Management for the patients with severe Parkinson's disease during dental treatments and tooth extractions: A retrospective observational study.

Background/purpose: When Parkinson's disease (PD) progresses, oral and swallowing functions decline, and special care is necessary when performing dental treatments. This study aimed to retrospectively investigate the records of patients with PD and analyze dental and general problems to establish countermeasures during dental treatments. Materials and methods: We retrospectively examined the medical records of patients with PD to obtain data on dental treatments and management methods. Results: Of the 27 patients, 40% had severe grade IV or higher Hoehn-Yale (HY) scores, and the wearing-off phenomenon was observed in those with grade III or higher. Additionally, 19% of the patients were receiving levodopa 500 mg/day or more. Intravenous sedation was administered 21 times (three patients) and general anesthesia eight times (three patients). Discontinuation of tooth extraction was observed in four patients: two with difficulty in opening the mouth, one with respiratory failure caused by the wearing-off phenomenon, and one with excessively elevated blood pressure due to the interaction between adrenaline in local anesthesia and the catechol-O-methyltransferase inhibitor. Tooth extraction was performed by adjusting the time of levodopa administration in two patients, under general anesthesia in one patient, and using adrenaline-free local anesthetics under intravenous sedation in one patient. Conclusion: When PD progresses, oral and swallowing functions decline and body motor function deteriorates. Thus, the respiratory and circulatory conditions and the wearing-off phenomenon during dental treatments should be properly managed in patients with severe PD.

Insulin Resistance Is Better Estimated by Using Fasting Glucose, Lipid Profile, and Body Fat Percent Than by HOMA-IR in Japanese Patients with Type 2 Diabetes and Impaired Glucose Tolerance: An Exploratory Study.

Aims: The aim of the present study is to estimate insulin resistance (IR) using clinically available parameters except for serum insulin or C-peptide concentration to overcome the limitation of homeostasis model assessment of IR (HOMA-IR), which has been widely used in clinical practice. Patients and Methods: Fifty-two admitted patients with type 2 diabetes or impaired glucose tolerance were enrolled, and steady state plasma glucose (SSPG) method and cookie meal tolerance test were performed together with fasting blood sampling and anthropometric measurements. Insulin sensitivity measured by SSPG was estimated as glucose clearance corrected by the excretion of glucose into urine (C-GC). Results: Log-transformed (C-GC) was negatively correlated with fasting plasma glucose (FPG), log (Fasting triglyceride: TG), log (Fasting TG/Fasting high-density lipoprotein cholesterol: HDLC), and their area under the curves (AUCs). Fasting and AUC-HDLC was positively and fasting free fatty acid (FFA) was negatively correlated with log (C-GC). Body fat (%) was negatively correlated with log (C-GC). Multiple regression analysis on log (C-GC) as an outcome variable revealed that FPG, log (AUC-TG/AUC-HDLC), body fat (%), and fasting FFA were selected as significant predictive variables and contributed to log (C-GC) by 60% (adjusted R2). Replacing log (AUC-TG/AUC-HDLC) with its fasting value, log (Fasting TG/Fasting HDLC), this model still showed a strong contribution to log (C-GC) by 57% (adjusted R2). These contributions were stronger than those in log (HOMA-IR) (52.5%), log (Fasting C-peptide) (45.7%) to log (C-GC). Conclusions: It is plausible that our estimation for IR without the inclusion of plasma insulin concentration can be applied in Japanese patients whose HOMA-IR is not appropriately available. The model using fasting values is less complicated and could be the best way for the estimation of IR.

Prosthetic Rehabilitation of a Female With Bilateral Transfemoral Amputation in Japan: A Case Report.

Individuals with bilateral transfemoral (TF) amputation experience difficulties when walking with lower limb prostheses. Walking with prostheses is even more difficult when the cause of the amputation is nontraumatic, or the gender is female. We provided prosthetic rehabilitation to a woman who underwent bilateral TF amputation due to internal disease.  A 42-year-old woman underwent bilateral TF amputation for ischemic necrosis of the lower extremities during septic shock treatment. Upon admission to our convalescent rehabilitation ward 3 months after surgery, the patient weighed 32 kg and was underweight. After admission, she underwent strength training of the trunk and hip muscles, hip joint range of motion exercises, and bottom shuffle exercises on the physical therapy table. The prosthetist created stubby prostheses for standing and standing-up exercises on the floor, as well as gait exercises. We gradually extended the length of her prostheses and subsequently switched her knee joints to Ottobock locking and polycentric knees and eventually to Kenevo, which are microprocessor-controlled prosthetic knees (MPK). During occupational sessions, she practiced household activities such as washing dishes, cleaning, and cooking while wearing her prostheses. Six months after admission, the patient was discharged and could walk outdoors alone with two canes without using a wheelchair. At discharge, the Kenevo modes were Mode C on the right and Mode B + on the left. The patient's weight recovered to 41 kg. The patient completed the 10-meter walk test at 0.50 m/s at a comfortable walking speed, the 6-minute walk test at 180 meters, and the timed up and go (TUG) test in 26 seconds. The motor Functional Independence Measure (FIM) score was improved from 60 on admission to 83 on discharge.  Strengthening the hip and trunk muscles, improving endurance and balance, preventing hip contracture, and maintaining the hip range of motion are necessary for walking with bilateral TF prostheses. In the prosthetic rehabilitation of bilateral TF amputations, stubby prostheses, protocols for gradual extension of the prosthetic length, and Kenevo, a mode-changeable MPK, are helpful. MPK is essential for individuals with bilateral TF amputations to walk independently and use their prostheses daily. This report is a valuable reference for healthcare professionals involved with bilateral TF amputees in the future who need prosthetic rehabilitation.

Up-Regulated Expression of ICAM1, MT1A, PTGS2, LCE3D, PPARD, and GM-CSF2 Following Solar Skincare Protection and Repair Strategies in a 3-Dimensional Reconstructed Human Skin Model.

Background: Clinical, optical and histological research confirms that solar skin damage continues to pose a threat to human skin health globally despite widespread sunscreen usage and sun awareness campaigns. Despite this, very few studies examine the critical changes in gene expression and DNA repair activity following recommended topical solar protection and repair strategies to ameliorate the harmful effects of ultraviolet, visible light and near-infrared radiation. Purpose: To investigate alterations in gene expression following topical solar protection and solar repair strategies. Methods: Using epidermal keratinocytes and dermal fibroblasts derived from a 3-dimensional reconstructed human skin model, gene expression was assessed via the Genemarkers Standard Skin Panel using 112 genes deploying two analytical techniques: DNA microarray and quantitative real-time PCR exploration. Tissues were inoculated with products then collected after 24 hours following application of solar protection formulations and 16 hours following solar repair formulations (The Essential Six, RATIONALE, Victoria, Australia). Results: A DNA microarray revealed 67 genes that were significantly up-regulated or down-regulated following the treatment. The quantitative real-time PCR revealed that, in comparison to the control, the genes encoding Intercellular Adhesion Molecule 1 (ICAM1), Metallothionein 1A (MT1A), Prostaglandin-Endoperoxide Synthase 1 (PTGS2), Late Cornified Envelope 3D (LCE3D), Peroxisome Proliferator Activated Receptor (PPARD), and Granulocyte/Macrophage Colony Stimulating Factor 2 (GM-CSF2) have been up-regulated following usage of the solar protection regime, 1.87, 861.16, 4.34, 1.91, 1.06, and 3.6, respectively. ICAM1, MT1A, PTGS2, LCE3D, PPARD, and GM-CSF2 were up-regulated following use of the solar repair regime, 3.78, 2.98, 14.89, 5.09, 2.42, and 13.51, respectively. Conclusion: This study demonstrates that a specific solar protection and repair regime upregulated genes involved in photoprotection and repair mechanisms in a 3-dimensional (3D) reconstructed human-like skin model.

Results of Neuropathy Screening Test for Lower Limb Amputees With Diabetes Mellitus and Their Prosthetic Rehabilitation: A Cross-Sectional Study.

Introduction To prevent foot ulcers and subsequent amputation on the non-amputated side, we conducted tests for diabetic neuropathy. The results were then used in prosthetic rehabilitation for lower limb amputees with diabetes mellitus. Materials and methods This cross-sectional retrospective study included patients admitted to our convalescent rehabilitation ward for prosthetic rehabilitation between April 2019 and December 2022 following lower limb amputation due to diabetes. We investigated the positive rate of the modified Ipswich Touch Test (mIpTT) in lower limb amputees with diabetes, and physical and orthotic therapy and prosthetic rehabilitation based on medical records. Results Twenty-seven transtibial amputees and nine transfemoral amputees had diabetes. The mIpTT results were positive in 22 (81%) transtibial and eight (89%) transfemoral amputees. There were no apparent differences in positivity rates by amputation level, gender, or age. Based on these results, personalized physical therapy and insoles were prescribed for the non-amputee foot in parallel with prosthetic rehabilitation. Conclusions Lower limb amputees with diabetes have diabetic neuropathy more frequently than diabetic patients without amputation. As a result, they may also be at a higher risk of developing foot ulcers and subsequent amputation due to neuropathy. Therefore, rehabilitation to prevent amputation on the non-amputated side of lower limb amputees with diabetes had better encompassing foot exercises and orthotic therapy on the non-amputated side during the prosthetic rehabilitation period.

Progress in muscle strength of the reconstructed knee and quality of life of the patient after knee rotationplasty: A case report.

Knee rotationplasty (KRP) is a function-preserving surgery that serves as an alternative to above-knee amputation in patients diagnosed with malignant bone and soft tissue tumors around the knee joint. However, the short-term progress of the reconstructed knee in terms of muscle strength is unclear after KRP. This case report describes the progress of a 37-year-old man diagnosed with synovial sarcoma in the distal femur, 1 year after undergoing KRP. Changes in muscle strength of the reconstructed knee and physical function are reported. Physical therapy was started on postoperative day 1 after the KRP, and mobilization proceeded step-by-step with sitting, wheelchair transfer, and crutch walking. Active and passive range-of-motion exercises of the reconstructed knee were started on postoperative day 5. The isometric reconstructed knee extension strength, 10-m walk test, timed up and go test, Musculoskeletal Tumor Society score, Toronto Extremity Salvage Score, and quality of life (QOL) were evaluated. One month postoperatively, muscle strength had increased, and at 6 and 12 months postoperatively, isometric knee extension strength and physical function had improved. Furthermore, activities of daily living and QOL gradually improved over the course of the 12 months. Our case shows the previously unknown course of reconstructed knee muscle strength in the early post-KRP period, with corresponding improvements in physical function, activities of daily living, and QOL.

Bone Shortening After Amputation: A Report of Two Cases.

We report two cases of shortening of the bone at the stump after amputation. Case 1 was a 57-year-old male with a traumatic transhumeral amputation. The remaining humerus had shortened by 3.5 cm in eight months. Case 2 was a 27-year-old male with a traumatic transtibial amputation. The remaining tibia had shortened by 1.4 cm in 72 months. These two cases had the same cause of amputation, but the amputation site, age, and time course differed. Few studies have examined the bone length of stumps after amputation. The bone length of stumps is generally assumed to not change after amputation. However, the residual bone at the stump can shorten after amputation.

Effect of masticatory training using confectioneries on oral function in elderly patients - A randomized controlled trial.

Background/purpose: The number of patients with oral hypofunction is increasing with the aging of the population, and such hypofunction increases their risk for dysphagia and malnutrition. The purpose of this study was to measure the hardness of commercially available confectioneries, select a confectionery with a hardness suitable for masticatory training for elderly patients, and evaluate the effects of 1-week masticatory training on oral function (occlusal force, masticatory ability, and tongue pressure). Materials and methods: The average hardness values of 25 confectioneries were determined. Among them, one of the softest confectioneries that the patients felt as "chewable but difficult to chew" was selected as the training confectionery for each patient. The patients in the training group continued training, which involved eating of approximately 5 g of one selected confectionery daily for 7 days. The patients in the control group did not undergo any training. Oral function (occlusal force, masticatory ability, and tongue pressure) on the first day and after 7 days was evaluated and compared between the groups. Results: The occlusal force of the patients in the training group increased significantly. However, their masticatory ability and tongue pressure did not change significantly. Conclusion: Patients aged 65 years and older underwent masticatory training, which involved eating of a confectionery with its hardness adjusted individually for a week. A significant increase in the occlusal force was observed, suggesting that masticatory training using confectioneries with a hardness suitable for each patient is effective.

Facial Tightening Effects, Following Focused and Radial Acoustic Wave Therapy Assessment, Using a Three-Dimensional Digital Imaging.

BACKGROUND AND OBJECTIVES: Acoustic wave therapy is a novel facial tightening technique that involves nonthermal penetration of the skin and subcutaneous tissue, affecting cells and their metabolism, and resulting in an increased release of unwanted fat and activation of blood and lymphatic flow in tissues. The objective of this study was to investigate the effectiveness of acoustic wave therapy. STUDY DESIGN/MATERIALS AND METHODS: A total of 333 patients underwent multiple facial tightening treatment sessions using focused and radial acoustic waves. Each patient received 2,000-3,000 pulses of focused acoustic waves at a power of 0.45-0.88 mJ/mm2 with a pulse frequency of 3-5 Hz and 4,000 pulses of radial acoustic waves at 4-bar power at a frequency of 21 Hz. These sessions were performed more than three times, and treatments were repeated at 1-month intervals. Digital photographs superimposed three-dimensional volumetric assessments, and three-dimensional skin surface displacement calculations using vectors were used to evaluate the results 12 months after the last treatment. Patients also evaluated the results using a 5-point Likert scale. RESULTS: Improvements in skin texture, clarity, and laxity were observed in digital photographs. Superimposed three-dimensional color images showed marked volumetric reduction and/or formative modification for even contour toward the lower mid-face. Most vectors showed three-dimensional skin surface displacement at the lateral sides of the temples, cheeks, and chin, in an upward direction. These results were obtained and sustained for up to 12 months without edematous reactions. Almost all patients reported improvement, with 79% reporting "good" or "excellent" improvement. Complications were minor and transitory. Persistent side effects were not observed. CONCLUSION: Acoustic wave therapy could be used as a standard facial tightening treatment, with skin rejuvenation effects shown on digital photographs and three-dimensional quantification assessments. This noninvasive acoustic wave approach was found to be a safe, long-lasting, and effective method for facial tightening. Lasers Surg. Med. 00:00-00, 2020. © 2020 Wiley Periodicals LLC.

Development of a Shoulder Disarticulation Prosthesis System Intuitively Controlled With the Trunk Surface Electromyogram.

We developed an intuitively operational shoulder disarticulation prosthesis system that can be used without long-term training. The developed system consisted of four degrees of freedom joints, as well as a user adapting control system based on a machine learning technique and surface electromyogram (EMG) of the trunk. We measured the surface EMG of the trunk of healthy subjects at multiple points and analyzed through principal component analysis to identify the proper EMG measurement portion of the trunk, which was determined to be distributed in the chest and back. Additionally, evaluation experiments demonstrated the capability of four healthy subjects to grasp and move objects in the horizontal as well as the vertical directions, using our developed system controlled via the EMG of the chest and back. Moreover, we also quantitatively confirmed the ability of a bilateral shoulder disarticulation amputee to complete the evaluation experiment similar to healthy subjects.

Three-dimensional Quantification of Skin Surface Displacement Following Skin Rejuvenation Using Solar Protection and Solar Repair.

BACKGROUND: Common techniques, including photography and subjective assessments, have been used to measure the efficacy of skin rejuvenation treatments. However, the efficacy of skin treatments can be difficult to assess, particularly when the effects are gradual or subtle. OBJECTIVE: This study investigated the effectiveness of a skincare regimen for skin rejuvenation that employs comprehensive solar protection, ranging from ultraviolet through to near-infrared radiation, and nightly repair of photodamage, and clarified the difference in the results relative to other lifting medical procedures. METHODS: Twenty Japanese patients were enrolled in this study. The participants used topical skincare products (The Essential Six; RATIONALE, Victoria, Australia) for six months. Patients did not use any other skincare formulations and did not undergo any form of aesthetic procedures during the study. A superimposed three-dimensional volumetric assessment and quantification of three-dimensional skin surface displacement with vectors were performed at baseline and after six months of treatment with the topical skincare products. RESULTS: Improvements in skin texture and clarity as recorded via digital photography and volumetric reduction was observed relative to pretreatment in all patients. All patients self-reported skin rejuvenation, tightening, and lifting. Most vectors suggested three-dimensional skin surface displacement at the forehead, lateral sides of the cheek, and around the chin. CONCLUSION: Skin tightening and lifting effects are not synonymous. The results of this study suggest the solar-specfic skincare formulations evaluated here constitute a safe and effective means of skin rejuvenation and tightening.

Long-term objective assessments of skin rejuvenation using solar protection and solar repair shown through digital facial surface analysis and three-dimensional volumetric assessment.

BACKGROUND: Despite the knowledge that the vast majority of skin aging is caused by the sun, and the widespread prevalence of sunscreen usage, solar skin damage continues to occur due to the combined biological impact of ultraviolet, visible light and near-infrared radiation. Sunscreens have only proven effective at filtering ultraviolet light. They do not attenuate visible light or near-infrared. OBJECTIVE: To evaluate the effectiveness of a novel, solar-specific skincare approach embracing both comprehensive daily solar protection from ultraviolet through to near-infrared radiation and nightly solar repair. PARTICIPANTS: Eighteen Japanese patients were enrolled in this study. Topical skincare products (The Essential Six, RATIONALE, Victoria, Australia), comprising solar protection preparations to be used in the morning and topical solar repair at night, were applied to the patients' skin for 12 months. Patients refrained from using any other skincare formulations and did not undergo any form of medical esthetic treatment during the study. MEASUREMENTS: Digital facial skin and three-dimensional volumetric assessment were performed pre- and post-treatment, and patient assessments were recorded after 6 and 12 months post-treatment. RESULTS: Improvements in skin texture and luminosity as recorded via digital photography, significant amelioration of skin redness and pigmentation in facial surface analysis, and volumetric reduction in three-dimensional volumetric assessment were observed compared to the pre-treatment for all patients. Eighty-nine percent, and 94% of patients self-reported their approval of treatment outcomes after 6 and 12 months post-treatment, respectively. Minor complications, characterized by slight pain and itching were observed in 3 patients. These minor complications resolved spontaneously. CONCLUSION: The results of this study indicate that the solar-specific skincare formulations focused on the daily comprehensive prevention of negative solar effects and nightly repair of photodamage provide a safe and highly effective pathway to skin preservation and rejuvenation.

Skin Tightening Following Multisource, Phase-controlled Radiofrequency Treatments with Novel Unique Concentric Electrodes in Asian Patients.

Background: Radiofrequency energy has been shown to penetrate deeper into the skin, independent of skin color, and to be beneficial for skin tightening. It was previously reported that multisource, phase-controlled radiofrequency treatments provide safe and effective skin tightening and rejuvenation. The present study evaluated the effectiveness of multisource, phase-controlled radiofrequency treatments with a unique concentric electrode configuration for skin tightening. Methods: Twenty-five Japanese patients were treated with the novel multisource phase-controlled radiofrequency system. Digital photographs and three-dimensional imaging were used to evaluate the results. The patients also provided subjective assessments. Results: Objective assessments with digital photographs and superimposed three-dimensional color images showed significant volumetric reduction in the treated areas. Ninety-six percent of patients reported satisfaction with the results, and all patients reported satisfaction with the convenience of the procedure. Complications were minor and transitory, consisting of a slight burning sensation and mild erythema, which resolved within one hour of treatment. No side effects were observed. Conclusions: The multisource phase-controlled radiofrequency treatments evaluated in this study showed efficacy with minimal discomfort and side effects. Repeated treatments using this method can provide an alternative to more invasive tightening treatments.

Risk of Delayed Healing of Tooth Extraction Wounds and Osteonecrosis of the Jaw among Patients Treated with Potential Immunosuppressive Drugs: A Retrospective Cohort Study.

Bone-modifying or antiresorptive agents that target osteoclasts, such as bisphosphonates, are known to cause delayed wound healing and osteonecrosis of the jaw (ONJ) following tooth extraction. However, there are no data on whether such adverse events are also caused by drugs that may suppress the immune system, including corticosteroids, immunosuppressants, biological agents, and disease-modifying anti-rheumatic drugs (DMARDs). The aim of this retrospective study was to examine the incidence of delayed post-extraction wound healing and identify risk factors among patients treated with potential immunosuppressive drugs undergoing tooth extraction. We performed a retrospective cohort study involving 101 patients by reviewing their medical records. The underlying diseases of the enrolled patients included dilated cardiomyopathy, hematological malignancy, sarcoidosis, rheumatoid arthritis, and systemic lupus erythematosus. The sample comprised 131 cases of tooth extraction among the 101 patients; delayed post-extraction wound healing occurred in 10 patients (12 cases, 9.2%), including ONJ in three patients (3 cases, 2.3%). The surgical tooth extraction performed for impacted teeth or a residual root (P = 0.009), the number of surgical tooth extraction (P = 0.012), decreased lymphocyte counts (P = 0.008), and decreased eosinophil counts (P = 0.009) were significantly related to delayed wound healing. Thus, among patients taking corticosteroids, immunosuppressants, biological agents, and/or DMARDs, there is a risk of delayed wound healing and ONJ. Moreover, the significant risk factors are low lymphocyte counts, low eosinophil counts, and surgical extraction. It is of particular importance to prevent surgical site infection, when the high-risk patients undergo tooth extraction.

Androgenetic Alopecia Treatment in Asian Men.

Background: Androgenetic alopecia (AGA) is a common form of hair loss in Asian men. Although AGA is often regarded as a relatively minor dermatological condition, hair loss can impact self-image and is a main cause for anxiety and depression in some men. We have treated patients with AGA for seven years. Objective: The goal of this study was to evaluate the effectiveness of our combination therapy in Asian men with AGA. Participants: Between the years 2011 and 2017, 18,918 male patients were treated in our center. Our combination therapy consists of oral finasteride once daily, oral and topical minoxidil twice daily, and an injectable treatment of lidocaine and an AGA treatment solution comprising minoxidil, arginine, aspartic acid, caffeine, copper tripeptide, lysine, niacin, panthenol, propanediol, propylen glycol, retinyl palmitate, pyridoxine, sodium hyaluronate, and ubiquinone once monthly for more than six months. Measurements: Digital photographs were taken pre- and post-treatment, and patient assessments were recorded after six and 12 months post-treatment. Results: Significant improvement was observed in all patients in the digital photographs. Ninety-six and 80 percent of the patients reported satisfaction with the results of the treatment after six and 12 months post-treatment. Minor complications were observed in 802 (4.2%) patients, characterized by slight pain and bleeding due to injection, swelling, dizziness, itching, and erythema of the scalp. Slight pain was reported in 651 patients (3.4%), and slight bleeding was reported in 56 patients (0.3%). Sexual dysfunctions were uncommon. These minor complications resolved spontaneously. No treatment-related adverse events were observed. Conclusion: A combination of these therapeutic options offers safe and highly efficacious treatment for AGA with minimal complications.

Upregulated expression of La ribonucleoprotein domain family member 6 and collagen type I gene following water-filtered broad-spectrum near-infrared irradiation in a 3-dimensional human epidermal tissue culture model as revealed by microarray analysis.

BACKGROUND/OBJECTIVES: Water-filtered broad-spectrum near-infrared irradiation can induce various biological effects, as our previous clinical, histological, and biochemical investigations have shown. However, few studies that examined the changes thus induced in gene expression. The aim was to investigate the changes in gene expression in a 3-dimensional reconstructed epidermal tissue culture exposed to water-filtered broad-spectrum near-infrared irradiation. METHODS: DNA microarray and quantitative real-time polymerase chain reaction (PCR) analysis was used to assess gene expression levels in a 3-dimensional reconstructed epidermal model composed of normal human epidermal cells exposed to water-filtered broad-spectrum near-infrared irradiation. The water filter allowed 1000-1800 nm wavelengths and excluded 1400-1500 nm wavelengths, and cells were exposed to 5 or 10 rounds of near-infrared irradiation at 10 J/cm2 . RESULTS: A DNA microarray with over 50 000 different probes showed 18 genes that were upregulated or downregulated by at least twofold after irradiation. Quantitative real-time PCR revealed that, relative to control cells, the gene encoding La ribonucleoprotein domain family member 6 (LARP6), which regulates collagen expression, was significantly and dose-dependently upregulated (P < 0.05) by water-filtered broad-spectrum near-infrared exposure. Gene encoding transcripts of collagen type I were significantly upregulated compared with controls (P < 0.05). CONCLUSIONS: This study demonstrates the ability of water-filtered broad-spectrum near-infrared irradiation to stimulate the production of type I collagen.

Near-Infrared Irradiation Increases Length of Axial Pattern Flap Survival in Rats.

Objective: We previously reported that near-infrared irradiation nonthermally induces long-lasting vasodilation of the subdermal plexus by causing apoptosis of vascular smooth muscle cells. To clarify the possible application of near-infrared irradiation to prevent skin flap necrosis, we evaluated the length of axial pattern flap survival in rats by near-infrared irradiation. Methods: A bilaterally symmetric island skin flap was elevated under the panniculus carnosus on the rat dorsum. Half of the flap was subjected to near-infrared irradiation just before flap elevation with a device that simulates solar radiation, which has a specialized contact cooling apparatus to avoid thermal effects. The length of flap survival of the near-infrared irradiated side was measured 7 days after flap elevation and compared with the nonirradiated side. Results: The irradiated side showed elongation of flap survival compared with the nonirradiated side (73.3 ± 11.7 mm vs 67.3 ± 14.9 mm, respectively, P = .03). Conclusions: Near-infrared irradiation increases the survival length of axial pattern flaps in rats.

Improvement of walking ability during postoperative rehabilitation with the hybrid assistive limb after total knee arthroplasty: A randomized controlled study.

OBJECTIVE: We aimed to compare the efficacies of rehabilitation with the hybrid assistive limb and conventional rehabilitation after total knee arthroplasty. MATERIALS AND METHODS: A total of 37 consecutive patients who underwent primary total knee arthroplasty for knee osteoarthritis were enrolled. Seven patients withdrew from the study after randomization, and 30 patients (hybrid assistive limb group: n = 16; conventional group: n = 14) completed the randomized controlled trial. Patients in the hybrid assistive limb group underwent ten 20-min rehabilitation sessions with the hybrid assistive limb as well as 20-min conventional sessions over the course of 2 weeks, whereas patients in the conventional group received ten 40-min conventional sessions during the same period. The primary outcome measure was walking speed, whereas the secondary outcome measures included quadriceps strength and knee pain assessed using a numerical rating scale. The outcome measures were evaluated prior to surgery and on postoperative weeks 1, 2, and 3. RESULTS: In the early postoperative period, rehabilitation after total knee arthroplasty with the hybrid assistive limb resulted in a significantly greater improvement in walking speed (weeks 1 and 2: p = 0.045), quadriceps strength (weeks 1 and 2; weeks 1 and 3: p < 0.0001), and numerical rating scale scores (week 1: p = 0.03) than conventional rehabilitation. CONCLUSION: Rehabilitation with the hybrid assistive limb after total knee arthroplasty led to greater improvements in walking speed, quadriceps strength, and pain scores than conventional rehabilitation.

Long-term Nasal and Peri-oral Tightening by a Single Fractional Noninsulated Microneedle Radiofrequency Treatment.

Background: The skin tightening effects induced by non-insulated microneedle radiofrequency have proved long-lasting. Our previous three-dimensional volumetric assessment showed significant facial tightening for up to six months. However, nasal and peri-oral tightening effects lasted longer. The objective of this study was to investigate the distribution of the long-term volumetric reduction in facial area induced by a single fractional non-insulated microneedle radiofrequency treatment. Methods: Fifteen Asian patients underwent full facial skin tightening using a sharply tapered non-insulated microneedle radiofrequency applicator with a novel fractionated pulse mode. Three-dimensional volumetric assessments were performed at six and 12 months post-treatment. Patients rated their satisfaction using a 5-point scale at each follow up. Results: Objective assessments with superimposed three-dimensional color images showed significant volumetric reduction in the nasal and peri-oral areas at 12 months post-treatment in all patients. Median volumetric reductions at six and 12 months post-treatment were 13.1 and 12.3ml, respectively. All of the patients were satisfied with their results 12 months post-treatment. Side effects were not observed. Conclusions: This single fractional NIMNRF treatment provided long-lasting nasal and peri-oral tightening as shown via 3D volumetric assessment. Moreover, NIMNRF produced minimal complications, downtime, and few side effects. This approach provides safe and effective treatment of skin tightening.

Biodegradable lipid nanoparticles induce a prolonged RNA interference-mediated protein knockdown and show rapid hepatic clearance in mice and nonhuman primates.

Lipid nanoparticles based on ionizable lipids have been clinically validated as a means of delivery for RNA interference (RNAi) therapeutics. The ideal properties of RNAi carriers are efficient delivery of oligonucleotides into target cells and rapid elimination after the function is performed. Here, we report that degradable lipid nanoparticles are effective carriers of small interfering RNA (siRNA) and have a high therapeutic index. The newly developed degradable lipid nanoparticles carrying siRNA showed potent gene-silencing activity in mouse hepatocytes (ED50≈0.02mg/kg siRNA). The ester bond in the lipid tail was hydrolyzed in the liver, resulting in rapid metabolism of the lipid. Toxicity assays showed that the degradable lipid was well-tolerated at siRNA doses of up to 16mg/kg in rats (over 800-fold higher than ED50). A single intravenous injection of siRNA targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) in cynomolgus monkeys resulted in more than 90% protein silencing, and a 50% decrease in plasma low-density lipoprotein (LDL) cholesterol, with a measurable reduction for 2 months. Moreover, quantification of lipids in liver biopsies revealed rapid hepatic clearance of the degradable lipid in nonhuman primates. These degradable lipid nanoparticles with a high therapeutic index hold promise for RNA-based treatments.