Multimodal Radiofrequency Application for Lower Face and Neck Laxity.

Nonexcisional facial skin tightening has long been an elusive goal in aesthetic surgery. The "treatment gap" includes cases who are not "severe" enough for excisions surgery but not "mild" enough for most traditional noninvasive aesthetic modalities. In this retrospective review, we present the largest evaluation to date of radiofrequency (RF) skin tightening technology combination including bipolar RF (FaceTite; InMode) and fractional bipolar RF (Fractora modified to Morpheus8; InMode). METHODS: A multicenter retrospective study was conducted between January 2013 and December 2018 using a combination of bipolar RF and fractional bipolar RF for the treatment of facial aging. Data collection included demographic information, Baker Face/Neck Classification, amount of energy used, adverse events, and patient satisfaction. Four cadaver dissections were also conducted to correlate the underlying neuromuscular anatomy with RF treatment of the lower face and neck. RESULTS: Two hundred forty-seven patients (234 women and 13 men) were included in the study. Average age was 55.1 years (SD, ±8), body mass index was 24.3 (±2.4), and 9% (23/247) of patients were active smokers at the time of treatment. Patients had an average Baker Face/Neck Classification score of 3.1 (SD, ±1.4). The procedure was performed under local anesthesia in 240/247 cases (97.2%). Patients objectively improved their Baker Face/Neck Classification score by 1.4 points (SD, ±1.1). Ninety-three percent of patients indicated that they were pleased with their results and would undergo the procedure again. Complications recorded for our cohort included prolonged swelling >6 weeks (4.8%, 12/247), hardened area >12 weeks (3.2%, 8/247), and marginal mandibular neuropraxia (1.2%, 3/247), which all resolved without further intervention. When considering possible control variables, age seems to be a significant factor. That is, older patients were more likely to benefit from a larger magnitude of the treatment effect (as demonstrated by a decrease in the Baker rating from pre- to posttreatment) when compared with younger patients. However, both groups did demonstrate significant improvements across time. CONCLUSION: While this combination RF treatment (FaceTite bipolar RF and fractional bipolar RF) does not aim to replace a facelift/necklift in appropriate candidates, it does broaden the plastic surgeons' armamentarium to potentially fill a treatment gap.

Finite-element modeling of time-dependent sodium exchange across the hollow fiber of a hemodialyzer by coupling with a blood pool model.

INTRODUCTION: Hollow fiber models describe the exchange of solutes between blood and dialysate across the membrane of a single fiber of the hemodialysis filter (hemodialyzer). This work aims to develop a new approach to simulate the solute exchange in a hollow fiber in a dynamic and realistic way. Sodium was chosen as our solute of interest due to its importance in hemodialysis as an osmotic regulator. METHODS: A 2-dimensional (2D) hollow fiber model based on the finite element method (FEM) is coupled to a simple blood pool model to dynamically update the concentration of the solute entering the dialyzer. The resulting coupled model maintains the geometrical detail of the 2D fiber representation and gains a dynamic, blood-side inlet solute concentration. In vitro dialysis sessions were carried out for model validation, by implementing a combination of blood volume loss and/or sodium concentration steps. Plasmatic sodium concentration was recorded by blood gas sampling. Dialysate inlet and outlet conductivities were continuously recorded. RESULTS: Simulated plasmatic sodium concentration was compared with data from the blood gas samples. A mean error of 1.76 ± 1.03 mM was found for the complete dataset, along with a 3.87 mM maximum error. The simulated outlet dialysate sodium concentration was compared with the recorded outlet dialysate conductivity: a very high correlation was found on the whole dataset (R2 = 0.992). CONCLUSIONS: Coupling our FEM hollow fiber model to a simple blood pool model proved to be an effective approach for dynamical analysis of the properties of the hemodialyzer.

Age-related changes of adaptive and neuropsychological features in persons with Down Syndrome.

Down Syndrome (DS) is characterised by premature aging and an accelerated decline of cognitive functions in the vast majority of cases. As the life expectancy of DS persons is rapidly increasing, this decline is becoming a dramatic health problem. The aim of this study was to thoroughly evaluate a group of 67 non-demented persons with DS of different ages (11 to 66 years), from a neuropsychological, neuropsychiatric and psychomotor point of view in order to evaluate in a cross-sectional study the age-related adaptive and neuropsychological features, and to possibly identify early signs predictive of cognitive decline. The main finding of this study is that both neuropsychological functions and adaptive skills are lower in adult DS persons over 40 years old, compared to younger ones. In particular, language and short memory skills, frontal lobe functions, visuo-spatial abilities and adaptive behaviour appear to be the more affected domains. A growing deficit in verbal comprehension, along with social isolation, loss of interest and greater fatigue in daily tasks, are the main features found in older, non demented DS persons evaluated in our study. It is proposed that these signs can be alarm bells for incipient dementia, and that neuro-cognitive rehabilitation and psycho-pharmacological interventions must start as soon as the fourth decade (or even earlier) in DS persons, i.e. at an age where interventions can have the greatest efficacy.