Prospective Multicenter Clinical Trial of a Temperature-Controlled Subcutaneous Microneedle Fractional Bipolar Radiofrequency System for the Treatment of Cellulite

BACKGROUND A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array. OBJECTIVE Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite. METHODS The study design was an institutional review board-approved multicenter clinical trial after a per-protocol analysis. Fifty subjects with Nurnberger–Muller Grade II or III cellulite were enrolled at 4 treatment centers and received 1 subcutaneous microneedle RF treatment (67°C/4-second duration). Efficacy was evaluated by blinded grading by 3 dermatologists using randomized, standardized photographs and investigator grading at baseline, 1-, 3-, and 6-month follow-up. As per the Food and Drug Administration, treatment success was defined by ≥1-point improvement on dimple number or severity of undulation irregularities scales by at least 2 of 3 blinded physicians. Study subjects' self-assessments and satisfaction questionnaires and procedural pain levels and adverse events were monitored. RESULTS Blinded physician evaluations revealed a procedural success rate of 93% at 6-month follow-up. Procedural pain level was 3.74 ± 1.96 on a 10-point scale. There were no adverse events. Seventy-five percent of subjects were satisfied with the results at 6-month follow-up. CONCLUSION The results indicate that subcutaneous microneedle RF treatment is safe and effective for long-term treatment of Type II and III cellulite in a single session. Address correspondence and reprint requests to: Macrene Alexiades, MD, PhD, 955 Park Avenue, New York, NY 10021, or e-mail: dralexiades@nyderm.org M. Alexiades, G. Munavalli, and D. Goldberg executed the study protocol, conducted the clinical study, and did not receive any compensation from Syneron Inc. Drs. Shlomit Mann and D. Berube are employed by Syneron Inc. Shlomit Mann performed data compilation and statistical analysis. M. Alexiades and D. Berube prepared the manuscript. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Growth Factors and Cell Homing in Dental Tissue Regeneration

Abstract

Purpose of Review

To summarize current views on the role and therapeutic potential of growth factors (GFs) within endodontic cell homing.

Recent Findings

Cell homing/revitalization techniques aim to regenerate dentin and pulp using endogenous cells. Clinically, revitalization has successfully created new vital tissue in necrotic permanent teeth with an open apex; however, there is no evidence of new odontoblasts, pulp tissue, or predictable extension in root length. Although the response is reparative rather than regenerative, exciting opportunities to improve these biologically-based strategies remain by (1) efficiently sequestering dentin-matrix-components (DMCs) using irrigants and dental materials (2) designing next-generation GF-releasing scaffold materials and (3) utilizing other sources of GF such as cells and plasma-rich plasma and plasma-rich fibrin.

Summary

GFs can promote reparative-dentinogenesis and pulp-like tissue formation. The future development and clinical approval of GF-functionalized-scaffolds is a priority; however, current focus should be to harness DMCs and target the interaction of stem cells and GFs.

https://ift.tt/2NJDKvl

Palmoplantar keratoderma Bothnia type with acrokeratoelastoidosis‐like features due to AQP5 mutations

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2OubEkQ

Tea waste derived activated carbon for the adsorption of sodium diclofenac from wastewater: adsorbent characteristics, adsorption isotherms, kinetics, and thermodynamics

Abstract

The present experimental study reports the performance of tea waste (TW) derived adsorbent for the adsorption of sodium diclofenac (SD) from aqueous solution (SD concentration = 10–50 mg/L). The waste-derived activated carbon was prepared by chemical activation process of raw waste using H₂SO₄, KOH, ZnCl₂, and K₂CO₃ as activating agents (TW: activating agent = 1:1 by weight). Subsequently, the oven-dried material was carbonized at 600-°C temperature for 2 h. The synthesized adsorbents were porous and their Brunauer-Emmett-Teller (BET) surface area was ranged 115–865 m²/g. Among all synthesized adsorbents, the adsorbent activated by ZnCl₂ exhibited the highest adsorption capacity (= 62 mg/g), though it was much lower compared to 91 mg/g obtained with commercial activated carbon (CAC) (SD concentration = 30 mg/L, adsorbent dose = 300 mg/L and initial wastewater pH = 6.47). SD equilibrium data could be described by Langmuir isotherm adequately, while pseudo-second-order rate model showed better fit to the time based adsorption data. Low activation energy of the adsorption process suggests the reaction to be temperature independent. Thermodynamic parameters showed the spontaneous and endothermic nature of adsorption process conducted in the presence of waste derived adsorbent.

https://ift.tt/2MCSXJR

Insights into adsorption behaviour of binary liquid mixtures in porous media using fast field cycling NMR

Publication date: Available online 16 September 2018

Source: Magnetic Resonance Imaging

Author(s): J. Ward-Williams, L.F. Gladden

Abstract

Fast field cycling, FFC, NMR relaxometry experiments are reported in the frequency range of 10 kHz–40 MHz to characterise the adsorption behaviour of cyclohexane:THF (non-polar:polar) and THF:methanol (polar:polar) binary liquid mixtures adsorbed on a γ-alumina surface of catalytic interest. Laplace inversion of the relaxation rate data is employed to identify the chemical species in the binary mixture. In both systems studied, the more polar molecule preferentially interacts with the surface compared to the co-imbibed species. The relaxation rate data were analysed to explore the relative influences of surface dynamics and surface accessibility on the observed relaxation rates. For both binary systems, the change in relaxation behaviour with composition is interpreted as a change in the surface accessibility of each species caused by a micro-phase separation at the pore surface.

https://ift.tt/2D3ue1O

Fast spatially-resolved T2 measurements with constant-gradient CPMG

Publication date: Available online 15 September 2018

Source: Magnetic Resonance Imaging

Author(s): Stefan A. Hertel, Daan W. de Kort, Isabelle Bush, Andrew J. Sederman, Lynn F. Gladden, Benjamin Anger, Hilko de Jong, Matthias Appel

Abstract

Speed of acquisition is paramount for the application of magnetic resonance to flow experiments through porous rocks. One popular method for imaging core floods is the spatially resolved T₂ experiment which can separate fluids either by their viscosity contrast or by doping one fluid with a relaxation agent. Existing techniques for spatial-T₂ may suffer from long acquisition times and eddy currents due to the pulsing of magnetic field gradients. Here, we propose a constant gradient method for 1d spatially-resolved T₂ which embraces the speed of frequency encoding techniques and avoids eddy currents by the absence of any gradient ramps during the radio frequency (r.f.) pulse train. We provide the operating envelope for this kind of experiment, which is restricted due to the slice selectivity of the r.f. pulses in the presence of the magnetic field gradient. Additionally, we show that the effects of self-diffusion and the mixing of T₁ and T₂ contributions are manageable. As an illustration, we have applied this technique to an enhanced oil recovery experiment. The two fluid phases were tracked without any doping and with a time resolution of 40 s. In this case, the increased time resolution allowed us to observe dynamic flow phenomena such as fluid fingering and the calculation of the velocity of the fluid displacement fronts.

https://ift.tt/2NLRohq

Nodal Staging of High Risk Cutaneous Squamous Cell Carcinoma

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Matthew Fox, Marc Brown, Nicholas Golda, Dori Goldberg, Christopher Miller, Melissa Pugliano-Mauro, Chrysalyne Schmults, Thuzar Shin, Thomas Stasko, Yaohui G. Xu, Kishwer Nehal

Abstract

Background

While progress has been made in defining the clinical and histopathologic features of high-risk cutaneous squamous cell carcinoma (HRcSCC), optimal staging guidelines remain elusive.

Objective

We seek to guide clinical practice regarding nodal staging options for patients with HRcSCC via review of evolving definitions of HRcSCC, nodal staging options and how nodal staging may impact treatment and affect outcomes.

Methods

Retrospective review of published peer-reviewed literature regarding risk stratification, nodal staging and treatment and outcomes for patients with HRcSCC via PubMed search.

Results

For patients without clinical lymphadenopathy, based on literature from head and neck SCC, pre-operative nodal staging with US may be more useful than CT or MRI. Since early nodal disease is usually curable, sentinel lymph node biopsy (SLNB) may be considered in those with negative imaging while we await studies of nodal staging outcomes.

Limitations

More data is needed to validate the relationships between primary tumor stage and SLNB status and to determine if early detection of nodal disease impacts survival for patients with HRcSCC.

Conclusion

It is reasonable to consider nodal staging for patients with HRcSCC (BWH stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, SLNB.

https://ift.tt/2MEaW2y

Assessment of Clinician Accuracy for Diagnosing Melanoma Based on Electrical Impedance Spectroscopy Score Plus Morphology Versus Lesion Morphology Alone

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Ryan M. Svoboda, Giselle Prado, Rachel S. Mirsky, Darrell S. Rigel

https://ift.tt/2payN0D

Long-term outcomes of laser treatment for congenital melanocytic nevus

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Yeongjoo Oh, Si-Hyung Lee, Jung Min Lim, Kee Yang Chung, Mi Ryung Roh

Abstract

Background

Although various laser treatments have been tried for CMNs, only small retrospective studies with short-term follow-up had been done to assess outcomes.

Objective

We analyzed the long-term outcomes of laser treatment for CMN and compared the outcomes with the combination treatment of partial excisions and lasers.

Methods

Patients with CMN treated with lasers were retrospectively reviewed and patients with more than 3-year follow-up were grouped as the long-term follow-up group.

Results

A total of 67 cases of CMN were reviewed. Among 20 patients (20/52, 38.5%) with nearly total clearance during laser-only treatment, 11 patients were in long-term follow-up group and 5 of them showed repigmentation. 15 patients showed repigmentation regardless of clearance, and the mean period until repigmentation was 3.93 years from the initial treatment. Patients with combination treatment of partial excision and lasers showed higher Investigator's Global Assessment (IGA) scores, less number of laser treatments and shorter treatment period compared to patients with laser-only treatment.

Limitations

This is a retrospective study and various laser devices were used.

Conclusion

More than 4 years of follow-up is required to evaluate the efficacy of lasers in CMN and combination treatment of partial excision and lasers can be an effective treatment option.

https://ift.tt/2MAYXTx

Long-term safety results from a Phase 3 open-label study of a fixed combination halobetasol propionate 0.01% and tazarotene 0.045% (HP/TAZ) lotion in moderate-to-severe plaque psoriasis

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Mark G. Lebwohl, Jeffrey L. Sugarman, Linda Stein Gold, David M. Pariser, Tina Lin, Radhakrishnan Pillai, Gina Martin, Susan Harris, Robert Israel

https://ift.tt/2pexr4N

Analysis of Dermatologic Procedures Billed Independently by Non-Physician Practitioners in the United States

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Qiaochu Qi, Brian P. Hibler, Brett Coldiron, Anthony M. Rossi

Abstract

Background

Non-physician practitioners (NPPS), including nurse practitioners (NPs) and physician assistants (PAs) are expanding their scope of practice outside of primary care and performing more procedures in dermatology.

Objective

To understand the scope and geographic pattern of practice by NPs and PAs in dermatology in the US.

Methods

Cross-sectional retrospective cohort analysis of dermatology practices in the 2014 Medicare Physician/Supplier Procedure Summary Master File, which reflects Part B carrier and durable medical equipment fee-for-service claims in the US.

Results

Over 4 million procedures were billed independently by NPs and PAs, which accounts for 11.51% of all. Injection, simple repair, and biopsy were the most commonly billed by non-physician practitioners, but complex procedures were also increasingly billed independently by NPs and PAs. Proportions of their claims are higher in the East Coast, Midwest, and Mountain states.

Limitations

Data is at the state level, limited to Medicare beneficiaries, and doesn't include billing incident-to physicians.

Conclusions

This study demonstrated the increasing scope of practice of NPs and PAs in dermatology, despite limited training and lack of uniform regulations. To ensure quality and safety of care, it is prudent to set benchmarks for proper supervision and utilization of procedures in dermatology.

https://ift.tt/2MAYS2b

Rouleaux: a microscopic clue that helps distinguish psoriasis from dermatitis

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Ying Luo, Brett Keeling, Jessica A. Forcucci, Dirk M. Elston

https://ift.tt/2pc8irL

Safe and efficacious treatment of purpura with Nd:YAG laser in Skin Types IV-VI

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Dana S. Saade, Neelam A. Vashi

https://ift.tt/2MAYGzZ

Toll-like receptor signaling induces the expression of lympho-epithelial Kazal-type inhibitor in epidermal keratinocytes

Publication date: Available online 15 September 2018

Source: Journal of Dermatological Science

Author(s): Saeko Sugimoto, Shin Morizane, Hayato Nomura, Mina Kobashi, Satoru Sugihara, Keiji Iwatsuki

Abstract

Background

Lympho-epithelial Kazal-type inhibitor (LEKTI) tightly controls the activities of serine proteases such as kallikrein-related peptidase (KLK) 5 and KLK7 in the epidermis. LEKTI is known to be an essential molecule for the epidermal skin barrier, as demonstrated by SPINK5 nonsense mutation, which results in Netherton syndrome. Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns or damage-associated molecular patterns and produce inflammatory cytokines, chemokines, and antimicrobial peptides. However, the effect of TLR signaling on the expression of LEKTI is not clear.

Objective

To investigate whether TLR signaling can affect expression of LEKTI in epidermal keratinocytes.

Methods

We stimulated a panel of TLR ligands and investigated the expression of LEKTI in normal human epidermal keratinocytes (NHEKs). We further measured trypsin or chymotrypsin-like serine protease activity in NHEK cultured media under stimulation with TLR3 ligand, poly (I:C). Immunostaining for LEKTI was performed using skin samples from skin infectious diseases.

Results

TLR1/2, 3, 5, and 2/6 ligands induced the expression of LEKTI in NHEKs. The trypsin or chymotrypsin-like serine protease activity in NHEKs was up-regulated with the stimulation of poly (I:C). The gene expressions of KLK6, KLK10, KLK11, and KLK13 were also increased by poly (I:C). An immunohistochemical analysis demonstrated that the expression of LEKTI was up-regulated in the lesions of varicella, pyoderma, and rosacea.

Conclusions

TLR signaling induces the expression of LEKTI in epidermal keratinocytes, which might contribute to the control of aberrant serine protease activities in inflammatory skin diseases.

https://ift.tt/2NO7vuR

Precision and reproducibility of automated computer‐guided PASI measurements in comparison to trained physicians

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Qzgmz9