No Tradeoff between Coherence and Sub-Poissonianity for Heisenberg-Limited Lasers.

The Heisenberg limit to laser coherence C-the number of photons in the maximally populated mode of the laser beam-is the fourth power of the number of excitations inside the laser. We generalize the previous proof of this upper bound scaling by dropping the requirement that the beam photon statistics be Poissonian (i.e., Mandel's Q=0). We then show that the relation between C and sub-Poissonianity (Q<0) is win-win, not a tradeoff. For both regular (non-Markovian) pumping with semiunitary gain (which allows Q→-1), and random (Markovian) pumping with optimized gain, C is maximized when Q is minimized.

Interleukin 1 of the central nervous system is produced by ameboid microglia.

By screening specific populations of rat brain cells, we found that ameboid microglia secrete an 18 kD peptide with IL-1 biological activity. The IL-1 activity released by microglia was found to be identical to rat macrophage IL-1 on fractionation by gel filtration and high pressure liquid anion-exchange chromatography, and it was neutralized by an antiserum specific for murine IL-1. When added to astroglia grown in culture, microglial IL-1 increased the cell number of five- to sevenfold, and increased astroglial incorporation of [3H]thymidine by three- to fivefold. We propose that the proliferation of astroglia in specific brain regions may be regulated by the signaled release of IL-1 from activated microglial cells.

Peptides released by ameboid microglia regulate astroglial proliferation.

Peptides that stimulate astroglial proliferation are produced in traumatized adult rat brain by 10 d after injury. These same peptides are released by ameboid microglia activated in vitro. Our findings suggest that astroglial scarring is regulated in part by the release of factors from ameboid microglia near the site of brain injury.

Brain peptides and glial growth. I. Glia-promoting factors as regulators of gliogenesis in the developing and injured central nervous system.

Glia-promoting factors (GPFs) are peptides of the central nervous system which accelerate the growth of specific glial populations in vitro. Although these factors were first discovered in the goldfish visual system (Giulian, D., Y. Tomozawa, H. Hindman, and R. Allen, 1985, Proc. Natl. Acad. Sci. USA., 83:4287-4290), we now report similar peptides are found in mammalian brain. The cerebral cortex of rat contains oligodendroglia-stimulating peptides, GPF1 (15 kD) and GPF3 (6 kD), as well as astroglia-stimulating peptides, GPF2 (9 kD) and GPF4 (3 kD). The concentrations of specific GPFs increase in brain during periods of gliogenesis. For example, GPF1 and GPF3 are found in postnatal rat brain during a peak of oligondendroglial growth while GPF2 and GPF4 are first detected at a time of astroglial proliferation in the embryo. Stab wound injury to the cerebral cortices of rats stimulates astroglial proliferation and induces marked elevations in levels of GPF2 and GPF4. Our findings suggest that two distinct classes of GPFs, those acting upon oligodendroglia and those acting upon astroglia, help to regulate cell growth in the developing and injured central nervous system.

Production, characterisation and use of monoclonal antibodies to human interleukin-5 in an enzyme-linked immunosorbent assay.

Two mouse monoclonal antibodies (Mabs) against recombinant human interleukin-5(rhIL-5) have been produced, characterised and purified. Both are IgG1 antibodies and neutralised the activity of rhIL-5 in the B13 assay. Neither Mab cross-reacted with mouse IL-5. A two-site sandwich enzyme-linked immunosorbent assay (ELISA) was developed with different combinations of the mouse Mabs and also a rat anti-mouse IL-5 Mab, TRFK5, which also has activity against rhIL-5. The most sensitive assay, with a lower detection limit of 0.5 ng/ml IL-5, used TRFK5 as the capture antibody and the mouse anti-human IL-5 Mab as second antibody. The sensitivity of this assay was increased by an enhanced chemiluminescent reagent and resulted in a lower limit of detection around 40 pg/ml IL-5.

Total synthesis of Monatin.

The naturally occurring sweetener Monatin, a diastereomer of Monatin, and a phenyl analogue of Monatin have been prepared and isolated in their enantiomerically pure forms.

Chemical peel.

Chemical face peeling as described in this article produces gross and microscopic changes in the skin which are permanent. The most important aspect in assuring the success of this procedure is the proper selection of patients. The primary use of this procedure is for the purpose of eliminating wrinkles, whether as the primary or ancillary procedure, such as regional peeling. Chemical peeling of the face is a valuable adjunct in the treatment of the aging face and can produce some rather dramatic results with the careful selection of patients and meticulous attention to detail in carrying out the peel, as well as the exact adherence to the post peel instructions by the patient.

Treatment of photoaging. Facial chemical peeling (phenol and trichloroacetic acid) and dermabrasion.

A complete armamentarium using phenol, trichloroacetic acid, and dermabrasion allows the physician to successfully treat a variety of difficult photoaged skin problems in a consistent fashion. These three techniques have their specific indications, and patient selection is the key to a successful outcome. Proper attention to technical detail will allow the physician to fine-tune technique to meet the individual's needs. It is important to realize that phenol, trichloroacetic acid, and dermabrasion are not exclusive of each other, but are additive in their value. As one becomes well versed in these differing treatment modalities, one can tailor these techniques to obtain consistent results according to the needs and desires of the patient.

Extended SMAS dissection as an approach to midface rejuvenation.

The objective in rhytidectomy is to rejuvenate and improve facial appearance. To obtain consistent results, facelifting should be approached not just as a tightening or lifting procedure but also as a reconstructive procedure, reversing the anatomic changes that occur in aging. The ability to bring aesthetic harmony back into the aging face requires the blending of surgical technique, anatomic knowledge, and artistic sensitivity to individualize the surgical approach for a given patient. To obtain surgical rejuvenation while minimizing signs of surgical distortion remains the ultimate goal of our facelifting procedures.

What's new in aesthetic surgery.

This article describes new trends, techniques, and instrumentation in aesthetic surgery. Advances in our understanding of anatomy and the changes that come about with intrinsic and extrinsic factors are discussed. Specifically, anatomic approaches to rhytidectomy, the preservation of lid shape in blepharoplasty, and CO2 facial resurfacing are highlighted. Body contouring surgical techniques, including minimal scar breast reductions, endoscopic-assisted augmentation mammoplasty, and superficial liposuction, are reviewed.

Preapplication of mitomycin C for enhanced patency of myringotomy.

OBJECTIVES: Ventilation tubes are the mainstay of surgical treatment for eustachian tube dysfunction and have been used successfully for many years. Certain disadvantages of ventilation tubes, however, have prompted research into alternative techniques including laser myringotomy. We investigated the use of KTP laser myringotomy in conjunction with topical mitomycin C to delay healing and prolong the patency of the myringotomy. METHODS: Twenty myringotomies were created in 10 Sprague-Dawley rats. A solution of mitomycin C was applied to the intact tympanic membrane for 15 minutes. The solution was then suctioned free, and a myringotomy was created with a KTP laser. Fifty-three rats with saline application serving as controls from a previous study were used to allow statistical assessment. RESULTS: The myringotomies remained open for a median of 9.5 weeks. Control myringotomies, which received saline solution instead of mitomycin C, healed within a median of 1.5 weeks. The difference was statistically significant at P < 0.0001. No complications were noted. CONCLUSION: Topically administered mitomycin C before laser myringotomy is effective in prolonging the patency of laser myringotomies in rats. The patency rate is similar to that achieved in experiments in which topical mitomycin C is placed into the myringotomy site created by the laser.

Midazolam (Versed) in ambulatory surgery.

Midazolam is a very useful drug in outpatient aesthetic surgery. Its principal advantages are (1) short duration of action (a half-life of 2.3 hours), (2) painless injection, (3) no incidence of postoperative phlebitis (as compared with diazepam), and (4) a high degree of safety and effectiveness. Since one of the main objectives in outpatient surgery is to have the patient recover as quickly as possible and be discharged without any significant drug hangover, we recommend the incorporation of midazolam into the armamentarium of the aesthetic surgeon. Subsequent to the presentation of this paper (Twentieth Annual Meeting of the American Society for Aesthetic Plastic Surgery, in Los Angeles, California, March 23, 1987), we have administered midazolam to an additional 400 patients undergoing outpatient surgery and no apnea has occurred requiring an airway or supportive respiratory measures.

Upper lid blepharoplasty.

We reviewed, retrospectively, our upper lid blepharoplasties to critically compare our own postoperative results after (1) conventional blepharoplasty, or (2) fixation of the levator aponeurosis to the lower margin of the orbicularis, or (3) fixation of the levator to the lower margins of the orbicularis and the skin. We found no demonstrable difference in our results with these 3 techniques. It is our opinion that the standard conventional blepharoplasty (including excision of a strip of orbicularis muscle) is preferable for use in most caucasian eyelids. The results are as good, it is simple, and it is less likely to cause problems.

Rhytidectomy: a statistical analysis.

A statistical analysis of 1,500 consecutive rhytidectomies is presented. In rhytidectomy, complications occur in a significant percentage of the operations. The plastic surgeon must be aware of the incidence and significance of these complications, and also he must know how to avoid or manage them.

Nonsurgical breast enlargement using an external soft-tissue expansion system.

Less than 1 percent of the women interested in having larger breasts elect to have surgical augmentation mammaplasty with insertion of breast implants. The purpose of this report is to describe and test the efficacy of a nonsurgical method for breast enlargement that is based on the ability of tissues to grow when subjected to controlled distractive mechanical forces. Seventeen healthy women (aged 18 to 40 years) who were motivated to achieve breast enlargement were enrolled in a single-group study. The participants were asked to wear a brassiere-like system that applies a 20-mmHg vacuum distraction force to each breast for 10 to 12 hours/day over a 10-week period. Breast size was measured by three separate methods at regular intervals during and after treatment. Breast tissue water density and architecture were visualized before and after treatment by magnetic resonance imaging scans obtained in the same phase of the menstrual cycle. Twelve subjects completed the study; five withdrawals occurred due to protocol noncompliance. Breast size increased in all women over the 10-week treatment course and peaked at week 10 (final treatment); the average increase per woman was 98 +/- 67 percent over starting size. Partial recoil was seen in the first week after terminating treatment, with no significant further size reduction after up to 30 weeks of follow-up. The stable long-term increase in breast size was 55 percent (range, 15 to 115 percent). Magnetic resonance images showed no edema and confirmed the proportionate enlargement of both adipose and fibroglandular tissue components. A statistically significant decrease in body weight occurred during the course of the study, and scores on the self-esteem questionnaire improved significantly. All participants were very pleased with the outcome and reported that the device was comfortable to wear. No adverse events were recorded during the use of the device or after treatment. We conclude that true breast enlargement can be achieved with the daily use of an appropriately designed external expansion system. This nonsurgical and noninvasive alternative for breast enlargement is effective and well tolerated.

Long-term histologic follow-up of phenol face peels.

Deep phenol peels were done on 11 middle-aged white women with severe actinic damage. Subsequently, face lifts were carried out after periods of 1.5 to 20 years. This made it possible to obtain a full-thickness specimen extending several centimeters on either side of the border between peeled and unpeeled skin. In contrast to the markedly abnormal elastotic appearance of unpeeled skin, a new band of connective tissue 2 to 3 mm in width was laid down in the subepidermal region. Fine elastic fibers formed a dense network in the band of regenerated collagen. The disarray and cytologic abnormalities of sun-damaged epidermis were also largely corrected. Melanocytes were not eliminated, but melanin synthesis was evidently impaired, accounting for the bleaching effects. The effects of a phenol peel are very long lasting and adequately account for the effacement of wrinkles and obliteration of actinic keratoses, mottling, and freckling.

Refinements in face lifting: enhanced facial contour using vicryl mesh incorporated into SMAS fixation.

As we have gained experience with the extended superficial musculoaponeurotic system (SMAS) technique in face lifting, refinements in our procedure have led to increased consistency in results. The important factors that have led to our technical modifications include the following: (1) the significance of the retaining ligaments of the midface, which determine the degree of surgical dissection required for both skin and SMAS in rhytidectomy; (2) the changes in facial shape that occur with aging, secondary to the descent of facial fat; (3) the possibility of modifying facial shape through the repositioning of facial fat in an extended SMAS face lift; (4) the improved longevity of result to be obtained by incorporating Vicryl mesh into SMAS fixation; (5) the artistic nuances of incision design that help to minimize scar perceptibility. Understanding these factors enables surgeons to use the extended SMAS technique successfully with more challenging cases, enhancing facial appearance while minimizing signs that the patient has undergone a surgical procedure.

The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging.

Controversy persists regarding the relationship of the superficial facial fascia (SMAS) to the mimetic muscles, deep facial fascia, and underlying facial nerve branches. Using fresh cadaver dissection, and supplemented by several hundred intraoperative dissections, we studied facial soft-tissue anatomy. The facial soft-tissue architecture can be described as being arranged in a series of concentric layers: skin, subcutaneous fat, superficial fascia, mimetic muscle, deep facial fascia (parotidomasseteric fascia), and the plane containing the facial nerve, parotid duct, and buccal fat pad. The anatomic relationships existing within the facial soft-tissue layers are (1) the superficial facial fascia invests the superficially situated mimetic muscles (platysma, orbicularis oculi, and zygomaticus major and minor); (2) the deep facial fascia represents a continuation of the deep cervical fascia cephalad into the face, the importance of which lies in the fact that the facial nerve branches within the cheek lie deep to this deep fascial layer; and (3) two types of relationships exist between the superficial and deep facial fascias: In some regions of the face, these fascial planes are separated by an areolar plane, and in other regions of the face, the superficial and deep fascia are intimately adherent to one another through a series of dense fibrous attachments. The layers of the facial soft tissue are supported in normal anatomic position by a series of retaining ligaments that run from deep, fixed facial structures to the overlying dermis. Two types of retaining ligaments are noted as defined by their origin, either from bone or from other fixed structures within the face.(ABSTRACT TRUNCATED AT 250 WORDS)

Histologic effects of the high-energy pulsed CO2 laser on photoaged facial skin.

To delineate the histologic effects of laser resurfacing at photoaged skin, a protocol was designed to biopsy laser test sites in conjunction with adjacent actinically damaged skin at the time of rhytidectomy. Five patients with photodamaged skin underwent resurfacing of the preauricular region to examine the effect of increasing pulse energy and increasing number of passes on depth of dermal penetration. Histologic examination of these specimens showed that the depth of laser injury was dose-dependent. Increasing pulse energy created a deeper wound, and increasing the number of passes similarly produced a larger band of necrosis. Ten patients with photodamaged skin underwent resurfacing of the preauricular region 15 days to 6 months prior to undergoing a rhytidectomy. A comparison of the laser-resurfaced test spot with the adjacent untreated photodamaged skin demonstrated consistent histologic changes to both epidermis and dermis in all specimens examined. Following laser resurfacing, epidermal atrophy and atypia were eliminated, and all specimens exhibited a regeneration of epithelium that was normal in its morphology. Melanocytic hypertrophy and hyperplasia were corrected following treatment, although density and function of epidermal melanocytes appeared normal. All specimens exhibited a substantial amount of neocollagen formation involving both the superficial and middermis following resurfacing. In association with new collagen development within the dermis, there was noted to be a similar degree of proliferation of elastic fibers, as well as a diminution of glycosaminoglycans, which are typically present in actinically damaged elastotic dermis. To determine the effect of laser resurfacing on-black skin, laser test spots were placed in the postauricular region of three black patients. Biopsy of these test sites showed that the histologic effects of laser resurfacing were similar to those observed in Caucasian patients, with complete repopulation of epidermal melanocytes in specimens biopsied 3 months following resurfacing. The histologic effects of laser resurfacing are microscopically similar to those of phenol peeling in terms of the amelioration of photodamage. The distinction between these two treatment methods lies in their apparent effect on epidermal melanocytes, which appear to function normally following laser resurfacing.

The anatomy and clinical applications of the buccal fat pad.

The buccal fat pad is an anatomically complex structure that has great importance in facial contour. In properly selected individuals, judicious harvesting of buccal fat can produce dramatic changes in facial appearance by reducing the fullness of the cheek and highlighting the malar eminences. Using fresh cadaver dissection, the anatomy of the buccal fat pad is delineated and its relationship to the masticatory space, facial nerve, and parotid duct is defined. An intraoral approach for buccal fat harvesting is described based on these anatomic findings. Clinical experience manipulating the buccal fat pad for aesthetic modification of facial contour is illustrated.