Forehead Movement Discrepancies After Botulinum Toxin Injections: A Review of Etiology, Correction, and Prevention.

BACKGROUND: Forehead rhytides are a popular target for botulinum toxin injections, but neuromodulation of the frontalis can be fraught with complications because of its anatomic complexity and integral role in brow position and expressivity. OBJECTIVE: This article explores common forehead movement discrepancies that can occur after neuromodulation of the frontalis, as well as how to correct and prevent them. METHODS: A review of the literature was conducted and combined with clinical experience to examine underlying forehead anatomy, etiology and correction of forehead movement discrepancies, and important factors to consider before injecting the frontalis with botulinum toxin. RESULTS AND CONCLUSION: Variable anatomy from person to person necessitates an individualized treatment approach to achieve the best cosmetic results and prevent the occurrence of forehead movement discrepancies.

Temperature should not be measured on forearm with infrared thermometers for Covid-19 screening.

Not available.

Reliability of alternative devices for postoperative patient temperature measurement: two prospective, observational studies.

Peri-operative hypothermia is associated with significant morbidity, yet limitations exist regarding non-invasive temperature assessment in the post-anaesthesia care unit (PACU). In this prospective study of 100 patients, we aimed to determine the reliability of two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, in addition to an indwelling urinary catheter with temperature probe, in comparison with the final nasopharyngeal core temperature at the end of surgery. Agreement of forehead measurement with nasopharyngeal temperature showed a mean bias (±95% limits of agreement) of 0.15 °C (±1.4 °C), with a steep slope of the relationship on the Bland-Altman plot of -0.8, indicating a tendency to normalise patient temperature readings to 36.4 °C. Only 54% of hypothermic cases were correctly detected by the forehead measurement device. Agreement of tympanic measurement with nasopharyngeal core temperature measurement was marginally improved with a mean bias of 0.13 °C (95% limits of agreement ±1.15 °C). In contrast, agreement of bladder temperature with nasopharyngeal temperature showed a mean (SD) bias of 0.19 (0.28) °C (95% limits of agreement ±0.54 °C), with a relatively flat line of best fit. We demonstrated that two commonly used temperature measurement devices, forehead temporal artery temperature and tympanic measurement, compared with nasopharyngeal core temperature, were imprecise and unreliable following major surgery. However, the indwelling catheter with temperature sensor was precise and acceptable for continuous core temperature measurement in the PACU.

A 119dB Dynamic Range Charge Counting Light-to-Digital Converter For Wearable PPG/NIRS Monitoring Applications.

This paper presents a low power, high dynamic range (DR), reconfigurable light-to-digital converter (LDC) for photoplethysmogram (PPG), and near-infrared spectroscopy (NIRS) sensor readouts. The proposed LDC utilizes a current integration and a charge counting operation to directly convert the photocurrent to a digital code, reducing the noise contributors in the system. This LDC consists of a latched comparator, a low-noise current reference, a counter, and a multi-function integrator, which is used in both signal amplification and charge counting based data quantization. Furthermore, a current DAC is used to further increase the DR by canceling the baseline current. The LDC together with LED drivers and auxiliary digital circuitry are implemented in a standard 0.18 µm CMOS process and characterized experimentally. The LDC and LED drivers consume a total power of 196 µW while achieving a maximum 119 dB DR. The charge counting clock, and the pulse repetition frequency of the LED driver can be reconfigured, providing a wide range of power-resolution trade-off. At a minimum power consumption of 87 µW, the LDC still achieves 95 dB DR. The LDC is also validated with on-body PPG and NIRS measurement by using a photodiode (PD) and a silicon photomultiplier (SIPM), respectively.

Expressure: Detect Expressions Related to Emotional and Cognitive Activities Using Forehead Textile Pressure Mechanomyography.

We investigate how pressure-sensitive smart textiles, in the form of a headband, can detect changes in facial expressions that are indicative of emotions and cognitive activities. Specifically, we present the Expressure system that performs surface pressure mechanomyography on the forehead using an array of textile pressure sensors that is not dependent on specific placement or attachment to the skin. Our approach is evaluated in systematic psychological experiments. First, through a mimicking expression experiment with 20 participants, we demonstrate the system's ability to detect well-defined facial expressions. We achieved accuracies of 0.824 to classify among three eyebrow movements (0.333 chance-level) and 0.381 among seven full-face expressions (0.143 chance-level). A second experiment was conducted with 20 participants to induce cognitive loads with N-back tasks. Statistical analysis has shown significant correlations between the Expressure features on a fine time granularity and the cognitive activity. The results have also shown significant correlations between the Expressure features and the N-back score. From the 10 most facially expressive participants, our approach can predict whether the N-back score is above or below the average with 0.767 accuracy.

Reference Jitter Values for Concentric Needle Electrode of Orbicularis Oculi and Frontalis Muscles Using Voluntary Activation Method in Sudanese Population.

Single fibre electromyography is the most sensitive neurophysiological test for the diagnosis of neuromuscular junction disorders, particularly myasthenia gravis. The study aimed at establishing concentric needle (CN) normal jitter values for voluntarily activated orbicularis-oculi (V-OOc) & Frontalis (V-FRO) muscles in Sudanese population. 57 healthy volunteers (20 males & 37 females) were included in the study (mean Age 43.6 ± 14.2 years, range 18-70 years). V-OOc and V-FRO were tested in the same individual using CN. Jitter values were expressed as the mean consecutive difference (MCD) of 30 potential pairs in microseconds. The mean jitter, mean individual fibre pairs jitter & mean outliers jitter values with (upper 95% Confidence Limit-CL) for [OOc] were [26.9 ± 3.3 (31.97), 26.1 ± 8.9 (41.8) & 38.5 ± 5.7 (49.0) µs] & for [FRO] were [27.1 ± 3.0 (31.32), 26.4 ± 9.4 (42.9) & 39.9 ± 5 (49.2) µs] respectively. The suggested practical upper limits for mean jitter & for outliers were (32, 49 µs) for OOc & (31, 49 µs) for FRO. Our CN-jitter values were within the range of the few published studies. The study was unique in that it established and compared between CN reference jitter values of two voluntarily activated facial muscles (V-OOc & V-FRO) in the same individual in large number of healthy subjects.

Design of Multi-Wavelength Optical Sensor Module for Depth-Dependent Photoplethysmography.

The multi-wavelength photoplethysmography sensors were introduced to measure depth-dependent blood volume based on that concept that the longer the light wavelength, the deeper the penetration depth near visible spectrum band. In this study, we propose an omnidirectional optical sensor module that can measure photoplethysmogram while using multiple wavelengths, and describe implementation detail. The developed sensor is manufactured by making a hole in a metal plate and mounting an LED therein, and it has four wavelength LEDs of blue (460 nm), green (530 nm), red (660 nm), and IR (940 nm), being arranged concentrically around a photodetector. Irradiation light intensity was measured by photoluminescent test, and photoplethymogram was measured with each wavelength simultaneously at a periphery of the human body such as fingertip, earlobe, toe, forehead, and wrist, in order to evaluate the developed sensor. As a result, the developed sensor module showed a linear increase of irradiating light intensity according to the number of LEDs increases, and pulsatile waveforms were observed at all four wavelengths in all measuring sites.

Internal precooling decreases forehead and core temperature but does not alter choice reaction time during steady state exercise in hot, humid conditions.

This study aimed to determine if precooling via crushed ice ingestion reduces forehead skin temperature (Thead) and core temperature (Tcore) during exercise in the heat and whether it has an effect on choice reaction time (CRT). Ten males commenced a 30 min precooling period, ingesting either 7 g kg-1 of crushed ice (ICE) or room temperature water (CON) prior to cycling 60 min at 55% V̇O2peak in hot, humid conditions (35.0 ± 0.3 °C, 50.2 ± 2.1% Relative Humidity). The CRT task was completed upon arrival and after the precooling period in the lab, then at 15 min intervals during exercise in the heat. Precooling reduced Thead and Tcore to a greater degree in ICE (Thead: -0.8 ± 0.31 °C; Tcore: -0.9 ± 0.3 °C) compared with CON (Thead: -0.2 ± 0.3 °C; Tcore: -0.2 ± 0.2 °C) (p ≤ 0.001). Choice reaction time performance improved throughout the cycle for both conditions (p ≤ 0.05). Ice ingestion lowered thermal sensation (p = 0.003) and skin temperature (d = 0.88; Tskin), while heart rate, ratings of perceived exertion and thirst were similar between conditions (p > 0.05). Precooling effectively reduced Thead and Tcore but did not provide additional improvement in CRT during moderate exercise in the heat. Further investigation is required to determine whether the lower central and peripheral temperature after ice ingestion is beneficial for tasks of greater cognitive effort.

Identifying Ketamine Responses in Treatment-Resistant Depression Using a Wearable Forehead EEG.

This study explores responses to ketamine in patients with treatment-resistant depression (TRD) using a wearable forehead electroencephalography (EEG) device. We recruited and randomly assigned 55 outpatients with TRD into three approximately equal-sized groups (A: 0.5-mg/kg ketamine; B: 0.2-mg/kg ketamine; and C: normal saline) under double-blind conditions. The ketamine responses were measured by EEG signals and Hamilton depression rating scale scores. At baseline, the responders showed significantly weaker EEG theta power than the non-responders (p < 0.05). Compared to the baseline, the responders exhibited higher EEG alpha power but lower EEG alpha asymmetry and theta cordance post-treatment (p < 0.05). Furthermore, our baseline EEG predictor classified the responders and non-responders with 81.3 ± 9.5% accuracy, 82.1 ± 8.6% sensitivity, and 91.9 ± 7.4% specificity. In conclusion, the rapid antidepressant effects of mixed doses of ketamine are associated with prefrontal EEG power, asymmetry, and cordance at baseline and early post-treatment changes. Prefrontal EEG patterns at baseline may serve as indicators of ketamine effects. Our randomized double-blind placebo-controlled study provides information regarding the clinical impacts on the potential targets underlying baseline identification and early changes from the effects of ketamine in patients with TRD.

Comparison of an unsupervised machine learning algorithm and surgeon diagnosis in the clinical differentiation of metopic craniosynostosis and benign metopic ridge.

Metopic suture closure can manifest as a benign metopic ridge (BMR), a variant of normal, to "true" metopic craniosynostosis (MCS), which is associated with severe trigonocephaly. Currently, there is no gold standard for how much associated orbitofrontal dysmorphology should trigger surgical intervention. In our study, we used three-dimensional (3D) curvature analysis to separate the phenotypes along the spectrum, and to compare surgeons' thresholds for operation. Three-dimensional curvature analyses on 43 subject patients revealed that the mean curvature of mid-forehead vertical ridge was higher for patients who underwent operation than those who did not undergo operation by 1.3 m-1 (p < 0.0001). In addition, these patients had more retruded supraorbital areas by -16.1 m-1 (p < 0.0001). K-means clustering classified patients into two different severity groups, and with the exception of 2 patients, the algorithm's classification of deformity completely agreed with the surgeons' decisions to offer either conservative or operative therapy (i.e. 96% agreement). The described methods are effective in classifying severity of deformity and in our experience closely approximate surgeon therapeutic decision making. These methods offer the possibility to consistently determine when surgical intervention may be beneficial and to avoid unnecessary surgeries on children with benign metopic ridge and associated minimal orbitofrontal deformity.

A novel forehead temperature-regulating device for insomnia: a randomized clinical trial.

Study Objectives: Insomnia is one of the most common disorders in the general population. Hypnotic medications are efficacious, but their use is limited by adverse events (AEs). This study evaluated the safety and efficacy of a novel forehead temperature-regulating device that delivers frontal cerebral thermal therapy (maintained at 14-16°C, equivalent to 57-61°F) for the treatment of insomnia. Methods: This was a prospective, randomized controlled trial involving two nights of therapy in 106 adults diagnosed with insomnia. The main outcome measures included latency to persistent sleep and sleep efficiency derived from polysomnographic (PSG) recordings and frequency and severity of AEs. Results: The safety profile was comparable to sham treatment. Statistically significant differences were not found in the two a priori co-primary endpoint measures absolute latency to persistent sleep (p = 0.092) or absolute sleep efficiency. Frontal cerebral thermal therapy produced improvements over sham in other convergent measures of sleep latency including relative changes from baseline in latency to persistent sleep (p = 0.013), the latency to stage 1 NREM sleep (p = 0.006), the latency to stage 2 NREM sleep (p = 0.002), a trend for the latency to stage 3 NREM sleep (p = 0.055), and an increase in the minutes of sleep during the first hour of the night (p = 0.024). Conclusions: Two-night frontal cerebral thermal therapy produced improvements in PSG measures of insomnia patients' ability to fall asleep and had a benign safety profile. Further studies are warranted to determine the role of this therapy in the longer-term management of insomnia. Trial Registration: clinicaltrials.gov Identifier: NCT01966211.

Rectal and Bladder Temperatures vs Forehead Core Temperatures Measured With SpotOn Monitoring System.

BACKGROUND: Methods and frequency of temperature monitoring in intensive care unit patients vary widely. The recently available SpotOn system uses zero-heat-flux technology and offers a noninvasive method for continuous monitoring of core temperature of critical care patients at risk for alterations in body temperature. OBJECTIVE: To evaluate agreement between and precision of a zero-heat-flux thermometry system (SpotOn) and continuous rectal and urinary bladder thermometry during fever and defervescence in adult patients in intensive care units. METHODS: Prospective comparison of SpotOn vs rectal and urinary bladder thermometry in eligible patients enrolled in a randomized clinical trial on the effect of acetaminophen on core body temperature and hemodynamic status. RESULTS: A total of 748 paired temperature measurements from 38 patients who had both SpotOn monitoring and either continuous rectal or continuous bladder thermometry were analyzed. Temperatures during the study were from 36.6°C to 39.9°C. The mean difference for SpotOn compared with bladder thermometry was -0.07°C (SD, 0.24°C; 95% limits of agreement, ± 0.47°C [-0.54°C, 0.40°C]). The mean difference for SpotOn compared with rectal thermometry was -0.24°C (SD, 0.29°C; 95% limits of agreement, ± 0.57°C [-0.81°C, 0.33°C]). Most differences in temperature between methods were within ± 0.5°C in both groups (96% bladder and 85% rectal). CONCLUSIONS: The SpotOn thermometry system has excellent agreement and good precision and is a potential alternative for noninvasive continuous monitoring of core temperature in critical care patients, especially when alternative methods are contraindicated or not available.

Detailed Anatomy of Osteoperiosteal Ligamentous Structures in the Forehead.

This study aimed to present the anatomic characteristics of osteoperiosteal ligamentous attachments of the forehead and provide a better understanding of lateral eyebrow descent for safe and effective foreheadplasty. Anatomic dissections of the face were performed in 10 fresh Korean adult cadavers (20 hemifaces) using 2.5× magnification surgical loupes. Supraorbital, inferomedial orbital, and frontonasal osteoperiosteal ligamentous attachments were identified as fibrous tissues originating from a bone, and their tensile strengths were measured. The supraorbital osteoperiosteal ligamentous attachment had medial and lateral parts. It can be classified into 4 subtypes. It was located 11.0 ±â€Š6.6 mm lateral to the midline and 9.2 ±â€Š12.3 mm superior to the superior orbital margin. The inferomedial orbital osteoperiosteal ligamentous attachment was located 16.2 ±â€Š3.9 mm lateral to the midline and 2.2 ±â€Š2.7 mm inferior to the superior orbital margin, whereas the frontonasal osteoperiosteal ligamentous attachment was located 5.4 ±â€Š2.3 mm lateral to the midline and 1.4 ±â€Š8.5 mm superior to the superior orbital margin. Tensile strengths of all the osteoperiosteal ligamentous attachments in the forehead were above 10 N. These results indicate that osteoperiosteal ligamentous attachments develop in the rather medial region of the eyebrow and have a tensile strength adequate enough to maintain the medial eyebrow. Thus, the current study provides surgeons with detailed anatomic information that can be used as a valuable reference for forehead rejuvenation procedures.

Cathodal transcranial direct-current stimulation over right posterior parietal cortex enhances human temporal discrimination ability.

BACKGROUND: Time perception associated with durations from 1 s to several minutes involves activity in the right posterior parietal cortex (rPPC). It is unclear whether altering the activity of the rPPC affects an individual's timing performance. Here, we investigated the human timing performance under the application of transcranial direct-current stimulation (tDCS) that altered the neural activities of the rPPC. METHODS: We measured the participants' duration-discrimination threshold by administering a behavioral task during the tDCS application. The tDCS conditions consisted of anodal, cathodal, and sham conditions. The electrodes were placed over the P4 position (10-20 system) and on the left supraorbital forehead. On each task trial, the participant observed two visual stimuli and indicated which was longer. The amount of difference between the two stimulus durations was varied repeatedly throughout the trials according to the participant's responses. The correct answer rate of the trials was calculated for each amount of difference, and the minimum amount with the correct answer rate exceeding 75% was selected as the threshold. The data were analyzed by a linear mixed-effects models procedure. RESULTS: Nineteen volunteers participated in the experiment. We excluded three participants from the analysis: two who reported extreme sleepiness while performing the task and one who could recognize the sham condition correctly with confidence. Our analysis of the 16 participants' data showed that the average value of the thresholds observed under the cathodal condition was lower than that of the sham condition. This suggests that inhibition of the rPPC leads to an improvement in temporal discrimination performance, resulting in improved timing performance. CONCLUSIONS: In the present study, we found a new effect that cathodal tDCS over the rPPC enhances temporal discrimination performance. In terms of the existence of anodal/cathodal tDCS effects on human timing performance, the results were consistent with a previous study that investigated temporal reproduction performance during tDCS application. However, the results of the current study further indicated that cathodal tDCS over the rPPC increases accuracy of observed time duration rather than inducing an overestimation as a previous study reported.

Evaluation of the relation between lipid coat, transepidermal water loss, and skin pH.

OBJECTIVE: The epidermis is an epidermal barrier which accumulates lipid substances and participates in skin moisturizing. An evaluation of the epidermal barrier efficiency can be made, among others, by the measurement of the following values: the lipid coat, the transepidermal water loss (TEWL) index, and pH. MATERIALS: The study involved 50 Caucasian, healthy women aged 19-35 years (mean 20.56). METHODS: Measurements were made using Courage & Khazaka Multi Probe Adapter MPA 580: Tewameter TM 300, pH-Meter PH 905, Sebumeter SM 815. The areas of measurements included forehead, nose, left cheek, right cheek, chin, and thigh. RESULTS: In the T-zone, the lipid coat was in the range between 0 and 270 µg/cm2 (mean 128 µg/cm2 ), TEWL between 1 and 55 g/m2 /h (mean 11.1 g/m2 /h), and pH 4.0-5.6 (mean 5.39). Lower values of the lipid coat up to 100 µg/cm2 were accompanied by TEWL greater than 30 g/m2 /h and less acidic pH of 5.6-9.0. In the U-zone the range of lipid coat was up to 200 µg/cm2 (mean 65.2 µg/cm2 ), the skin pH remained 4.0-5.6 (mean 5.47), and TEWL was in the range between 1 and 20 g/m2 /h (mean 8.7 g/m2 /h). Lower values of the lipid coat up to 100 µg/cm2 were accompanied by TEWL between 1 and 20 g/m2 /h and less acidic pH of 5.6-9.0. High values of the lipid coat between 180 and 200 µg/cm2 were connected with TEWL of 1-15 g/m2 /h. On the skin of the thigh, we observed a very thin lipid coat - 35 µg/cm2 (mean 5.6 µg/cm2 ), pH (mean 5.37), and TEWL (mean 8.5 g/m2 /h) were considered by us to be within regular limits. CONCLUSIONS: In the T-zone, a thinner lipid coat resulted in relatively high TEWL and pH levels changing toward alkaline. In the U-zone, thinner lipid coat was accompanied by lower TEWL and pH changing toward alkaline. We also observed that lower values of lipid coat up to 100 µg/cm2 were associated with higher pH values ranging toward the basic character pH 5.6-9.0).

Orofacial electromyographic correlates of induced verbal rumination.

Rumination is predominantly experienced in the form of repetitive verbal thoughts. Verbal rumination is a particular case of inner speech. According to the Motor Simulation view, inner speech is a kind of motor action, recruiting the speech motor system. In this framework, we predicted an increase in speech muscle activity during rumination as compared to rest. We also predicted increased forehead activity, associated with anxiety during rumination. We measured electromyographic activity over the orbicularis oris superior and inferior, frontalis and flexor carpi radialis muscles. Results showed increased lip and forehead activity after rumination induction compared to an initial relaxed state, together with increased self-reported levels of rumination. Moreover, our data suggest that orofacial relaxation is more effective in reducing rumination than non-orofacial relaxation. Altogether, these results support the hypothesis that verbal rumination involves the speech motor system, and provide a promising psychophysiological index to assess the presence of verbal rumination.

A Wearable Thermometry for Core Body Temperature Measurement and Its Experimental Verification.

A wearable thermometry for core body temperature (CBT) measurement has both healthcare and clinical applications. On the basis of the mechanism of bioheat transfer, we earlier designed and improved a wearable thermometry using the dual-heat-flux method for CBT measurement. In this study, this thermometry is examined experimentally. We studied a fast-changing CBT measurement (FCCM, 55 min, 12 subjects) inside a thermostatic chamber and performed long-term monitoring of CBT (LTM, 24 h, six subjects). When compared with a reference, the CoreTemp CM-210 by Terumo, FCCM shows 0.07 °C average difference and a 95% CI of [-0.27, 0.12] °C. LTM shows no significant difference in parameters for the inference of circadian rhythm. The FCCM and LTM both simulated scenarios in which this thermometry could be used for intensive monitoring and daily healthcare, respectively. The results suggest that because of its convenient design, this thermometry may be an ideal choice for conventional CBT measurements.

Lapses in skin conductance responding across anatomical sites: Comparison of fingers, feet, forehead, and wrist.

The fingers are widely accepted as the gold standard for skin conductance (SC) recording, with the feet as a strong alternative. However, there are gaps in the current literature comparing these sites. There is also a great deal of interest in alternative recording sites to permit mobility, but data evaluating these are few and inconsistent. The present report compared multiple sites (fingers, abductor hallucis of the foot, arch of the foot, toes, forehead, and wrist) from 45 college student participants in a short-term sedentary laboratory setting and found large variation in both tonic and phasic SC responses, as well as crucial lapses in responding at nonpalmar sites. Across-site correlations between participants and within participants were also examined. The present data show that, in the laboratory setting employing commonly used recording techniques and stimuli, the nonpalmar sites are generally less responsive than the fingers, and the wrist in particular is the lowest in responding, whereas the toes are most similar to the fingers in responding. Within-participant correlations between the fingers and other sites were greatest for the plantar sites and least for the forehead.