Handheld dermatoscope versus digital camera for hair counts in laser facial hair removal.

The lack of uniform and objective techniques to evaluate treatment efficacy in photo-epilation studies leads to contradictory results. Thus, there is an urgent need to explore commonly accepted assessment tools. One of the most common methods uses hair counts via digital photography. However, macrophotography may not be able to depict the vellus-like hair induced by photo-epilation. On the other hand, handheld dermatoscopy is practical, affordable and offers high-quality magnification. Hair counts from a handheld dermatoscope and a digital camera were compared in 73 women who underwent 6 sessions with the Alexandrite 755 nm laser. Significantly more hairs were counted using the dermatoscope than using the digital camera (76.9 ± 41.3 vs. 58.6 ± 31.4, p < .005), independently of hair thickness and hair density. The difference in hair counts between the two instruments was inversely related to hair thickness and directly related to hair density. The handheld dermatoscope may be a more effective tool than the widely used digital camera in evaluating the response to laser hair removal treatment.

Iontophoresis in dermal delivery: A review of applications in dermato-cosmetic and aesthetic sciences.

OBJECTIVE: Iontophoresis is defined as the use of electric current to drive molecules across cell membranes through an electrolyte solution. In therapeutic context, it is used to facilitate the administration of bioactive substances, either systemically or locally. The technique presents various advantages and that is why it has been successfully used by a plethora of medical sciences. The constantly developing field of dermato-cosmetic science has also taken advantage of the possibilities offered by iontophoresis, aiming to enhance the delivery of the applied active ingredients and, thus, induce the desired cosmetic effects. METHODS: The available literature was examined for evidence-based reports of safe and successful iontophoresis of pharmaceutical and cosmetic substances, in order to explore different iontophoretic applications in the field of dermato-cosmetic and dermato-aesthetic sciences. CONCLUSION: Iontophoresis can be safely and successfully used in the treatment of ageing, photoageing, hyperpigmentation, oxidative stress, hair loss, hair removal, acne, acne sequelae and cellulite, providing many possibilities for enhanced treatment results.

OBJECTIF: L'iontophorèse est définie comme l'utilization d'un courant électrique pour faire traverser les membranes cellulaires avec une solution électrolytique. Dans un contexte thérapeutique, elle est utilisée pour faciliter l'administration de substances bioactives, que ce soit par voie systémique ou locale. Cette technique présente divers avantages et c'est pourquoi elle a été utilisée avec succès par une pléthore de sciences médicales. Le domaine en constante évolution de la science dermato-cosmétique a également tiré parti des possibilités offertes par l'iontophorèse, dans le but d'améliorer l'administration des principes actifs appliqués et, ainsi, d'induire les effets cosmétiques souhaités. MÉTHODES: La littérature disponible a été examinée à la recherche de rapports fondés sur des preuves concernant l'iontophorèse sûre et réussie de substances pharmaceutiques et cosmétiques, afin d'explorer différentes applications iontophorétiques dans le domaine des sciences dermato-cosmétiques et dermato-esthétiques. CONCLUSION: L'iontophorèse peut être utilisée avec succès et en toute sécurité dans le traitement du vieillissement, du photovieillissement, de l'hyperpigmentation, du stress oxydatif, de la chute des cheveux, de l'épilation, de l'acné, des séquelles de l'acné et de la cellulite, offrant ainsi de nombreuses possibilités d'amélioration des résultats du traitement.

Worldwide actions against plastic pollution from microbeads and microplastics in cosmetics focusing on European policies. Has the issue been handled effectively?

Microbeads are solid primary microplastics < 5 mm in diameter that are added to cosmetic products for cleansing and/or exfoliation of the skin. After use, they are discharged into the drain and end up in Wastewater Treatment Plants (WWTPs), from which they can escape into waters. Once disposed, there is no efficient method of recovery and the environmental conditions do not allow full biodegradation. Focusing mainly on the possible effect of microbeads on the environment and the human health, and taking into account that there have always been alternatives with similar cost, scientists suggested banning microbeads from cosmetic products. Despite the increasing knowledge on the microplastics' effects, the pressure from non-governmental organizations (NGO's) and the increasing public concern, few European and other countries worldwide have taken legislative steps against microbeads, and even fewer against other microplastics used in cosmetic products, mainly because it is a common belief that cosmetic industries responded massively to the call for a phase-out. Although EU acted soon after scientists focused on microbeads' effects by restricting cosmetics with microbeads to bare the EU Ecolabel in 2014, there is still no European-wide ban, which will probably take place as of 2022. Present study offers a thorough literature review on the presence of microbeads in cosmetics up to date, focusing primarily on the actions against their use, and questioning whether future pollution from microbeads or/and microplastics in cosmetics has been successfully handled.

Predicting developmental dysplasia of the hip in at-risk newborns.

BACKGROUND: The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring. Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum. METHODS: Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH - we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n = 2191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth. The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded. RESULTS: The risk model includes four predictors: female sex (OR = 5.6; 95% CI: 2.9-10.9; P <  0.001); first degree family history of DDH (OR = 4.5; 95% CI: 2.3-9.0; P <  0.001), birthweight > 4000 g (OR = 1.6; 95% CI: 0.6-4.2; P = 0.34), and abnormal examination of hip (OR = 58.8; 95% CI: 31.9, 108.5; P <  0.001). This model demonstrated excellent discrimination (C statistic = 0.9) and calibration of observed and predicted risk (P = 0.35). A model without the variable 'hip examination' demonstrated similar performance. CONCLUSION: The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.

The use of low-intensity pulsed ultrasound in hand and wrist nonunions.

The management of hand and wrist nonunions is challenging and alternatives or adjuncts to surgery to promote healing are an attractive prospect. Low-intensity pulsed ultrasound (LIPUS) is reported to improve bone healing and is supported for use in nonunions. However, evidence supporting its use for established nonunions is based largely on long bones, with little evidence guiding use in the hand and wrist. The objective of this study is to present our experience using LIPUS in established nonunions of the hand and wrist. This is a retrospective cohort study of hand and wrist nonunions managed with LIPUS in two UK tertiary referral centers. Nonunion was defined as the failure of fracture healing at a minimum of 9 months post injury. Demographic and clinical data including nonunion site, union rates, surgery and time from surgery to LIPUS application were obtained from electronic patient and LIPUS device records. Patients were subcategorized into early or delayed LIPUS applications groups. Twenty-six hand and wrist nonunions were treated with LIPUS alone or as a surgical adjunct. The overall union rate was 62%. Age, sex, fracture characteristics and previous treatment had no significant effect on union rates. There was no association between LIPUS timing and union following adjustment for co-variates. Our findings suggest previously quoted union rates using LIPUS for lower limb nonunions may not be achievable in the hand and wrist. However, LIPUS offers a safe adjunct to surgery and may offer a potential alternative when surgery is not feasible. Further prospective comparative studies are required before the efficacy of LIPUS for hand and wrist nonunions is proven.

Dip and drip, swipe or squeeze? The best method of draining water for optimal strength in a plaster of Paris backslab.

Plaster of Paris backslabs are used post-operatively to provide stability and protect repaired structures. We hypothesized that forceful expulsion of excess water during backslab construction could weaken the backslab by reducing the final gypsum content. Our aim was to compare the final dry mass and strength of backslabs prepared by three different techniques: 'dip and drip', 'swipe' and 'squeeze'. We applied an increasing force until the point of failure of the 30 backslabs prepared by the three methods. Backslabs prepared by swiping or squeezing away excess water were 9% lighter and 26% weaker and 13% lighter and 33% weaker, respectively, in comparison with simple drip drainage, and all results were statistically significant. We conclude that forceful drainage of excess water produces significantly weaker backslabs.

Patient-reported outcome (PRO) questionnaires for men who have radical surgery for prostate cancer: a conceptual review of existing instruments.

To critically review conceptual frameworks for available patient-reported outcome (PRO) questionnaires in men having radical prostatectomy (RP), psychometrically evaluate each questionnaire, and identify whether each is appropriate for use at the level of the individual patient. We searched PubMed, the Reports and Publications database of the University of Oxford Patient-Reported Outcomes Measurement Group and the website of the International Consortium for Health Outcomes Measurement (ICHOM) for psychometric reviews of prostate cancer-specific PRO questionnaires. From these we identified relevant questionnaires and critically appraised the conceptual content, guided by the Wilson and Cleary framework and psychometric properties, using well established criteria. The searches found four reviews and one recommendation paper. We identified seven prostate cancer-specific PROs: the Expanded Prostate Cancer Index Composite-26 (EPIC-26), Expanded Prostate Cancer Index Composite-50 (EPIC-50), University of California-Los Angeles Prostate Cancer Index (UCLA-PCI), Functional Assessment of Cancer Therapy - Prostate Cancer Subscale (FACT-P PCS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - prostate specific 25-item (EORTC QLQ-PR25), Prostate Cancer - Quality of Life (PC-QoL), and Symptom Tracking and Reporting (STAR). Six out of seven measures purported to measure health-related quality of life (HRQL), but items focused strongly on urinary and sexual symptoms/functioning. The remaining questionnaire (STAR) claimed to assess functional recovery after RP. The psychometric evidence for these questionnaires was incomplete and variable in quality; none had evidence that they were appropriate for use with individual patients. Several questionnaires provide the basis of measures of urinary and/or sexual symptoms/functioning. Further work should explore other aspects of HRQL that are important for men having RP. Further psychometric work is also needed to determine whether they can be used at the individual level.

Association between the ossific nucleus and osteonecrosis in treating developmental dysplasia of the Hip: updated meta-analysis.

BACKGROUND: A meta-analysis concluded that there was no effect of the femoral head ossification and the incidence of osteonecrosis in the treatment of developmental dysplasia of the hip (DDH), unless only osteonecrosis grades II-IV were considered. The meta-analysis, limited due to the small number of studies available at that time, identified a need for an update as further research emerges. We observed a trend in recent years towards delaying treatment of DDH in the absence of an ossified nucleus. Numerous new publications on this topic encouraged us to update the 2009 meta-analysis. METHODS: We performed a systematic review of the literature from 1967 to 2016 and included studies that reported on the treatment of DDH, the ossific nucleus and osteonecrosis. Two independent reviewers evaluated all articles. We performed a meta-analysis with the main outcome defined as the development of osteonecrosis of the femoral head at least two years after closed or open reduction. RESULTS: Of four prospective and ten retrospective studies included in the systematic review, 11 studies (1,021 hips) met the inclusion criteria for the meta-analysis. There was no significant effect of the ossific nucleus on the development of all grades of osteonecrosis (relative risk, 0.88; 95% confidence interval, 0.56-1.41) or osteonecrosis grades II-IV (0.67; 0.41-1.08). In closed reductions, the ossific nucleus halved the risk for developing osteonecrosis grades II-IV (0.50; 0.26-0.94). CONCLUSIONS: Based on current evidence there does not appear to be a protective effect of the ossific nucleus on the development of osteonecrosis. In contrast to the previous meta-analysis, this update demonstrates that this remains the case irrespective of the grade of osteonecrosis considered relevant. This updated meta-analysis is based on twice as many studies with a higher quality of evidence.

The most relevant diagnostic criteria for developmental dysplasia of the hip: a study of British specialists.

BACKGROUND: Developmental dysplasia of the hip (DDH) is the most common orthopaedic disorder in newborns. Despite this considerable variation in practice exists. The aim of this study was to determine the clinical relevance and a ranking order for the diagnostic criteria in DDH amongst paediatric orthopaedic surgeons practicing in the UK. METHOD: One hundred members of the British Society of Children's Orthopaedic Surgery (BSCOS) were asked to rate the importance of 37 criteria useful in the diagnosis of DDH in newborns, using a 10 cm visual analogue scale. We determined the consistency among specialists in rating the criteria with the intraclass correlation coefficient (ICC) and compared the results to a group of international peers. RESULTS: Ortolani/Barlow tests, asymmetry in abduction ≥20° and a first-degree relative treated for DDH ranked among the top ten. Participants demonstrated poor consistency in rating the 37 criteria (ICC 0.39; 95% CI 0.29, 0.52), but for clinical examination criteria alone their consistency improved (ICC 0.52; 0.35, 0.75). The importance ratings of members of BSCOS and members of the European Paediatric Orthopaedic Society differed for 15/37 (41%) criteria (p <0.05). CONCLUSIONS: Members of BSCOS had a preference for criteria relating to clinical examination and ultrasound.

Weighted diagnostic criteria for developmental dysplasia of the hip.

OBJECTIVE: To establish clinical diagnostic criteria for developmental dysplasia of the hip (DDH) that model the practices of expert clinicians. STUDY DESIGN: Of 23 clinical criteria for the diagnosis of DDH, ranked in order of diagnostic importance by international consensus, the 7 most highly ranked were placed in all possible combinations to create unique case vignettes. Twenty-six experts rated 52 vignettes for the presence of DDH. We modeled the data to determine which of the 7 criteria were associated with a clinician's opinion that the vignette represented DDH. From the resulting regression coefficients, for each vignette we calculated a probability of DDH. An independent panel rated the same vignettes using a visual analog scale response. We correlated the visual analog scale ratings with probabilities derived from the model. RESULTS: Our model identified 4 of 7 criteria as predictive of DDH (P < .001): Ortolani/Barlow test (ß = 3.26), limited abduction (ß = 1.48), leg length discrepancy (ß = 0.74), and first-degree family history of DDH (ß = 1.39). There was substantial correlation between the probability of DDH predicted by the model and that derived from an independent expert panel (r = 0.73; P < .001). CONCLUSION: Weighted clinical criteria for inferring the likelihood of DDH produced consistent results in the judgment of 2 separate groups of experts. Using these weights, nonexperts could establish the probability of DDH in a manner approaching the practice of clinical experts.

Variations in the use of diagnostic criteria for developmental dysplasia of the hip.

BACKGROUND: Wide variation exists in reported prevalence estimates and management standards of developmental dysplasia of the hip (DDH). Discrepancies in diagnosticians' opinions may explain some of this variation. QUESTIONS/PURPOSES: We sought to determine (1) the consistency with which pediatric orthopaedic surgeons rate the importance of diagnostic criteria for DDH, and (2) whether there were geographic differences in how the diagnostic criteria were rated by surgeons. METHODS: One hundred ninety-seven of 220 members of the European Paediatric Orthopaedic Society and 100 of 148 members of the British Society of Children's Orthopaedic Surgery treating children with DDH participated in this cross-sectional study across 35 countries (15 regions). Each rated 37 items in four domains that specialists previously had identified as the most important features associated with DDH in early infancy. We determined consistency using the intraclass correlation coefficient (ICC; two-way random-effects model) interpreted as poor (0-0.40), acceptable (0.41-0.74), or good (≥ 0.75). RESULTS: Poor consistency among surgeons was found in rating the 37 diagnostic criteria (ICC, 0.33; 95% CI, 0.24-0.45). Consistency was poor for three domains (patient characteristics/history: ICC, 0.29; 95% CI, 0.16-0.58; ultrasound: ICC, 0.26; 95% CI, 0.14-0.52; radiography: ICC, 0.34; 95% CI, 0.12-0.95) and acceptable for one (clinical examination: ICC, 0.50; 95% CI, 0.33-0.73). Surgeons in particular regions appeared to have a concept of DDH diagnosis that distinguished them from specialists of other regions; consistency in eight regions was greater (ICC ≥ 0.40) than consistency among all 15 regions. CONCLUSIONS: The consistency of specialists in rating diagnostic criteria for DDH was lower than expected, and there was considerable geographic variation in terms of how specialists assigned importance ratings of the diagnostic criteria; these findings are somewhat counterintuitive, given the frequency with which this condition is diagnosed. These inconsistencies could explain, partly, the widely differing prevalence estimates and management standards of DDH.

Osteonecrosis complicating developmental dysplasia of the hip compromises subsequent acetabular remodeling.

BACKGROUND: Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear. QUESTIONS/PURPOSES: Using four measures of acetabular development, we (1) determined whether acetabular remodeling differed in hips with and without osteonecrosis; and (2) determined the impact of severity of osteonecrosis contributing to acetabular remodeling. METHODS: We retrospectively reviewed 95 patients (118 hips) treated for DDH by closed or open reduction with or without femoral osteotomy between 1992 and 2006. We evaluated serial radiographs from the time when a stable reduction had been achieved. In 902 radiographs taken over 19 years, we measured the acetabular index and three other indices of hip development. Patients were followed for a mean of 8 years (range, 1-19 years). At last followup, 86 of the 118 hips (73%) had osteonecrosis according to the criteria by Bucholz and Ogden. RESULTS: The acetabular index improved with time in all hips but the magnitude of improvement was larger in hips without osteonecrosis. The adjusted mean acetabular index at 14 years was 17° for hips with osteonecrosis (95% CI, 15°-18°) and 10° for hips without osteonecrosis (95% CI, 7°-13°). The lateral centering ratio improved after reduction to a normal value less than 0.85 in both groups but the rate of change with 0.06 versus 0.05 was higher in hips with osteonecrosis. The superior centering ratio was worse at all times in hips with osteonecrosis with a mean difference of 0.04. If only radiographic changes of Grades II and greater were considered osteonecrosis, the mean adjusted acetabular index at 14 years was 17.7° (15.6°-19.7°) for hips with osteonecrosis and 12.4° (10.3°-14.4°) for hips without osteonecrosis. CONCLUSIONS: Although radiographic indices improved consistently with time in hips without osteonecrosis, hips with osteonecrosis had abnormal indices of acetabular remodeling throughout followup. Osteonecrosis of the femoral head inhibited acetabular remodeling. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Does Pain Acceptance Predict Physical and Psychological Outcomes in Cancer Outpatients with Pain?

Pain acceptance has been associated with improved physical and psychosocial well-being in chronic non-malignant pain patients. However, its effects are unclear in cancer outpatients with pain. Our aim was to determine whether pain acceptance predicts reduced pain, pain interference with function, anxiety, and depression in cancer outpatients. We recruited 116 outpatients from a tertiary oncology center, with various types of cancer and pain levels. Patients completed the Brief Pain Inventory, the Hospital Anxiety and Depression Scale and the Chronic Pain Acceptance Questionnaire, the latter of which comprises activity engagement and pain willingness. We carried out multiple regression analyses, adjusting for patient characteristics and outcomes. Activity engagement and pain willingness significantly predicted pain interference with function (P=0.033 and P=0.041 respectively). However, only activity engagement predicted anxiety (P=0.001) and depression (P<0.001). These findings support the beneficial role of pain acceptance in patients' functional adaptation to cancer-related pain. Activity engagement in particular, shows promise in fostering psychological well-being. Further studies could confirm its role in reducing anxiety and depression in cancer patients with pain and whether it should be included in cancer pain management interventions. Further studies could confirm its role in reducing anxiety and depression in cancer patients with pain, and whether it should be included in cancer pain management interventions.