Long-term results of nail correction with double wires for pincer nail deformity: A retrospective cohort study.

There is no consensus on the best treatment for pincer nail deformity. We developed a novel procedure that uses double wires to treat pincer nail deformity on the great toe. This study aimed to describe this technique for pincer nail deformity treatment and present the long-term findings/observations. After injecting a local anesthetic, a mini router was used to make holes on both sides of the nail plate edge, and the wire was inserted in two places, one proximal and the other distal to the great toenail. The wire was removed when it moved to the tip of the great toe as the nail grew. Patients who underwent this method were evaluated retrospectively from 2014 to 2020. Patients with less than 24 months of follow-up were excluded. If pain occurred again, it was deemed as a recurrence. A total of 27 patients (36 toes, mean age: 69.5 years) were evaluated. In all cases, the pain disappeared 1 week after the procedure. In the correction period (mean 2.7 months), six toes had complications (nail break, four toes and nail hold pain, two toes), while recurrence occurred in four toes within 2 years. Curvature (nail tip height/width of nail tip × 100%) improved significantly up to 1-year post-procedure (37.7 ± 14.4%, p < 0.05) as compared to pre-correction (53.8 ± 24.7%). The procedure time was short (approximately 10 minutes), and the treatment was completed with a single procedure. In addition, the recurrence rate was low.

The Prospective Natural History Study of Patients with Intractable Venous Malformation and Klippel-Trenaunay Syndrome to Guide Designing a Proof-of-Concept Clinical Trial for Novel Therapeutic Intervention.

Background: The natural history of venous malformation (VM) and Klippel-Trenaunay Syndrome (KTS) has not been quantitatively studied. To obtain benchmarks to guide designing clinical trials to assess safety and efficacy of novel drug candidates, the clinical course of the patients was followed for 6 months. Methods and Results: This is a multicenter prospective observational study evaluating the change rate in lesion volume from baseline with magnetic resonance images, as the primary endpoint. In addition, disease severities, performance status (PS), pain visual analog scale (VAS) score, quality of life (QoL), infections, and coagulation markers were also evaluated. Thirty-four patients (VM = 17, KTS = 17, 1-53 of age; median 15.9 years) with measurable lesion volume were analyzed. There was no statistically significant difference in the lesion volume between baseline and day 180, and the mean change rate (standard deviation) was 1.06 (0.28). There were no baseline characteristics that affected the change in lesion volume over 6 months. However, there were patients who showed more than 20% volume change and it was suggested that the lesion volume was largely impacted by local infection. There were no statistically significant changes in pain VAS score, severity, PS, QoL score, D-dimer, and platelet count over 6 months within all patients analyzed. Conclusion: The results showed the representative natural course of VM and KTS for a 6-month period with objective change of lesion volume and other factors, suggesting that it is scientifically reasonable to conduct a Phase 2 proof-of-concept study without a placebo arm, using the results of this study as the control. Clinical Trial Registration: NCT04285723, NCT04589650.

Treatment of Ecchymosis with a Pulsed Dye Laser.

Ecchymosis is a common side effect after injury and surgery. A pulsed dye laser (PDL) is the gold standard for vascular lesions and can minimize ecchymosis. Heating induces hemoglobin modification due to oxidative and heat reactions with the formation of bilirubin and methemoglobin, resulting in color changes to brown-yellow. Therefore, downtime following cosmetic procedures can be shortened.

Aberrant Water Structure Dynamics in B16 Melanoma-Bearing Mice by Time Domain Refractometry Analysis.

Living bodies comprise approximately 55-75% water to maintain homeostasis. However, little is known about the comprehensive differences in in vivo water molecule dynamics (water structure dynamics; WSD) between physiological and pathophysiological statuses. Here, we examined the WSD of ex vivo tumor tissues and organs from tumor-bearing mice with engrafted mouse malignant melanoma cells (B16-F10) in the right flanks to compare with those in healthy mice, using time domain reflectometry of dielectric spectroscopy at days 9, 11, and 14 after engrafting. The relaxation parameters of relaxation time (τ), relaxation time distribution parameter (ß), and relaxation strength (∆ε) were measured on tumor tissues and lung, liver, kidney, and skin tissues. Immediately afterward, the water contents (%) in the tumor and the other organs were calculated by measuring their weights before and after freeze-drying. Each parameter of the tumor was compared to that of pooled values of other organs in tumor-bearing (TO) and healthy mice (HO). The tumor water content temporarily increased compared to that of HO at day 11; the tumor volume was also prone to increase. In contrast, tumor tissues exhibited significantly higher values of ß close to 1 of ultrapure water and ∆ε compared to TO and HO at all times. Moreover, ß in the viscera of TO was prone to increase compared to that of HO with significantly higher levels at day 11. Conclusively, tumor-bearing mice exhibited systemically aberrant WSD, unlike healthy mice. Thus, dielectric spectroscopy in terms of WSD may provide novel pathophysiological perspectives in tumor-bearing living bodies.

Prospective comparison study of a 550 picosecond 755 nm laser vs a 50 ns 755 nm laser in the treatment of nevus of Ota.

Since the introduction of selective photothermolysis, Q-switched nanosecond lasers have been used for the treatment of dermal pigmented lesions. Over the past several years, picosecond lasers have been introduced to the cosmetic community. We recently performed a study comparing a 550 picosecond 755 nm laser versus a 50 ns 755 nm laser, with the purpose of evaluating the clinical efficacy and complications of each laser when treating nevus of Ota. Ten Asian patients with nevus of Ota were enrolled in the study. Each lesion was split into 2 parts, and patients were treated with a 755 nm picosecond laser (PSL) and a 755 nm nanosecond laser (NSL). The clinical endpoint for fluence choice was immediate whitening (PSL: 2.33 ~ 3.36 J/cm2, NSL: 5.5 ~ 7 J/cm2) of the treated area. The pulse duration was fixed at 550 picoseconds (PSL) and 50 ns (NSL). The spot size of each laser was 2.5-3 mm. Laser treatments were performed until excellent clinical improvement was observed. Patients were examined 1 week after the first treatment, at each follow-up visit, and 6 months after the last laser treatment. The average number of treatment sessions to achieve excellent clinical improvement was 4.2 treatments using PSL and 5.4 treatments using NSL. One case of hyperpigmentation and one case of hypopigmentation were observed in the NSL treatment group. There were no complications in the PSL treatment group. The 755 nm 550 picosecond laser is significantly more effective than the 755 nm 50 ns laser in the treatment of nevus of Ota. The PSL treatment group also had minimum side effects.

Mechanism of crescent-shaped and ring-shaped epidermal damage from laser hair removal with cryogen spray cooling.

The safety and efficacy of laser hair removal have been well established through many clinical studies and through clinical use over the past 25 years. A laser hair removal device that protects the epidermis by utilizing cryogen spray cooling (CSC) is widely used internationally. In darker skin types, post-inflammatory hyperpigmentation (PIH) can occur after laser hair removal. In particular, laser hair removal with CSC is known to cause crescent-shaped or ring-shaped PIH. In this experiment, we report a visualization of this PIH mechanism. The laser used in this experiment is a 755-nm-long-pulsed alexandrite laser. Graph paper was treated with this laser to assess for thermal damage. We investigated changes in thermal damage due to differences in laser spot size, fluence output, and laser beam angle in relation to the graph paper. When using a spot size of 18 mm, we observed that higher fluences caused crescent-shaped thermal damage on the margins of the treated graph paper. It was also confirmed that when the hand piece is not held perpendicular to the skin, the laser-treated area is expanded and the CSC range is narrowed. These factors caused the area of thermal damage to widen. This widening causes ring-shaped thermal injury, leading to PIH. We treated graph paper using a hair removal laser with CSC to investigate the mechanism of crescent or ring-shaped thermal damage. Laser treatment on graph paper is effective as a test for defects in the CSC device. Factors that cause inadequate cooling, which leads to PIH, are large spot size, high fluence, not holding the laser hand piece perpendicular to the skin, and malfunctioning of CSC device.

Accelerated human epidermal turnover driven by increased hyaluronan production.

BACKGROUND: Hyaluronan (HA) is an essential component of extracellular matrix in the skin, but its functions in the epidermis remain elusive. OBJECTIVE: We examined the interaction of increased HA production mediated by 1-ethyl-ß-N-acetylglucosaminide (ß-NAG2), a newly developed highly selective inducer of HA production which is intracellularly converted to UDP-N-acetylglucosamine, a substrate of HA, with epidermal proliferation and differentiation. METHODS: The amount, molecular size and epidermal tissue distribution of HA and expression of CD44, a cell surface receptor for HA, were analyzed in ß-NAG2-treated organ cultured human skin, reconstructed human skin equivalents or cultured human skin keratinocytes. The relationship between HA and epidermal proliferation or differentiation was examined. RESULTS: ß-NAG2 significantly increased HA production in the epidermis of skin explants or skin equivalents without affecting molecular size of HA (>2000 kDa) or CD44 mRNA expression. Histochemical experiments revealed that ß-NAG2 enhances HA signals in the basal to granular layers of the epidermis of skin equivalents, accompanying increased epidermal stratification. Immunohistochemical experiments demonstrated that signals of Ki67, transglutaminase 1 and filaggrin are increased in ß-NAG2-treated skin equivalents, and these observations were confirmed by the data showing that mRNA expression of PCNA, transglutaminase 1 (TGM1) and filaggrin (FLG) is significantly up-regulated by ß-NAG2 in skin equivalents. Importantly, blockade of HA production by inhibiting conversion of ß-NAG2 to UDP-NAG abolished ß-NAG2-mediated up-regulation of PCNA, TGM1 and FLG mRNA expression in cultured keratinocytes. CONCLUSION: These results suggest that increased epidermal HA production plays a key role in epidermal morphogenesis and homeostasis by accelerating keratinocyte proliferation and differentiation.

Prospective Comparison Study of 532/1064 nm Picosecond Laser vs 532/1064 nm Nanosecond Laser in the Treatment of Professional Tattoos in Asians.

BACKGROUND AND AIMS: Although, the pulse width should be shorter than the thermal relaxation time of the target, nanosecond laser pulses are not short enough for tattoo removal. Complications are common, such as hyper or hypopigmentation, textural changes, and scarring. Moreover, patients with darker skin types are at a higher risk of complications from tattoo removal using these lasers. Picosecond lasers were developed to overcome the limitation of nanosecond lasers. We did a comparison study of a 532/1064 nm picosecond laser vs a 532/1064 nm nanosecond laser to evaluate the clinical efficacy and complications of multi-color tattoos in Asians. MATERIALS AND METHODS: Eleven Asian patients with 37 professional tattoos were enrolled in the study. Each patient was treated with a 532/1064 nm nanosecond laser and a 532/1064 nm picosecond laser. The spot size that was used with each laser was 3 mm. Four treatments were performed, with four week intervals between each treatment. Patients were examined a week after the first treatment and 3 months after the last treatment. RESULTS AND CONCLUSIONS: All patients tolerated the treatments well. The efficacy of the 1064 nm picosecond laser for black tattoos is significantly better than the other studied lasers. The efficacy of the 532 nm picosecond laser is significantly better than the other studied lasers for red tattoos. The efficacy of the 532 nm picosecond laser is significantly better than the 532 nm nanosecond laser and better than the 1064 nm picosecond laser for green tattoos. Mild to moderate post-inflammatory hyperpigmentation was observed in 35.1%, 24.3% 27.0%, and 21.6% of the tattoos treated with the 532 nm nanosecond laser, the 532 nm picosecond laser, the 1064 nm nanosecond laser, and the 1064 nm pico-second laser, respectively. Paradoxical darkening (5.4%) was observed equally with each type of laser. There was no scar formation in any of the tattoos treated. The 532/1064 nm picosecond laser is more effective than the 532/1064 nm nanosecond laser in the treatment of multi-color tattoos in Asians. The 532 nm picosecond laser is more effective than 1064 nm picosecond laser in every tattoo color, with the exception of black. Paradoxical darkening was observed, even the use of picosecond lasers.

Myxofibrosarcoma that Developed Rapidly in the Breast of an Elderly Man and Recurred Early after Surgery: A Case Report.

BACKGROUND: Myxofibrosarcoma is a rare disease occurring subcutaneously in the limbs. We report a case of a rapidly growing myxofibrosarcoma in the breast of an elderly man that recurred early after surgery. CASE PRESENTATION: A 73-year-old man presented with a breast mass. Physical findings showed a large tumor in the right breast, and malignancy was suspected on ultrasonography. Computed tomography (CT) revealed tumor invasion into the pectoralis major and pectoralis minor muscles. Positron emission tomography/CT showed no abnormality in other organs. Needle biopsy results excluded breast cancer but did not provide a definitive diagnosis. However, the tumor grew rapidly before further results were available, so emergency mastectomy was performed. The final pathological diagnosis was high-grade myxofibrosarcoma. Postoperative radiotherapy was started because of remnant tumor. The wound became worsened and swollen, and needle biopsy 10 days after the start of therapy indicated recurrence. Radical resection and thoracoplasty were performed. Postoperative pathological specimens showed no residual tumor. Radical radiation therapy was resumed. The patient has shown no recurrence after an year. CONCLUSIONS: It is important to consult a soft tissue oncologist for tumors in the breast and perform appropriate examination and treatment if soft tissue tumors cannot be ruled out.

Pyoderma Gangrenosum after Breast Mastectomy and Primary Rectus Abdominis Flap Reconstruction.

Pyoderma gangrenosum is an intractable disease of unknown cause involving recurrent ulcerative lesions on the skin, and may accompany ulcerative colitis, rheumatoid arthritis, leukemia, systemic lupus erythematosus, and other conditions. Here, we report a rare case of pyoderma gangrenosum in the thoracic abdomen following post-mastectomy reconstructive surgery. A 39-year-old presented at the hospital with a complaint of left papilla erosion. Skin biopsy at the site revealed invasive skin cancer, with Paget-like progression in the cancerous nipple and suspected malignancy of skin appendages. After partial mastectomy including the areola, invasive ductal breast carcinoma was diagnosed. The patient underwent a subsequent full mastectomy with simultaneous sentinel lymph node biopsy and primary breast reconstructive surgery using a rectus abdominis myocutaneous flap. Two weeks post-surgery, healing of the abdominal surgical wound was found to be delayed, and suture abscess was suspected. Despite localized treatment, an ulcerative lesion developed in the thoracic region, and pyoderma gangrenosum was diagnosed following skin biopsy. After the introduction of steroid pulse therapy, no progression of the lesion was observed. This report describes the disease characteristics, diagnosis, and treatment of post-surgical pyoderma gangrenosum and discusses the case in the context of previous literature.

Theoretical review of the treatment of pigmented lesions in Asian skin.

Asian skin has a higher epidermal melanin content, making it more likely to develop adverse pigmentary reactions following laser surgery. The nanosecond lasers are the gold standard for the treatment of pigmented lesions, but the risk of complications, such as post-inflammatory hyperpigmentation, is increased in dark-skinned patients. Intense Pulsed Light (IPL) or long-pulsed lasers are available for treating superficial pigmented lesions, and fewer complications are seen when using these devices compared to the nanosecond lasers. Nanosecond lasers are essential in the treatment of dermal melanosis. Recently, picosecond lasers have been investigated. Picosecond lasers will also play an important role in the treatment of pigmented lesions.

A blinking periorbital prosthesis using surface electromyographic signals of the orbicularis oculi muscle.

BACKGROUND: Recent advances in human-machine interface technology have enabled the development of multifunctional, primarily orthopedic myoelectric prostheses. We developed a noninvasive blinking periorbital prosthesis that can synchronize with blinking of the intact eyelid by using surface electromyographic signals of the orbicularis oculi muscle. METHODS: Myoelectric potentials of the orbicularis oculi muscle while blinking were measured with surface electrodes on the eyelid in four healthy adults. Possible cross talk introduced via the electrodes was also measured and assessed to determine whether cross talk would affect surface electromyographic measurements while blinking. RESULTS: The amplitude of the surface myoelectric potential of the orbicularis oculi muscle was sufficiently high for the practical use of blinking prostheses. Our blinking model was successfully synchronized with blinks of the subjects' eyelids under experimental conditions without cross talk between the orbicularis oculi muscle and other muscles. CONCLUSIONS: Although our study revealed several problems, the use of surface electromyographic signals could be a promising and useful technique for synchronizing blinking of the prosthetic eyelid with blinking of the intact eyelid. Level of Evidence: Level V, therapeutic study.

MRI analysis of chronological changes in free-flap volume in head and neck reconstruction by volumetry.

OBJECTIVE: To evaluate changes in flap volumes for head and neck cancer patients by MRI. METHODS: MRI examinations of a total of 21 head and neck cancer patients (13 males and 8 females; average age, 67 years) were performed after surgery to monitor changes in flap volumes, including muscle and fat content, using volumetric analysis of T2-weighted images at 1, 3, 6, and 12 months after surgery. RESULTS: Fat-to-muscle ratios of all flaps at 1 month varied (muscle/fat ratio, 0.04-0.96). Flap volumes in all patients decreased at 12 months after surgery. The average final volumes of overall, muscle, and fat volumes reached 76.9% ± 5.2%, 37.1% ± 3.7%, and 85.5% ± 5.7%, respectively. The average fat volume slightly increased between 6 and 12 months, whereas compared with the fat volume, the average muscle volume significantly decreased (p<0.001). CONCLUSIONS: The final overall flap volume in all patients decreased to approximately 25% of the original volume after surgery, which primarily resulted from muscle atrophy. Therefore fat-rich flaps may maintain flap volumes after surgery. MRI is a useful method to evaluate the size and shape of flaps of the head and neck.

Autologous G-CSF-mobilized peripheral blood CD34+ cell therapy for diabetic patients with chronic nonhealing ulcer.

Recently, animal studies have demonstrated the efficacy of endothelial progenitor cell (EPC) therapy for diabetic wound healing. Based on these preclinical studies, we performed a prospective clinical trial phase I/IIa study of autologous G-CSF-mobilized peripheral blood (PB) CD34(+) cell transplantation for nonhealing diabetic foot patients. Diabetic patients with nonhealing foot ulcers were treated with 2 × 10(7) cells of G-CSF-mobilized PB CD34(+) cells as EPC-enriched population. Safety and efficacy (wound closure and vascular perfusion) were evaluated 12 weeks posttherapy and further followed for complete wound closure and recurrence. A total of five patients were enrolled. Although minor amputation and recurrence were seen in three out of five patients, no death, other serious adverse events, or major amputation was seen following transplantation. Complete wound closure was observed at an average of 18 weeks with increased vascular perfusion in all patients. The outcomes of this prospective clinical study indicate the safety and feasibility of CD34(+) cell therapy in patients with diabetic nonhealing wounds.

A case of fat injection for treating subcutaneous atrophy caused by local administration of corticosteroid.

A 42 year old female received intramuscular injection of 40 mg triamcinolone acetonide on the right upper arm for the treatment of pollen allergy at another clinic. Subcutaneous atrophy appeared at the injection site a few days after. Since there were no signs of improvement, the patient visited our clinic for further examination. The subcutaneous atrophy after local injection of corticosteroids is generally considered to be reversible and it improves within about 1 year after the injection. After one year since local injection, subcutaneous atrophy did not improve and we performed fat injection using autologous fat. As a treatment, we thought that the fat injection method is a superior method since it is less invasive from a cosmetic standpoint.

Reconstruction of wide cleft lip scar by Abbe flap and advancement flap from lateral upper lip.

Primary surgery of cleft lip and palate has dramatically improved with technical and material advances. Some adults who previously underwent surgery still have upper lip deformities or extensive scar, and they are occasionally seen for secondary treatment. We reported a case of unilateral cleft lip patient who had extensive scar involving the central 1/4 of the upper lip, with gross lip and nasal deformity. In this patient, we reconstructed the entire affected upper lip using an Abbe flap and an advancement flap from the lateral lip. This not only improved the upper lip contracture, but also moved the scar to the margin of the aesthetic unit. This removal of the visible scar from central portion of the lip provided a satisfactory aesthetic result. A large V-Y advancement flap from lateral upper lip has several advantages. These are sufficient soft tissue volume, inconspicuous scar in accordance with margin of aesthetic unit, and texture and color match. There is no previous report describes the application of V-Y advancement flap for secondary lip reconstruction of unilateral cleft lip deformity in the literature.

Salvage operations of free tissue transfer following internal jugular venous thrombosis: a review of 4 cases.

The internal jugular vein (IJV) is used as the optimal recipient for free-tissue transfer in reconstruction following modified radical neck dissection. Some reports documented rare cases of flap compromise following IJV thrombosis, but large sample studies are few. We present cases of emergent exploration and an analysis of factors to improve salvage rates of compromise due to IJV thrombosis. From a survey of 756 patients, four developed congestion due to IJV thrombosis and returned to the operating room. A restrospective analysis was made from the case records. This represents a rate of 0.5% for the entire series. Three flaps survived,and one failed. Detection of compromise ranged from 7-25 h postoperatively. All four IJVs recovered to provide adequate drainage after thrombectomy. While flap compromise following IJV thrombosis is rare, careful observation and early exploration are crucial for salvage, as in other microvascular venous crises.

CdZnTe detector in mammographic x-ray spectroscopy.

A CdZnTe (CZT) detector was utilized in mammographic x-ray spectroscopy under clinical conditions. First, the detector response was investigated using y-rays from 241Am. The escape of secondary (Compton scattered and K fluorescent) x-rays and tailing due to carrier trapping were minor in the mammographic energy range. In addition, the transmission of primary x-rays was minimal from the results calculated using the mass attenuation coefficients of CZT. Therefore, spectral distortion in this energy range was expected to be negligible. Secondly, x-ray spectroscopy was carried out with the CZT detector. The measured spectra were in good agreement with the spectra obtained with the Compton-scatter method with a high-purity germanium detector. Moreover, the half-value layers (HVLs) calculated from the CZT spectra were consistent with the HVLs measured with an ionization chamber. The results indicate that a CZT detector can be utilized in mammographic x-ray spectroscopy without any corrections.

CdZnTe detector in diagnostic x-ray spectroscopy.

A method to utilize CdZnTe (CZT) detectors in diagnostic x-ray spectroscopy is described in this article. Spectral distortion due to transmission of primary x rays, the escape of cadmium- and tellurium-K fluorescent x rays, and tailing was severe in measured x-ray spectra. Therefore, correction for the distortion was performed with the stripping method using response functions. The response functions were calculated with the Monte Carlo method. The Hecht equation was employed to approximate the effects of carrier trapping in the calculations. The parameters in the Hecht equation, the mean-free path (lambda) of electrons and holes, were determined such that the tailing in calculated response functions fit that in measured gamma-ray spectra. Corrected x-ray spectra agreed well with the reference spectra measured with an HPGe detector. The results indicate that CZT detectors are suitable for diagnostic x-ray spectroscopy with appropriate corrections.