Malar augmentation with Hyaluronic acid enriched with glycine and proline: a clinical evaluation.

The aging process causes skin modification and wrinkle formation with an alteration of the face harmony and imperfections. The aim of the present investigation was to evaluate a cross-linked hyaluronic acid enriched with glycine and proline for zygomatic malar region infiltrations. A total of twenty healthy female patients were treated for zygomatic hypotonia. The level of patients and surgeon satisfaction was evaluated by global aesthetic improvement scale (GAIS) at baseline, immediately after the procedure and at 6 months from the treatment. The healing phase was uneventful, and no complications were reported in the perioperative and follow-up periods. No significant differences were reported between patients and surgeon GAIS score (p<0.05). A significant difference of GAIS score was reported immediately after the procedure and at 6 months if compared to the baseline (p<0.05). The cross-linked hyaluronic acid enriched with glycine and proline is a useful biomaterial for zygomatic- malar augmentation with no significant local complications and a high stability and satisfaction level of the procedure.

Clinical evaluation of efficacy and tolerance of a skin reconditioning compound for anti-aging.

Facial aging involves all facial structures located at different levels: bones soft tissues and skin with a reduction of the extracellular matrix. The aim of the study was to evaluate the efficacy of the injectable solution antiaging complex composed by non-reticulated hyaluronic acid (HA) and amino acids vitamins and antioxidants conveyed with mesotherapy technique in subjects with different expressions of aging. 114 patients with different expressions of aging were enrolled in this study with mean age (49±6). HA and amino acids vitamins and antioxidants complex solution Neofound (Love Cosmedical, Castagneto, Italy) was injected on the dermal plane or superficial subdermal plane. Among the various imperfections, fine roughness surface irregularities skin firmness brightness/discoloration cutaneous hydration were those with the greatest response to therapy. The clinical data showed that the medical device Neofound is effective and safe to treat various skin signs of chrono and photoaging thanks to its ability to protect tissues from oxidative stress and hydrate the skin.

Non-surgical treatment of lower eyelid fat pads with an injectable solution acid deoxycholic based.

The use of sodium deoxycholate (DC) in aesthetic medicine for reducing unwanted localized fat deposits is a procedure in use for over 30 years. Lower eyelid fat pads are one of the main imperfections of the middle third of the face. The purpose of the study is to assess the effectiveness and the safety of a second-generation injectable solution containing sodium deoxycholate 1.25% (DB125) for the treatment of lower eyelid fat pads. A multi-centre observational prospective study was carried out between May and October 2017. Patients presented various forms and degrees of lower eyelid fat pads. They were treated montly apart until the clinical result was obtained. The technique was explained. The study treated 120 patients for a total of 306 infiltration sessions (average 2.55 per patient). Patients gave the effectiveness of the treatment an average score of 7.125 (7.28 in men and 7.03 in women). The greatest successes were in patients under the age of 40. The medical evaluation showed therapeutic success in 85.83%. Adverse events were reported. The results of the study are encouraging since they have shown a therapeutic success from both the viewpoint of specialist medical assessment and from the personal, subjective view of the patients treated. This success did not show any significant differences between sex. On the other hand, outcome has been better in the younger age groups. The high degree of effectiveness shown in the study was associated with a minimal occurrence of adverse events. Therefore DB125, used with the right technique and dosage, is effective and safe to treat lower eyelid fat pads.

Evaluation of the effectiveness and safety of peppermint peel (PMP) soft peeling for skin ageing.

Turning to peeling in a dermatological sphere is extensively common and has been used for a long time. From the use of single acids moving on to the so-called compound peelings (associations of more than one substance in the same product) and the combined peelings which take advantage of the action of different substances in a synergistic manner (different products are applied sequentially) in order to best guarantee a greater effectiveness of the treatment for the recommended target. Superficial peelings, combined and not, have led to a drastic reduction in the percentage of incidence of adverse events typical of medium and deep peels. Nevertheless, it has been demonstrated that superficial peels bring about a rejuvenating effect through the mechanical stimulation of the Skin Stress Response System (SSRS), system designated to repairing the damaged tissue and restoring of the normal homeostasis. Clinical trials aims to evaluate the effectiveness and safety of the peppermint peel (PMP) medical device in subjects with different ageing expressions both in qualitative terms (different blemishes such as discolouration, fine wrinkles, elastosis, atony and skin inelasticity, laxity, scarce superficial hydration) and in quantitative terms (degree, extension and number of lesions). A non-controlled multi-centric clinical trial was done in 121 subjects. The use protocol calls for a session every 2 weeks for a total of 4 sessions. Subjects were evaluated before each subsequent session at the first and at 2-4-8 weeks of the fourth and last treatment. During the study there were no adverse events. Only a minimal scurfy flaking and a very slight redness were reported. From an effectiveness point of view, the percentage of therapeutic failure, judged with a score equal to or greater than 4 or 5 in Global Aesthetic Improvement Scale (GAIS) scale was 0%. Best score was obtained in subjects ranging in ages between 38 and 57 (2.02) and in women (2.02) years, while the less satisfactory one was obtained in males (2.14). The study has demonstrated that PMP and the proposed protocol are effective and safe to treat subject with skin signs of chrono and photo ageing, thanks to its capabilities of carrying out a mechanic action indicated as a coadjuvant in the treatment of the dermoepidermic revitalisation through chemical exfoliation and hydration.

Hyaluronic acid fillers in lip augmentation procedure: a clinical and histological study.

Several approaches have been proposed for soft tissue augmentation using injectable materials for lip and soft-tissue augmentation due to their physical and biological properties. Hyaluronic acid represents a natural component of the connective tissues, related to wound healing and skin regeneration. The aim of this research was to investigate the clinical and histological effectiveness of cross-linked hyaluronic acid for lip augmentation. A total of 8 patients were treated for lip augmentation with a clinical follow up of 60 days. After this period a histological evaluation was performed to evaluate the healing of the treated regions. The healing phase reported no inflammatory response, tissue contractions and no local flogistic evidence in the treated areas, where the filling volume appeared maintained. The 60 days histological evaluation showed evidence of filler resorption with few infiltrated inflammatory cells. The clinical and histological findings suggested that cross-linked hyaluronic acid represents a safe and effective tool for lip augmentation.

Reduction of double chin without surgery using ascorbic acid and ascorbyl-palmitate solution: a clinical study.

OBJECTIVE: The purpose of the present clinical study is to assess the effectiveness of a lipolytic solution containing sodium salt of ascorbic acid at 0.24% and a surfactant agent at 0.020% ascorbyl-palmitate (SAP) for the treatment of double chin. PATIENTS AND METHODS: A total of 10 healthy adult subjects affected by double chin (8 female and 2 male) were evaluated in the present investigation. The patients were admitted to a total of 4 sessions, with biweekly procedures, without no other active agents addiction. RESULTS: In all the subjects a reduction of the convexity of the chin after the treatment with SAP was observed. Improvement in submental appearance was achieved in 90% (9/10) of the patients. One patient did not see any improvement in submental appearance after two section treatments and withdrew from the treatment. CONCLUSIONS: In conclusion, in the present study, a new adipocytolytic solution consisting of sodium ascorbate mixed with ascorbyl-palmitate was used with success as a surfactant agent for the treatment of double chin.

Chronic lip edema and pain secondary to lip augmentation procedure: histological, scanning electron microscopy and X-ray microanalysis evaluation.

BACKGROUND: In parallel with the increase in requests for filler injections, reported complications (immediate or delayed and transient or permanent) increased too. CASE REPORT: In the presented case report, a patient reported a delayed complication of filler injection. The complaints of the patient and the objective evaluation revealed the presence of multiple lip nodules, that were painful both spontaneously and at the touch, after 10 years from a lip filler injection. The surgical excision of the neoformations permitted the complete healing of the lesions. The histological analysis showed a not specific pattern, showing a material encapsulated by a tissue reaction, confirming that the possible cause of the multiple injuries could be attributable to the injection received years earlier. CONCLUSIONS: The professional who intends to perform filler injections needs a complete training process, both from a theoretical and practical point of view. Also, the patients must be informed of the possible risks associated with each product.

Effect of air-drying on the solvent evaporation, degree of conversion and water sorption/solubility of dental adhesive models.

This study evaluated protocols to eliminate acetone from dental adhesives and their effect on the kinetic of water sorption and percent of conversion of these adhesives. Experimental methacrylate-based adhesives with increasing hydrophilicity (R2, R3, R5) were used as reference materials. Primer-like solutions were prepared by addition of 50 wt% acetone. Acetone elimination was measured gravimetrically before and after: a spontaneous evaporation, an application of air-drying at room temperature or application of 40°C air-drying. Protocols were performed from 15 to 60 s. Specimens of adhesive/acetone mixtures were photo-activated and tested for degree of conversion, water sorption and solubility. Data were analyzed by ANOVA and Bonferroni's tests (α = 0.05). Complete acetone elimination was never achieved, but it was significantly greater after the 40°C air-drying application. Higher acetone elimination was observed for the least hydrophilic adhesive. Longer periods for acetone evaporation and heated air-stream can optimize polymerization and reduce the water sorption/solubility of adhesive system models.

Polyacrylamide gel for facial wasting rehabilitation: how many milliliters per session?

BACKGROUND: Facial lipoatrophy is most distressing for HIV patients in pharmacologic treatment. Nonabsorbable fillers are widely used to restore facial features in these patients. We evaluated the safety and aesthetic outcomes of two samples of HIV+ patients affected by facial wasting who received different filling protocols of the nonabsorbable filler Aquamid® to restore facial wasting. METHODS: Thirty-one HIV+ patients affected by facial wasting received injections of the nonabsorbable filler Aquamid for facial wasting rehabilitation. Patients were randomly divided into two groups: A and B. In group A, the facial defect was corrected by injecting up to 8 ml of product in the first session; patients were retreated after every 8th week with touch-up procedures until full correction was observed. In group B, facial defects were corrected by injecting 2 ml of product per session; patients were retreated after every 8th week until full correction was observed. RESULTS: Patients of group A noted a great improvement after the first filling procedure. Patients in group B noted improvement of their face after four filling procedures on average. Local infection, foreign-body reaction, and migration of the product were not observed in either group during follow-up. CONCLUSION: The rehabilitation obtained with a megafilling session and further touch-up procedures and that with a gradual build-up of the localized soft-tissue loss seem not to have differences in terms of safety for the patients. However, with a megafilling session satisfaction is achieved earlier and it is possible to reduce hospital costs in terms of gauze, gloves, and other items.

LaBaNiO(4): a Fermi glass.

Polycrystalline samples of LaSr(1-x)Ba(x)NiO(4) show a crossover from a state with metallic transport properties for x = 0 to an insulating state as [Formula: see text]. The end member LaBaNiO(4) with a nominal nickel Ni 3d(7) configuration might therefore be regarded as a candidate for an antiferromagnetic insulator. However, we do not observe any magnetic ordering in LaBaNiO(4) down to 1.5 K, and despite its insulating transport properties several other physical properties of LaBaNiO(4) resemble those of metallic LaSrNiO(4). Based on an analysis of electrical and thermal-conductivity data as well as magnetic-susceptibility and low-temperature specific-heat measurements, we suggest that LaBaNiO(4) is a Fermi glass with a finite electron density of states at the Fermi level but these states are localized.

Chlorhexidine Inhibits the Proteolytic Activity of Root and Coronal Carious Dentin in vitro.

The purpose of this study was to evaluate the effect of chlorhexidine on the proteolytic activity of carious coronal and root dentin collected from patients. Sound dentin from freshly extracted human teeth was used as a control. Dentin fragments were mixed with a synthetic substrate for proteolytic enzymes (N-benzoyl-DL-arginine-naphthylamide--BANA) and the suspensions mixed with either 0.12% chlorhexidine digluconate or distilled water. These mixtures were incubated for 18 h at 37 degrees C, color was developed by the addition of 0.1% Fast Garnet and their optical density was recorded spectrophotometrically. BANA hydrolysis measured by the optical density of incubated specimens was detected in all tested groups, but was significantly higher for carious than for sound dentin (p < 0.05). The proteolytic activity was reduced for carious coronal and root dentin by chlorhexidine (p < 0.05; 50 and 30%, respectively). Chlorhexidine also reduced the proteolytic activity in sound root dentin (p < 0.05; 20%). Conversely, changes in the proteolytic activity of sound coronal dentin were not observed in the presence of chlorhexidine. The reduction in proteolytic activity by chlorhexidine was significantly higher in carious coronal dentin than in carious root dentin (p < 0.05). In conclusion, part of the effect of chlorhexidine in controlling caries progression in humans may be due to a decrease in the proteolytic activity of carious coronal and root dentin. Because of the prolonged incubation time in the present study, similar results may be obtained clinically with prolonged dentin exposure to chlorhexidine, e.g. chlorhexidine-containing varnishes.

Prospective 3-year surveillance for nosocomial and environmental Legionella pneumophila: implications for infection control.

OBJECTIVES: To perform a 3-year, prospective surveillance program for legionnaires disease (LD) in a large university hospital in Rome, and to assess the usefulness of the hospital water monitoring program in predicting the risk of nosocomial LD. METHODS: Samples from patients with new cases of nosocomial pneumonia were sent for legionella laboratory investigations. Meanwhile, water samples for bacteriological analysis were collected every 6 months from high- and medium-risk hospital wards (10 in total). Legionella pneumophila isolates collected were serotyped and analyzed by pulsed-field gel electrophoresis. RESULTS: From June 2001 through May 2004, the pneumonia surveillance identified one case of nosocomial LD among 43 cases of nosocomial pneumonia (2.3%). Environmental investigations detected L. pneumophila in 12 (18.7%) of the 64 water samples, of which 50% belonged to serogroup 1. The L. pneumophila count and the percentage of positive locations never exceeded 10(2) colony-forming units/L and 20%, respectively, except when the LD nosocomial case occurred (positive water samples, 40%; L. pneumophila count, <10(2) colony-forming units/L). Genotyping showed 3 prevalent clones of L. pneumophila in the water distribution network, of which one persisted over the 3 years. One clone contained 3 different L. pneumophila serogroups (2, 4, and 6). CONCLUSIONS: The low incidence of nosocomial cases of LD appears to be associated with a low percentage (<20%) of positive water samples per semester and with a low contamination level (<10(2) colony-forming units/L). An infection control system for nosocomial LD should, therefore, be based on both environmental and clinical surveillance, together with the appropriate maintenance of the hospital water distribution system.

A novel chromosomal abnormality detected in a case of acute myelomonocytic leukemia.

A not yet recorded translocation, t(3:17)(q21;q23), detected in a case of acute myelomonocytic leukemia, is reported. In spite of an aggressive cytotoxic chemotherapy, the disease showed a rapid fatal course, confirming the dismal prognostic significance of structural, 'primary' chromosomal abnormalities in acute leukemias.

Cloning and expression in Saccharomyces cerevisiae of the NAD(P)H-dependent xylose reductase-encoding gene (XYL1) from the xylose-assimilating yeast Pichia stipitis.

The XYL1 gene of the yeast Pichia stipitis has been isolated from a genomic library using a specific cDNA probe, and its nucleotide (nt) sequence has been determined. In the 5' noncoding region of the P. stipitis XYL1 gene a TATAAA element (known to be necessary for transcription initiation in most yeast genes) is found at nt -81, and two CCAAT recognition motifs (often referred to as the CCAAT box) are present at nt -146 and -106. The XYL1 encodes a polypeptide of 35,927 Da that constitutes a NADH/NADPH-dependent xylose reductase (XR). The enzyme is part of the xylose-xylulose pathway that is absent or only weakly expressed in Saccharomyces cerevisiae. Extensive homology is found to the N terminus of the XR of Pachysolen tannophilus and Candida shehatae. None of the known cofactor binding domains found in many NAD-dependent dehydrogenases are present in the protein. Transformants of S. cerevisiae containing XYL1 of P. stipitis synthesize an active XR. Fusion of XYL1 with the prokaryotic tac promoter leads to a gene that can be expressed in S. cerevisiae and Escherichia coli.

Expression of cathepsin D in malignant and in the corresponding non-malignant node-negative laryngeal samples: correlation with receptors for androgen, glucocorticoid, oestrogen and progesterone.

A standard immunoradiometric technique was used to investigate the distribution of the intracellular aspartic proteinase cathepsin D in 33 malignant and in the corresponding histologically-proven non-malignant fragments obtained from lymph node negative patients suffering from larynx cancer. In both tissues the androgen, glucocorticoid, oestrogen and progesterone receptors were also assayed. Our data indicate that cathepsin D was present in both tissues, with level significantly higher (P < 0.0001) in the cancerous fragments (with a mean of 33 +/- 3.4 pmol/mg protein) than in the corresponding non-cancerous specimen (with a mean of 20.8 +/- 2 pmol/mg protein). A significant positive association (P < 0.001) between cathepsin D and PR concentration values in the cancerous larynx was observed; accordingly, tumours expressing PR had significantly (P = 0.0005) higher cathepsin D levels than the tumours which did not contain the receptor. In contrast, such a relationship was absent in the non-malignant specimens. As regards the other steroid receptors, no significant relationship between them and cathepsin D was observed. We conclude that cathepsin D may have a role also in laryngeal carcinoma and that its association with the PR could indicate a possible role of the receptor in the biology of this disease.

Primary Ewing's sarcoma of the maxilla, a rare and curable localization: report of two new cases, successfully treated by radiotherapy and systemic chemotherapy.

Primary maxillary localization of Ewing's sarcoma is unusual. Involvement of facial bones is characterized by clinical and radiological features distinct from those commonly observed in other sites. Because of the above peculiarities a delay in diagnosis and thus in starting treatment is very probable in such cases. We report here two new cases of Ewing's sarcoma localized to facial bones, successfully treated by local high dosage radiotherapy and systemic chemotherapy. Our experience suggests that, especially for particular sites not suitable to radical surgery, radiation therapy can represent an effective tool to achieve local control of the tumor.

Radiation late effects in children treated for orbital rhabdomyosarcoma.

BACKGROUND AND PURPOSE: The experience resulting from large cooperative studies shows that correct radiation therapy at doses adequate to the tumor bulk are crucial for local control of rhabdomyosarcoma. The aim of the present study was to document the correlation between modalities and doses of radiotherapy and radiation side effects. PATIENTS AND METHODS: Between 1980 and 1997, 19 patients affected by primary orbital rhabdomyosarcoma have been followed at the University Federico II of Naples. All but three patients, who received 45, 54 and 55 Gy respectively, have been treated by immediate radiation at the dose of 60 Gy, delivered in 2 Gy fractions, five times per week, by cobalt 60 megavoltage equipment. Combined chemotherapy using vincristine and vincristine plus dactinomycin on alternate weeks was also administered as part of induction therapy. RESULTS: An overall survival rate of 94.7% was registered. In our patients the majority of radiation late effects were paid by orbit and ocular adnexa. Side effects to lens and ocular structures were fewer and of low grade. CONCLUSIONS: Radiation therapy is still essential for local control of orbital rhabdomyosarcoma, however radiation side effects have to be carefully considered together with the therapeutic goal to be obtained.

Hemodynamic assessment of vascular malformations by angio CT with generation of functional transit time images.

We performed a CT dynamic study during the first pass of an intravenously injected bolus of a iodinated contrast medium, followed by generation of the regional arm-brain circulation time (rABCT) image, in 11 patients with vascular malformations. All lesions could be detected as changes of rABCT, and the comparison with values of normal arteries and veins allowed the deduction of the hemodynamic conditions of the lesions. Seven cases showed evidence of altered distribution of rABCT in the corresponding brain hemisphere, suggesting a perfusion reserve impairment.

Intravenous 99mTc HM-PAO radionuclide angiography as an adjunct to SPECT assessment of cerebral disease.

An application of intravenous radionuclide angiography as an adjunct to SPECT with 99mTc HM-PAO is presented. From the angiographic sequence a two-dimensional parametric image is generated computing, pixel by pixel, the center of gravity (COG) of the local time curves. This index is independent of blood flow and reflects the relation between transmitted and extravasated activity. COG value, compared in two symmetrical regions analyzed for differences in flow by SPECT, may help to state whether a detected SPECT changed uptake is linearly related or not to the corresponding change of blood flow. All 23 ischemic patients taken into consideration had a similar backflux in symmetrical regions with conspicuous changed uptake. In 3 meningiomas and 2 arteriovenous angiomas it was possible to detect the occurrence of a changed backflux in the lesion suggesting a nonlinearity between blood flow and 99mTc HM-PAO uptake.