Elastografía por ultrasonido endoscópico en el tumor de recto / Endoscopic ultrasound elastography in the rectal tumor

Introducción: Para definir una adecuada estrategia terapéutica en el cáncer de recto es preciso una correcta estadificación. El ultrasonido endoscópico es un método de estadiaje preciso que define la profundidad del tumor y el estado nodal. En los tumores tratados con radioterapia disminuye su rentabilidad por la fibrosis que se origina en la pared rectal; indistinguible de los elementos de malignidad. La elastografía brinda la posibilidad de resolver esta limitación. Objetivo: Ofrecer una actualización sobre la elastografía por ultrasonido endoscópico en el diagnóstico del paciente con tumor rectal. Desarrollo: La elastografía se basa en las alteraciones que en la elasticidad del tejido inducen la fibrosis y el cáncer. Determina si un tejido es maligno o benigno mediante el análisis de su dureza. Se obtienen imágenes que se expresan en un mapa de colores superpuestas a la imagen convencional del ultrasonido endoscópico. Muchas investigaciones demuestran su elevada sensibilidad y especificidad en tumores de páncreas y ganglios linfáticos, algunas en tumores de esófago, sin embargo muy pocas en el cáncer rectal. Conclusiones: La elastografía ha mejorado el diagnóstico y seguimiento oncológico del paciente con tumor rectal(AU)

Introduction: To define an adequate therapeutic strategy in rectal cancer, a correct staging is necessary. For this, advanced diagnostic means have been developed to evaluate the rectal wall. Endoscopic Ultrasound a fundamental technique; combines endoscopic image with ultrasound; in tumors treated with radiotherapy, its profitability decreases due to fibrosis that originates in the rectal wall; indistinguishable from the elements of malignancy. Elastography offers the possibility of resolving this limitation. Objective: To offer an update on elastography by endoscopic ultrasound in the diagnosis of the patient with rectal tumor. Development: Elastography is based on the alterations that fibrosis and cancer induce in the elasticity of the tissue. Determine if a tissue is malignant or benign by analyzing its hardness. Images are obtained that are expressed on a color map superimposed on the conventional endoscopic ultrasound image. Many investigations demonstrate its high sensitivity and specificity in tumors of the pancreas and lymph nodes, some in esophageal tumors, however very few in rectal cancer. Conclusions: Elastography has improved the diagnosis and oncological follow-up of the patient with rectal tumor(AU)

In silico model of the early effects of radiation therapy on the microcirculation and the surrounding tissues.

BACKGROUND: Radiation-induced organ dysfunction are frequently described by Normal Tissue Complication Probability models. The approximations of this radiobiological approach do not allow to consider the important role played by the microvasculature not only in the dose-response of the blood vessels but also of the organs where it is located. To this purpose, we presented a computational model that describes the fluid dynamics of microcirculation when the parameters of the network and the surrounding tissues are affected by radio-induced changes. MATERIALS AND METHODS: The effects of the ionizing radiation on the capillary bed are mediated by the inflammatory response. We derived from a literature search the possible morphological and functional variations of the network due to the process of the acute inflammation. Specifically, we considered vasodilation, increased membrane permeability with consequent fluid extravasation and increased wall elasticity. These perturbations to the system were included in a computational model, already able to describe the physics of the microcirculation and its exchanges with the surrounding tissues. RESULTS: Two computational descriptions were considered. In the first one, we changed a set of 4 parameters associated with the increased fluid exchange from the health scenario at the baseline to a seriously compromised scenario with the edema formation. The second study investigated the effect of a perturbation to the vessel wall elasticity. CONCLUSIONS: These simulations represent a first step towards the challenging objective of understanding and describing in a mechanistic way the effects of radiation on the vascular microenvironment.

Acoustic diagnosis of elastic properties of human tooth by 320 MHz scanning acoustic microscopy after radiotherapy treatment for head and neck cancer.

BACKGROUND: On the elastic profiles of human teeth after radiotherapy for head and neck cancers, generation of dental complications, which may bring several side effects preventing the quality of life, has not well clarified. Thus, we aimed to show the applicability of using 320 MHz Scanning Acoustic Microscopy (SAM) in the evaluation of the tooth damage acoustically at the micrometer level following radiation therapy, and also in the determination of the safe dose limits to impede severe dental damage. METHODS: This prospective study was performed by SAM employed at 320 MHz by an azimuthal resolution of 4.7 µm resolving enamel and dentin. A total of 45 sound human third molar teeth collected between September 2018 and May 2019 were used for the acoustic impedance measurements pre- and post irradiation. Nine samples for each group (control, 2 Gy, 8 Gy, 20 Gy, 30 Gy and 60 Gy) were evaluated to acquire the acoustic images and perform a qualitative analysis. Scanning Electron Microscopy (SEM) images were obtained to establish a relationship between micromechanical and morphological characteristics of the teeth. Statistical analysis was conducted using the Student t-test succeded by Mann-Whitney U investigation (p < .05), while SEM images were assessed qualitatively. RESULTS: The analysis included 45 sound teeth collected from men and women 18 to 50 years old. Post irradiation micromechanical variations of human teeth were significant only in the radiation groups of 30 Gy and 60 Gy compared to pre-irradiation group for enamel (7.24 ± 0.18 MRayl and 6.49 ± 028 MRayl; p < 0.05, respectively). Besides, the teeth subjected to radiation doses of 20, 30 and 60 Gy represented significantly lower acoustic impedance values relative to non-irradiated group for dentin (6.52 ± 0.43 MRayl, 5.71 ± 0.66 MRayl and 4.82 ± 0.53 MRayl p < 0.05), respectively. CONCLUSIONS: These results are evidence for a safe acoustic examination device which may be a useful tool to visualize and follow the safe dose limits to impede severe dental damage through the radiation therapy treatment for head and neck cancers.

Skin Biomechanics and miRNA Expression Following Chronic UVB Irradiation.

Objective: Exposure to ultraviolet (UV) light from the sun is known to accelerate the skin aging process and leads to significant alterations in skin biomechanics; however, the molecular mechanisms by which chronic UVB affects biomechanical properties of the skin have not been well described. Approach: A murine model for chronic UVB exposure was used to examine changes in epidermal barrier function, skin biomechanics, and miRNA expression as a result of UVB. Results: UVB irradiation caused skin to be weaker, less elastic, stiffer, and less pliable. Notably, these changes were not reversed after a 5-week period of recovery. Following UVB exposure, dermal collagen fibrils were significantly smaller in diameter and expression of the miR-34 family was significantly increased. Innovation: To our knowledge, this is the first study to concurrently examine alterations in skin function, miRNA expression, and tissue biomechanics in response to chronic UVB exposure. Conclusion: The data suggest that UVB alters miR-34 family expression in skin, in addition to dysregulating collagen structure with subsequent reductions in strength and elasticity. miRNAs may play a pivotal role in regulating extracellular matrix deposition and skin biomechanics following chronic UVB exposure, and thus may be a possible target for therapeutic development. However, additional studies are needed to directly probe the link between UVB exposure, miRNA production, and skin biomechanics.

Improvement of skin texture and wrinkles using radiofrequency ultra-thin electrode technology.

BACKGROUND: Application of radiofrequency (RF) energy with microneedles to facial skin shown to promote skin renewal. AIM: To evaluate the safety and efficacy of the VoluDerm technology with 100 ultra-thin electrodes gen100 tip for improvement of skin texture and wrinkles. METHODS: A prospective, open-label, intra-individual-controlled trial. Twelve subjects (mean age, 45.5; Fitzpatrick skin types II-III) with Fitzpatrick Elastosis Scale (FES) score 3-6 were treated with VoluDerm RF technology using the gen100 ultra-thin electrodes disposable tip. The participants underwent three treatments at 3-week intervals. Treatment safety was evaluated at each treatment visit and at the follow-up visits (1 and 3 months post last treatment). Efficacy of treatment evaluated at 1 and 3 months after the last treatment using the FES as well as evaluator- and subject-rated Global Aesthetic Improvement Scale (GAIS). RESULTS: Treatment was well tolerated, with no downtime or adverse events. One and three months after the last treatment session, physician-rated FES showed statistically significant improvement of 2.67 ± 1.18 and 2.33 ± 1.03, respectively (P < .0001), from baseline (4.83 ± 0.69). According to the investigator assessment of improvement using the GAIS scale, all subjects had an improvement in skin texture and pigmentation and most of the patients (91.7%) had an improvement in skin brightness, tightness, and wrinkles. CONCLUSION: This is the first study evaluating the Legend+ RF System with VoluDerm technology using the novel gen100 ultra-thin electrodes tip. This study demonstrated effective and well-tolerated treatment for improving skin texture and appearance with minimal to no downtime.

Radiofrequency therapy in esthetic dermatology: A review of clinical evidences.

BACKGROUND: Chronological skin aging causes the modification of genetic material through enzymes and proteins changes. The process reduces cellular proliferation, along with loss of tissue elasticity, reduced ability to regulate aqueous exchanges, and inefficient tissue replication. Appearance is negatively affected by cumulative changes in coloration, texture, and elasticity over time. The increase in the population's average life expectancy boosts the search for cosmetic therapies that can delay aging, mostly for the noninvasive modalities. Among the various options, radiofrequency therapy is a technique that can help reduce the effects of skin aging. AIM: Therefore, this study aims to review clinical evidence provided by scientific literature on the benefits of using radiofrequency therapy in reducing skin aging effects. METHODS: A review of the literature concerning skin aging, characteristics of radiofrequency therapy, and radiofrequency therapy in the treatment of skin laxity and mechanism of action was conducted using PubMed. RESULTS: The included studies have suggested that the mechanism of radiofrequency action is heating the dermis while preserving the epidermis. This heating causes immediate collagen denaturation, which is followed by the formation of new collagen, naturally providing skin tightening and greater elasticity. CONCLUSION: Even when used as single therapeutic modality, radiofrequency seems to meet the expectations in reducing the effects of skin aging.

Increased elasticity of melanoma cells after low-LET proton beam due to actin cytoskeleton rearrangements.

Cellular response to non-lethal radiation stress include perturbations in DNA repair, angiogenesis, migration, and adhesion, among others. Low-LET proton beam radiation has been shown to induce somewhat different biological response than photon radiation. For example, we have shown that non-lethal doses of proton beam radiation inhibited migration of cells and that this effect persisted long-term. Here, we have examined cellular elasticity and actin cytoskeleton organization in BLM cutaneous melanoma and Mel270 uveal melanoma cells. Proton beam radiation increased cellular elasticity to a greater extent than X-rays and both types of radiation induced changes in actin cytoskeleton organization. Vimentin level increased in BLM cells after both types of radiation. Our data show that cell elasticity increased substantially after low-LET proton beam and persisted long after radiation. This may have significant consequences for the migratory properties of melanoma cells, as well as for the cell susceptibility to therapy.

The evaluation of elasticity after nonablative radiofrequency rejuvenation.

BACKGROUND: Laxity and rhytides are manifestations of photodamage on the face and chest. Nonablative radiofrequency (RF) is one of the most common procedures used for skin rejuvenation. AIM: The aim of this study was to assess the elasticity of face and chest skin after multipolar radiofrequency. PATIENTS/METHODS: Thirty women, aged 43-68, were included in the study. Twenty women were postmenopausal and 10 were premenopausal. They received 4 treatment sessions with an application of nonablative radiofrequency in 2-week intervals. Biomechanical properties of the skin were measured with the use of a Cutometer. RESULTS: The objective evaluation in a cutometric analysis showed a statistically significant improvement between measurements taken in the pretreatment period and 3 months after the treatment. CONCLUSIONS: The study is an objective confirmation that RF treatment improves skin elasticity. The method may appear to be beneficial for women of any age and skin types. It is a noninvasive treatment with a low risk of complications.

Effects of irradiance on UVA-induced skin aging.

BACKGROUND: Ultraviolet A (UVA) radiation is the most relevant component of solar radiation-induced skin aging. Sunscreens were used to minimize the harmful effects of UV radiation on our skin by reducing UV irradiance. We previously found that at equivalent fluence, UVB radiation at low irradiance (LI) has higher photocarcinogenic potential as compared to its high irradiance (HI) counterpart. OBJECTIVES: To examine the effects of equivalent fluence of UVA radiation administered at different irradiance on photoaging. METHODS: Both the hairless mice (SKH-1) and human dermal fibroblasts were irradiated with high irradiance UVA (HIUVA) or low irradiance UVA (LIUVA; 50% irradiance of HIUVA) at equivalent fluence. Parameters related to skin photoaging were evaluated. RESULTS: For hairless mice receiving equivalent fluence of UVA radiation, LIUVA treated mice showed prominent skin aging as compared to its HIUVA treated counterpart. In addition, LIUVA radiation induced higher reactive oxygen species (ROS) production and c-Jun N-terminal kinases (JNK) phosphorylation as compared to their HIUVA treated counterparts. Pretreatment with N-acetylcysteine (NAC) abrogate the difference between HI and LIUVA radiation on fibroblasts in terms of intracellular ROS, JNK phosphorylation, MMP-1 expression and type I collagen expression. CONCLUSION: UVA radiation administered at LI (a scenario similar to sunscreen use) led to more severe aging process as compared to its HI counterpart. Unexpected negative effect may be imposed on the skin if sunscreen use is accompanied by longer duration spent under the sun.

Short-term effects of X-ray on viscoelastic properties of epithelial cells.

Examining the effects of ionizing radiation on the living cell is significant due to its usage in recent centuries. Investigations into the long- and short-term effects of ionizing radiation began simultaneously with its discovery. Previous studies were done on the effects of radiation on cell DNA or the biochemical cycle based on the electromagnetic radiation wavelength, intensity, and exposure time. Considering some dependent parameters like cell communication, the differentiation and the mechanical interactions of intercellular environment, and cell mechanical properties, the effects of ionizing radiation on the viscoelastic properties of cells seem to be important. The current research investigated the short-term biomechanical effects of ionizing radiation and examined the mechanical properties of cells using magnetic tweezer cytometry with nanomagnetic particles. To evaluate these effects, cells were incubated with nanomagnetic particles and then separated into controlled and irradiated groups. A 3 mGy cm2 X-ray was radiated to the irradiated group for 0.02 s. The dishes of both groups were inserted into magnetic tweezer cytometry for applying a magnetic force pulse, and the cell membrane displacement was detected by an image processing system. The creep response of the membrane was determined for viscoelastic model curve fitting. The frequency responses of the model for both groups were calculated. The results showed that radiation could decrease cell extensibility from 0.084 ± 0.001 to 0.019 ± 0.001 µm and change the storage and loss modulus as the indicator of the viscoelastic property of the material. This research explains that radiation could affect cellular mechanical properties.

Radiation therapy affects the mechanical behavior of human umbilical vein endothelial cells.

Radiation therapy has been widely utilized as an effective method to eliminate malignant tumors and cancerous cells. However, subjection of healthy tissues and the related networks of blood vessels adjacent to the tumor area to irradiation is inevitable. The aim of this study was to investigate the consequent effects of fractionation radiotherapy on the mechanical characteristics of human umbilical vein endothelial cells (HUVECs) through alterations in cytoskeleton organization and cell and nucleus morphology. In order to simulate the clinical condition of radiotherapy, the HUVECs were exposed to the specific dose of 2 Gy for 1-4 times among four groups with incremental total dose from 2 Gy up to 8 Gy. Fluorescence staining was performed to label F-actin filaments and nuclei. Micropipette aspiration and standard linear solid model were employed to evaluate the elastic and viscoelastic characteristics of the HUVECs. Radiotherapy significantly increased cell elastic moduli. Due to irradiation, instantaneous and equilibrium Young's modulus were also increased. Radiotherapy diminished HUVECs viscoelastic behavior and shifted their creep compliance curves downward. Furthermore, gamma irradiation elevated the nuclei sizes and to a lesser extent the cells sizes resulting in the accumulation of F-actin filaments within the rest of cell body. Endothelial stiffening correlates with endothelial dysfunction, hence the results may be helpful when the consequent effects of radiotherapy are the focus of concern.

Effect of Single-Session, Cryogen-Cooled Monopolar Radiofrequency Therapy on Sexual Function in Women with Vaginal Laxity: The VIVEVE I Trial.

OBJECTIVE: This subanalysis of the VIVEVE I trial aimed to evaluate the impact of cryogen-cooled monopolar radiofrequency (CMRF) therapy, for the treatment of vaginal laxity, on the domains of sexual function included in the Female Sexual Function Index (FSFI). MATERIALS AND METHODS: The VIVEVE I clinical trial was prospective, randomized, single-blind, and Sham-controlled. Nine clinical study centers in Canada, Italy, Spain, and Japan were included. This subanalysis included premenopausal women with self-reported vaginal laxity who had ≥1 term vaginal delivery and a baseline FSFI total score ≤26.5, indicating sexual dysfunction. Enrolled subjects were randomized (2:1) to receive CMRF therapy [Active (90 J/cm2) vs. Sham (≤1 J/cm2)] delivered to the vaginal tissue. Independent analyses were conducted for each FSFI domain to evaluate both the mean change, as well as the clinically important change for Active- versus Sham-treated subjects at 6 months post-intervention. RESULTS: Subjects randomized to Active treatment (n = 73) had greater improvement than Sham subjects (n = 35) on all FSFI domains of sexual function at 6 months postintervention. The analysis of covariance change from baseline analyses showed statistically significant improvements, in favor of Active treatment, for sexual arousal (p = 0.004), lubrication (p = 0.04), and orgasm (p = 0.007). In addition, Active treatment was associated with clinically important and statistically significant improvements in sexual desire [Odds ratio (OR) = 3.01 (1.11-8.17)], arousal [OR = 2.73 (1.06-7.04)], and orgasm [OR = 2.58 (1.08-6.18)]. CONCLUSIONS: This subanalysis showed CMRF therapy is associated with statistically significant and clinically important improvements in sexual function in women with vaginal laxity. These findings provide the first randomized, placebo-controlled energy-based device evidence for functional improvements associated with a nonsurgical modality for a highly prevalent and undertreated condition.

Effect of Single-Treatment, Surface-Cooled Radiofrequency Therapy on Vaginal Laxity and Female Sexual Function: The VIVEVE I Randomized Controlled Trial.

INTRODUCTION: Vaginal laxity is a highly prevalent and undertreated medical condition. AIM: To evaluate the efficacy and safety of surface-cooled, monopolar radiofrequency (RFc) therapy for the treatment of vaginal laxity in the VIVEVE I trial. METHODS: The VIVEVE I trial was a prospective, randomized, single-blinded, and sham-controlled study. Nine study centers in Canada, Italy, Spain, and Japan participated. Women presenting with vaginal laxity were screened and informed consent was obtained. Major study inclusion criteria were premenopausal status, age at least 18 years, at least one full-term vaginal delivery, and normal genito-pelvic examination results. Enrolled subjects were randomized (2:1) to receive RFc therapy (Active [90 J/cm2] vs Sham [1 J/cm2], respectively) delivered to the vaginal tissue. MAIN OUTCOME MEASURES: The primary efficacy outcome was the proportion of randomized subjects reporting "no vaginal laxity" (Active vs Sham) at 6 months postintervention, which was assessed using the Vaginal Laxity Questionnaire. Treatment-emergent adverse events were evaluated in all treated subjects. Secondary efficacy end points included change on the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R). RESULTS: No vaginal laxity was achieved by 43.5% and 19.6% (P = .002) in the Active and Sham groups, respectively. Differences in FSFI and FSDS-R total scores (Active vs Sham) were 1.8 (P = .031) and -2.42 (P = .056), respectively, in favor of Active treatment. Treatment-emergent adverse events were reported by 11.1% and 12.3% of subjects in the Active and Sham arms, respectively. CONCLUSION: The VIVEVE I trial is the first randomized, controlled, blinded, clinical study of RFc for the treatment of vaginal laxity. A single treatment of RFc therapy was found to be safe and associated with both improved vaginal laxity and improved sexual function. The results from this trial support the use of a novel non-surgical therapy for vaginal laxity, a prevalent and undertreated condition.

Skin microtopography as a measure of photoaging and risk of squamous cell carcinoma of the skin in a US population.

BACKGROUND: Skin microtopography as a measure of photoaging is a noninvasive approach to measuring chronic ultraviolet radiation exposure and reflects the degree of dermal elastosis in populations of European descent in the subtropics. Less is known about the utility of this approach in populations at different latitudes, and whether it relates to skin cancer risk. METHODS: A population-based case-control study of 342 squamous cell carcinoma (SCC) cases and 331 age- and gender-matched controls were evaluated for histologic evidence of solar damage and severity of photoaging based on microtopography on a six-grade scale. Odds ratios (OR) for SCC associated with degree of photoaging were estimated using logistic regression analysis adjusted for potentially confounding factors. RESULTS: After adjustment for known risk factors, SCC was associated with increasing photoaging grade (OR = 1.7, 95% CI = 0.9-3.0 for severe photoaging; OR = 2.8, 95% CI = 1.6-5.0 for very severe photoaging). Associations remained among those with actinic keratosis (OR = 3.4, 95% CI = 0.9-12.4 for severe photoaging, OR = 5.7, 95% CI = 1.7-19.6 for very severe photoaging). LIMITATIONS: There was limited statistical power, particularly for subgroup analyses. CONCLUSION: Our findings provide further evidence of microtopography as an independent, objective indicator of risk of SCC.

Scleral Cross-Linking Using Riboflavin UVA Irradiation for the Prevention of Myopia Progression in a Guinea Pig Model: Blocked Axial Extension and Altered Scleral Microstructure.

PURPOSE: To develop methods of collagen cross-linking (CXL) in the sclera for the treatment of progressive myopia and to investigate the biomechanical and histological changes that occur in as a result. METHODS: Twenty 14-day-old guinea pigs were divided into 3 groups: the cross-linking group (CL, n = 8), non cross-linking group (NCL, n = 8), and control group (n = 4). The scleras of the right eyes of the guinea pigs in the CL group were surgically exposed and riboflavin was dropped onto the irradiation zone for 20 seconds prior to ultraviolet-A (UVA) irradiation. The same procedure was conducted on the NCL group but without UVA irradiation. No procedure was conducted on the control group. The right eyes of the guinea pigs in the CL and NCL groups were then fitted with -10.00DS optics for six weeks. Retinoscopy and the axial lengths (AXL) were measured at baseline, and at the second, fourth and sixth weeks post-treatment in all three groups. All animal subjects were euthanized after the sixth week and then biomechanical and histopathological examinations of the scleras were conducted. RESULTS: The mean AXL of the NCL group was longer than both the control and CL groups at six weeks (P = 0.001). The mean refractive error in the NCL group was statistically significantly more negative than both the control and the CL groups at six weeks (P = 0.001). The scleral collagen fiber arrangements of the CL and control groups were denser and more regularly distributed than the NCL group. Ultimate stress of the sclera was lowest in the NCL group, followed by the CL then the control group (P<0.05). Ultimate strain (%) of the sclera was lowest in the CL group followed by the NCL and then the control group (P<0.05). CONCLUSION: Our study demonstrates that scleral CXL using riboflavin UVA irradiation effectively prevents the progression of myopia by increasing scleral biomechanical strength in a guinea pig model.

Nonablative radiofrequency treatment for the skin in the eye area - clinical and cutometrical analysis.

OBJECTIVE: The purpose of the research was to evaluate skin elasticity and reduction in the aging eye area after using a nonablative radiofrequency treatment. MATERIAL AND METHODS: This study included 23 patients, aged 34-58 years with Fitzpatrick skin type II and III. They received five treatment sessions with a nonablative radiofrequency in 1-week intervals. Biomechanical properties of the skin were measured using Cutometer. A photodocumentation was used to compare changes before and after the series of treatment sessions. Additionally, the patients filled in a questionnaire in which they were asked to make a self-evaluation of the procedure. RESULTS: Cutometrical analysis showed improvement of skin elasticity. Changes in the measurements of R2 and R6 parameters indicate that the statistical significance level is mostly P < 0.0001 for the differences in the measurements. The comparison of clinical changes in the therapy, based on photodocumentation, showed a 33.26% improvement. CONCLUSIONS: This treatment was used to improve skin tightness and decrease the amount and depth of wrinkles. It is a noninvasive treatment, with low risk of complications. The cutometrical measurements seem to be useful to assess improvement of elasticity of the skin after cosmetology or esthetic dermatology treatments.

Nonablative fractional laser treatment for the skin in the eye area - clinical and cutometric analysis.

OBJECTIVE: The purpose of the research was to evaluate skin elasticity and reduction in the aging eye area using a 1410-nm nonablative fractional laser treatment, cutometric measurements and photographic documentation. MATERIAL AND METHODS: This study included 24 patients (21 women, three men), aged 33-50 years (the average age was 44.6) with Fitzpatrick skin type II and III. They received five successive treatment sessions with a 1410-nm nonablative fractional laser in 2-week intervals. Biomechanical properties of the skin were measured by using Cutometer (Courage+Khazaka electronic). Measurements of skin elasticity were made in three places of the eye area. A photographic documentation was used to compare changes after the series of treatment sessions. Additionally, the patients filled in a survey in which they were asked to make a self-evaluation of the administered procedure. RESULTS: Cutometric analysis showed a significant improvement of skin elasticity. Changes in the measurements of R2 and R6 parameters indicate that the statistical significance level is mostly P < 0.0001 for the differences in the measurements. The analysis of clinical results of the therapy, using photographic documentation, showed a 47% decrease in the quantity and depth of wrinkles in the eye area. CONCLUSIONS: A 1410-nm nonablative fractional laser treatment seems to be an effective method aiming at reducing wrinkles in the eye area and improving tightness. Cutometric measurements provide invaluable help in the objective evaluation of the anti-aging treatment and the photographic documentation is an excellent addition to the clinical analysis.

The comparison of the melanin content and UV exposure affecting aging process: seven countries in Asia.

BACKGROUND: The skin brightness is determined according to the amount and type of melanin. People with darker skin have a greater amount of melanin that makes their skin less susceptible to UV damages. They live in lower latitude and receive a greater amount of the intensity of the UV radiation. AIM: We wanted to know how the latitude and skin brightness affect skin aging. METHODS: Three thousand volunteers from seven countries (Korea, China, India, Thailand, Vietnam, Indonesia, and Malaysia), aged 20-59 years, participated in this study. We measured skin brightness, Ra (wrinkles parameter), and R2 (elasticity parameter) under controlled environmental conditions. The skin brightness of the face was measured using the Janus® which is a facial analysis system. Cutometer® the elasticity was measured by on the cheeks, and PRIMOS lite® was used to evaluate wrinkles on crow's feet. RESULTS: Latitude and skin brightness showed a positive correlation (0.346). Also, the correlations of Ra and R2 with skin brightness were significantly negative (-0.181) and positive (0.105), respectively. Results of comparison of Ra and R2 with age among the countries showed no significant difference among the 20s, but there was a significant difference among the 50s between countries with high latitude and low latitude. CONCLUSION: The long-term exposure of UV radiation, the natural environmental factor, seems to have more decisive effect on the skin aging process than the photoprotective effect of melanin of epidermal skin. This study helps to understand differences of the skin properties among countries in Asia.

A 12-week clinical and instrumental study evaluating the efficacy of a multisource radiofrequency home-use device for wrinkle reduction and improvement in skin tone, skin elasticity, and dermal collagen content.

This study was performed in order to evaluate the safety and efficacy of a new handheld home-use multisource radiofrequency device on facial rejuvenation. Forty-seven male and female subjects were enrolled. All subjects received a NEWA® 3DEEP™ home-use device (EndyMed Medical, Caesarea, Israel) to be used on facial skin three times per week for the first four weeks and then reduced to two times per week for the following eight weeks. Assessments included expert clinical grading for efficacy, instrumental evaluation, image analysis, and photography. Forty-five subjects completed the study; all subjects reported the treatment to be painless with only mild erythema lasting up to 15 minutes post-treatment. No other adverse events were reported. Statistically significant improvements were noted in the appearance of marionette lines, skin brightness, elasticity, firmness, lift (facial), lift (jawline), texture/smoothness, tone, and radiance/luminosity by expert visual assessment. Statistically significant improvements in skin firmness and elasticity were found using a Cutometer MPA 580, as well as in collagen and hemoglobin content of the skin using a SIAscope. The results of this study indicate that the NEWA® multisource radiofrequency home-use device is effective in self-administered skin rejuvenation.

Assessment of UVA-Riboflavin Corneal Cross-Linking Using Small Amplitude Oscillatory Shear Measurements.

PURPOSE: The effect of ultraviolet (UV)-riboflavin cross-linking (CXL) has been measured primarily using the strip extensometry technique. We propose a simple and reliable methodology for the assessment of CXL treatment by using an established rheologic protocol based on small amplitude oscillatory shear (SAOS) measurements. It provides information on the average cross-link density and the elastic modulus of treated cornea samples. METHODS: Three fresh postmortem porcine corneas were used to study the feasibility of the technique, one serving as control and two receiving corneal collagen cross-linking treatment. Subsequently, five pairs of fresh postmortem porcine corneas received corneal collagen cross-linking treatment with riboflavin and UVA-irradiation (370 nm; irradiance of 3 mW/cm2) for 30 minutes (Dresden protocol); the contralateral porcine corneas were used as control samples. After the treatment, the linear viscoelastic moduli of the corneal samples were measured using SAOS measurements and the average cross-linking densities extracted. RESULTS: For all cases investigated, the dynamic moduli of the cross-linked corneas were higher compared to those of the corresponding control samples. The increase of the elastic modulus of the treated samples was between 122% and 1750%. The difference was statistically significant for all tested samples (P = 0.018, 2-tailed t-test). CONCLUSIONS: We report a simple and accurate methodology for quantifying the effects of cross-linking on porcine corneas treated with the Dresden protocol by means of SAOS measurements in the linear regime. The measured dynamic moduli, elastic and viscous modulus, represent the energy storage and energy dissipation, respectively. Hence, they provide a means to assess the changing physical properties of the cross-linked collagen networks after CXL treatment.