Calcium Hydroxylapatite: Over a Decade of Clinical Experience

Background: Calcium hydroxylapatite is one of the most well-studied dermal fillers worldwide and has been extensively used for the correction of moderate-to-severe facial lines and folds and to replenish lost volume. Objectives: To mark the milestone of 10 years of use in the aesthetic field, this review will consider the evolution of calcium hydroxylapatite in aesthetic medicine, provide a detailed injection protocol for a global facial approach, and examine how the unique properties of calcium hydroxylapatite provide it with an important place in today’s market. Methods: This article is an up-to-date review of calcium hydroxylapatite in aesthetic medicine along with procedures for its use, including a detailed injection protocol for a global facial approach by three expert injectors. Conclusion: Calcium hydroxylapatite is a very effective agent for many areas of facial soft tissue augmentation and is associated with a high and well-established safety profile. Calcium hydroxylapatite combines high elasticity and viscosity with an ability to induce long-term collagen formation making it an ideal agent for a global facial approach.Aesthetic medicine has advanced greatly in the past decade in terms of our understanding of facial anatomy; the cumulative effects of the aging process; and how dermal fillers may be used to repair, reduce, and even reverse these changes. Initially, aesthetic practitioners were “chasing lines and wrinkles,” based on experience with bovine collagen injections beginning in the early 1980s. We now appreciate that a natural and more youthful appearance is dependent on reversing the cumulative effect of age-related changes both on the surface and in the subsurface tissues. For surface aging, restoration of textural and pigmentary alterations is of paramount importance; for the subsurface, restoring lost volume and shape is the key to the more youthful proportions desired by our patients. This focus on facial shape and volume to restore balance, symmetry, and the proportions of youth has led to the development and worldwide clinical use of an ever-expanding list of dermal fillers for treatment of facial aging.Dermal fillers as a category of implantable medical devices, consist of a wide array of products that differ significantly in their chemical composition, mechanism of action, duration, safety, and interaction with host tissues. Many different methods of categorization have been proposed, based in part on these differing characteristics; however, no single, universally agreed upon system exists to date. Of the proposed classification systems, one based on primary mechanism of action (MOA) first proposed by Werschler and Narurkar has been widely used.1 In this approach, dermal fillers are placed into categories of either collagen biostimulation or replacement volume as a primary MOA.In this schema, Radiesse® (calcium hydroxylapatite; CaHA, Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a unique product because it provides both replacement volume and collagen biostimulation as a primary MOA. In addition, CaHA is biodegradable and reabsorbed naturally by the host’s metabolic processes. This biostimulatory MOA, with ultimate reabsorption, results in a performance profile that is unique to Radiesse.CaHA is a highly effective agent for many areas of facial soft-tissue augmentation and is associated with a well-established safety profile.2 The year 2013 marked a decade of Radiesse technology, which first received EU approval in 2003 for plastic and reconstructive surgery, including deep dermal and subdermal soft tissue augmentation of the facial area. In the intervening years, the range of uses for CaHA has evolved alongside developments in the field of aesthetic medicine from a surface-oriented two-dimensional approach, concentrating on removal of facial lines and folds, to a three-dimensional approach that also addresses both soft and hard tissue volume loss in both the face and the hands.3With the popularity of dermal fillers demonstrated by increasing numbers of treated patients, public awareness and acceptance of nonsurgical enhancement has greatly increased the treatment options available. Along with botulinum toxin injections and energy-based devices, fillers are the mainstay of most medical aesthetic clinics. With increasing patient demand and the increased availability of aesthetic providers, private practices have become more competitive. Patient retention is now a major objective of most aesthetic businesses. Patient satisfaction is a key element for patient retention and requires a portfolio of safe and effective products. Long-term clinical experience, clinical research, peer-reviewed publications and regulatory approvals have combined to demonstrate the safety and efficacy of CaHA. The product has been evolved to meet the demands of a continuum of aesthetic care in terms of enhancement of youthful patients (ages 25-35); early prevention, rejuvenation, and volume restoration for patients in the middle decades of life (35-55); and for the delay and maintenance as part of restoration for mature (55-75+) patients as well.In this tenth anniversary year, the authors consider the historical milestones of CaHA in aesthetic medicine, propose a protocol for a global facial approach using CaHA, and look at how its unique properties provide it with a place in today’s market and keep it at the forefront of modern aesthetic treatments. Throughout this publication, reference is made to labeled and off-label indications, techniques, and dilution protocols performed by experts in the field of aesthetic medicine. The reader is reminded that some of these are not approved by regulatory authorities and are not endorsed by Merz Pharmaceuticals GmbH.     

6 种化学发光系统检测肿瘤标志物的应用评估分析

目的　探讨6 种化学发光系统检测甲胎蛋白（AFP）、癌胚抗原（CEA）、总前列腺特异抗原（tPSA）、游离前列腺特异性抗原（fPSA）、糖类抗原CA199（CA199）、糖类抗原CA153（CA153）和糖类抗原CA125（CA125）仪器参数、西格玛值（σ）、可比性及临床可接受程度。方法　收集6 种系统的检测速度,试剂仓位,开展项目数等硬件参数,使用单位半年质控数据,计算各系统检测项目的精密度及σ 值。以Roche E602 电化学发光系统为参考系统,根据EP9-A2 文件的要求,对检测结果进行方法比对和偏倚评估。结果　① 比较6 种检测系统的检测速度,试剂仓位,软件功能等参数,6 种检测系统基本满足临床需求。② Roche E602 与A厂家比较,多数检测项目σ 值多数高于6σ 水平;B,D 和E 三家厂家检测项目σ 值基本处于优秀水平（5~6）;C 厂家多个项目小于4σ 水平,存在较大差距。③除B厂家外,其它厂家与Roche E602 多数项目偏移超过1/2 TEa,临床不可接受。结论　实验室同时存在多种不同品牌化学发光检测系统检测同一检验项目时,应进行方法比对和偏倚评估,判断其临床可接受性能,以保证检验结果的可比性。     

Non-cytotoxic,temperature-responsive and antibacterial POEGMA based nanocomposite coatings with silver nanoparticles

Non-cytotoxic, temperature-responsive and antibacterial poly(di(ethylene glycol)methyl ether methacrylate) – POEGMA188 based nanocomposite coatings attached to a glass surface were successfully prepared using ATRP polymerization. The thickness, morphology and wettability of the resulting coatings were analyzed using ellipsometry, AFM and contact angle measurements, respectively. The strong impact of the thicknesses of the POEGMA188 grafted brush coatings and content of AgNPs on the morphology and temperature-induced wettability changes of the nanocomposite was demonstrated. In addition to the strong temperature-dependent antibacterial activity, the proposed nanocomposite coatings have no significant cytotoxic effect towards normal cells. Moreover, the slight anti-cancer effect of AgNPs may be suggested.

Non-cytotoxic, temperature-responsive and antibacterial polymer/silver nanoparticles nanocomposite coatings with prolonged action.     

Intussusception caused by dried apricot: A case report

INTRODUCTION

An unusual cause of intussusception due to small bowel obstruction secondary to dried apricot consumption was encountered. Phytobezoar small bowel obstruction is a rare, but interesting pathology that accounts for 2–4% of small bowel obstructions (18). Even rarer, is an intussusception caused by dried fruit ingestion. We present the case of a 56-year-old female that presented with an intussusception after she ingested a large amount of dried apricots.

PRESENTATION OF CASE

The patient is a 56-year-old female with a small bowel obstruction secondary to intussusception in the distal ileum. She was taken to the operating room for a celiotomy where an intussusception of the distal small bowel was found. An enterotomy was performed which revealed dried apricots as the lead point. The intussusception was successfully reduced and the apricots removed.

DISCUSSION

Small bowel obstruction due to intussusception can be caused secondary to malignancy, Meckel''s Diverticulum, benign neoplasm, and strictures. A less common cause for small bowel obstruction due to intussusception in adults is secondary to mechanical obstruction by bezoars. Risk factors for bezoar formation include previous gastric surgery, diabetes, and mastication problems.

CONCLUSION

Bezoars are an extremely rare cause of intussusception in adults. A high level of suspicion needs to exist in the presence of a history of eating dried fruit, history of gastric surgery, diabetes mellitus, and problems with mastication. Various treatment modalities exist to treat obstructions secondary to bezoars, including open reduction and removal of bezoar via enterotomy.     

Oligostilbenoids from <Emphasis Type="Italic">Shorea gibbosa</Emphasis> and their cytotoxic properties against P-388 cells

A new oligostilbenoid derivative, diptoindonesin F (1), along with five known oligostilbenoids, (−)-ampelopsin A (2), (−)-α-viniferin (3), ampelopsin E (4), (−)-vaticanol B (5), and (−)-hemsleyanol D (6), were isolated from the methanol extract of the tree bark of Shorea gibbosa. The structure of the new compound was determined based on the analysis of spectroscopic data, including UV, IR, NMR 1-D and 2-D, and mass spectra. Cytotoxic properties of the isolated oligostilbenoids were evaluated against murine leukemia P-388 cells with the result that compounds 2 and 4 showed the highest cytotoxicity.     

Role of systemic endocannabinoid CB-1 receptor antagonism in the acquisition and expression of fructose-conditioned flavor-flavor preferences in rats

Rats learn to prefer a flavor mixed into a fructose-saccharin solution over a different flavor mixed into a saccharin-only solution which is considered to be a form of flavor-flavor conditioning. Fructose-conditioned flavor preferences are impaired by systemic dopamine D1 and to a lesser degree, D2 receptor antagonism as well as by NMDA, but not opioid, receptor antagonism. Given the emerging role of the endocannabinoid system in mediating hedonically-driven food intake, the present study examined whether systemic administration of the inverse CB-1 receptor agonist, AM-251 would alter fructose-conditioned flavor preferences. In Experiment 1, food-restricted rats were trained over 10 sessions (30 min/day) to drink a fructose-saccharin solution mixed with one flavor (CS+/Fs) and a less-preferred saccharin-only solution mixed with another flavor (CS-/s). Subsequent two-bottle tests with the two flavors in saccharin (CS+/s, CS-/s) occurred 15 min following counterbalanced pairs of AM-251 doses of 0, 0.1, 1 or 3 mg/kg. Preference for CS+/s over CS-/s following vehicle treatment (74%) was significantly reduced by the 0.1 (67%) and 1 (65%) AM-251 doses, whereas CS+/s, but not CS-/s intake was significantly reduced by the 1 and 3 mg/kg AM-251 doses. In Experiment 2, rats received systemic injections of AM-251 (1 mg/kg) or vehicle prior to the 10 CS+/Fs and CS-/s training sessions. In subsequent two-bottle tests (drug-free) the AM-251 and control groups displayed similar preferences for the CS+ flavor (66% vs. 69%). Experiment 3 demonstrated that AM-251 significantly decreased chow intake (24 h), and 1-h intakes of fructose-saccharin and saccharin-only solutions in ad libitum-fed rats. These data indicate that functional CB-1 receptor antagonism significantly reduces the expression, but not the acquisition of fructose-conditioned flavor-flavor preferences. The endogenous endocannabinoid system is therefore implicated in the maintenance of this form of learned flavor preferences.     

Efficacy and safety of montelukast adjuvant therapy in adults with cough variant asthma: A systematic review and meta‐analysis

Background

Montelukast is a highly selective and specific cysteinyl leukotriene receptor antagonist used in the treatment of asthma. Whether montelukast as adjuvant therapy can significantly and safely treat adults with cough variant asthma (CVA) remains inconclusive.

Aims

This meta-analysis systematically evaluated the efficacy and safety of montelukast as an adjuvant treatment for adults with CVA.

Materials and methods

Randomized controlled trials (RCTs) on montelukast combined with inhaled corticosteroids (ICS) and long-acting β2 agonists (LABAs) to treat CVA in adults, from inception to March 6, 2023, were retrieved from the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, and Web of Science databases and Clinical Trials website. Review Manager (version 5.4) and Stata (version 15.0) were used to conduct the meta-analysis.

Results

A total of 15 RCTs were ultimately included in the meta-analysis. It was established that montelukast as adjuvant therapy raised the total effective rate (RR = 1.20, 95% confidence interval [CI] [1.13, 1.27], P < 0.01) and improved the FEV1% (SMD = 0.91, 95% CI [0.40, 1.41], P < 0.01), PEF% (SMD = 0.63, 95% CI [0.38, 0.88], P < 0.01), FEV1 (SMD = 1.15, 95% CI [0.53, 1.77], P < 0.01), PEF (SMD = 0.64, 95% CI [0.42, 0.86], P < 0.01), and FEV1/FVC% (SMD = 0.76, 95% CI [0.51, 1.01], P < 0.01) and reduced the recurrence rate (RR = 0.28, 95% CI [0.15, 0.53], P < 0.01). The incidence of adverse reactions was higher in the montelukast auxiliary group compared to the control group but with no statistical difference (RR = 1.32, 95% CI [0.89, 1.96], P = 0.17).

Conclusion

Existing evidence indicated that the use of montelukast as an adjuvant therapy had therapeutic efficacy superior to ICS + LABA alone for the treatment of adult patients with CVA. However, further research is needed, especially a combination of high-quality long-term prospective studies and carefully designed RCTs.