Changes in blood center red blood cell distributions in the era of patient blood management: the trends for collection (TFC) study.

BACKGROUND: As patient blood management becomes more widespread, fewer red blood cell (RBC) units have been transfused. This multinational study evaluated changes in blood center RBC distributions. STUDY DESIGN AND METHODS: Data on number and ABO and D groups of RBC distributions were obtained from several large American blood centers and national or provincial blood services (NPBS) from fiscal year (FY) 2010 through FY2014. Due to relatively larger numbers of distributions and differences in ABO and D groups between the Japanese Red Cross and the other NPBS, Japanese data were not included in distributions calculations. RESULTS: Data from seven American blood centers and eight NPBS were obtained. Overall, at both the American and the seven NPBS that were analyzed, there were declines in the number of RBC distributions between FY2010 and FY2014, 16.9 and 8.0%, respectively. The number of O- RBC distributions decreased by 9.0% at American blood centers but the proportion of RBC distributions that were O- increased by 9.3% during this time. The NPBS had 1.6% increase in O- RBC distributions and 10.5% increase in the proportion of O- distributions. The proportion of O+ distributions increased slightly over time at American centers (2.9%) while decreasing slightly (1.1%) at NPBS despite reductions in the absolute numbers of O+ distributions. Overall there was 2.6% decrease in the proportion of B+ and AB+ RBCs distributed and 13.6% absolute reduction in the number of these units distributed. CONCLUSION: Although overall RBC distributions have decreased over time, the proportion of O units has increased substantially.

Impact on facial rejuvenation with dermatological preparations.

The treatment options for facial rejuvenation using dermatological, nonsurgical techniques have dramatically increased in the past 10 years. This follows the introduction of botulinum toxin and a variety of dermal fillers. The public interest in noninvasive treatments has changed the market beyond recognition with more physicians involved in providing services to satiate the demand. The impact on the public and medical profession is discussed.

Botulinum toxin cosmetic therapy correlates with a more positive mood.

BACKGROUND: It has been suggested that botulinum toxin A (BTX-A) treatment for frown lines can also be used as a treatment for depression. A psychological mechanism for this effect is reviewed in which paralysis of the corrugator (frown) muscles leads to less facial feedback for negative emotions. Consequently, a negative affect is harder to maintain and so the person has a more positive mood. METHODS: In order to test this mechanism, the mood of patients who had received BTX-A treatment for glabelar frown lines was measured and compared with patients who had received other cosmetic treatments. RESULTS: The BTX-A-treated patients showed significantly less negative mood. CONCLUSION: The results support the facial feedback view that frowning can make one unhappier. Treatments that prevent frowning correlate with reduced negative mood.

Dermal and epidermal remodeling using botulinum toxin type A for facial, non reducible, hyperkinetic lines: two case studies.

BACKGROUND: Many studies confirm the safety and efficacy of botulinum toxin type A in a variety of clinical indications. Its use for treatment of hyperfunctional facial lines has become the most popular cosmetic procedure. These case studies comprise an evaluation of the long-term treatment of two subjects treated with botulinum toxin type A (BOTOX(R), Allergan, Irvine, CA, USA) for hyperfunctional, non reducible, facial lines. AIMS: This paper aims to assess the long-term effectiveness of BOTOX treatment for hyperfunctional facial lines in two subjects over 7 years. PATIENTS/METHODS: Two subjects (case 1: female aged 53 years; case 2: male age 50 years) presenting with glabelar, forehead, and periorbital facial lines were treated with BOTOX over a 7-year period. Case 1 received a total of 24 treatments at 4-monthly intervals, and case 2 received 21 treatments at 3- to 6-monthly intervals. RESULTS: Skin quality continued to improve over time, revealing a smoother, enhanced, yet "natural" look. In particular, non reducible forehead lines were effaced suggesting dermal and epidermal remodeling over long-term treatment. There was no evidence of development of any new wrinkles secondary to BOTOX use, and both subjects continue to report high levels of treatment satisfaction. No safety issues were raised. CONCLUSIONS: These case studies demonstrate that non reducible horizontal forehead lines can show long-term reduction with BOTOX treatment and high levels of subject satisfaction.

Clinical experience and safety using phosphatidylcholine injections for the localized reduction of subcutaneous fat: a multicentre, retrospective UK study.

BACKGROUND: Phosphatidylcholine has been in safe use for over 30 years. Subcutaneous injections of phosphatidylcholine have now become used internationally for localized subcutaneous fat reduction on the face and body, but concerns about the safety of this treatment have arisen. AIMS: To assess retrospectively treatment outcomes and adverse effects associated with subcutaneous phosphatidylcholine use. PATIENTS AND METHODS: Thirty-nine UK doctors specifically trained and experienced in this treatment completed questionnaires, focusing on outcome and adverse effects experienced by patients. RESULTS: Ten thousand five hundred and eighty-one treatments had been administered over a mean duration of 13.1 months. Localized adverse effects (swelling, erythema, burning/stinging, pain, tenderness and bruising) were described by most patients as "very mild' (18.4%) or "mild" (39.2%). The total incidence of systemic side-effects was 3%: diarrhoea, nausea, dizziness/light-headedness and intermenstrual bleeding were described by most patients as "very mild" (36%) or "mild" (55%). Only 15 (0.14%) "unexpected, unusually severe or prolonged" adverse reactions (commonly pain and/or swelling) were reported. These were all self-limiting and none were judged as serious. 73.8% of patients were either "very satisfied" or "satisfied" with treatment. CONCLUSIONS: This treatment appears to be associated with minimal risks when used by specifically trained and experienced doctors. The possible risks associated with this treatment should be balanced against the risks of other treatment options.

A retrospective study in the use of botulinum toxin type-A in a UK multidisciplinary cosmetic practice.

BACKGROUND: Botulinum toxin type-A is established as safe and effective and is widely used for cosmetic indications; however, little data exist on patient satisfaction following treatment. AIMS: To correlate patient satisfaction with dose levels in the treatment of hyperfunctional facial lines. PATIENTS/METHODS: Retrospective data were collected on 300 patients treated with Botox for facial lines. Patients completed a subjective assessment of satisfaction with their treatment, and details of dose and treatment area were recorded. RESULTS: Eighty-five percent of patients rated their satisfaction with treatment as > or = 8 (on a 10-point scale), with higher scores seen at higher dosages. The highest mean score was seen in the 51-75 U dose group. Satisfaction was highest in patients who had three facial areas treated vs. those who had one or two areas treated. No safety issues were raised. CONCLUSIONS: The results show a high level of satisfaction with botulinum toxin type-A treatment, with most patients achieving a desired "natural" look. Future studies should be carried out to standardize ways of achieving optimum patient satisfaction to maximize the link between physical appearance and psychological well-being.

A retrospective study of the efficacy of intense pulsed light for the treatment of dermatologic disorders presenting to a cosmetic skin clinic.

BACKGROUND: One hundred seven patients presenting to a cosmetic skin clinic were treated with intense pulsed light (IPL) over a 12-month period. The main categories of patients offered treatment were those with vascular problems such as rosacea, facial telangiectasia, and spider nevi; pigmentation disorders such as solar damage, lentigines, and hyperpigmentation; and assorted problems such as scarring and poikiloderma. METHODS: Each patient who entered into the study had the full medical history taken and a dermatologic assessment. Polaroid photographs were taken and the images used for comparison before and after treatment. Outcomes were assessed by physicians' global assessment and a patients' postal questionnaire. Patients were treated with a Lumina IPL (Lynton Lasers Ltd) using a multiple pulsing facility with variable interpulse spacing, incorporating a 585-nm head. Fluence levels varied between 10 and 40 J/cm(2), although the average fluence over all patients was 25 J/cm(2). The delay was set between 10 and 30 ms and two to four pulses were used. Results Excellent results were seen in 80% of patients treated. There was a high patient satisfaction rate and low prevalence of side effects. CONCLUSIONS: IPL has been shown to provide a safe and effective noninvasive treatment for a wide range of dermatologic disorders and is suitable for wider use in primary care.