Hyaluronic Acid and Radiofrequency in Patients with Urogenital Atrophy and Vaginal Laxity.

Vaginal laxity (VL) and genitourinary syndrome of menopause (GSM), as well as aesthetic changes in the vulvar skin, often occur together and cause physical, psychological, and functional problems for women and their partners. The current study evaluated the efficacy of a nonsurgical radiofrequency device (RF) procedure combined with hyaluronic acid (HA) injection into the skin of the labia majora on clinical, histological, and aesthetic levels. Twenty women with GSM and VL, aged between 36 and 72 (mean age 53.4), were treated with bipolar RF SECTUM, vaginal and vulvar application, as well as with a hyaluronic acid (HA) injection into the skin of the labia majora. The Vaginal Laxity Questionnaire (VLQ), Vaginal Health Index (VHI), and Female Sexual Function Index (FSFI) were used to examine the clinical effects of the operations. The Global Aesthetic Improvement Scale was utilized to measure patient satisfaction. On a histochemical level, the concentrations of elastin and collagen in the vaginal wall and vulvar skin were examined. Results: There was significantly higher patient satisfaction and a considerable clinical improvement across all areas of analysis. On the histochemical level, elastin and collagen fiber concentration increased after the treatment protocol both in the vulvar skin and in the vaginal wall: elastin in the vaginal wall, 11.4%, and in the vulvar skin, 61%; collagen in the vaginal wall, 26%, and in the vulvar skin, 27%. The current study demonstrated the efficacy and safety of this nonsurgical RF procedure combined with a hyaluronic acid (HA) injection into the skin of the labia majora on clinical, histochemical, and aesthetic levels.

Thalamic Deep Brain Stimulation for tremor: The critical role of intraoperative testing.

INTRODUCTION: Optimal placement of Deep Brain Stimulation (DBS) lead is critical to ensure an adequate therapeutic benefit and minimize stimulation-induced side effects. METHODS: We reviewed data from 2004 to 2018 of all cases of essential tremor treated with thalamic DBS at the University of Cincinnati. All procedures were performed with the patient awake. Change in parallel trajectory was classified as major repositioning, whereas a change in depth of electrode classified as minor repositioning. The following data were compared between groups (no vs. minor vs. major repositioning): age at surgery, sex, AC-PC length, third ventricle width, cerebral atrophy, small vessel disease burden, and intraoperative tremor control. Univariate and multivariate analyses were conducted to identify factors associated with intraoperative repositioning. RESULTS: Of the 127 encounters with essential tremor, 71 required repositioning (33 major and 38 minor). Comparing procedures with major, minor, and no repositioning, mean number of changes per procedure (4 vs. 1.2 vs 0; p < 0.001) and AC-PC length (26 vs. 27 vs. 27.2 mm; p = 0.021) differed between the three groups. Older age at surgery (OR 1.04, p = 0.042), left side (OR 2.56, p = 0.04) and decrease in AC-PC length (OR 1.33, p = 0.026) were associated with greater odds of any (minor or major) repositioning. A decrease in AC-PC length was associated with greater odds of major repositioning (OR 1.37, p = 0.009). CONCLUSION: Intraoperative functional testing may be critical to ensure the accuracy of thalamic DBS targeting based on neuroimaging data, particularly in patients with reduced AC-PC length.

SHORT-TERM OUTCOMES OF CONSERVATIVE TREATMENT FOR FEMOROACETABULAR IMPINGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Femoroacetabular Impingement (FAI) is becoming increasingly more common with noted impairments in physical function, increased pain, and decreased quality of life. Typically, a conservative approach is used through physical therapy or intra-articular injections before an invasive surgical approach is utilized. Identifying the proper course of conservative care by the clinician will aid in improving outcomes. PURPOSE: The purpose of this systematic review and meta-analysis was to investigate short-term effects of conservative physical therapy and intra-articular injections on pain and physical function measures in patients with FAI. STUDY DESIGN: Systematic Review & Meta-Analysis. METHODS: A systematic review and meta-analysis were completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with the International Prospective Registry of Systematic Reviews. A literature review was performed in May 2018 using Pubmed, CINAHL, Proquest, and Scopus. Inclusion criteria included humans classified as having femoroacetabular impingement, conservative rehabilitation, and utilization of outcome measures in the domains of pain or function. Exclusion criteria included absence of skilled interaction and study protocols that were not completed. RESULTS: Seven studies were included that summarized physical therapy or intra-articular injection outcomes for femoroacetabular impingement management. Results showed that conservative interventions for short-term periods are effective in reducing pain and improving function for femoroacetabular impingement. Overall, physical therapy revealed moderate to large effect sizes and statistically significant differences in both pain (SMD, 0.91, CI: 0.07, 1.76, p=0.030) and function (SMD, 0.80, CI: 0.34, 1.28, p=0.001) for femoroacetabular impingement. Intra-articular injection demonstrated small effect sizes for pain outcomes (SMD, 0.29, CI: -1.25, 1.83, p = 0.710) and small to moderate effect size for improvement in function (SMD, 0.49, CI: 0.03, 0.96, p = 0.040). CONCLUSIONS: Physical therapy demonstrated positive results to self-reported pain and function and may hold more promise than intra-articular injection alone. Common treatments that were associated with improved outcomes were patient education, activity modification, manual therapy, and strengthening. There are a limited number of high-quality articles on this topic, which should be addressed in future research. LEVEL OF EVIDENCE: 1a.

Parameter Optimization in High-Throughput Testing for Structural Materials.

High-throughput screenings are established evaluation methods in the development of functional materials and pharmaceutical active ingredients. The transfer of this approach to the development of structural materials requires extensive adaptations. In addition to the investigation of new test procedures for the determination of material properties and the treatment of metallic materials, the design of experiments is a research focus. Based on given descriptor target values, the statistical design of experiments determines investigations and treatments for the investigation of these materials. In this context, process parameters also have to be determined, as these have a major influence on the later material properties, especially during the treatment of samples. In this article, a method is presented which determines the process parameters iteratively. The validation of the calculated process parameters takes place based on differential scanning calorimetry used as the furnace for the heat treatment of small batches and particle-oriented peening as the characterization method.

Accelerating High-Throughput Screening for Structural Materials with Production Management Methods.

High-throughput screenings are widely accepted for pharmaceutical developments for new substances and the development of new drugs with required characteristics by evolutionary studies. Current research projects transfer this principle of high-throughput testing to the development of metallic materials. In addition to new generating and testing methods, these types of high-throughput systems need a logistical control and handling method to reduce throughput time to get test results faster. Instead of the direct material flow found in classical high-throughput screenings, these systems have a very complex structure of material flow. The result is a highly dynamic system that includes short-term changes such as rerun stations, partial tests, and temporarily paced sequences between working systems. This paper presents a framework that divides the actions for system acceleration into three main sections. First, methods for special applications in high-throughput systems are designed or adapted to speed up the generation, treatment, and testing processes. Second, methods are needed to process trial plans and to control test orders, which can efficiently reduce waiting times. The third part of the framework describes procedures for handling samples. This reduces non-productive times and reduces order processing in individual lots.