Pre-clinical studies are an obligatory tool to develop and translate novel therapeutic strategies into clinical practice. Acute and chronic rejection mediated by the recipient's immune system remains an important limiting factor for the (long-term) survival of vascularized composite allografts (VCA). Furthermore, high intensity immunosuppressive (IS) protocols are needed to mitigate the immediate and long-term effects of rejection. These IS regiments can have significant side-effects such as predisposing transplant recipients to infections, organ dysfunction and malignancies. To overcome these problems, tolerance induction has been proposed as one strategy to reduce the intensity of IS protocols and to thereby mitigate long-term effects of allograft rejection. In this review article, we provide an overview about animal models and strategies that have been used to induce tolerance. The induction of donor-specific tolerance was achieved in preclinical animal models and clinical translation may help improve short and long-term outcomes in VCAs in the future.

The integrity of the metacarpophalangeal (MCP) joints is essential for finger and hand function. Preservation of range-of-motion is one of the aims in reconstruction of complex injuries to these joints. Osteochondral transplants have shown to be reliable in reconstruction of various joint defects. This series presents three patients with traumatic injuries to four MCP joints, which were reconstructed by seven avascular osteochondral transplants of metatarsophalangeal (MTP) joints. The joints were examined for radiographic signs of resorption or joint space narrowing, and if this would affect the joints' function in the long term. In three patients (40, 45 and 48years) with complex injuries to their MCP joints (one milling, two saw injuries), four joints were reconstructed by three metatarsal head and four osteochondral transplants of the base of the proximal toe phalanges. Beside the joint itself, various soft tissue defects were reconstructed in each patient. The patients were clinically and radiographically examined after 9, 6, respectively, 7years. All patients were satisfied with the result without any pain in the MCP joints. Range-of-motion in the four affected joints rated 25, 60, 75, and 80°, DASH scores rated 13, 29, and 17, respectively. None of the patients complained of problems at their feet. Radiographic examination revealed moderate joint space narrowing in one of the four joints. In another patient, localized osteolysis was found around the screws' heads, so that the screws were removed 7years post-op. Osteochondral transplants for reconstruction of MCP defects are able to preserve function in severely injured joints even in the long term. Joint space narrowing may occur, which is not accompanied by pain, however. Since localized osteolysis can cause screw head prominence, mid-term radiographic follow-up is necessary to prevent damage to the joint. In the long term, remaining bone stock may be adequate for total joint replacement.

Minimally invasive arthroscopically assisted reconstruction of scaphoid nonunions. Delayed union or nonunion of the scaphoid with sclerosis and with indication for bone transplantation. Limited arthritic changes at the radial styloid. Severe humpback deformity with dorsal intercalated segment instability. Midcarpal arthritic changes. Supine position with the forearm upright and in neutral position, the elbow flexed by90°, axial traction of 3 to 4 kg. Standard wrist arthroscopy via the 3-4 and the 4-5portal and the midcarpal joint via the radial and ulnar portal, respectively, with sodium chloride as arthroscopy medium. Change of the optic to the ulnar midcarpal portal and opening of the nonunion with an elevator via the radial midcarpal portal. Resection of the sclerosis with a3.0 mm burr while irrigating the joint. Harvesting of cancellous bone via the second extensor compartment. On the hand table, closed reduction by joy-stick K‑wires if needed and insertion of K‑wires for the scaphoid screw. Insertion of the screw without entering of the distal thread into the bone. Arthroscopic insertion of the bone transplant by ablunt drill sleeve via the radial portal with steady compression by the obturator. Complete insertion of the screw under arthroscopic control of the compression of the nonunion space with arthroscopic control of stability with the probe. Six weeks forearm cast including the thumb metacarpophalangeal joint, radiographic control and non-load bearing movements for two more weeks, CT scan in the oblique sagittal plane after 8weeks, and increase of load, as well as physiotherapy on demand depending on the radiographic results. To date, 17patients with amean age of the nonunion of 18months were treated. In14patients, bony union was achieved after 8weeks. In one patient, an extraosseous screw placement was corrected. In another patient with extraosseous screw placement, persisting nonunion was treated with an angular stable plate. One scaphoid demonstrated an asymptomatic tight nonunion after 14months, while one scaphoid with sclerosis of the proximal pole did not heal.

Cryolipolysis is a noninvasive method that allows selective reduction of adipose tissue. The aim of the present study was to evaluate the efficacy of cryothermogenesis, the repetitive applications of cryotherapy, in body contouring of the abdomen and saddlebag areas. Thirty participants were included in the study. Premenopausal women with an overload of subcutaneous abdominal and saddlebag adipose tissue were enrolled. For each participant, five cryothermogenesis sessions were carried out using a medical device equipped with two cooling probes. The primary endpoint was metric measurement. The secondary endpoints were the measurement of subcutaneous fat mass using a Lunar iDXA whole-body scanner (GE Healthcare, Madison, Wis.) and a metabolic assessment conducted before treatment and 15 days after treatment. The mean age of participants was 36.72 ± 7 years. Participants had different phototypes and an average body mass index of 23.0 ± 1.41 kg/m2. A decrease in body mass index was observed 3 months after the last session; the body mass index dropped to 20.5 ± 2.1 kg/m2 (p = 0.004 compared to baseline). Waist measurements showed a significant decrease, with an average loss of 4.1 cm after 15 days and 4.62 cm after 3 months. Concerning the circumference of saddlebags, a decrease was observed 3 months after treatment. These results were confirmed by iDXA computed tomographic measurements, showing a significant fat mass reduction in the treated areas. The results indicate that subcutaneous fat in the abdomen and saddlebags was reduced after five successive cryothermogenesis sessions, without any complications, in a cohort of participants with different phototypes. Therapeutic, IV.

Objective of this open, noninterventional, noncontrolled study was to investigate the tolerability and performance of a woad extract containing cream in subjects with dry, pruritic skin after twice daily application over 2 weeks. Assessments included sensorial characteristics, skin condition, pruritus (numeric rating scale [NRS], dynamic pruritus score [DPS]), skin dryness (itch-controlled days [ItchCD], overall dry skin [ODS]), transepidermal water loss (TEWL), skin hydration and quality of life (5PLQ, DLQI). All sensorial characteristics were well perceived (>4), with tolerability (4.77 ± 0.47) and no negative skin feelings (4.73 ± 0.74) achieving the highest scores (0-5 scale). Dry skin and symptoms improved significantly (p < .001) for all variables: NRS (from 4.8 ± 1.74 to 1.83 ± 2.18), ItchCD (from 8.23 ± 4.40 to 4.81 ± 4.07), ODS (from 1.80 ± 0.85 to 0.65 ± 0.65), hydration (23.33 ± 1.33 to 40.70 ± 1.86), and quality of life (5PLQ: from 7.12 ± 4.25 to 4.24 ± 3.67; DLQI: from 5.29 ± 4.79 to 3.00 ± 3.98). The DPS revealed a moderate antipruritic effect. The TEWL decreased slightly (p = .511). No side effects were reported. The study suggests that, the cream is effective, and well tolerated in treating dry, irritated, and pruritic skin.

Previous reports have demonstrated that cell-derived nanoparticles (CDNPs) composed of bovine or porcine protein complexes exerted therapeutic effects against viral infections and cancer in mice and humans. Based on these observations, we asked whether CDNPs would improve inflammatory skin disorders. To address this, we utilized two distinct mouse models of cutaneous inflammation: the autoimmune skin-blistering disease epidermolysis bullosa acquisita (EBA) as an example of an autoantibody-induced cutaneous inflammation, and Leishmania major (L.major) infection as an example of a pathogen-induced cutaneous inflammation. In both models, we observed that CDNPs increased mRNA expression of the Th2 cytokine IL-4. Clinically, CDNPs decreased inflammation due to EBA and increased L.major-specific IgG1 levels without major effects on infected skin lesions. In addition, CDNPs supported the growth of keratinocytes in human skin cultures. In vitro studies revealed that CDNPs were taken up predominantly by macrophages, leading to a shift towards the expression of anti-inflammatory cytokine genes. Altogether, our data demonstrate that treatment with porcine CDNPs may be a new therapeutic option for the control of autoimmune-mediated inflammatory skin disorders.

The aesthetic appearance of the mouth region, in addition to the eye and nose area, is the impressive element for facial aesthetics. Therefore, the reconstruction of the intraoral region is very important for the facial aesthetics in the case of genetic dysplasia, trauma, or even in cases for rejuvenating purposes only. The entire region is complex so that in many patient cases only the team work of restorative dentists, surgeons, and orthodontists will be effective. A key role is played here by the dental technician. Besides the frequent necessity of osseous augmentation, the mucogingival complex needs to be, in most cases, harmonized and reconstructed, respectively. There is often a lack of keratinized gingiva and disturbing cicatrice tracks. Quite frequently the mucogingival appearance is also unsatisfactory due to preceding operations and attempted plastic coverages. The aim of this report is to describe the successful surgical and prosthetic treatment of aesthetically and functionally impaired intraoral hard and soft tissue. For surgeons who are interested in aesthetics, it is advisable to learn from experiences of a specialized restorative dentist, oral surgeon, and orthodontist.

The article discusses the intricate relationship between sound and signification through notions of noise. The emergence of new fields of sonic artistic practices has generated several questions of how to approach sound as aesthetic form and material. During the past decade an increased attention has been paid to, for instance, a category such as “sound art” together with an equally strengthened interest in phenomena and concepts that fall outside the accepted aesthetic procedures and constructions of what we traditionally would term as musical sound—a recurring example being “noise”. In order to explore the effects and signifying modes of sonic material considered peripheral to established musicological methodologies, other types of discourses have appeared. The aim of this article is to investigate and evaluate such discourses of the sonic arts and to do so from the perspective of a continuum between sound and noise. It is moreover suggested that we consider sound in relation to the concept of “signal” which is exemplified through analysis of actual works.Thomas Bøgevald Bjørnsten is a Ph.D. fellow at the Department of Aesthetics and Communication, Aarhus University. His current dissertation project investigates the role of silence and noise as transmedial phenomena—a topic on which he has published a number of articles, for instance: “Ohört märkbara—om infraljudens gränstillstånd” (Nutida Musik, Nr. 3, 2009, s. 5–11) and “Resounding Catastrophe: Auditory Perspectives on 9/11” (in: The Cultural Life of Catastrophes and Crises, De Greuyter Verlag, 2012 [in press]). He is also a regular contributor to various journals and magazines, writing primarily about experimental music and sound art.