Satisfaction with Facial Appearance and Quality of Life after Treatment of Face Scars with a Transparent Facial Pressure Mask.

Treatment of facial hypertrophic scars and deformities has developed from the use of elastic fabric hoods to transparent facemasks. The clinical effects of these masks have been described. However, the psychological impact of wearing such a mask is not well documented. The aim of this study was to assess patients' satisfaction with their current facial appearance, to assess the end result of facemask therapy, and to assess the decision to have undergone facemask therapy by means of four different FACE-Q questionnaires. Out of the eligible 87 patients who completed the facemask therapy between January 2012 and November 2017, 42 filled out the questionnaires. These patients wore a custom-fabricated facemask because of facial hypertrophic scars and severe postsurgical facial irregularities. Patients who wore the mask 12 to 16 hours per day were significantly more satisfied with the end result compared with those who wore it 4 to 8 hours daily. Also, patients who wore the mask 8 to 12 and 12 to 16 hours each day were more satisfied to have undergone therapy compared with those who wore it 4 to 8 hours daily. Furthermore, patients who finished therapy 3 to 4 years and 4 to 5 years ago reported a significant higher satisfaction with facial appearance compared with those who completed therapy in a time period shorter than 1 year ago. Patients who finished therapy 3 to 4 years ago reported higher satisfaction with their facial appearance compared with those who finished therapy 2 to 3 years ago. Additionally, the Patient and Observer Scar Assessments Score (POSAS) showed a significant reduction between start and end of therapy. This study shows facemask therapy to result in long-lasting stable results. It also shows a longer daily wearing of the facemask to result in the highest satisfaction according to patients.

A new treatment of hypertrophic and keloid scars with combined triamcinolone and verapamil: a retrospective study.

BACKGROUND: Since the management of keloid and hypertrophic scars still remains a difficult clinical problem, there is need for adequate, effective therapy. In this study, we explored for the first time the efficacy and the potential synergetic effect of combined triamcinolone and verapamil for the treatment of hypertrophic and keloid scars. The objective was to assess the efficacy of combined intralesional triamcinolone and verapamil therapy for hypertrophic and keloid scars. METHODS: Fifty-eight patients with hypertrophic scars (n = 31) and keloid scars (n = 27) were included. A specific injection therapy scheme was applied. Five follow-up moments were chosen, with a maximum follow-up of nearly 2 years. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and pruritus were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: Our results reveal a fast and abiding improvement of both keloid and hypertrophic scars after treatment with the combination therapy. All POSAS components showed a reduction in scar score, while scar relief, pain, itchiness, and surface area improved significantly (P < 0.05) in keloids. Significant improvement in hypertrophic scars was found in scar pigmentation, vascularization, pliability, thickness, pain, and surface area. Overall POSAS scores revealed statistically significant decreases between baseline and 3-4 months, 4-6 months, and >12 months after start of therapy in both keloids and hypertrophic scars. CONCLUSIONS: This study reveals that combined therapy of triamcinolone and verapamil results in overall significant scar improvement with a long-term stable result.Level of evidence: Level IV, therapeutic study.

Effects of selective α2 -adrenergic receptor agonists on electrical field-stimulated contractions of isolated bronchi in horses.

We investigated the effects of different selective α2 -adrenergic receptor (AR) agonists (detomidine, medetomidine, xylazine, and brimonidine) on the contractions of horse-isolated bronchi induced by electrical field stimulation (EFS) and by carbachol. No effects were observed on the contraction induced by carbachol, while α2 -AR agonists reduced EFS-evoked contractions in a concentration-related fashion. The rank order of potency (pD2 ) was brimonidine (7.40 ± 0.20) >medetomidine (7.09 ± 0.24) >detomidine (6.13 ± 0.55) >xylazine (4.59 ± 0.16). The maximal effects (Emax ) were -56.3% ± 6.3%, -40.4% ± 6.9%, -48.6% ± 9.9%, and -72.7% ± 12.7% for brimonidine, medetomidine, detomidine, and xylazine, respectively. Adrenergic block by guanethidine enhanced the potency (8.10 ± 0.05, 7.30 ± 0.15, 6.83 ± 0.41, and 5.40 ± 0.22) and the efficacy (-95.2% ± 0.7%, -45.2% ± 11.7%, -58.5% ± 9.8%, and -97.9% ± 0.6%) of brimonidine, medetomidine, detomidine, and xylazine, respectively. Selective α2 -AR antagonist, atipamezole, competitively antagonized the inhibition of EFS-evoked contractions induced by all agonists except xylazine. These results suggest the existence of presynaptic α2 -ARs on cholinergic neurons, negatively regulating the release of acetylcholine in horse bronchial muscle, and that α2 -AR agonists may be beneficial against vagally mediated bronchoconstriction.

27Al MQMAS of the δ-Al13-Keggin.

One-dimensional 27Al, 23Na Magic-Angle-Spinning (MAS) NMR and 27Al Multiple-Quantum Magic-Angle-Spinning NMR (MQMAS) measurements are reported for the δ-isomer of the Al13 Keggin structure at high spinning speed and 14.1 T field. Values for the CQ and η parameters are on the same scale as those seen in other isomers of the Al13 structure. Density functional theory (DFT) calculations are performed for comparison to the experimental fits using the B3PW91/6-31+G* and PBE0/6-31+G* levels of theory, with the Polarizable Continuum Model (PCM).

Three-dimensional imaging for volume measurement of hypertrophic and keloid scars, reliability of a previously validated simplified technique in clinical setting.

INTRODUCTION: Evidence behind many of the current treatments in hypertrophic and keloid scars remains limited. Current objective methods to assess efficacy and provide follow-up can be complex and are not easily applied in clinical setting. The aim of this study was to assess reliability of a recently validated simplified technique for volume measurement in clinical practice. METHODS: Volume measurement of 28 hypertrophic and keloid scars was conducted in 22 consecutive patients, using a three-dimensional stereophotogrammetry. Intra- and inter-rater reliability was assessed by the intraclass correlation coefficient (ICC) and the coefficient of variation (CV). The measurement error was expressed as limits of agreement (LoA). RESULTS: The simplified method for three-dimensional volume measurement showed good intra-rater reliability with an ICC of 0.997 and a CV of 7.3%, and a good inter-rater reliability with an ICC of 0.999 and a CV of 5.7%. The plot of the differences and LoA showed near-perfect agreement between observers. CONCLUSION: Objective evaluation of scar volume using the simplified three-dimensional measurement technique may complement subjective scoring and improve the ability to quantitatively compare the response to therapeutic methods.

Efficacy of custom-made pressure clips for ear keloid treatment after surgical excision.

BACKGROUND: Mechanical pressure is increasingly applied as a means to prevent or treat keloid scars. AIM: The aim of this study is to analyze the long-term efficacy of our custom-molded pressure-adjustable earclips to prevent keloid recurrence after surgical excision. METHODS: Using our custom-molded earclip, 88 patients who had undergone ear surgery for keloid scars were treated for 12 h a day for 6-18 months. The mean follow-up was 6.5 years. The primary outcome was the recurrence of keloids with patient satisfaction being the secondary outcome as assessed by Patient and Observer Scale (POSAS). RESULTS: Keloid scars did not recur in 70.5% of treated patients. The Fitzpatrick scale, which classifies human skin by type, was significantly different between the recurrence and nonrecurrence group. Differences in other patient characteristics were not found between both groups. All parameters mentioned in the POSAS patient scale drastically improved after therapy. There were no severe side effects observed after the therapy. CONCLUSION: Our pressure-adjustable earclip model is an effective tool in the prevention of ear keloid recurrence and is associated with high patient satisfaction. Its benefits should prompt further studies on its value as an adjuvant therapy to surgery in keloid treatment. LEVEL OF EVIDENCE: Level III on the Evidence Rating Scale for Therapeutic Studies.

A simplified three-dimensional volume measurement technique in keloid scars: Validity and reliability.

INTRODUCTION: Effective treatment of keloid scars is important because patients are often confronted with major cosmetic, psychological, and social consequences. Three-dimensional (3D) imaging has been reported for the evaluation of keloid treatment. These techniques were complex to use in clinical practice. In this study, the validity and reliability of a simplified 3D volume measurement technique are defined. METHODS: Thirty-three scars were simulated using deformable modeling compound. The volume of the compound is calculated using the weight and density of the modeling compound, and it is compared with the 3D volume measurement. RESULTS: The mean simulated keloid volume was 2.884 cc. The correlation was very high (r = 0.999), but there was a significant mean difference of 0.252 cc (p < 0.001). This was corrected using a formula, actual volume = 1.072 × measured volume. This formula was validated using a new data set of 33 simulated scars. There was a nonsignificant mean difference of 0.010 cc (p = 0.731). CONCLUSION: This 3D measurement technique combined with the correcting formula is valid and reliable to be used in practice for the evaluation of keloid scar treatment.

Fisioterapia complexa descongestiva associada a terapias de compressão no tratamento do linfedema secundário ao câncer de mama: uma revisão sistemática / Complex Decongestive Physiotherapy Associated Compression Therapy in the Treatment of Secondary Lymphedema in Breast Cancer: a Systematic Review

Introdução: O câncer de mama é a neoplasia mais incidente na população feminina, sendo o linfedema de membro superior a complicação mais frequente no pós-operatório de mastectomia. Objetivo: Verificar a eficácia da fisioterapia complexa descongestiva associada ao uso de kinesiotape, enfaixamento compressivo e compressão pneumática no tratamento do linfedema secundário ao câncer de mama. Método: Revisão sistemática, cujas bases de dados consultadas foram: MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, Periódicos Capes, Cinahl e Scholar Google. As palavras-chave foram: "kinesiotape", "bandage", "drainage", "mastectomy", "lymphedema", "physioterapy", "physical therapy", "compressive bandaging", "pneumatic compression". Resultados: Foram selecionados dez ensaios clínicos randomizados. Foi possível verificar que a compressão pneumática reduz os níveis de volume de linfedema quando associada à fisioterapia complexa descongestiva. O enfaixamento compressivo se mostra eficaz na redução do linfedema; porém muitas vezes é abandonado pelas pacientes pelo desconforto que causa. A kinesiotape surge como uma alternativa terapêutica para pacientes que não se adaptaram ao enfaixamento; porém, os artigos que abordam essa temática são em sua maioria estudos de casos e, por isso, se tornam insuficientes para confirmar sua eficácia. Conclusão: Essa revisão sistemática mostrou-se relevante na medida em que permitiu verificar os efeitos de cada uma das técnicas no tratamento do linfedema pós-mastectomia. No entanto, os estudos clínicos randomizados ainda se mostram escassos, principalmente no que se refere ao uso da kinesiotape. Por essa razão, não há como estabelecer qual técnica é mais eficaz na redução do linfedema e na manutenção dos níveis de redução conquistados durante a fisioterapia complexa descongestiva.

Overuse of short-interval bone densitometry: assessing rates of low-value care.

UNLABELLED: We evaluated the prevalence and geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries. Short-interval DXA use varied across regions (coefficient of variation = 0.64), and unlike other DXAs, rates decreased with payment cuts. INTRODUCTION: The American College of Rheumatology, through the Choosing Wisely initiative, identified measuring bone density more often than every 2 years as care "physicians and patients should question." We measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) DXAs among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change. METHODS: Using 100 % Medicare claims data, 2006-2011, we identified DXAs and short-interval DXAs for female Medicare beneficiaries over age 66. We determined the population rate of DXAs and short-interval DXAs, as well as Medicare spending on short-interval DXAs, nationally and by hospital referral region (HRR). RESULTS: DXA use was stable 2008-2011 (12.4 to 11.5 DXAs per 100 women). DXA use varied across HRRs: in 2011, overall DXA use ranged from 6.3 to 23.0 per 100 women (coefficient of variation = 0.18), and short-interval DXAs ranged from 0.3 to 8.0 per 100 women (coefficient of variation = 0.64). Short-interval DXA use fluctuated substantially with payment changes; other DXAs did not. Short-interval DXAs, which represented 10.1 % of all DXAs, cost Medicare approximately US$16 million in 2011. CONCLUSIONS: One out of ten DXAs was administered in a time frame shorter than recommended and at a substantial cost to Medicare. DXA use varied across regions. Short-interval DXA use was responsive to reimbursement changes, suggesting carefully designed policy and payment reform may reduce this care identified by rheumatologists as low value.

Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly.

A total of 105 infants with nonsynostotic posterior plagiocephaly were treated using a helmet or by head positioning. Effect of treatment was scored using a cosmetic outcome score (0-10 points) assigned by the parents. The onset of the observed skull deformity correction was not different for the helmet vs. nonhelmet treatment. Improvement was significantly better and faster in the helmet group compared with nonhelmet treatment (p < 0.01 and p < 0.001, respectively).

Ocular albinism: evidence for a defect in an intracellular signal transduction system.

G protein-coupled receptors (GPCRs) participate in the most common signal transduction system at the plasma membrane. The wide distribution of heterotrimeric G proteins in the internal membranes suggests that a similar signalling mechanism might also be used at intracellular locations. We provide here structural evidence that the protein product of the ocular albinism type 1 gene (OA1), a pigment cell-specific integral membrane glycoprotein, represents a novel member of the GPCR superfamily and demonstrate that it binds heterotrimeric G proteins. Moreover, we show that OA1 is not found at the plasma membrane, being instead targeted to specialized intracellular organelles, the melanosomes. Our data suggest that OA1 represents the first example of an exclusively intracellular GPCR and support the hypothesis that GPCR-mediated signal transduction systems also operate at the internal membranes in mammalian cells.

[Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results]. / Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Risultati a 4 anni di follow-up.

In order to evaluate the efficacy and tolerability of mesalazine (5-ASA) in the prophylaxis of symptomatic relapses, of major complications and of microhemorrhagic phenomena in diverticular disease of the large intestine (MDC), prospective clinical study was conducted on patients with light-moderate symptomatic MDC under treatment with sulbactam-ampicillin 1.5 g/12 h i.m. and rifaximine 400 mg/12 h per os for 7 days. Follow-up period of 5 years with seriated checkups and laboratory and instrumentation controls. End points are represented by the relapse on inflammation and/or by the occurrence of major complications. On enrollment, 166 patients were randomized to receive mesalazine (Pentacol tablets--SOFAR S.p.A.) 400 mg b.i.d. per os for 8 weeks (81 patients; group M) or no supplementary treatment (85 patients; group C). After 4 years of follow-up, 44 patients dropped out of the study (9 because of major complications, 3 for massive hemorrhage, and 32 drop outs). Symptomatic relapses occurred in 51 patients (12 M; 39 C), while minor diverticular hemorrhages occurred in 43 patients (12 M; 31 C), with an estimated probability of remaining free respectively from symptomatic relapse (p=0.00005) and from microhemorrhagic phenomena (p=0.001) decisively in favor of the group treated with mesalazine. The duration of abdominal pain due to diverticolitis was also shorter in patients of group M (p=0.0002), while the incidence of major complications and side effects was comparable in the two groups. In conclusion, supplementary treatment with mesalazine in patients affected with MDC--at a follow-up limited to 48 months--proved to be well tolerated and effective in reducing the frequency of symptomatic relapses and microhemorrhagic phenomena and in reducing the duration of abdominal pain.

Analysis of gastroduodenitis and oesophagitis in relation to dyspeptic/reflux symptoms.

BACKGROUND/AIMS: The pathogenesis of dyspeptic/reflux symptoms and the clinico-pathologic profile of affected patients are still poorly understood. To improve our knowledge in this field we carried out a systematic, comparative analysis of symptom profiles and histopathologic patterns of oesophagogastroduodenal mucosa in a series of 221 subjects, 140 with and 81 without endoscopic evidence of hiatal hernia. Of these, 190 showed reflux and/or dyspeptic symptoms. METHODS: Before endoscopy, all the subjects were questioned about the presence and severity of 12 individual symptoms. Biopsies were taken from the distal oesophagus, cardia, corpus, angulus, antrum and duodenal bulb, and were scored in accordance with the Sydney system. RESULTS: Patient groups with a distinct clinico-pathologic profile were better identified when symptoms of adequate severity were compared with histopathologic parameters. A correlation between gastroesophageal reflux disease (GORD) symptoms and histologic signs of oesophagitis was mostly restricted to patients endoscopically positive for oesophagitis. Retroxiphoid pyrosis correlated with cardial gastritis but not with oesophagitis, either endoscopic or histologic, while ulcer-like epigastric pain correlated with active duodenitis and distal gastritis. No definite histopathologic background was detected in patients with putative dysmotility-like symptoms, endoscopy-negative GORD and low score or mixed symptoms. CONCLUSION: A contribution of Helicobacter pylori gastroduodenitis to the pathogenesis of some dyspeptic symptoms seems likely. However, the identification of specific histologic changes causing individual symptoms remains rather elusive, with the exception of active antroduodenitis in patients with ulcer-like pain and of active proximal gastritis in patients with severe retroxiphoid pyrosis.

[Efficacy of low dose mesalazine (5-ASA) in the treatment of acute inflammation and prevention of complications in patients with symptomatic diverticular disease. Preliminary results]. / Efficacia della mesalazina (5-ASA) a basse dosi nel trattamento della flogosi acuta e nella prevenzione delle complicanze in pazienti con malattia diverticolare sintomatica. Risultati preliminari.

MATERIALS AND METHODS: To assess the efficacy of mesalazine in treating acute diverticulitis and preventing diverticular disease (DD) complication. 166 patients with symptomatic DD were randomly assigned to receive mesalazine Pentacol (400 mg b.i.d., orally; M group) or no additional treatment (controls; C group). RESULTS: After a 12 months follow-up, 26 patients experienced a symptomatic relapse (8%M vs 27% C, p=0.003), with a higher rate in C group for the patients with a history of previous diverticulitis (p=0.006) and independently of the diverticular site (sigmoid p=0.041; colon and sigmoid p=0.044). Minor diverticular haemorrhages were less frequent in M group (p=0.016), with a significant difference only for the patients with sigmoid diverticula (p=0.023); abdominal pain persisted for a shorter time in the treated group (p=0.0015). CONCLUSIONS: No significant difference was found between the two groups for the incidence of DD major complications.