Age, lifestyle and self-perceptions of hair: Is there an association with hair diameter and tensile properties?

OBJECTIVE: To determine the association of age, lifestyle habits and the self-perception of hair condition with the objectively measured physical properties of hair in Caucasian females with brown hair. METHODS: Hair biophysical properties, lifestyle habits data and self-perceptions of hair condition were collected on 110 Caucasian females with brown hair ranging in age from 17 to 78. Hair diameter (cross-sectional area) and tensile properties (elastic modulus, break strength and break extension) were measured at the root end of individual fibres (n = 100/subject) from the crown and frontal regions using objective instrumental methods. Other measures included body mass index (BMI) and Savin female pattern hair loss grades based on judging of standardized front, top and side view head images. Lifestyle habits and practices and self-perceived hair condition were obtained via a standardized self-assessment questionnaire. RESULTS: Hair fibre diameter and break extension decreased significantly with age. Hair fibre elastic modulus and Savin hair loss scores increased significantly with age. No age-related change in hair fibre break stress was observed. A history of smoking or being overweight was significantly associated with having lower hair fibre cross-sectional area but was not associated with any of the measured tensile properties. Subjects who perceived their hair as fine, thinning or weak had significantly lower cross-sectional areas than subjects who did not. Subjects who perceived their hair to be healthy or strong had significantly higher cross-sectional areas than subjects who did not. CONCLUSION: The biophysical properties of hair change significantly with age. A history of smoking or being overweight was significantly associated with having smaller hair cross-sectional area but was not associated with differences in hair tensile properties. The self-perception of having strong or healthy hair seems more associated with having a larger cross-sectional area than any real differences in hair strength.Abstrait.

OBJECTIF: Déterminer l'association entre l'âge, les habitudes de vie et la perception de l'état des cheveux avec les propriétés physiques mesurées de manière objective chez les femmes de race blanche à cheveux bruns. MÉTHODES: Les propriétés biophysiques des cheveux, les données sur les habitudes de vie et la perception de leur état de santé ont été recueillies chez 110 femmes de race blanche aux cheveux bruns âgés de 17 à 78 ans. Le diamètre des cheveux (surface transversale), résistance à la rupture et extension à la rupture) ont été mesurés à la racine des fibres individuelles (n = 100 / sujet) à partir des régions de la couronne et de la partie frontale en utilisant des méthodes instrumentales objectives. Parmi les autres mesures, citons l'indice de masse corporelle (IMC) et les degrés de perte de cheveux selon le modèle féminin de Savin, fondés sur l'évaluation d'images de tête normalisées de face, de dessus et de côté. Les habitudes et pratiques de mode de vie et l'état de poil auto-perçu ont été obtenues à l'aide d'un questionnaire d'autoévaluation standardisé. RÉSULTATS: Le diamètre de la fibre capillaire et l'extension de la rupture ont diminué de manière significative avec l'âge. Le module d'élasticité de la fibre capillaire et les scores de perte de cheveux de Savin augmentaient considérablement avec l'âge. Aucun changement lié au vieillissement du stress lié à la rupture de la fibre capillaire n'a été observé. Des antécédents de tabagisme ou d'embonpoint étaient significativement associés à une section inférieure de la fibre capillaire mais n'étaient associés à aucune des propriétés de traction mesurées. Les sujets qui percevaient leurs cheveux fins, fins ou clairsemés avaient une section transversale significativement plus basse que les autres. Les sujets qui percevaient que leurs cheveux étaient en bonne santé ou forts avaient des zones transversales significativement plus élevées que les sujets qui n'en avaient pas. CONCLUSION: Les propriétés biophysiques des cheveux changent de manière significative avec l'âge. Les antécédents de tabagisme ou d'embonpoint étaient significativement associés à une plus petite section transversale des cheveux mais n'étaient pas associés à des différences de propriétés de tension des cheveux. La perception de soi d'avoir des cheveux forts ou en bonne santé semble plus associée à une plus grande surface transversale que toute différence réelle dans la résistance des cheveux.

[Peripartum cardiomyopathy: interdisciplinary challenge]. / Peripartale Kardiomyopathie: Interdisziplinäre Herausforderung.

Peripartum cardiomyopathy (PPCM) is a rare type of heart failure which presents towards the end of pregnancy or in the first 5 months after delivery. Depending on the geographical location the incidence is reported in the literature as 1:300 up to 1:15,000. There are a number of known risk factors, such as multiparity and age of the mother over 30 years. The symptoms of PPCM correspond to those of idiopathic cardiomyopathy. The diagnosis is mainly carried out using echocardiography which shows a clear reduction of systolic left ventricular function. The therapeutic approach is the same as for idiopathic cardiomyopathy and in this context it is absolutely necessary to show caution concerning the state of pregnancy and the resulting contraindications for therapeutic drugs. The prognosis is dependent on recovery from the heart failure during the first 6 months postpartum. The lethality of the disease is high and is given in the literature as up to 28 %. Because of its complexity PPCM is an interdisciplinary challenge. In the peripartum phase a close cooperation between the disciplines of cardiology, cardiac surgery, neonatology, obstetrics and anesthesiology is indispensable. For anesthesiology the most important aspects are the mostly advanced unstable hemodynamic condition of the mother and the planning and implementation of the perioperative management. This article presents the case of a patient in advanced pregnancy with signs of acute severe heart failure and a suspected diagnosis of PPCM. The patient presented as an emergency case and delivery of the child was carried out using peridural anesthesia with a stand-by life support machine.

Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women.

BACKGROUND: Acne vulgaris is a common skin disease with a large quality of life impact, characterized by comedones, inflammatory lesions, secondary dyspigmentation and scarring. There are few large objective studies comparing acne epidemiology between racial and ethnic groups. OBJECTIVE: This study aimed to define the prevalence and subtypes of acne in women of different racial groups from four ethnicities. METHODS: The sample consisted of 2895 (384 African American, 520 Asian, 1295 Caucasian, 258 Hispanic and 438 Continental Indian) women ranging in age from 10 to 70 years. Photographs of subjects were graded for acne lesions, scars, dyspigmentation, and measurements taken of sebum excretion and pore size. RESULTS: Clinical acne was more prevalent in African American and Hispanic women (37%, 32% respectively) than in Continental Indian, Caucasian and Asian (23%, 24%, 30% respectively) women. All racial groups displayed equal prevalence of both subtypes of acne with the exception of Asians, for whom inflammatory acne was more prevalent than comedonal (20% vs. 10%) acne, and in Caucasians, for whom comedonal acne was more prevalent than inflammatory (14% vs. 10%) acne. Hyperpigmentation was more prevalent in African American and Hispanic (65%, 48% respectively) than in Asian, Continental Indian and Caucasian (18%, 10%, 25% respectively) women. Dyspigmentation and atrophic scarring were more common in African American and Hispanic women than in all other ethnicities. There was a negative correlation between pore size and skin lightness for all ethnicities. Sebum production was positively correlated with acne severity in African American, Asian and Hispanic women, and pore size was positively correlated with acne in African American, Asian and Continental Indian women, (for all above results, P<0.05). LIMITATIONS: Only female participants were recruited. Data collection was restricted to four cities, with some ethnicities from single cities. Acne was evaluated only on the left side of the face and the two-dimensional nature of photography may not capture all skin surface changes. CONCLUSION: Acne prevalence and sequelae were more common in those with darker skin types, suggesting that acne is a more heterogeneous condition than previously described and highlight the importance of skin-colour tailored treatment.

A randomized, controlled comparative study of the wrinkle reduction benefits of a cosmetic niacinamide/peptide/retinyl propionate product regimen vs. a prescription 0.02% tretinoin product regimen.

BACKGROUND: Tretinoin is considered the benchmark prescription topical therapy for improving fine facial wrinkles, but skin tolerance issues can affect patient compliance. In contrast, cosmetic antiwrinkle products are well tolerated but are generally presumed to be less efficacious than tretinoin. OBJECTIVES: To compare the efficacy of a cosmetic moisturizer regimen vs. a prescription regimen with 0.02% tretinoin for improving the appearance of facial wrinkles. METHODS: An 8-week, randomized, parallel-group study was conducted in 196 women with moderate to moderately severe periorbital wrinkles. Following 2 weeks washout, subjects on the cosmetic regimen (n = 99) used a sun protection factor (SPF) 30 moisturizing lotion containing 5% niacinamide, peptides and antioxidants, a moisturizing cream containing niacinamide and peptides, and a targeted wrinkle product containing niacinamide, peptides and 0.3% retinyl propionate. Subjects on the prescription regimen (n = 97) used 0.02% tretinoin plus moisturizing SPF 30 sunscreen. Subject cohorts (n = 25) continued treatment for an additional 16 weeks. Changes in facial wrinkling were assessed by both expert grading and image analysis of digital images of subjects' faces and by self-assessment questionnaire. Product tolerance was assessed via clinical erythema and dryness grading, subject self-assessment, and determinations of skin barrier integrity (transepidermal water loss) and stratum corneum protein changes. RESULTS: The cosmetic regimen significantly improved wrinkle appearance after 8 weeks relative to tretinoin, with comparable benefits after 24 weeks. The cosmetic regimen was significantly better tolerated than tretinoin through 8 weeks by all measures. CONCLUSIONS: An appropriately designed cosmetic regimen can improve facial wrinkle appearance comparably with the benchmark prescription treatment, with improved tolerability.

New wrinkles on wrinkling: an 8-year longitudinal study on the progression of expression lines into persistent wrinkles.

BACKGROUND: While cumulative lifetime sun exposure is well recognized as having an important role in the progression of facial wrinkling, the role of facial expression has largely been overlooked, in part due to the lack of comprehensive longitudinal data on the change in both expression lines and persistent wrinkles with age. OBJECTIVES: To track the detailed pattern of facial wrinkling in the same group of people over several years and to verify that expression lines evolve into persistent wrinkles. In addition, to identify factors predictive of a faster or slower rate of wrinkling. METHODS: Standardized images were captured at baseline and at 8 years of 122 women (ages 10-72 years, skin types I-VI) with and without a smiling expression. The wrinkle pattern with expression at baseline was compared with the pattern without expression at 8 years. Severity of facial wrinkling was quantified using computer-based image analysis. Skin colour, hydration, sebum and pH were measured at baseline. A structured questionnaire captured demographic and lifestyle data at baseline and at 8 years. RESULTS: Each subject's unique pattern of persistent facial wrinkling observed without expression at year 8 was predicted by the pattern of lines observed with a smiling expression at baseline. Having a drier, more alkaline stratum corneum, a lighter complexion, being middle-aged (40s) or becoming menopausal were associated with faster persistent wrinkling. CONCLUSIONS: Repeated skin flexure during facial expression causes persistent wrinkles. The pattern of expression lines predicts the pattern of future persistent wrinkles. Certain intrinsic and extrinsic factors are not causative, but influence the rate, of facial wrinkling.

Calcineurin inhibitor-free immunosuppressive strategy in elderly recipients of renal allografts from deceased donors: 1-year results from a prospective single center trial.

Recently published data from our center have demonstrated the feasibility of a nephrotoxicity- and atherogenicity-free, mycophenolate mofetil (MMF)-based immunosuppressive protocol for elderly recipients of kidneys from elderly cadaveric donors. We investigated a therapeutic regimen of strictly monitored MMF (target mycophenolic acid [MPA] trough levels between 2-6 microg/mL) and steroids combined with a polyclonal-monoclonal induction regimen consisting of a low-dose, single shot of rabbit ATG (ATG-Fresenius) and the interleukin-2 receptor (IL-2R)-antibody basiliximab (d0 and d4). Between 1997 and 2007, we treated 175 elderly patients with an MMF-based, calcinearin inhibitor (CNI)-free immunosuppressive protocol. For the present cohort, 30 elderly recipients (67.8 +/- 3.8 years) of renal transplants from deceased donors (69.4 +/- 13.3 years) were recruited consecutively for this 5-year prospective, open, single center, pilot trial. One-year results of this clinical trial were patient and renal allograft survivals of 87% and 83%, respectively; death-censored 1-year graft survival was 97%. Mostly steroid-sensitive rejection episodes were observed in 46% of patients, with only 3 patients requiring serum antibody therapy. Renal allograft function was satisfactory, as reflected by a mean serum creatinine of 1.78 +/- 0.45 mg/dL and a Nankivell glomerular filtration rate (GFR) of 48.8 +/- 13.9 mg/dL at 6 months. Twenty-three percent of all patients demonstrated cytomegalovirus (CMV) infections; however, only 3.3% developed CMV disease. Application of a combined polyclonal-monoclonal induction regimen using a nephrotoxicity- and atherogenicity-free, MMF-based immunosuppressive maintenance protocol in elderly cadaveric kidney transplant recipients led to acceptable short-term outcomes, albeit at the expense of an increased rejection rate, comparable to that previously published for elderly (>50 years) recipients of allografts from elderly (>50 years) cadaveric donors.

Age-related maculopathy and sunlight exposure evaluated by objective measurement.

AIM: To study the relationship between age-related maculopathy (ARM) and exposure to sunlight using an objective method. METHODS: In a case-control study of Japanese men aged > or = 50 years (67 controls without ophthalmic disease and 148 with ARM), those with ARM were separated into groups of early (n = 75) and late (n = 73) ARM. Facial wrinkle length and area of hyperpigmentation, which are considered to be associated with exposure to sun, were measured using imaging with computer-based image analysis. Skin tone was also measured on the upper inner arm, which is not exposed to sun. Early and late ARM association with skin measurements was then evaluated. RESULTS: Significantly more facial wrinkling (p = 0.047, odds ratio 3.8; 95% CI 1.01 to 13.97) and less facial hyperpigmentation (p = 0.035, odds ratio 0.3; 95% CI 0.08 to 0.92) was present in late ARM cases. The relationship between skin tone and ARM risk was not statistically significant. CONCLUSIONS: This objective method showed that lifetime exposure to sunlight is an important factor in the progression of late ARM. An individual's reaction to sunlight exposure may have a role in ARM progression in addition to total lifetime exposure to sunlight.

Comparative evaluation of oxidative and antioxidative capacity during high-flux hemodialysis using two different membranes.

AIM: In patients with end-stage renal disease (ESRD) cardiovascular morbidity and mortality are increased. Apart from traditional and uremia-specific factors oxidative stress has been implicated as a main risk factor. This study investigated the influence of two different high-flux hemodialysis membranes on parameters of oxidative stress during a dialysis session. PATIENTS AND METHODS: 14 stable ESRD patients were enrolled in the study and randomly assigned to high-flux hemodialysis using either a polyamide membrane (Polyflux 14; PA group) or a new polysulfone membrane (Diacap Polysulfone HI PS 15; PS group). All patients received 6 treatments with the same membrane. During the 5th treatment parameters of dialysis efficiency, biocompatibility (cell counts, complement C3a, thrombin-antithrombin complex) and oxidative stress (lipid peroxides, total antioxidative capacity) were measured. RESULTS: Parameters of dialysis efficiency and biocompatibility were similar in both treatment groups. At the beginning of the dialysis session both groups showed a low to moderate level of oxidative stress and a reduced total antioxidative capacity as compared to healthy controls. Both parameters deteriorated significantly during the extracorporeal procedure with a similar magnitude in both membrane groups. No correlation between oxidative or antioxidative capacity and parameters of biocompatibility or dialysis efficiency could be found. CONCLUSIONS: Dialysis with synthetic high-flux membranes induces a temporary deterioration of oxidative stress parameters in ESRD patients despite good dialysis efficiency and biocompatibility.

[Development, state of the art and perspectives of transplantation medicine, exemplified by kidney transplantation]. / Trotz grosser Fortschritte bei der Nierentransplantation: Warum steht nur jeder fünfte Dialysepatient auf der Warteliste?

In particular the knowledge of the immunological aspects of organ rejection represented a giant step forward in the field of transplantation medicine. However, despite the fact that, in the absence of a contraindication, every dialysis-requiring preterminal/terminal renal insufficiency is an indication for transplantation, fewer than 20% of 50,000 candidate patients in Germany are earmarked for a new kidney. Furthermore, the fate of the patients on the waiting list is determined in particular by the dearth of donor organs. As a rule, the source of a transplantable kidney continues to be a brain-dead donor. If, however, no such organ is likely to be available in the foreseeable future, a kidney from a living donor is an alternative option. The proportion of organs from living donors in Germany is currently between 10 and 20%.

The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer.

BACKGROUND: Cutaneous hyperpigmentation occurs in multiple conditions. In addition, many Asian women desire a lighter skin colour. Thus, there is a need for the development of skin lightening agents. Niacinamide is a possible candidate. OBJECTIVES: To investigate the effects of niacinamide on melanogenesis in vitro and on facial hyperpigmentation and skin colour in vivo in Japanese women. METHODS: Melanin production was measured in a purified mushroom tyrosinase assay, cultured melanocytes, a keratinocyte/melanocyte coculture model, and a pigmented reconstructed epidermis (PREP) model. The clinical trials included 18 subjects with hyperpigmentation who used 5% niacinamide moisturizer and vehicle moisturizer in a paired design, and 120 subjects with facial tanning who were assigned to two of three treatments: vehicle, sunscreen and 2% niacinamide + sunscreen. Changes in facial hyperpigmentation and skin colour were objectively quantified by computer analysis and visual grading of high-resolution digital images of the face. RESULTS: Niacinamide had no effect on the catalytic activity of mushroom tyrosinase or on melanogenesis in cultured melanocytes. However, niacinamide gave 35-68% inhibition of melanosome transfer in the coculture model and reduced cutaneous pigmentation in the PREP model. In the clinical studies, niacinamide significantly decreased hyperpigmentation and increased skin lightness compared with vehicle alone after 4 weeks of use. CONCLUSIONS: The data suggest niacinamide is an effective skin lightening compound that works by inhibiting melanosome transfer from melanocytes to keratinocytes.

Quantitative evaluation of skin condition in an epidemiological survey of females living in northern versus southern Japan.

Image analysis and biophysical methods were used to compare the skin condition of a group of females ranging in age from 5 to 65 years who had lived all of their lives in either Kagoshima (n=300), located in southern Japan, or Akita (n=302), located in northern Japan. Kagoshima annually receives approximately 1.5 times more solar UVB radiation than Akita. The methods used and corresponding skin parameters reported in this survey were: high resolution digital imaging followed by computer analysis of facial images for facial skin wrinkling and hyperpigmentation; silicone skin replicas followed by Moiré interferometry for facial skin surface roughness (texture); the Minolta Chromameter for skin color (L*a*b*) on sun-exposed (forehead) and sun-protected (upper inner arm) skin sites; the Corneometer for skin capacitance (hydration) on the cheek and ventral forearm; the Sebumeter for sebum excretion rate on the forehead; and the Minolta Spot Thermometer for skin temperature on the upper cheek. Compared with Japanese women living in Akita, Japanese women living in Kagoshima had significantly longer facial wrinkles, higher number of wrinkles, larger hyperpigmented spots, higher number of spots, rougher facial skin texture, more yellow foreheads and upper inner arms, darker foreheads, and less stratum corneum hydration in the cheeks and arms. When compared on an age-for-age basis, the average 40-year-old Kagoshima women has the same level of facial wrinkling as a 48-year-old Akita women, a delay of 8 years for living in the northern latitude. For facial hyperpigmentation, the delay is 16 years; the average 40-year-old Kagoshima women has the same level of facial hyperpigmentation as a 56-year-old Akita women. The results further testify to the skin damaging effects of sun exposure and may be useful in public health education to promote everyday sun protection.

The efficacy of glycolic acid for treating wrinkles: analysis using newly developed facial imaging systems equipped with fluorescent illumination.

The clinical characteristics of photodamaged skin, such as coarse and fine wrinkling, can not be quantitatively evaluated from ordinary photographic records. The purpose of this study was to assess the efficacy of glycolic acid (GA) peeling on facial wrinkling, using computer assisted image analysis. This was accomplished with reproducible imaging techniques, which allowed precise repositioning of the subject's face in front of the camera. Two parameters, the change in wrinkle number and the change in wrinkle length were assessed. Although the clinical improvement of wrinkles correlated with both parameters, wrinkle length more precisely reflected the degree of clinical wrinkles, because the wrinkle number appeared to increase as some shallow wrinkles divided into multiple smaller wrinkles during their improvement. Comparison of responses by different age groups showed that the reduction of total wrinkle length was observed in the order of: 50s>30s and 40s>60s>over 70>under 30. The lack of response by subjects over 70 might be due to the nature of their wrinkles being mainly coarse wrinkles rather than fine ones. We next compared the effect of GA by concentration (35, 50 or 70%), but found no significant differences. As the concentration of GA used for treatment was determined by each subject's erythema reaction, our present result suggests that erythema elicited by GA correlates with improvement of wrinkles and that these two phenomena can be induced by a common pathway of GA treatment. This quantitative analysis clearly shows the efficacy and limitation of GA treatment of wrinkles, and might help to disclose the precise mechanisms of GA effects on the skin structure and function.

[Living donors in kidney transplantation. Renaissance by non-related donors?]. / Lebendspende bei Nierentransplantation. Renaissance durch nicht verwandte Spender?

Renal Transplantation is hampered worldwide by the continuing lack of cadaveric organs. The discrepancy between the number of patients on the waiting list and the number of organs available is further compounded by the still unresolved problem of chronic transplant failure. Against this background, the arguments for increasing acceptance of the use of kidneys from living donors, both related and unrelated, are discussed. Initial reports on appreciably improved transplant survival rates of organs from unrelated living donors (85% survival after 3 years [19]) have since been confirmed by more recent studies. Our own results, in part obtained during a prospective study involving 103 patients (53 related, 50 unrelated) done between October 1994 and April 1999, with strict psychological care/evaluation prior to and after transplantation, revealed a four-year transplant survival rate of 98% in both groups. So far, the higher rejection rate of 34% in unrelated, vs. 13.2% in related, donors has not led to any earlier chronic dysfunction of the transplant. The expanded use of living kidney donors is not only ethically justifiable, but also improves the outcome.

Hereditary fructose intolerance and alpha(1) antitrypsin deficiency.

A patient with coexisting hereditary fructose intolerance (HFI) and alpha(1) antitrypsin deficiency (alpha(1)ATD) is described. Protease inhibitor typing was not conclusive, presumably because of impaired N-glycosylation secondary to HFI. The case underlines the diagnostic role of molecular genetic techniques in inborn errors of metabolism.

[Contrast enhanced MR angiography in the preoperative evaluation of living kidney donors]. / Die kontrastverstärkte MR-Angiographie in der präoperativen Diagnostik von Lebendnierenspendern.

PURPOSE: To compare Gadolinium-enhanced MR angiography with conventional DSA in the preoperative evaluation of living kidney donors. MATERIAL AND METHODS: 27 potential living kidney donors were examined with contrast-enhanced MR angiography after conventional angiography. The MR angiograms were evaluated for the number of renal arteries, the presence of early arterial branching and vascular pathologies by two independent readers. The results were compared with those of selective conventional angiography and intraoperative findings. RESULTS: Conventional angiography detected 14 accessory renal arteries. Reader A detected 13 of 14 accessory arteries with no false positive result (sensitivity 93%, specificity 100%). Reader B detected 11 of 14 accessory vessels with one false positive finding (sensitivity 79%, specificity 98%). Early arterial branching was detected by both readers in 9 of 12 vessels with no false positive result (sensitivity 75%, specificity 100%). None of the patients had additional vascular pathology. DISCUSSION: Gadolinium-enhanced MR angiography is a non-invasive alternative to conventional angiography in the preoperative evaluation of living kidney donors. In order to achieve high accuracy in detecting accessory renal arteries and early arterial branching extensive experience with the method and the specific preoperative needs is required. Selective conventional angiography is still superior in detecting very small accessory vessels and early arterial branching.