The Role of microRNA in the Regulation of Cortisol Metabolism in the Adipose Tissue in the Course of Obesity.

The similarity of the clinical picture of metabolic syndrome and hypercortisolemia supports the hypothesis that obesity may be associated with impaired expression of genes related to cortisol action and metabolism in adipose tissue. The expression of genes encoding the glucocorticoid receptor alpha (GR), cortisol metabolizing enzymes (HSD11B1, HSD11B2, H6PDH), and adipokines, as well as selected microRNAs, was measured by real-time PCR in adipose tissue from 75 patients with obesity, 19 patients following metabolic surgery, and 25 normal-weight subjects. Cortisol levels were analyzed by LC-MS/MS in 30 pairs of tissues. The mRNA levels of all genes studied were significantly (p < 0.05) decreased in the visceral adipose tissue (VAT) of patients with obesity and normalized by weight loss. In the subcutaneous adipose tissue (SAT), GR and HSD11B2 were affected by this phenomenon. Negative correlations were observed between the mRNA levels of the investigated genes and selected miRNAs (hsa-miR-142-3p, hsa-miR-561, and hsa-miR-579). However, the observed changes did not translate into differences in tissue cortisol concentrations, although levels of this hormone in the SAT of patients with obesity correlated negatively with mRNA levels for adiponectin. In conclusion, although the expression of genes related to cortisol action and metabolism in adipose tissue is altered in obesity and miRNAs may be involved in this process, these changes do not affect tissue cortisol concentrations.

The elastography of distal ulnar nerve branches in cyclists.

INTRODUCTION: Forced elbow flexion and pressure during bicycling result in ulnar nerve traction and pressure exerted in Guyon's canal or the nerve's distal branches. The compression of the nerves causes a change in their stiffness related to edema and eventually gradual fibrosis. PURPOSE: This study aimed to evaluate the elastography of terminal branches of the ulnar nerve in cyclists. STUDY DESIGN: Cross-sectional study. METHODS: Thirty cyclists, 32 healthy individuals, and 32 volunteers with ulnar nerve entrapment neuropathies participated in the study. Each participant underwent a nerve examination of the cubital tunnel, Guyon's canal and the deep and superficial branches of the ulnar nerve using shear wave elastography. The cyclist group was tested before and after a 2-hour-long workout. RESULTS: Before cycling workouts, the ulnar nerve stiffness in the cubital tunnel and Guyon's canal remained below pathological estimates. Cycling workouts altered nerve stiffness in the cubital tunnel only. Notably, the stiffness of the ulnar terminal branches in cyclists was increased even before training. The mean deep branch stiffness was 50.85 ± 7.60 kPa versus 20.43 ± 5.95 kPa (p < 0.001) in the cyclist and healthy groups, respectively, and the mean superficial branch stiffness was 44 ± 12.45 kPa versus 24.55 ± 8.05 kPa (p < 0.001), respectively. Cycling contributed to a further shift in all observed values. DISCUSSION: These observations indicate the existence of persistent anatomical changes in the distal ulnar branches in resting cyclists that result in increased stiffness of these nerves. The severity of these changes remains, however, to be determined. CONCLUSIONS: These data show elastography values of the ulnar terminal branches in healthy individuals and cyclists where despite lack of clinical symptoms that they seem to be elevated twice above the healthy range.

Elastography of nerves in the wrists of cyclists.

Purpose: This study aimed to investigate changes in the elasticity of the median and ulnar nerves in cyclists. Material and methods: The study included 30 cyclists and 2 non-biking reference groups that included 32 healthy volunteers and 32 individuals with ulnar nerve entrapment neuropathies. All participants underwent physical, ultrasonographic, and elastographic examinations including assessment of nerve cross-sectional area (CSA) and stiffness (SWE). The cyclists' group was tested before and after a 2-hour workout. Results: The values of ulnar nerve CSA and stiffness in Guyon's canal in resting cyclists were 5.30 ± 1.51 mm2 and 49.05 ± 11.18 kPa, respectively. These values were significantly higher than in the healthy volunteers, but not higher than in the nerve entrapment group. Median nerve CSA and stiffness at rest were 9.10 ± 2.61 mm2 and 38.54 ± 14.87 kPa, respectively. Both values were higher than respective values in the healthy group. Cycling induced an increase in all these parameters, although the increase in nerve stiffness was more noticeable than in CSA. Conclusions: The elasticity of the median and ulnar nerve in cyclists remains within normal limits, questioning the belief that cyclists are at risk of nerve palsy in Guyon's canal. However, cycling workout does exert compression, resulting in transient oedema of both nerves. The dynamics of changes was more noticeable in SWE examination than in conventional ultrasound, which may depend on SWE sensitivity.

Treatment of Complications After Minimally Invasive Breast Augmentation with Aquafilling Gel.

INTRODUCTION: Recent studies have revealed that Aquafilling gel used for breast augmentation causes complications. In this study, we investigated which surgical approach should be used to treat these complications. MATERIALS AND METHODS: This observational cohort study analysed the data of 31 women suffering from complications after breast enlargement with Aquafilling injection who were treated at our department in 2016-2021. Patients underwent either conservative or radical surgery. GraphPad Prism 9 (GraphPad Software, La Jolla, CA, USA) was used for data processing. RESULTS: Approximately 88.89% of patients after conservative surgery required reoperation, while only 22.73% of patients treated radically needed revision surgery. Every patient who underwent an attempt to remove the gel via needle prior to admission required surgery. Seventy-five per cent of them had positive culture swabs, whereas only 26.09% of patients who did not undergo needle aspiration had positive cultures. A positive correlation between the volume of injected filler and the number of symptoms was observed. CONCLUSIONS: In addition to irrigation and drainage, Aquafilling removal should include infiltrated tissue excision during primary surgery. Moreover, needle aspiration of the filler is ineffective, and it may lead to a gel infection. Furthermore, the more filler is injected, the higher the number of complications observed. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

AGER-1 Long Non-Coding RNA Levels Correlate with the Expression of the Advanced Glycosylation End-Product Receptor, a Regulator of the Inflammatory Response in Visceral Adipose Tissue of Women with Obesity and Type 2 Diabetes Mellitus.

The advanced glycosylation end-product receptor (AGER) is involved in the development of metabolic inflammation and related complications in type 2 diabetes mellitus (T2DM). Tissue expression of the AGER gene (AGER) is regulated by epigenetic mediators, including a long non-coding RNA AGER-1 (lncAGER-1). This study aimed to investigate whether human obesity and T2DM are associated with an altered expression of AGER and lncAGER-1 in adipose tissue and, if so, whether these changes affect the local inflammatory milieu. The expression of genes encoding AGER, selected adipokines, and lncAGER-1 was assessed using real-time PCR in visceral (VAT) and subcutaneous (SAT) adipose tissue. VAT and SAT samples were obtained from 62 obese (BMI > 40 kg/m2; N = 24 diabetic) and 20 normal weight (BMI = 20-24.9 kg/m2) women, while a further 15 SAT samples were obtained from patients who were 18 to 24 months post-bariatric surgery. Tissue concentrations of adipokines were measured at the protein level using an ELISA-based method. Obesity was associated with increased AGER mRNA levels in SAT compared to normal weight status (p = 0.04) and surgical weight loss led to their significant decrease compared to pre-surgery levels (p = 0.01). Stratification by diabetic status revealed that AGER mRNA levels in VAT were higher in diabetic compared to non-diabetic women (p = 0.018). Elevated AGER mRNA levels in VAT of obese diabetic patients correlated with lncAGER-1 (p = 0.04, rs = 0.487) and with interleukin 1ß (p = 0.008, rs = 0.525) and resistin (p = 0.004, rs = 0.6) mRNA concentrations. In conclusion, obesity in women is associated with increased expression of AGER in SAT, while T2DM is associated with increased AGER mRNA levels and pro-inflammatory adipokines in VAT.

Distal Hand Migration of Polyacrylamide Gel after Breast Augmentation: A Case Report and Review of the Literature.

Breast augmentation is one of the most popular cosmetic surgery procedures in the world and it requires a comprehensive study of the methods performed. As less-invasive techniques are sought, tissue fillers have found its purpose in these procedures. However, it has been revealed that some of them may be associated with serious complications. One of them is the Aquafilling/Los Deline gel. A case report of a female patient who developed unprecedented sequelae after Aquafilling injection-distant migration of the gel in the hand-was presented in this study. The patient underwent total gel removal from the left forearm, arm, and both breasts as well as wound debridement and irrigation. We discovered a canal connecting the left breast to the left forearm, created by a polyacrylamide hydrogel dislocation. It was thoroughly revised using an endoscope. Despite the advantages of tissue fillers such as simplicity of use and less invasiveness, certain complications can occur after injection. Although a few of them have been banned due to these sequelae, new ones continue to appear. Every new product should be examined very carefully before it is introduced to the market.

Efficiency assessment of irrigation as an alternative method for improving the regenerative potential of non-healing wounds.

The application of mesenchymal stem/stromal cells (MSC) in regenerative medicine offers hope for the effective treatment of incurable or difficult-to-heal diseases. However, it requires the development of unified protocols for both safe and efficient cell acquisition and clinical usage. The therapeutic effect of fat grafts (containing stem cells) in non-healing wounds has been discussed in previous studies, although the application requires local or general anaesthesia. The treatment of MSC derived from adipose tissue (ASC) could be a less invasive method, and efficient delivery could lead to more favourable outcomes, which should encourage clinicians to use such therapeutic approaches more frequently. Therefore, the aim of this study was to optimise the methods of ASC isolation, culture and administration while maintaining their high survival, proliferation and colonisation potential. The ASC were isolated by an enzymatic method and were characterised according to International Society for Cellular Therapy and International Federation for Adipose Therapeutics and Science guidelines. To assess the opportunity to obtain a sufficient number of cells for transplantation, long-term cell cultures in two oxygen concentrations (5% vs. 21%) were conducted. For these cultures, the population doubling time, the cumulative time for cell population doublings and the rate of cell senescence were estimated. In a developed and pre-defined protocol, ASC can be efficiently cultured at physiological oxygen concentrations (5%), which leads to faster proliferation and slower cell senescence. Subsequently, to select the optimal and minimally invasive methods of ASC transplantation, direct cell application with an irrigator or with skin dressings was analysed. Our results confirmed that both the presented methods of cell application allow for the safe delivery of isolated ASC into wounds without losing their vitality. Cells propagated in the described conditions and applied in non-invasive cell application (with an irrigation system and dressings) to treat chronic wounds can be a potential alternative or supplement to more invasive clinical approaches.

Epigenetic Regulation of Estrogen Receptor Genes' Expressions in Adipose Tissue in the Course of Obesity.

Estrogen affects adipose tissue function. Therefore, this study aimed at assessing changes in the transcriptional activity of estrogen receptor (ER) α and ß genes (ESR1 and ESR2, respectively) in the adipose tissues of obese individuals before and after weight loss and verifying whether epigenetic mechanisms were involved in this phenomenon. ESR1 and ESR2 mRNA and miRNA levels were evaluated using real-time PCR in visceral (VAT) and subcutaneous adipose tissue (SAT) of 78 obese (BMI > 40 kg/m2) and 31 normal-weight (BMI = 20−24.9 kg/m2) individuals and in 19 SAT samples from post-bariatric patients. ESR1 and ESR2 methylation status was studied using the methylation-sensitive digestion/real-time PCR method. Obesity was associated with a decrease in mRNA levels of both ERs in SAT (p < 0.0001) and ESR2 in VAT (p = 0.0001), while weight loss increased ESR transcription (p < 0.0001). Methylation levels of ESR1 and ESR2 promoters were unaffected. However, ESR1 mRNA in the AT of obese subjects correlated negatively with the expression of hsa-miR-18a-5p (rs = −0.444), hsa-miR-18b-5p (rs = −0.329), hsa-miR-22-3p (rs = −0.413), hsa-miR-100-5p (rs = −0.371), and hsa-miR-143-5p (rs = −0.289), while the expression of ESR2 in VAT correlated negatively with hsa-miR-576-5p (rs = −0.353) and in SAT with hsa-miR-495-3p (rs = −0.308). In conclusion, obesity-associated downregulation of ER mRNA levels in adipose tissue may result from miRNA interference.

The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study.

BACKGROUND: Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability. METHODS: The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis. RESULTS: Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up. CONCLUSIONS: Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . TRIAL REGISTRY NAME: The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction. REGISTRATION IDENTIFICATION NUMBER: NCT03197103. URL FOR THE REGISTRY: https://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6.

Autoimmune syndrome induced by adjuvants after breast enhancement with polyacrylamide hydrogel: a study in Poland.

Autoimmune syndrome induced by adjuvants (ASIA) is the spectrum of diseases in which the substances considered inert to the body induce autoimmune reactions and inflammation. Some of the biomaterials recently used in plastic surgery, such as silicone or polyacrylamide hydrogel (PAAG) seem to trigger clinical features of ASIA. The aim of this study was to assess the incidence of these features within a group of women after breast augmentation with PAAG. As many as 30 consecutive patients (26-59 years, mean age 39.5) referred to the Clinic of Plastic Surgery after breast enhancement with PAAG were examined. The validated criteria of ASIA syndrome were employed. Descriptive statistics were chosen based on the distribution of variables. The research was approved by the Bioethical Committee of the Centre of Postgraduate Medical Education in Warsaw, Poland. Within the studied group, 50% of patients (n = 15) fulfilled ASIA diagnostic criteria. Apart from local complications, we encountered various general symptoms, among which fever (n = 13, 43.3%), tingling and numbness of upper extremities (n = 10, 33.3%) and chronic fatigue (n = 9, 30%) were the most common. These symptoms were present on an ambulatory visit, before qualification to the operation of hydrogel removal. All patients undergoing surgical PAAG removal (n = 8) declared alleviation or complete resolution of the symptoms. Polyacrylamide hydrogel breast filling, although limiting the invasiveness of the procedure in relation to silicone breast implants, also carries the risk of developing ASIA symptoms. The removal of PAAG may bring improvement in some cases.

The Impact of N-Acetylcysteine on Autologous Fat Graft: First-in-Human Pilot Study.

BACKGROUND: Our goal was to determine whether N-acetylcysteine (NAC) administered to the tumescent solution can reduce oxidative stress and increase autologous fat graft (AFG) viability. METHODS: The study included 15 women with a mean age of 31.8 years (range 23-39 years) who underwent breast asymmetry correction with AFG harvested from both thighs. One thigh was infiltrated with a standard tumescent fluid (control graft) and other with a NAC-enriched tumescent fluid (NAC-treated graft). Each participant had breast MRI imaging before and 6 months after the procedure. Also, adipose tissue samples from each graft were subjected to biochemical analysis, flow cytometric assay and qRT-PCR to determine the markers of oxidative stress, angiogenesis and adipogenesis. RESULTS: Concentration and activity of superoxide dismutase in the NAC-treated grafts turned out to be significantly higher than in the control grafts, in both fresh (p = 0.041 and p = 0.023, respectively) and frozen samples (p = 0.004 and p = 0.003, respectively). The level of nitric oxide in frozen samples from the control grafts was significantly higher than in the NAC-treated grafts (p = 0.009). iNOS was the only qRT-PCR target showing significant intergroup differences, with higher transcription levels observed in the control grafts (p = 0.027). Breast volumetric analysis demonstrated that the NAC-treated group had a 12.19% lower resorption rate than the control group, although it was found to be statistically insignificant (p = 0.149). No postoperative complications were observed during a 6-month follow-up. CONCLUSIONS: Some results of this study are promising. Further studies on larger groups are needed to determine NAC impact on AFG. TRIAL REGISTRY NAME: The Impact of N-Acetylcysteine on Volumetric Retention of Autologous Fat Graft for Breast Asymmetry Correction. REGISTRATION IDENTIFICATION NUMBER: NCT03197103. URL FOR THE REGISTRY: https://clinicaltrials.gov/ct2/show/NCT03197103?term=acetylcysteine&rank=6 LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Molecular Analysis of the ABCA4 Gene Mutations in Patients with Stargardt Disease Using Human Hair Follicles.

ABCA4 gene mutations are the cause of a spectrum of ABCA4 retinopathies, and the most common juvenile macular degeneration is called Stargardt disease. ABCA4 has previously been observed almost exclusively in the retina. Therefore, studying the functional consequences of ABCA4 variants has required advanced molecular analysis techniques. The aim of the present study was to evaluate whether human hair follicles may be used for molecular analysis of the ABCA4 gene splice-site variants in patients with ABCA4 retinopathies. We assessed ABCA4 expression in hair follicles and skin at mRNA and protein levels by means of real-time PCR and Western blot analyses, respectively. We performed cDNA sequencing to reveal the presence of full-length ABCA4 transcripts and analyzed ABCA4 transcripts from three patients with Stargardt disease carrying different splice-site ABCA4 variants: c.5312+1G>A, c.5312+2T>G and c.5836-3C>A. cDNA analysis revealed that c.5312+1G>A, c.5312+2T>G variants led to the skipping of exon 37, and the c.5836-3C>A variant resulted in the insertion of 30 nucleotides into the transcript. Our results strongly argue for the use of hair follicles as a model for the molecular analysis of the pathogenicity of ABCA4 variants in patients with ABCA4 retinopathies.

The Impact of Mastectomy on Women's Visual Perception of Breast Aesthetics and Symmetry: A Pilot Eye-Tracking Study.

BACKGROUND: Little is known about breast cancer survivors' perception of breast attractiveness. A better understanding of this subjective concept could contribute to the improvement of patient-reported outcomes after reconstructive surgeries and facilitate the development of new methods for assessing breast reconstruction outcomes. OBJECTIVES: The aim of this eye-tracking (ET)-based study was to verify whether mastectomy altered women's visual perception of breast aesthetics and symmetry. METHODS: A group of 30 women after unilateral mastectomy and 30 healthy controls evaluated the aesthetics and symmetry of various types of female breasts displayed as highly standardized digital images. Gaze patterns of women from the study groups were recorded using an ET system and subjected to a comparative analysis. RESULTS: Regardless of the study group, the longest fixation duration and the highest fixation number were found in the nipple-areola complex. This area was also the most common region of the initial fixation. Several significant between-group differences were identified; the gaze patterns of women after mastectomy were generally characterized by longer fixation times for the inframammary fold, lower pole, and upper half of the breast. CONCLUSIONS: Mastectomy might affect women's visual perception patterns during the evaluation of breast aesthetics and symmetry. ET data might improve our understanding of breast attractiveness and constitute the basis for a new reliable method for the evaluation of outcomes of reconstructive breast surgeries.

Age-related changes in elastographically determined strain of the facial fat compartments: a new frontier of research on face aging processes.

INTRODUCTION: Our study goal was verification of shear-wave elastography (SWE) as an assessment tool enabling quantitative analysis of facial fat tissue elasticity, using the example of the deep medial cheek fat compartment (DMCFC), due to its major role in pseudoptosis etiology. AIM: Furthermore, we determined the age-specific reference values for DMCFC elasticity and analyzed its correlation with body mass index (BMI) and DMCFC thickness. MATERIAL AND METHODS: The study included 89 female patients (age: 18-63 years, mean: 45.9 ±14.2 years) with intact facial skin. Prior to the procedure, all participants were subjected to SWE of the DMCFC. Reference ranges for elastographic parameters were defined as ± 2 standard deviations (SD), or estimated by means of ROC analysis. RESULTS: The DMCFC elasticity correlated inversely with DMCFC thickness (R = -0.292, p < 0.001), age (R = -0.838, p < 0.001) and BMI of the study subjects (R = -0.258, p = 0.001). Age was found to be the only independent determinant of DMCFC elasticity on multiple linear regression analysis (ß = -0.837, p < 0.001). The cut-off values for DMCFC elasticity estimated during ROC analysis provided excellent accuracy in distinguishing between women from various age categories, and to a large degree overlapped with the reference intervals defined as ± 2 SD. CONCLUSIONS: Shear-wave elastography enables quantitative evaluation of facial fat pad elasticity, creating a new frontier in research on age-related processes. The results indicate that elasticity of the DMCFC decreases significantly with age. Tissue elasticity might be an indirect indicator of metabolic and structural properties of facial adipose tissue and its extracellular matrix.

Intra-rater reproducibility of shear wave elastography in the evaluation of facial skin.

INTRODUCTION: Recently, esthetic medicine has been gaining its momentum worldwide, mostly due to the development of minimally invasive techniques. In our opinion, elastography can be a candidate for an objective quantitative method to evaluate facial skin condition. The aim of this study was to determine intra-rater reproducibility of shear wave elastography (SWE) in the evaluation of facial skin in patients qualified for minimally invasive nonsurgical facial rejuvenation treatment. AIM: To determine intra-rater reproducibility of shear wave elastography (SWE) in the evaluation of facial skin in patients qualified for minimally invasive nonsurgical facial rejuvenation treatment. MATERIAL AND METHODS: The study included 57 women between 40 and 67 years of age (mean: 51.5 ±7.3 years). Prior to the laser treatment, all participants were subjected to ultrasonographic examination and elastography of the skin. Upon visualization of the area of interest, the thickness of the dermis, subcutaneous tissue and superficial muscular aponeurotic system (SMAS) in millimeters was measured. Then, SWE was performed. RESULTS: No statistically significant differences were found in intraclass coefficient values (ICC) for elastographic parameters of the skin on the right and left side of the face (0.953 ±0.001 vs. 0.953 ±0.001, p = 0.992). Moreover, no significant differences were observed in the ICC values for the SWE parameters of various skin layers: dermis, subcutaneous tissue and SMAS (0.945 ±0.001 vs. 0.953 ±.001 vs. 0.961 ±0.001, p = 0.597). Women with normal body weight and overweight did not differ significantly in terms of their elastographic parameters of facial skin. CONCLUSIONS: Shear wave elastography is a reliable method for the evaluation of facial skin elasticity, providing highly reproducible results in all patients, regardless of their age and body weight.

Shear Wave Elastography in the Evaluation of Facial Skin Stiffness After Focused Ultrasound Treatment.

BACKGROUND: No objective method for the evaluation of facial aesthetic procedures has been proposed thus far. The authors hypothesized that shear wave elastography may be an appropriate method to evaluate the outcomes of some aesthetic treatments. OBJECTIVE: The aim of the study was to compare elastographic parameters of facial skin, subcutaneous fat, and superficial musculoaponeurotic system before high-intensity focused ultrasound treatment and 60 days after this procedure. METHODS AND MATERIALS: The study included 57 female patients aged 51.5 ± 7.3 years. Shear wave elastography of facial skin was performed before the aesthetic procedure and 2 months thereafter. RESULTS: Baseline stiffness of all examined layers correlated inversely with patients' age. Sixty days after the aesthetic treatment, the stiffness of all tissues improved significantly. The extent of the improvement correlated inversely with patients' body mass index. CONCLUSION: Shear wave elastography can accurately assess the outcomes of facial treatment with high-intensity focused ultrasound. Using this method, the authors documented improved stiffness of facial skin as early as 60 days after the procedure. The beneficial effect of the aesthetic treatment was observed regardless of patients' age but was less evident in women with excess body weight.

Factors Influencing Elastographically Determined Remodeling of Venous Thrombi.

OBJECTIVES: To verify whether elastographically determined remodeling of venous obliterating material formed during sclerotherapy is influenced by patient-specific factors. METHODS: The study included 60 patients who underwent sclerotherapy for venous insufficiency. Elastographic parameters of obliterating material, including relative vascular cross sections (percent) with the highest (red), intermediate (green), and lowest elasticity (blue), determined 7 ± 1, 14 ± 2, and 21 ± 2 days after sclerotherapy, were analyzed against the patients' ages, sexes, physical activity levels, and pain severities. RESULTS: The patients included 45 women and 15 men with a mean age ± SD of 51.2 ± 14.7 years. A significant correlation was observed between the age of the patients and the relative area of the vessel highlighted in red during the third control visit (R = 0.289; P = .025). The proportion of men in whom the elastographic structure of venous obliterating material during the second visit was classified as mixed was higher than that of women (66.7% versus 28.9%; P = .032). During the third visit, the proportion of patients with low physical activity in whom the elastographic structure of venous obliterating material was classified as fibrous turned out to be lower than the respective percentages of patients with moderate and high activity levels (12.0% versus 35.0% versus 46.7%; P = .045). However, none of these effects was observed systematically throughout the whole follow-up period. CONCLUSIONS: The time to complete organization of venous obliterating material may be longer in older patients, women, and patients with lower levels of physical activity, but these factors seem to influence the thrombus structure solely at specific time points in its evolution. Nevertheless, they should be considered during elastographic assessments of thrombus age.

Ultrasonographic elastography in the evaluation of normal and pathological skin - a review.

The aim of this review article is to discuss the role of ultrasonographic elastography, a technique used to quantify tissue stiffness, in the evaluation of normal and pathological skin. A growing body of evidence suggests that elastography may be used for the diagnosis and monitoring of skin pathologies, in particular tumors, and fibrotic and sclerotic processes. Our knowledge about the elastographic parameters of normal skin is sparse, which together with the lack of reference values for cutaneous stiffness constitutes a serious limitation to the use of elastography in some medical disciplines, including aesthetic medicine.

Elastography reference values of facial skin elasticity.

INTRODUCTION: With an introduction of new ultrasonographic transducers, skin elastography may find an application in dermatology and aesthetic medicine enabling direct evaluation of various pathological or natural processes. AIM: To verify which elastographic technique, strain elastography (SE) or shear wave elastography (SWE), is a better candidate for the reference method of facial skin elasticity examination and to determine normal ranges for elastographic parameters in various facial regions. MATERIAL AND METHODS: The study included 71 female volunteers (age: 40-67 years, mean: 52 ±7.5 years). All participants were subjected to SE and SWE of the skin in five anatomical regions: the forehead, suborbital regions, cheeks, nasolabial folds and chin. Reference ranges for elastographic parameters were defined as 95% confidence intervals and ±2 standard deviations and estimated by means of ROC analysis. RESULTS: Shear wave elastography parameters, but not SE indices, showed strong inverse correlations with the patient age. No significant correlations were found between SE and SWE parameters of the facial skin. In contrast to SWE, no significant correlations were observed between bilateral SE parameters. Based on these findings, SWE was chosen as the reference method to determine age-specific normative values for the elasticity of the facial skin. Reference and cut-off values of SWE parameters were defined for three age groups. CONCLUSIONS: Shear wave elastography is suitable for the determination of elastographic parameters of normal facial skin, and can be used to determine reference ranges thereof. Elasticity of the facial skin decreases considerably with age, and this factor should be considered during determination of reference values for the elastographic parameters.

Application of the probit method for elastographic evaluation of venous obliterating material after sclerotherapy procedure.

PURPOSE: Status after sclerotherapy constitutes a good clinical model for venous thrombosis with known age. The aim of this study was to compare elastographic parameters of material obliterating the great saphenous vein at 7-21 days after polidocanol sclerotherapy. MATERIAL AND METHODS: The study included 60 patients subjected to sclerotherapy due to venous insufficiency (45 women and 15 men, mean age 51.2 ± 14.7 years, range 27-77 years). Elastographic parameters of obliterating material: total area of vessel cross-section (mm2), relative areas (%) covered by tissues with highest, intermediate, and lowest elasticity, were determined 7 ± 1, 14 ± 2, and 21 ± 2 days post-sclerotherapy, respectively. Mean time to partial and complete organisation of the obliterating material was estimated during probit regression analysis. RESULTS: The relative area of vessel cross-section covered by tissues with the lowest elasticity underwent a statistically significant enlargement, either between the first and the second (Z = 6.725, p < 0.001) or between the second and the third control visit (Z = 6.717, p < 0.001). This corresponded to a change in the structure of the obliterating material from elastic during the first visit (in all patients) to mixed (fibro-elastic) or fibrous during the third visit (71.7% and 28.3% of patients, respectively). Mean time after which the obliterating material reached mixed and fibrous structure on elastographic images was estimated at 14.3 days and > 21 days, respectively. CONCLUSIONS: Ultrasound elastography may accurately reflect the age of venous thrombosis in polidocanol sclerotherapy model. Mixed, fibro-elastic structure of a 14-day-old obliterating material visualised by elastography probably corresponds with chronic thrombus.