Resurfacing of atrophic facial acne scars with a multimodality CO2 and 1570 nm laser system.

BACKGROUND: Scarring is one of the most prevalent long-term complications of acne vulgaris and has cosmetic, psychological, and social burdens. Contemporary management programs integrate multiple modalities to best address the multiple factors underlying their development and persistence. This work assessed the impact of sequential multimodal laser therapy on acne scar geometrics and texture. METHODS: Adult patients (n = 16) with Fitzpatrick skin type II-IV and presenting with facial acne scars, underwent three combination ablative (CO2), and nonablative (1570 nm) laser treatment sessions at two-month intervals. Treatment was delivered using a ProScan Hybrid applicator, with each regimen including illumination with both ablative and a nonablative lasers applied in a grid mode sequence. Scar microtopography was assessed at baseline and 6 months after the last treatment session. RESULTS: At baseline, all patients had both box and rolling scars, while only three had icepick scars. Six months following treatment, mean scar volume improved from 5.7 ± 5.2 mm3 at baseline to 3.1 ± 3.0 mm3 and mean affected area improved from 165.6 ± 134.0 mm2 94.0 ± 80.1 mm2, translating to 47.0 ± 7.9% and 43.2 ± 8.6% reductions from baseline, respectively. Patients were highly satisfied with treatment outcomes, and no serious adverse reactions were documented during the course of treatment or follow-up. CONCLUSION: Multimodal CO2 and 1570-nm laser treatment improved the surface profilometry of patients with atrophic facial acne scars. Customization of both treatment intervals and laser settings to cosmetic regions, scar profiles and skin phototypes may further enhance treatment outcomes and expand its applicability to additional skin deformities.

Early-stage volume losses in the corpus callosum and thalamus predict the progression of brain atrophy in patients with multiple sclerosis.

BACKGROUND: A method that can be used in the early stage of multiple sclerosis (MS) to predict the progression of brain volume loss (BVL) has not been fully established. METHODS: To develop a method of predicting progressive BVL in patients with MS (pwMS), eighty-two consecutive Japanese pwMS-with either relapsing-remitting MS (86%) or secondary progressive MS (14%)-and 41 healthy controls were included in this longitudinal retrospective analysis over an observational period of approximately 3.5 years. Using a hierarchical cluster analysis with multivariate imaging data obtained by FreeSurfer analysis, we classified the pwMS into clusters. RESULTS: At baseline and follow-up, pwMS were cross-sectionally classified into three major clusters (Clusters 1, 2, and 3) in ascending order by disability and BVL. Among the patients included in Cluster 1 at baseline, approximately one-third of patients (12/52) transitioned into Cluster 2 at follow-up. The volumes of the corpus callosum, the thalamus, and the whole brain excluding the ventricles were significantly decreased in the transition group compared with the nontransition group and were found to be the most important predictors of transition. CONCLUSION: Decreased volumes of the corpus callosum and thalamus in the relatively early stage of MS may predict the development of BVL.

The Molecular Phenotype of Kidney Transplants: Insights From the MMDx Project.

This review outlines the molecular disease states in kidney transplant biopsies as documented in the development of the Molecular Microscope Diagnostic System (MMDx). These states include T cell-mediated rejection (TCMR), antibody-mediated rejection (AMR), recent parenchymal injury, and irreversible atrophy-fibrosis. The MMDx project, initiated through a Genome Canada grant, is a collaboration involving many centers. MMDx uses genome-wide microarrays to measure transcript expression, interprets the results using ensembles of machine learning algorithms, and generates a report. Experimental studies in mouse models and cell lines were extensively used to annotate molecular features and interpret the biopsy results. Over time, MMDx revealed unexpected aspects of the disease states: for example, AMR is usually C4d-negative and often DSA-negative, and subtle "Minor" AMR-like states are frequent. Parenchymal injury correlates with both reduced glomerular filtration rate and increased risk of graft loss. In kidneys with rejection, injury features, not rejection activity, are the strongest predictors of graft survival. Both TCMR and AMR produce injury, but TCMR induces immediate nephron injury and accelerates atrophy-fibrosis, whereas AMR induces microcirculation and glomerular damage that slowly leads to nephron failure and atrophy-fibrosis. Plasma donor-derived cell-free DNA levels correlate strongly with AMR activity, acute kidney injury, and in a complex way with TCMR activity. Thus, the MMDx project has documented the molecular processes that underlie the clinical and histologic states in kidney transplants, and provides a diagnostic tool that can be used to calibrate biomarkers, optimize histology interpretation, and guide clinical trials.

Effects of Cervical Paravertebral Extensors in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Grouped According to mK-Line.

OBJECTIVES: The objective of this study was to quantify the morphology, composition, and asymmetry of the paravertebral extensor muscles (PSEMs) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) who had different modified K-line (mK-line) and the minimum interval between the mK-line and OPLL (INTmin ) values and to investigate the relationship between PSEMs and symptoms and outcomes following laminoplasty. These original findings elucidated that the atrophy of PSEMs could predict decompression outcomes and provided a theoretical basis for paraspinal muscle rehabilitation. METHODS: A total of 94 consecutive patients who underwent laminoplasty for OPLL between January 2020 and January 2022 were enrolled in this retrospective study. The relative cross-sectional areas (rCSA), functional cross-sectional areas (rFCSA), and FCSA/CSA ratio of the multifidus (MF), semispinalis cervicalis (SSCe), semispinalis capitis (SSCa), and splenius capitis (SpCa) were measured at the C3-C7 segments on cervical magnetic resonance imaging (MRI). This study compared the differences between the mK-line (+) group and the mK-line (-) group, as well as between the INTmin <4 mm group and the INTmin ≥4 mm group, using the independent t-test or Mann-Whitney test for continuous variables and the χ2 -test for categorical variables. The correlations between the PSEMs and symptoms were analyzed using either the Pearson or Spearman correlation coefficient. RESULTS: The relative total CSA (rTCSA) of the PSEMs, especially the MF, was significantly smaller in the mK-line (-) group. However, the FCSA/CSA of the right deep extensor muscle (DEM) was larger. The asymmetry of the MF TFCSA/TCSA showed a significant difference between the mK-line groups. In the INTmin <4 mm group, the PSEMs rCSA and rFCSA were significantly smaller, while the bilateral MF TFCSA/TCSA and right SSCe TFCSA/TCSA were larger. The asymmetry of the superficial extensor muscle rCSA was significantly lower in the group with INTmin <4 mm. The postoperative modified Japanese Orthopedic Association score (mJOA) and mJOA recovery rate were positively correlated with the INTmin and DEM rCSA and negatively correlated with the asymmetry of MF FCSA/CSA. CONCLUSIONS: In patients with mK-line (-) or INTmin <4 mm, the PSEMs were smaller, and the DEM atrophy and composition changes were predominant. The MF asymmetry was higher in patients with mK-lines (-), whereas the SEM atrophy and asymmetry were more prevalent in patients with INTmin <4 mm. The DEM was related to the preoperative and postoperative mJOA scores. DEM-preserving surgery or DEM-specific rehabilitation exercises can improve the recovery of patients with OPLL during the perioperative period. In addition, attention should be paid to the evaluation of the SEM, especially the SpCa at the C3 and C5 levels.

Efficacy and safety of fractional 1064-nm picosecond laser for atrophic traumatic and surgical scars: A randomized, single-blinded, split-scar-controlled study.

OBJECTIVE: A fractional 1064-nm picosecond laser is an efficient and safe treatment for atrophic acne scars. However, evidence of using a picosecond laser for atrophic posttraumatic and surgical scar therapy is lacking. This study aimed to evaluate the efficacy and safety of using a 1064-nm picosecond laser with a microlens array (MLA) for the treatment of atrophic posttraumatic and surgical scars. METHODS: This was a prospective, intraindividual, single-blinded, randomized split-lesion-controlled trial. Twenty-five subjects with atrophic traumatic or surgical scars that existed for more than 1 year were enrolled. All atrophic scars were divided at the midline into two halves and randomly assigned to a treatment or control side. The treatment group was treated with a 1064-nm picosecond laser with an MLA handpiece (spot size: 6-8 mm, fluence: 1.0-1.2 J/cm2 , repetition rate: 5 Hz, three passes) for 3 monthly sessions. The scar volumes were objectively measured using a three-dimensional (3D) photograph at baseline, 1 month after the first and second treatments, and 3 and 6 months after the final treatment. Subjective assessments were conducted by a blinded dermatologist and patients' self-assessment to evaluate improvements at 3 months after the final treatment. RESULTS: The treated sides exhibited a significant volume reduction, with statistically significant improvements over the control group at 1 month after the first and second treatments and at 3 months after the final treatment (p = 0.024, 0.005, and 0.019, respectively). At 3 months after the final treatment, a blinded dermatologist correctly identified the treated side in 24 of 25 patients (96%). The patients rated the improvements as excellent (>75%) and marked (50%-75%) in 36% and 48% of patients, respectively. CONCLUSION: At 3 months, the 1064-nm picosecond laser with a fractionated MLA can significantly reduce the posttraumatic and postsurgical atrophic scar volume in patients with Fitzpatrick skin types III-V. Insufficient data preclude inferences regarding efficacy at 6 months.

Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis.

Objectives This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG). Methods A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists' evaluation(DE), the patients' overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH). Results Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2. Conclusion FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present. Registration PROSPERO CRD42021242160 (available from https://www.crd.york.ac.uk/prospero).

Temporal lobe atrophy as a potential predictor of functional outcome in older adults with acute ischemic stroke.

BACKGROUND: To explore whether temporal lobe atrophy predicts 3-month functional outcome in a population of patients with anterior circulation acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). METHODS: We retrospectively selected patients > 65 years from our prospective endovascular stroke registry between June 2013 and August 2018. According to 3-month modified Rankin Scale (mRS), patients were divided in two groups, named good (mRS ≤ 2) and poor (mRS > 2) outcome. Measures of temporal lobe atrophy (i.e., interuncal distance [IUD], medial temporal lobe thickness [mTLT] and radial width of temporal horn [rWTH]) were assessed on pre-treatment CT scan. Cutoff values for good outcome were obtained for IUD, mTLT and rWTH by means of non-parametric ROC curve analysis. Multivariate analysis was performed to identify predictors of outcome. Ordinal shift analysis based on cutoff values was built to evaluate differences in 3-month mRS. RESULTS: Among 340 patients, 130 (38.2%) had good and 210 (61.8%) had poor outcome. We found the following cutoff values for good outcome: < 25 mm for IUD, > 15 mm for mTLT and < 4 mm for rWTH. Lower IUD (OR 0.71; 95% CI 0.63-0.80; p < 0.0001) and rWTH (OR 0.73; 95% CI 0.61-0.87; p < 0.0001) and higher mTLT (OR 1.30; 95% CI 1.14-1.49; p < 0.0001) were independently associated with good outcome. Ordinal shift analysis based on cutoff values revealed significant differences in the rate of good outcome for rWTH (49 vs 27%; p < 0.0001), mTLT (52 vs 21%; p < 0.0001) and IUD (57 vs 17%; p < 0.0001). CONCLUSIONS: Assessment of temporal lobe atrophy may predict functional outcome in patients with AIS treated with MT.

15 years' experience in the single-port laparoscopic treatment of pediatric varicocele with Ligasure® technology. / Quince años de experiencia en el tratamiento laparoscópico del varicocele pediátrico con un solo puerto de trabajo y tecnología Ligasure®.

INTRODUCTION: Varicocele is an abnormal dilatation of the internal spermatic veins of the spermatic cord. It has an estimated prevalence of 15% in young male adults. Even though most of them are asymptomatic, scrotal pain and testicular hypotrophy are frequent in children and adolescents. There is controversy regarding the indications and optimal approach for treatment purposes. We present the results of our 15-year series in the laparoscopic repair of pediatric varicocele. MATERIALS AND METHODS: 238 patients diagnosed with varicocele and undergoing laparoscopic repair from 2006 to 2020 were reviewed. Variables collected included age, symptoms, grade, testicular atrophy, hospital stay, perioperative complications, recurrences, and formation of reactive hydrocele. Mean follow-up was 5.6 years (6 months-9 years). RESULTS: Mean age was 14.1 years. 188 patients had grade III varicocele. In 14 cases, varicocele was bilateral. Testicular atrophy at diagnosis was found in 42% of patients, 74% of whom were over 15 years old. 51 patients had testicular pain. All patients underwent laparoscopic treatment. Mean operating time was 36 min. Median hospital stay was 31 h. Recurrence rate was 2.1%. 43 patients (18%) developed hydrocele, but only 27 (11.2%) required hydrocelectomy according to Lord's plication at least 1 year following laparoscopy. Of the remaining 16 cases, 2 spontaneously resolved and 14 remained stable in the mean 7-year follow-up. In 7.1%, paresthesias were noted in the anterior-internal aspect of the left thigh. CONCLUSION: Based on our series, we believe laparoscopy should be regarded as the gold standard technique in the pediatric population. Laparoscopic varicocelectomy is technically easy and fast, causes no pain, and has a recurrence rate of 1%. The procedures involving lymphatic vessel preservation could reduce reactive hydrocele rates as a long-term complication to a minimum.

INTRODUCCION: El varicocele es una dilatación anormal de las venas espermáticas internas del cordón espermático. Su prevalencia se estima en 15% de varones adultos jóvenes. Aunque la mayoría son asintomáticos, en niños y adolescentes el dolor escrotal y la hipotrofia testicular son frecuentes. Existe controversia sobre las indicaciones y el abordaje óptimo para su tratamiento. Presentamos los resultados de nuestra serie de 15 años en la reparación laparoscópica del varicocele pediátrico. MATERIAL Y METODOS: Revisamos 238 pacientes diagnosticados de varicocele y sometidos a corrección laparoscópica desde 2006 hasta 2020. Las variables registradas fueron: edad, síntomas, grado, atrofia testicular, duración de la estancia, complicaciones perioperatorias, recidivas y formación de hidrocele reactivo. El seguimiento medio fue 5,6 años (6 meses-9 años). RESULTADOS: La edad promedio fue 14,1 años. 188 pacientes presentaban varicocele grado III. En 14 casos el varicocele era bilateral. Se observó atrofia testicular en 42% al diagnóstico, de los que el 74% eran mayores de 15 años. Cincuenta y un pacientes refirieron dolor testicular. Todos los pacientes se sometieron al tratamiento laparoscópico. El tiempo operatorio promedio fue 36 min. La mediana de estancia fue 31 horas. La tasa de recidiva fue 2,1%. Cuarenta y tres pacientes desarrollaron hidrocele (18%); pero solo 27 precisaron hidrocelectomía según plicatura de Lord al menos un año poslaparoscopia (11,2%). De los 16 restantes, dos se resolvieron espontáneamente y 14 se mantuvieron estables en el seguimiento medio de siete años. En 7,1% se notificaron parestesias en la cara anterointerna del muslo izquierdo. CONCLUSION: Basándonos en nuestra serie, creemos que la laparoscopia debe considerarse el gold standard en edad pediátrica. La varicocelectomía laparoscópica es técnicamente fácil y rápida, indolora y con una tasa de recurrencia del 1%. Los procedimientos de preservación de los linfáticos podrían reducir al mínimo las tasas de hidrocele reactivo como complicación a largo plazo.

The Effect of Surgical Positioning on Pneumocephalus in Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson Disease.

OBJECTIVES: This research analyzed the effect of surgical positioning on postoperative pneumocephalus and assessed additional potential risk factors of pneumocephalus in subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). MATERIALS AND METHODS: In this study, 255 consecutive patients with PD who received bilateral STN DBS under general anesthesia were retrospectively included. Of these, 180 patients underwent surgery with their heads in an elevated position, and 75 patients underwent surgery in a supine position. The postoperative pneumocephalus volume was compared between the two groups. Other potential risk factors for pneumocephalus also were analyzed. RESULTS: The mean pneumocephalus volume for the group with elevated-head positioning (16.76 ± 15.23 cm3) was greater than for the supine group (3.25 ± 8.78 cm3) (p < 0.001). Multivariable analysis indicated that the pneumocephalus volume was related to surgical positioning, lateral trajectory angle, intraoperative mean arterial pressure (MAP), microelectrode recording (MER) passage number, brain atrophy degree, and the anterior trajectory angle. No correlation was found between pneumocephalus and age, sex, duration of PD, surgery length, or intracranial volume. In the subgroup analysis, the pneumocephalus volume exhibited a negative correlation with intraoperative MAP (r = -0.210, p = 0.005) and positive correlations with degree of brain atrophy (r = 0.242, p = 0.001) and MER passage number (r = 0.184, p = 0.014) in the elevated-head group. Specifically, an MER passage number > 3 was a significant risk factor for pneumocephalus in the elevated-head group. A positive correlation was observed between the pneumocephalus volume and the lateral trajectory angle in both groups (elevated-head positioning, r = 0.153, p = 0.041; supine positioning, r = 0.546, p < 0.001). CONCLUSIONS: In patients with PD who were anesthetized and receiving STN DBS, supine positioning reduced pneumocephalus volume compared with patients with PD receiving STN DBS with their heads elevated. The pneumocephalus volume was negatively correlated with intraoperative MAP and positively correlated with the degree of brain atrophy, the lateral trajectory angle, and the MER passage number.

Subcision in acne scarring: A review of clinical trials.

Post-acne scarring is the most common permanent consequence of acne vulgaris. Subcision is an intervention in which a needle or blunt cannula is inserted under the scar and moved back and forth to cut fibrotic strands and form new connective tissue, thereby elevating the atrophic scars. In this study, we reviewed the efficacy and adverse effects of different subcision techniques alone or in combination with other modalities to manage acne scars. The terms (subcision), (subcision AND acne scar), and (subcision AND scar) were searched in PubMed and Google Scholar. We included all available reports on clinical trials written in English and published before June 2022. A total of 16 relevant articles were identified after reviewing the abstracts and full texts. Four articles compared blunt cannula-based subcision as a modified technique with needle-based subcision as a conventional method, while the others investigated the combination of subcision with other modalities. According to our findings, subcision is a safe and effective method for treating atrophic acne scars. Needle-based subcision and cannula-based subcision offer comparable efficacy, with the latter causing fewer side effects and inducing greater patient satisfaction. Combining subcision with the application of autologous tissues (platelet gel) or artificial materials (hyaluronic acid gels and threads) as fillers can improve outcomes and prevent the re-depressing of scars, as can its combination with frequent suctioning. Combinations with microneedling or fractionated microneedle radiofrequency have also been safe and effective. We conclude that modifications of the subcision procedure lessen its side effects, and combination therapies improve its efficacy.

Effect of mandibular bone atrophy on maxillary and mandibular bone remodeling and quality of life with an implant-retained mandibular overdenture after 3 years.

STATEMENT OF PROBLEM: The medium-term effect of an implant-retained mandibular overdenture on bone remodeling in the maxilla and posterior mandible of edentulous patients and the effects on quality of life have not been established. PURPOSE: The purpose of this prospective observational clinical study was to evaluate the 3-year effects of implant-retained mandibular overdentures on oral-health-related quality of life (OHRQoL) and bone remodeling in different regions of the maxilla and mandible in participants with atrophic or nonatrophic mandibles. MATERIAL AND METHODS: Twenty-six edentulous participants received 2 narrow-diameter implants in the anterior mandible. Mandibular bone atrophy was categorized from presurgical panoramic radiographs according to the Cawood and Howell criteria. OHRQoL was assessed by using the OHIP-EDENT questionnaire. Participants were evaluated annually for 3 years to measure the marginal bone loss and bone area of the posterior mandible, and the anterior and posterior regions of the maxilla were assessed annually through panoramic radiographs. The data were analyzed by using a mixed-effects linear regression to estimate time-dependent trends and a mixed-effect linear regression model to verify differences between groups. The Pearson correlation coefficients between bone variables and 3-year OHIP-EDENT outcomes were calculated. RESULTS: In the third year, atrophic participants had a significantly lower marginal bone loss (0.02 mm) than nonatrophic participants (-0.39 mm) (P=.030). Differences were also found in the functional limitation (nonatrophic=1.82 ±1.75, atrophic participants=1.92 ±1.54; P=.018) and handicap domains (nonatrophic=0.36 ±0.54, atrophic participants=0.08 ±0.27; P=.003). For nonatrophic participants, comparisons between baseline and 3-year outcomes showed significant bone resorption as indicated by the area ratio in the anterior maxilla (P=.035), posterior maxilla (P=.022), and posterior mandible (P=.009). Conversely, the bone area of the anterior maxilla (P=.019) decreased in atrophic participants between baseline and year 1, while the bone area of the anterior maxilla and posterior mandible increased (P<.001) between years 1 and 3. Higher effect sizes were observed in the OHRQoL domains of the atrophic participants. CONCLUSIONS: Bone atrophy influenced both the OHRQoL profile and bone remodeling profile in different regions of the mandible and maxilla in mandibular overdenture users. In atrophic participants, bone tissue in both jaws responded positively to overdenture use, with bone apposition after the first year and bone area preservation in the anterior maxilla, posterior mandible, and peri-implant regions after 3 years of follow-up.

Successful term pregnancy following cervical cerclage for uterine atrophy secondary to childhood radiotherapy.

Pelvic radiotherapy can lead to scarring and atrophy of reproductive organs including the uterus. This may lead to complications, such as preterm birth, during pregnancy. The mechanism by which preterm birth is associated with pelvic radiation is believed to be due to inefficient uterine stretch or a deficient cervix. We report a case of cervical shortening during the second trimester in a pregnant woman with a history of pelvic radiotherapy in childhood. Ultrasound surveillance and cervical cerclage inserted in the shortening cervix successfully prevented preterm labour in this case. Cerclage insertion led to a longer cervix and lower fibronectin. Although cervical cerclage does not influence uterine stretch, it may be able to prevent cervical dilatation and therefore prevent ascending infections and subsequent inflammatory sequelae which results in preterm labour. We recommend cervical surveillance and targeted cerclage interventions to prevent preterm labour in women with prior childhood pelvic radiotherapy.

Platelet-rich plasma in the treatment of scars, to suggest or not to suggest? A systematic review and meta-analysis.

Despite the rising trend for applying platelet-rich plasma (PRP) in the management of various types of scars, there is no convincing evidence supporting its use. This motivated us to review the randomized clinical trials that examine the effectiveness and safety of PRP, alone or in combination with other methods, for the management of atrophic or hypertrophic/keloidal scars. The Web of Science, Scopus, Google Scholar, and Cochrane Library databases were systematically searched until September 1st , 2020. Thirteen clinical trials were enrolled in the meta-analysis, and 10 more were reviewed for their results. The random effect meta-analysis method was used to assess the effect size of each outcome for each treatment type, and I2 was used to calculate the statistical heterogeneity between the studies. Patients treated with PRP experienced an overall response rate of 23%, comparable to the results seen with laser or micro-needling (22% and 23%, respectively) When used alone, moderate improvement was the most frequently observed degree of response with PRP (36%) whereas, when added to laser or micro-needling, most patients experienced marked (33%, 43%, respectively) or excellent (32% and 23%, respectively) results. Concerning the hypertrophic/keloid scars, the only study meeting the required criteria reported a better improvement and fewer adverse effects when PRP was added to the intralesional corticosteroids. Platelet-rich plasma appears to be a safe and effective treatment for various types of atrophic scars. In addition, when added to ablative lasers or micro-needling, it seems to considerably add to the efficacy of treatment and reduce the side effects.

Ocular malignancies treated with iodine-125 low dose rate (LDR) brachytherapy at a single high-volume institution: A retrospective review.

The aim of our study is to document our cases of choroidal melanoma treated with low dose rate (LDR) brachytherapy and to correlate the dosimetry and radiobiology with clinical effects and oncologic outcomes. Data from 157 patients treated from 2014 to 2018 with LDR brachytherapy were used for this investigation. Treatments used a collaborative ocular melanoma study eye plaque and Iodine-125 radioactive seeds. The seeds activities were chosen to deliver 85 Gy to the tumor apex or to a prescription point (if the apex < 5 mm). The plaque sizes used were 10, 12, 14, 16, 18, 20, and 22 mm including notched or deep notched. The plaques were modeled in Varian BrachyVision version 11.6 (Varian Medical Systems) with seed coordinates from the AAPM Task Group 129. The Task Group 43 from AAPM was used for brachytherapy dose planning. Dose data were extracted for the apex, prescription point, sclera, retina opposite to the implant, lens, macula, and optic disc. The radiobiological dosimetry were calculated using appropriate α/ß ratios found in the literature and then correlated to clinical side effects. Average biologically effective dose for associated organs at risk were calculated in cases where toxicity occurred. These included: radiation cataract (70.66 Gy), disc atrophy (475.49 Gy), foveal atrophy (263.07 Gy), radiation papillopathy (373.45 Gy), radiation maculopathy (213.62 Gy), vitreous hemorrhage (1437.68 Gy), vascular occlusion (1080.93 Gy), nonproliferative retinopathy (1066.89 Gy), proliferative retinopathy (1590.71 Gy), exudative retinal detachment (1364.32 Gy), and rhegmatogenous retinal detachment (2265.54 Gy). Average biologically effective dose was higher in patients who developed radiation induced long term side effects than in the whole patient population except for radiation maculopathy. In spite of the small patient population and short-term follow-up, it is of interest to correlate the radiation induced effects and create a guideline for the improvement of the treatment of patients treated with LDR brachytherapy.

Improving the outcome of treating striae gravidarum by combined therapies using topical ß-glucan and 1565-nm non-ablative fractional laser: A prospective randomized vehicle-controlled parallel group study.

Striae gravidarum (SG) is a kind of dermal scar associated with psychosocial and therapeutic challenge. Topical reagents and non-invasive laser are more preferred than invasive procedures for less pain and shorter downtime. However, there are few studies on comparing and combining these two modalities. The aim of the present study was to evaluate the efficacy and tolerance of a topical regimen containing ß-glucan, 1565-nm non-ablative fractional laser (NAFL; ResurFX), and combination of them for SG. A total of 128 unilateral abdomens from 64 subjects were randomly divided into four strategies and were followed up for 12 weeks: topical vehicle (Veh); topical ß-glucan (B); 1565-nm NAFL combined topical vehicle (NAFL); 1565-nm NAFL combined topical ß-glucan (B + NAFL). NAFL was applied three times with a 4-week interval. Topical reagent was applied b.i.d. for 12 weeks. Global Aesthetic Improvement Scale (GAIS) scores were assessed by blinded physician according to standard photograph, and by subjects at 12th week. The degree of SG atrophy was assessed by blinded physician before treatment and at the 12th week according to a standard 5-point scale. Collagen remodeling was evaluated by histological analysis and all adverse effects were recorded. A total of 56 women (112 unilateral abdomens) completed all study. The GAIS scores by blinded physician showed greater improvement in NAFL as compared with ß-glucan, and by subjects showed greater improvement in ß-glucan as compared with vehicle. In terms of striae atrophy scale, the improvement of SG atrophy was more prominent in NAFL compared to ß-glucan, and in ß-glucan + NAFL compared to Veh + NAFL. All treatments were well tolerated. Topical ß-glucan regimen can mildly improve SG. NAFL showed better results than topical ß-glucan regimen. The combined strategy may further improve the SG atrophy compared with single treatment strategy.

Autologous platelet-rich plasma 'fluid' versus 'gel' form in combination with fractional CO2 laser in the treatment of atrophic acne scars: a split-face randomized clinical trial.

BACKGROUND: The treatment of atrophic acne scars represents a therapeutic challenge. Recently, plasma gel has been introduced among treatment modalities. OBJECTIVE: To compare the efficacy of platelet-rich-plasma 'fluid' versus 'gel' form combined with fractional CO2 laser in the treatment of atrophic acne scars. METHODS: Twenty-seven patients with atrophic acne scars were included. Treatment with fractional CO2 laser plus plasma fluid/gel was randomly assigned to the right/left sides of the face. Clinical and Optical Coherence Tomography (OCT) assessments were scheduled at baseline, one month, and three months after the last session. RESULTS: There was a significant improvement in clinical assessment scores at third-month follow-up on the plasma gel- and plasma fluid-treated sides compared to those at the first-month follow-up (p < .001). Scar depth decreased significantly at third-month follow-up when compared to baseline on both plasma gel- and plasma fluid-treated sides (p < .001). The numerical pain score was significantly lower on the plasma fluid-treated side compared to the plasma gel-treated side (p = .004). CONCLUSION: The use of platelet-rich plasma in combination with fractional CO2 laser, both in fluid and gel form, produced significant results in the treatment of atrophic acne scars. Patients reported an immediate more noticeable effect with plasma gel. However, the fluid injection was less painful.

Delayed development of cerebral atrophy after cerebral hyperperfusion following arterial bypass for adult patients with ischemic moyamoya disease: supplementary analysis of a 5-year prospective cohort.

BACKGROUND: Adult patients with moyamoya disease (MMD) occasionally exhibit cerebral hyperperfusion after arterial bypass surgery, leading to persistent cognitive decline. The present supplementary analysis of a prospective 5-year cohort study aimed to determine whether cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD causes cerebral atrophy, and whether the development of cerebral atrophy is related to persistent cognitive decline. METHODS: In total, 31 patients who underwent arterial bypass surgery also underwent fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and neuropsychological testing before surgery and at the end of a 5-year follow-up. The development of cerebral hyperperfusion and hyperperfusion syndrome after surgery was defined based on brain perfusion single-photon emission computed tomography (SPECT) findings and clinical symptoms. Univariate and multivariate logistic regression analyses of factors related to the development of cerebral atrophy on FLAIR MRI or cognitive decline on neuropsychological testing at the end of the 5-year follow-up were performed. RESULTS: Eleven patients (35%) developed cerebral atrophy in the frontal lobe where the superficial temporal artery was anastomosed. Cerebral hyperperfusion on brain perfusion SPECT (odds ratio [OR], 50.6; p = 0.0008) or cerebral hyperperfusion syndrome (OR, 41.8; p = 0.0026) was independently associated with the development of cerebral atrophy, and cerebral atrophy development was significantly associated with cognitive decline (OR, 47.7; p = 0.0010). CONCLUSIONS: Cerebral hyperperfusion after arterial bypass surgery for adult patients with misery perfusion due to ischemic MMD can cause cerebral atrophy related to persistent cognitive decline.