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Αλέξανδρος Γ. Σφακιανάκης

Sunday, December 6, 2020

Decoding infraorbital dark circles with lasers and fillers.

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Patients who had tear troughs and/or hollow eyes responded well to fillers, patients with loose and wrinkled skin to CO2 laser, patients with tear troughs and hyperpigmentation to fillers, Q switched Nd:YAG and topical agents and patients with tear troughs and veins to fillers and long pulsed Nd:YAG lasers.

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Decoding infraorbital dark circles with lasers and fillers.

J Dermatolog Treat. 2020 Dec 03;:1-8

Authors: Kounidas G, Kastora S, Rajpara S

Abstract
BACKGROUND: The degree and severity of dark circles varies according to the skin type, age, and lifestyle.
OBJECTIVES: To evaluate different non-surgical treatment options for dark circles.
METHODS: In a private practice setting in the UK and India, 34 patients with dark circles with different Fitzpatrick skin types were treated with fillers (Group 1), lasers (Group 2), and fillers and lasers combined (Group 3). Pre and post treatment photos were taken and subjective and objective outcomes in appearance were reported.
RESULTS: All treatment options were effective in all three groups with minimal side effects reported. No statistically significant difference was found between the three treatment groups. Patients who had tear troughs and/or hollow eyes responded well to fillers, patients with loose and wrinkled skin to CO2 laser, patients with tear troughs and hyperpigmentation to fillers, Q switched Nd:YAG and topical agents and patients with tear troughs and veins to fillers and long pulsed Nd:YAG lasers. Most patients (82%) rated the improvement in their appearance as excellent.
CONCLUSIONS: All 3 treatment modalities were effective in the reduction of periorbital dark circles depending on underlying cause. Non-surgical treatments are capable of correcting and improving dark circles with minimum complications and downtime.

PMID: 33272039 [PubMed - as supplied by publisher]

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Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report.

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Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report.

Cochlear Implants Int. 2020 Dec 03;:1-6

Authors: Abrar R, Mawman D, Martinez de Estibariz U, Datta D, Stapleton E

Abstract
Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthesia (GA), precluding patients who have higher risk associated with GA. Recent literature describes the safety and efficacy of performing unilateral CI surgery under local anaesthesia (LA). We report the first simultaneous bilateral CI under LA in the UK in an adult patient with profound sensorineural deafness and visual impairment. Case study: A 46-year-old gentleman, registered blind, presented with a 20-year history of bilateral progressive hearing loss. He was assessed as unfit for surgery under GA due to significant cardiac comorbidities. We performed simultaneous bilateral CI surgery under LA on the patient; he was discharged h ome the following day. Postoperative free field audiometry showed a significant improvement; speech discrimination using Bamford, Kowal and Bench sentences presented in quiet, increased from 0% pre-operatively to 100% four months post-operatively. Conclusion: Simultaneous bilateral CI surgery under LA is a safe and feasible procedure for eligible patients who may otherwise have been denied surgery due to their GA risk.

PMID: 33272141 [PubMed - as supplied by publisher]

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A novel treatment for CI extrusion with vacuum-assisted closure device.

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A novel treatment for CI extrusion with vacuum-assisted closure device.

Cochlear Implants Int. 2020 Dec 03;:1-6

Authors: Chua CA, Thong JF, Binte Sudirman SR

Abstract
OBJECTIVE: To assess if a vacuum-assisted closure device initially utilised as a temporising measure to dress a wound defect over a cochlear implant prior to definitive surgical intervention could instead be used to close the soft tissue and avoid surgery.
METHOD: This is a case report describing the novel use of VAC (Vacuum-Assisted Closure Device) in the successful closure of a wound defect with cochlear implant hardware exposure post soft tissue infection during the Covid-19 pandemic.
RESULTS: While the VAC system was initiated for temporary wound coverage, it was observed at each dressing change to be successfully decreasing the soft tissue defect for our patient. This resulted in complete epithelisation of the soft tissue defect at Day 35 and avoidance of a surgical procedure. The patient was able to restart wearing her device on Day 50 and Cochlear MAPping performed on Day 58 showed minimal changes in patient's current requirements compared to her settings pre-infection.
CONCLUSION: The use of V.A.C dressing for a small soft tissue defect over an extruded cochlear implant seems promising as exemplified by our case study. However, due to the lack of literature, more studies should be done to prove its usefulness in such an application.

PMID: 33272148 [PubMed - as supplied by publisher]

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Elevated circulating Glutamate associates with subclinical Atherosclerosis independently of established Risk Markers: a cross-sectional study.

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Elevated circulating Glutamate associates with subclinical Atherosclerosis independently of established Risk Markers: a cross-sectional study.

J Clin Endocrinol Metab. 2020 Dec 05;:

Authors: Lehn-Stefan A, Peter A, Machann J, Schick F, Randrianarisoa E, Heni M, Wagner R, Birkenfeld AL, Fritsche A, Häring HU, Staiger H, Stefan N

Abstract
OBJECTIVE: Elevated plasma glutamate levels associate with an increased risk of cardiovascular disease (CVD). Because plasma glutamate levels also strongly associate with visceral adiposity, NAFLD, insulin resistance and high circulating levels of branched-chain amino acids (BCAA), it is unknown to what extent elevated circulating glutamate is an independent marker of an increased risk of atherosclerosis.
METHODS: Plasma levels of glutamate and BCAA were measured in 102 subjects who were precisely phenotyped for body fat mass and distribution (MR tomography), liver fat content ( 1H-MR spectroscopy), insulin sensitivity [oral glucose tolerance test and hyperinsulinemic, euglycemic clamp (N=57)] and carotid intima-media thickness (cIMT).
RESULTS: Plasma glutamate levels, adjusted for age, sex, body fat mass and visceral fat mass, correlated positively with liver fat content and cIMT (all std.-ß≥0.22, all p≤0.023) and negatively with insulin sensitivity (std.-ß≤-0.31, p≤0.0019). Glutamate levels also associated with cIMT, independently of additional adjustment for liver fat content, insulin sensitivity and BCAA levels (std.-ß≥0.24, p≤0.021). Furthermore, an independent positive association of glutamate and IL-6 levels was observed (N=50; std. ß=0.39, p=0.028). While glutamate, adjusted for age, sex, body fat mass and visceral fat mass, also correlated positively with cIMT in this subgroup (std. ß=0.31, p=0.019), after additional adjustment for the parameters liver fat content, insulin sensitivity, BCAA or IL-6 levels, adjustment for IL-6 most strongly attenuated this relationship (std. ß=0.28, p=0.05).
CONCLUSIONS: Elevated plasma glutamate levels are associated with increased cIMT, independently of established CVD risk factors and this relationship may in part be explained by IL-6-associated subclinical inflammation.

PMID: 33277657 [PubMed - as supplied by publisher]

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TNF-α Priming Elicits Robust Immunomodulatory Potential of Human Tonsil-Derived Mesenchymal Stem Cells to Alleviate Murine Colitis.

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TNF-α Priming Elicits Robust Immunomodulatory Potential of Human Tonsil-Derived Mesenchymal Stem Cells to Alleviate Murine Colitis.

Biomedicines. 2020 Dec 02;8(12):

Authors: Shin TH, Ahn JS, Oh SJ, Shin YY, Yang JW, Kang MJ, Kim JM, Lee BJ, Seo Y, Kim HS

Abstract
Mesenchymal stem cells (MSCs) have been spotlighted in the field of cell therapies as a promising tool for the treatment of intractable inflammatory diseases. However, their therapeutic potency still shows a gap between preclinical and clinical settings, and distinctive characteristics of specific tissue-derived MSCs and definitive ways to maximize their beneficial functions have not been fully elucidated yet. We previously identified the unique MSCs population from human palatine tonsil (TMSCs) and revealed their superior properties in proliferation and ROS regulation. Based on these findings, we explored further characteristics of TMSCs particularly focused on immunomodulatory function. We found the merit of TMSCs as a therapeutic agent that retains favorable MSCs properties until relatively late passages and revealed that pre-treatment of TNF-α can enhance the immunomodulatory abilities of TMSCs through the upregulation of the PTGS2/PGE2 axis. TMSCs primed with TNF-α eff ectively restrained the proliferation and differentiation of T lymphocytes and macrophages in vitro, and more interestingly, these TNF-α-licensed TMSCs exhibited significant prophylactic and therapeutic efficacy in a murine model of autoimmune-mediated acute colitis via clinical and histopathological assessment compared to unprimed naïve TMSCs. These findings provide novel insight into the optimization and standardization of MSCs-based anti-inflammatory therapies, especially targeting inflammatory bowel disease (IBD).

PMID: 33276479 [PubMed - as supplied by publisher]

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NRF2 and the Ambiguous Consequences of Its Activation during Initiation and the Subsequent Stages of Tumourigenesis.

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NRF2 and the Ambiguous Consequences of Its Activation during Initiation and the Subsequent Stages of Tumourigenesis.

Cancers (Basel). 2020 Dec 02;12(12):

Authors: Robertson H, Dinkova-Kostova AT, Hayes JD

Abstract
NF-E2 p45-related factor 2 (NRF2, encoded in the human by NFE2L2) mediates short-term adaptation to thiol-reactive stressors. In normal cells, activation of NRF2 by a thiol-reactive stressor helps prevent, for a limited period of time, the initiation of cancer by chemical carcinogens through induction of genes encoding drug-metabolising enzymes. However, in many tumour types, NRF2 is permanently upregulated. In such cases, its overexpressed target genes support the promotion and progression of cancer by suppressing oxidative stress, because they constitutively increase the capacity to scavenge reactive oxygen species (ROS), and they support cell proliferation by increasing ribonucleotide synthesis, serine biosynthesis and autophagy. Herein, we describe cancer chemoprevention and the discovery of the essential role played by NRF2 in orchestrating protection against chemical carcinogenesis. We similarly describe the discoveries of somatic mutations in NFE2L2 and the gene encodi ng the principal NRF2 repressor, Kelch-like ECH-associated protein 1 (KEAP1) along with that encoding a component of the E3 ubiquitin-ligase complex Cullin 3 (CUL3), which result in permanent activation of NRF2, and the recognition that such mutations occur frequently in many types of cancer. Notably, mutations in NFE2L2, KEAP1 and CUL3 that cause persistent upregulation of NRF2 often co-exist with mutations that activate KRAS and the PI3K-PKB/Akt pathway, suggesting NRF2 supports growth of tumours in which KRAS or PKB/Akt are hyperactive. Besides somatic mutations, NRF2 activation in human tumours can occur by other means, such as alternative splicing that results in a NRF2 protein which lacks the KEAP1-binding domain or overexpression of other KEAP1-binding partners that compete with NRF2. Lastly, as NRF2 upregulation is associated with resistance to cancer chemotherapy and radiotherapy, we describe strategies that might be employed to suppress growth and overcome drug resistance in tumours with overactive NRF2.

PMID: 33276631 [PubMed - as supplied by publisher]

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Effect of Endoscopic Glottoplasty on Acoustic Measures and Quality of Voice: A Systematic Review and Meta-Analysis.

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Effect of Endoscopic Glottoplasty on Acoustic Measures and Quality of Voice: A Systematic Review and Meta-Analysis.

J Voice. 2020 Dec 01;:

Authors: Aires MM, Marinho CB, Souza CSC

Abstract
INTRODUCTION: The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice therapy is not completely satisfactory, and surgery should be considered, with endoscopic glottoplasty being the current practice. While the increase in fundamental frequency (F0) after glottoplasty has been well described, no systematic review of the literature or meta-analysis regarding other acoustic parameters and quality of voice has been performed yet.
OBJECTIVE: To define the effect of endoscopic glottoplasty on acoustic measures and quality of voice by assessing F0, maximum phonation time (MPT), frequency range, and grade of dysphonia.
METHODS: A literature review was performed in Medline/PubMed, Cochrane, Science Direct, LILACS, and Google Scholar, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish that assessed transgender women who underwent endoscopic glottoplasty. All the included articles were measured in terms of their methodological quality.
RESULTS: The PRISMA approach yielded 14 studies, totaling 566 patients. There was significant heterogeneity between studies regarding follow-up time, surgical technique and perioperative care. Thirteen studies were submitted to meta-analysis. The results showed significant changes in pre- to postglottoplasty mean differences of F0 = 78.49 Hz (95%CI: 75.69-81.30), MPT = -1.11 seconds (95%CI -1.67 to -0.54), frequency range = -3.55 semitones (95%CI -5.74 to -1.36) and grade of dysphonia on the GRBAS scale = 0.44 (95%CI 0.27-0.61).
CONCLUSION: Glottoplasty is effective in significantly increasing fundamental frequency, but slightly decreases MPT, frequency range and vocal quality measured by the grade of dysphonia on the GRBAS scale.

PMID: 33277130 [PubMed - as supplied by publisher]

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