Use of hyaluronic acid fillers for the treatment of the aging face

Hyaluronic acid fillers have become popular soft tissue filler augmentation agents over the past several years. They have helped revolutionize the filler market with a number of new products available for use for our patients. The purpose of this manuscript is to review the characteristics of the HA fillers and to review each of the current products currently available for use in the US

1026-85 Enhanced Defibrillation Efficacy with an Active Pectoral Pulse Generator

An active pectoral pulse generator can be incorporated in a single coil defibrillation lead system to achieve low defibrillation thresholds (DFT). However, the incremental benefit of an active pulse generator with an integrated lead system has not been evaluated. Accordingly, we performed a prospective trial of a 65 cc pulse generator shell with an Endotak lead in 22 consecutive pts undergoing defibrillator implantation. Energy (E) and leading edge voltage (V) at DFT was measured using a step down protocol to first failure with biphasic waveforms (60:40 tilt). Either lead alone (proximal coil = anode) or lead + shell (proximal coil and shell = anode) were tested with paired testing in random order.E(joules)V(volts)R(ohms)Lead alone13.1±6.7395±10549±5Lead + Shell8.5±3.1*319±61*42±4**p<0.001A DFT of≤10J was found in 50% (11/22) of patients with lead alone and 86% (19/22) of patients with lead + shell (p<0.02).In conclusion, adding an active pulse generator to an integrated transvenous lead significantly reduced DFTs and system impedance (R). The consistently low defibrillation energy requirements with the use of an active small pectoral shell, makes the development of a defibrillator with reduced size and lower maximal output feasible

Aromatic ring cleavage of a β-biphenyl ether dimer catalyzed by lignin peroxidase of phanerochaete chrysosporium

AbstractUnder aerobic conditions homogeneous lignin peroxidase catalyzed the oxidation of 1-(4'-methoxyphenyl)-2-(2″,5′-dimethoxy-4″-phenylphenoxy)-1,3-dihydroxypropane (I) to yield four products: 1-(4'-methoxy-phenyl)-1,2,3-trihydroxypropane (X), 4-[α-hydroxy-α-(4'-methoxyphenyl)-methyl]-1,3-dioxolane-2-one (V), 4-(4'-methoxyphenyl)-5-hydroxymethyl-1,3-dioxolane-2-one (VI) and 5-hydroxy-5-carbomethoxy-4-phenyl-oxol-3-en-2-one (VIII). V, VI and VIII are all products of ring opening reactions. When the reaction was conducted under anaerobic conditions, the substrate was oxidized but no ring-cleaved products were detected. During the oxidation of I, 4 atoms of 18O from 18O2 were incorporated into the lactol product VIII

Correlation of pain relief with physical function in hand osteoarthritis: randomized controlled trial post hoc analysis

Abstract Introduction Nonsteroidal anti-inflammatory drugs are recommended for the relief of pain associated with hand osteoarthritis (OA) but do not alter the underlying structural changes that contribute to impaired physical function. The current analysis examined the relationship of pain relief with measures of function and global rating of disease in patients with hand OA. Methods This was a combined analysis of 2 prospective, randomized, double-blind, 8-week, multicenter, parallel-group studies comparing diclofenac sodium 1% gel with placebo gel (vehicle) in patients with radiographically confirmed mild to moderate hand OA. Patients (n = 783) aged ≥ 40 years applied diclofenac sodium 1% gel (2 g) or vehicle to each hand 4 times daily for 8 weeks. Outcome measures included pain intensity assessed on a 100-mm Visual Analog Scale (VAS); the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) subscales for pain, stiffness, and physical function (100-mm VAS); and a global rating of disease (100-mm VAS). Change in VAS pain intensity from baseline to week 8 was categorized (<0%, 0%-<15%, 15%-<30%, 30%-<50%, 50%-<70%, and ≥ 70%) without regard to treatment and compared in each category with the mean change from baseline in each AUSCAN subindex and the global rating of disease. Pearson correlations between changes in outcome measures from baseline to week 8 were calculated. Results Changes in VAS pain intensity were accompanied by similar changes in AUSCAN scores and global rating of disease. Pearson correlations confirmed significant associations (P < 0.001) between change in VAS pain intensity and changes in AUSCAN pain (correlation coefficient [r] = 0.81), AUSCAN function (r = 0.75), AUSCAN stiffness (r = 0.66), and global rating of disease (r = 0.76). Conclusions Pain relief correlated with improvements in physical function, stiffness, and global rating of disease in patients with hand OA, irrespective of treatment. This suggests that pain or anticipation of pain inhibits physical function and influences patient perception of disease severity in hand OA. These results also suggest that any intervention to relieve the pain of hand OA may improve function and patient perception of disease severity, despite the absence of a disease-modifying mechanism of action. Trial registration Clinicaltrials.gov NCT00171652, NCT00171665

Predictors of short-term clinical response to cardiac resynchronization therapy

Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with symptomatic heart failure and QRS prolongation but there is uncertainty about which patient characteristics predict short-term clinical response. Methods and results: In an individual patient meta-analysis of three double-blind, randomized trials, clinical composite score (CCS) at 6 months was compared in patients assigned to CRT programmed on or off. Treatment–covariate interactions were assessed to measure likelihood of improved CCS at 6 months. MIRACLE, MIRACLE ICD, and REVERSE trials contributed data for this analysis (n = 1591). Multivariable modelling identified QRS duration and left ventricular ejection fraction (LVEF) as predictors of CRT clinical response (P < 0.05). The odds ratio for a better CCS at 6 months increased by 3.7% for every 1% decrease in LVEF for patients assigned to CRT-on compared to CRT-off, and was greatest when QRS duration was between 160 and 180 ms. Conclusions: In symptomatic chronic heart failure patients (NYHA class II–IV), longer QRS duration and lower LVEF independently predict early clinical response to CRT

Complications and Solutions for Post-Operative Liposuction Deformities

In this chapter, the authors will review the complications associated with liposuction and laser liposuction procedures, using published reports as the guide to document these complications and deformities to the readers. In addition, the authors will also report on the use of tumescent anesthesia and the published documentation regarding safety concerns that have been presented via the use of tumescence versus general anesthesia when performing liposuction or laser liposuction. Real-world discussions also will take place in which the authors describe best treatment practices as solutions to those complications described. Liposuction and laser liposuction are wonderful procedures that have been performed for many years. Understanding and being able to identify and treat any untoward complications is extremely important to make everyone a better surgeon and a better physician

Tuning the bandgap of Cs2AgBiBr6 through dilute tin alloying.

The promise of lead halide hybrid perovskites for optoelectronic applications makes finding less-toxic alternatives a priority. The double perovskite Cs2AgBiBr6 (1) represents one such alternative, offering long carrier lifetimes and greater stability under ambient conditions. However, the large and indirect 1.95 eV bandgap hinders its potential as a solar absorber. Here we report that alloying crystals of 1 with up to 1 atom% Sn results in a bandgap reduction of up to ca. 0.5 eV while maintaining low toxicity. Crystals can be alloyed with up to 1 atom% Sn and the predominant substitution pathway appears to be a ∼2 : 1 substitution of Sn2+ and Sn4+ for Ag+ and Bi3+, respectively, with Ag+ vacancies providing charge compensation. Spincoated films of 1 accommodate a higher Sn loading, up to 4 atom% Sn, where we see mostly Sn2+ substitution for both Ag+ and Bi3+. Density functional theory (DFT) calculations ascribe the bandgap redshift to the introduction of Sn impurity bands below the conduction band minimum of the host lattice. Using optical absorption spectroscopy, photothermal deflection spectroscopy, X-ray absorption spectroscopy, 119Sn NMR, redox titration, single-crystal and powder X-ray diffraction, multiple elemental analysis and imaging techniques, and DFT calculations, we provide a detailed analysis of the Sn content and oxidation state, dominant substitution sites, and charge-compensating defects in Sn-alloyed Cs2AgBiBr6 (1:Sn) crystals and films. An understanding of heterovalent alloying in halide double perovskites opens the door to a wider breadth of potential alloying agents for manipulating their band structures in a predictable manner

Critical appraisal of the role of davunetide in the treatment of progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease characterized by the accumulation of tau protein aggregates in the basal ganglia, brainstem and cerebral cortex leading to rapid disease progression and death. The neurofibrillary tangles that define the neuropathology of PSP are comprised of aggregated 4R tau and show a well-defined distribution. Classically, PSP is diagnosed by symptoms that include progressive gait disturbance, early falls, vertical ophthalmoparesis, akinetic-rigid features, prominent bulbar dysfunction and fronto-subcortical dementia. There are currently no effective therapies for the treatment of this rapidly degenerating and debilitating disease. Davunetide is a novel neuroprotective peptide that is thought to impact neuronal integrity and cell survival through the stabilization of microtubules. Preclinical activity in models of tauopathy has been translated to clinical studies, demonstrating pharmacologic activity that has supported further development. Davunetide’s efficacy and tolerability are being tested in a placebo-controlled study in PSP patients, making it the most advanced drug candidate in this indication. This review examines the disease characteristics of PSP, the rationale for treating PSP with davunetide and assesses some of the challenges of clinical trials in this patient population

GLAS Spacecraft Pointing Study

Science requirements for the GLAS mission demand that the laser altimeter be pointed to within 50 m of the location of the previous repeat ground track. The satellite will be flown in a repeat orbit of 182 days. Operationally, the required pointing information will be determined on the ground using the nominal ground track, to which pointing is desired, and the current propagated orbit of the satellite as inputs to the roll computation algorithm developed by CCAR. The roll profile will be used to generate a set of fit coefficients which can be uploaded on a daily basis and used by the on-board attitude control system. In addition, an algorithm has been developed for computation of the associated command quaternions which will be necessary when pointing at targets of opportunity. It may be desirable in the future to perform the roll calculation in an autonomous real-time mode on-board the spacecraft. GPS can provide near real-time tracking of the satellite, and the nominal ground track can be stored in the on-board computer. It will be necessary to choose the spacing of this nominal ground track to meet storage requirements in the on-board environment. Several methods for generating the roll profile from a sparse reference ground track are presented

Improvements in Acne and Skin Oiliness with Tazarotene 0.045% Lotion in Patients with Oily Skin

BACKGROUND: Excessive sebum production is a factor in acne development. Tazarotene 0.045% lotion has demonstrated reductions in acne lesions and acne-induced sequalae. OBJECTIVE: Evaluate efficacy, changes in skin oiliness, and safety with tazarotene 0.045% lotion in participants with moderate-to-severe acne and oily skin. METHODS: In two phase 3, double-blind, 12-week studies (NCT03168321; NCT03168334), participants aged ≥9 years with moderate-to-severe acne were randomized 1:1 to once-daily tazarotene 0.045% lotion or vehicle lotion (N = 1,614). This pooled, post hoc analysis included only participants self-categorized with oily skin at baseline on the Acne Quality of Life questionnaire item 19 (scores: 0 [extremely oily] to 6 [not at all oily]). Inflammatory/noninflammatory lesion counts, treatment success, skin oiliness, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability were evaluated. RESULTS: In all participants with oily skin (n = 793), tazarotene provided greater reductions in inflammatory/noninflammatory lesions (P \u3c 0.001, both) and greater treatment success rates versus vehicle (P \u3c 0.01) at week 12. Over two-thirds of polymeric lotion-treated participants had subjective skin oiliness reductions by week 12, with around a third reporting \u27low/not\u27 oily skin. Tazarotene TEAE rates were similar to the overall population. CONCLUSION: Once-daily treatment with tazarotene 0.045% polymeric emulsion lotion may help improve patient-perceived skin oiliness in those with moderate-to-severe acne