Post-stroke cognitive impairment on the Mini-Mental State Examination primarily relates to left middle cerebral artery infarcts.

BACKGROUND: Post-stroke cognitive impairment can occur after damage to various brain regions, and cognitive deficits depend on infarct location. The Mini-Mental State Examination (MMSE) is still widely used to assess post-stroke cognition, but it has been criticized for capturing only certain cognitive deficits. Along these lines, it might be hypothesized that cognitive deficits as measured with the MMSE primarily involve certain infarct locations. AIMS: This comprehensive lesion-symptom mapping study aimed to determine which acute infarct locations are associated with post-stroke cognitive impairment on the MMSE. METHODS: We examined associations between impairment on the MMSE (<5th percentile; normative data) and infarct location in 1198 patients (age 67 ± 12 years, 43% female) with acute ischemic stroke using voxel-based lesion-symptom mapping. As a frame of reference, infarct patterns associated with impairments in individual cognitive domains were determined, based on a more detailed neuropsychological assessment. RESULTS: Impairment on the MMSE was present in 420 patients (35%). Large voxel clusters in the left middle cerebral artery territory and thalamus were significantly (p < 0.01) associated with cognitive impairment on the MMSE, with highest odds ratios (>15) in the thalamus and superior temporal gyrus. In comparison, domain-specific impairments were related to various infarct patterns across both hemispheres including the left medial temporal lobe (verbal memory) and right parietal lobe (visuospatial functioning). CONCLUSIONS: Our findings indicate that post-stroke cognitive impairment on the MMSE primarily relates to infarct locations in the left middle cerebral artery territory. The MMSE is apparently less sensitive to cognitive deficits that specifically relate to other locations.

A multicenter, randomized, open-label comparative study of prabotulinumtoxinA with two different dosages and diverse proportional injection styles for the reduction of gastrocnemius muscle hypertrophy in Asian women.

A botulinum toxin (BTX) injection can be a simple and safe alternative to calf reduction surgery or liposuction without interrupting daily life. However, its optimum dosage and clinical response are not yet well known. A total of 40 patients with bilateral gastrocnemius muscle hypertrophy were enrolled in this study. All volunteers were randomly categorized into four groups and then administered different amounts of BTX (160 U and 200 U) on the medial and lateral aspects of their calves. All subjects showed clinical improvement with a reduction in the gastrocnemius muscle size after BTX injection. However, our results showed that the decrease in leg circumference was not dose dependent. No side effects of the injections, such as weakness of the legs, deformity, or abnormal sensation, were observed. There were also no cases of swelling, edema, hematoma, or infection. BTX at both dosages can be safely and effectively applied for calf muscle contouring without disturbing gait during walking or running.

Efficacy of light-emitting diode photomodulation in reducing erythema after fractional carbon dioxide laser resurfacing: a pilot study.

BACKGROUND: The most common side effects of fractional carbon dioxide (CO2 ) laser resurfacing are erythema and edema of the treated skin. Light-emitting diode (LED) devices have been shown to stimulate fibroblast activity and hasten wound healing. The current study was designed to evaluate the efficacy of such LED devices in treating post-laser therapy erythema. OBJECTIVES: To evaluate the clinical efficacy of LED photomodulation in reducing erythema resulting from ablative fractional CO2 laser resurfacing. MATERIALS AND METHODS: Randomly selected facial halves of 10 Korean subjects (Fitzpatrick skin type III-IV) were treated using a 635-nm wavelength LED array immediately after full-face fractional laser skin resurfacing. Each participant was subsequently treated with LED daily for the following 7 days. Clinical photographs, subjective physician assessment, and chromometer erythema index were used to track the results, with clinical improvement assessed using a 5-point grading scale. RESULTS: The postlaser erythema resolved faster on the experimental side than the control side, with improvements noted according to physician assessment and chromometer erythema index. Statistically significant improvements between the two sides were first noted on day 4. CONCLUSION: Treatment using a 635-nm-wavelength LED array decreases the intensity and duration of post-fractional CO2 laser treatment erythema.

Efficacy and safety of a novel botulinum toxin type A product for the treatment of moderate to severe glabellar lines: a randomized, double-blind, active-controlled multicenter study.

BACKGROUND: A new botulinum toxin type A (NBoNT) produced from the same strain of Clostridium botulinum as onabotulinumtoxinA (OBoNT) is widely used in Asia. OBJECTIVES: To compare the efficacy and safety of NBoNT and OBoNT for moderate to severe glabellar wrinkles. METHODS: A double-blind, randomized, active-controlled, phase III study was performed. Three hundred fourteen patients were randomized at a 1:1 ratio to receive 20 U of toxin. The primary end point was the responder rate according to investigator live assessment at maximum frown at week 4. Secondary end points were responder rates according to investigator live assessment with frowning and at rest at weeks 8, 12, and 16, with additional photographic assessment by a panel of blinded raters 4 weeks after injection. Subjective satisfaction scores were also evaluated. RESULTS: Four weeks after treatment, responder rates for maximum frown were 93.7% (133/142) in the NBoNT group and 94.5% (138/146) in the OBoNT group. For secondary end points, there was no significant difference between the two groups for any variable at any time point. Noninferiority of NBoNT was confirmed. There were no serious adverse effects with either toxin. CONCLUSION: NBoNT is equally as effective as OBoNT for the treatment of glabellar frown lines. Both toxins were well tolerated.

Facial skin barrier function recovery after microneedle transdermal delivery treatment.

BACKGROUND: Microneedle treatment is currently used in the cosmetic industry for several skin conditions. Despite their extensive use, there is lack of sufficient data on the safety of microneedles. OBJECTIVE: To investigate the degree of acute skin damage and the time required for facial skin barrier function to recover using different microneedle lengths and numbers of applications. MATERIALS AND METHODS: Each side of a volunteer's face was randomly treated with one of the following treatments: five applications of 0.15-mm microneedles, five applications of 0.25-mm microneedles, 10 applications of 0.15-mm microneedles, or 10 applications of 0.25-mm microneedles. Transepidermal water loss, stratum corneum hydration, and skin erythema were measured at baseline, immediately after treatment, 4 hours after treatment, and 8 hours after treatment and at 24-hour intervals for 3 days. RESULTS: Prompt recovery of barrier function (within 72 hours) was observed after microneedle treatment. CONCLUSION: Microneedle treatment is simple and inexpensive, and the skin barrier disruption it causes resolves quickly. Therefore, it can serve as an effective physical method of enhancing transdermal delivery of medications for the treatment of many cosmetic and dermatological conditions.

Selective sebaceous gland electrothermolysis as a treatment for acne: a prospective pilot study.

Although many therapeutic options exist for acne, relapse often occurs after treatment is stopped. Some preliminary evidence suggests that selective electrothermolysis of the sebaceous glands may represent a novel therapeutic intervention. This trial was conducted to evaluate the efficacy and tolerability of selective sebaceous gland electrothermolysis for the treatment of facial acne. Twelve patients with facial acne were enrolled, all of whom underwent three sessions of therapy. During each session, a 1.5-mm long needle with 0.45-mm of base insulation was inserted into pores of acne lesions. Upon insertion, a high-frequency electrical current was applied for 0.25-0.50 seconds, for a total output of 40 W. Each treatment session took approximately 30-60 minutes. Subject response to therapy was evaluated at one month and 12 months after the final treatment. All the enrolled subjects completed the study and all reported satisfaction with treatment results. In all cases, a reduction in inflammatory and noninflammatory lesion counts was observed after three sessions of selective electrothermolysis, although a few small papules and comedones persisted in several areas of untreated facial skin. Mean lesion reduction at one month after the final treatment was 98.14% for inflammatory lesions and 83.09% for noninflammatory lesions. Clinical success was achieved in the majority of patients (seven of 12 patients) at one month after the second treatment and in all patients at one month after the final treatment. All patients reported transient post-treatment erythema, which faded after a few days. Clinically evident relapse occurred in two of 12 patients (16.7%) one year after the final treatment session. Selective sebaceous gland electrothermolysis can be a safe and effective method of achieving consistent remission in acne.