposed areas such as the neck, LPPI is seen in Caucasians and spares sun-exposed areas. Skin lesions tend to be very refractory to treatment attempts including potent topical steroids and oral corticosteroids. Given the increased penetration of potent topical steroids and the high risk of skin atrophy, especially when applied to intertriginous areas, this case shows that topical calcineurin inhibitors (tacrolimus 0.1%) might offer an effective and safe treatment option for LPPI

Clinical clues to identify patients with ocular rosacea - a Germany-wide epidemiologic analysis

Background and objectives Ocular rosacea is a special manifestation of rosacea with unknown etiology. Eye involvement in rosacea patients is surprisingly common;however, it is often underdiagnosed, resulting in inappropriate treatment. We aimed to provide an updated epidemiologic perspective on ocular rosacea in Germany to improve patient care. Patients and methods Data of 777 rosacea patients were assessed using a detailed online questionnaire regarding ocular and skin symptoms, previous dermatological and ophthalmological consults, presence of type 1 hypersensitivities, and Demodex testing. All data were statistically analyzed. Results Most patients reported ocular symptoms (399/777, 51.4%), including red eyes (179/399, 44.9%), itching (187/399, 46.9%), sty or chalazion (309/399, 77.4%), and dryness (108/399, 27.1%). Ocular rosacea was confirmed in 149/309 cases who consulted an ophthalmologist (45.3%). A total of 159/399 (39.8%) had no pre-existing allergies. Eye involvement was significantly associated with the presence of skin symptoms (P < 0.05), impacting patients' general well-being and overall treatment satisfaction. About half of Demodex-positive patients (21/45, 46.7%) showed ocular symptoms. Conclusions Eye involvement in rosacea patients was common, often presenting with unspecific symptoms