Global Improvement Research Articles

Trend and Burden of Vitamin A Deficiency in 1990–2021 and Projection to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021

Background/Objectives: In this study, we aim to provide an update on the global, regional, and national trends in VAD-associated mortality and morbidity for children under 20 years of age, across different age groups and sociodemographic backgrounds, to identify populations at risk that require further attention. Methods: Data from the Global Disease of Burden study were analysed to determine the temporal trends in VAD mortalities and VAD disease burden through disability-adjusted life years (DALYs) and Years Lived with Disability (YLD). Data on children under 20 years of age from 1990 to 2021 from 204 countries and territories were included for analysis. The Average Annual Percentage Change (AAPC) was used to show a temporal trend over a 30-year period. Results: Global VAD-associated mortality has decreased significantly, with an AAPC of −0.91 (95% CI= −0.95 to −0.85). No significant improvements in VAD morbidities were identified across Sub-Saharan African regions. In Central Sub-Saharan Africa, the number of VAD-associated disabilities increased from 70,032.12 to 73,534.15. Significant heterogeneity in changes in VAD morbidities were also identified across different countries. The highest age-standardized rate (ASR) of VAD YLD was 282.36 in Somalia, while countries with high sociodemographic indices had an ASR of 0. Conclusions: Significant global improvements in VAD mortalities indicate the efficacy of wide-scale high-dose vitamin A supplementation for children under 5 years of age. However, the lack of improvements in VAD morbidities in low-SDI countries highlights the need to continue crucial high-dose vitamin A supplementation and to implement additional vitamin A supplementation programs.

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To expedite the deployment of Sesuvium portulacastrum floating bed technology in Hangzhou Bay and the Yangtze River Estuary, and to overcome the cryogenic constraint, our study concentrated on investigating the impacts of both individual and combined stress factors, particularly low temperature and salinity, on its application. We detected the S. portulacastrum related enzyme activity and other biological macromolecules under low temperature stress, salt stress and combined stress. And we also analyzed the stress resistance mechanism under different stress conditions by transcriptomic technology. It was discovered that moderate salt stress could enhance plant tolerance to low temperature, indicating the presence of an antagonistic relationship between salinity and low temperature. The biological mechanism underlying this phenomenon lies in the fact that combined stresses induce the up-regulation of various genes and activate more pathways compared to single stress. Among these pathways, the linoleic acid metabolic pathway stands out as unique to combined stress conditions. This research represents the inaugural endeavor to investigate the impact of low temperature stress and combined stress on S.portulacastrum, offering a pivotal reference for the utilization of this plant in ecological restoration and management within the East China Sea. More valuable is that such conclusions may be extended to the coastal ecological governance of many high latitude countries, which is of great significance for global ecological environment improvement.

Podiatric Clinical Triage in a Foot and Ankle Orthopaedic Clinic: A Randomised Trial.

Hospitals are increasingly utilising allied-health professionals to provide clinical triage to patients. While these positions are routinely implemented, and several observational studies have reported positive outcomes, the effectiveness of this intervention has been rarely tested in a clinical trial. The objectives of this study were to (i) evaluate a podiatry-led orthopaedic triage service using patient-reported outcome measures (PROMs), and (ii) determine if it is cost-effective in terms of incremental cost/quality-adjusted life years (QALYs). This pragmatic, randomised, wait-list-control trial recruited participants referred to an orthopaedic foot and ankle clinic at a tertiary-level health service. Trial registration was 31 March 2020. Participants were randomised to either immediate clinical triage (intervention) or to remain on the waiting-list (control). The primary outcome measure was change in foot pain as measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) at 6-months. Core outcome measures for chronic musculoskeletal pain were also measured and cost-effectiveness calculated. One hundred and forty-eight participants were recruited, randomising 73 people to the intervention and 75 people to the control. No between-group differences in pain or demographics were detected at baseline. Foot pain as measured by the MOxFQ improved in both groups at 6-months follow-up, but no significant between-group differences were identified. Significant between-group differences, however, were detected in the patient global impression of change. Additionally, the intervention resulted in a 30% discharge rate, and is considered cost-effective, with each QALY gain costing < $30,000 in real-world scenarios. A clinical triage service has minimal impact on PROMS for foot and ankle pain or chronic musculoskeletal pain, but it is generally well-received, is cost-effective, and participants were more likely to report global improvement if they attended.

Clozapine for Treatment-Resistant Disruptive Behaviors in Youths With Autism Spectrum Disorder Aged 10-17 Years: Protocol for an Open-Label Trial.

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition emerging in early childhood, characterized by core features such as sociocommunicative deficits and repetitive, rigid behaviors, interests, and activities. In addition to these, disruptive behaviors (DB), including aggression, self-injury, and severe tantrums, are frequently observed in pediatric patients with ASD. The atypical antipsychotics risperidone and aripiprazole, currently the only Food and Drug Administration-approved treatments for severe DB in patients with ASD, often encounter therapeutic failure or intolerance. Given this, exploring pharmacological alternatives for more effective management of DB associated with ASD is essential. Clozapine, noted for its unique antiaggressive effects in schizophrenia and in various treatment-resistant neuropsychiatric disorders, independent from its antipsychotic efficacy, remains underexplored in youths with ASD facing severe and persistent DB. This study aimed to evaluate the efficacy, tolerability, and safety of clozapine for treatment-resistant DB in youths with ASD. This is a prospective, single-center, noncontrolled, open-label trial. After a cross-titration phase, 31 patients with ASD aged 10-17 years and with treatment-resistant DB received a flexible dosage regimen of clozapine (up to 600 mg/day) for 12 weeks. Standardized instruments were applied before, during, and after the treatment, and rigorous clinical monitoring was performed weekly. The primary outcome was assessed using the Irritability Subscale of the Aberrant Behavior Checklist. Other efficacy measures include the Clinical Global Impression Severity and Improvement, the Swanson, Nolan, and Pelham questionnaire-IV, the Childhood Autism Rating Scale, and the Vineland Adaptive Behavior Scale. Safety and tolerability measures comprised adverse events, vital signs, electrocardiography, laboratory tests, physical measurements, and extrapyramidal symptoms with the Simpsons-Angus Scale. Statistical analysis will include chi-square tests with Monte Carlo simulation for categorical variables, paired t tests or Wilcoxon tests for continuous variables, and multivariate linear mixed models to evaluate the primary outcome, adjusting for confounders. Recruitment commenced in February 2023. Data collection was concluded by April 2024, with analysis ongoing. This article presents the protocol of the initially planned study to provide a detailed methodological description. The results of this trial will be published in a future paper. The urgent need for effective pharmacological therapies in mitigating treatment-resistant DB in pediatric patients with ASD underscores the importance of this research. Our study represents the first open-label trial to explore the anti-aggressive effects of clozapine in this specific demographic, marking a pioneering step in clinical investigation. Adopting a pragmatic approach, this trial protocol aims to mirror real-world clinical settings, thereby enhancing the applicability and relevance of our findings. The preliminary nature of future results from this research has the potential to pave the way for more robust studies and emphasize the need for continued innovation in ASD treatment. Brazilian Clinical Trials Registry RBR-54j3726; https://ensaiosclinicos.gov.br/rg/RBR-54j3726. DERR1-10.2196/58031.

Auto Control and Monitoring of Biogas Plant by using LabVIEW

This paper titled as, "Auto Control and Monitoring of Biogas Plant using LabVIEW Software" addresses the presenting need for enhanced efficiency, reliability, and sustainability in biogas production. The study explores innovative control algorithms and automation strategies to improve biogas production processes. Also, it demonstrates the feasibility and benefits of automating biogas production processes through Lab VIEW software successfully. The results suggest that this approach could serve as a scalable model. The future developments for global improvement in biogas plants can be taken care of, with LabVIEW automating biogas plants for increased operational efficiency and safety. It can be found from the results that key performance metrics like real-time monitoring, effectiveness of control algorithm, and user interface responsiveness reveal that the system has the potential to optimize the biogas production process.

Prognostic value of right ventricular myocardial work in patients with pulmonary arterial hypertension

Abstract Background Right ventricular function is a key determinant of survival in patients with pulmonary arterial hypertension, with right heart failure being the leading cause of death. ESC/ERS guidelines recommend evaluating RV function at diagnosis and at first reevaluation under treatment to estimate the one-year mortality risk (1). However, few RV function markers address both systolic function and afterload. Noninvasive myocardial work is a promising new tool that incorporates both systolic function and its afterload by creating pressure-strain loops (2). The study aims to evaluate the association of RV myocardial work parameters with the estimated one-year mortality in patients with PAH. Methods This retrospective study included patients diagnosed with PAH who had transthoracic echocardiography and right heart catheterization within 48 hours at diagnosis and first reevaluation. Patients with unanalyzable echocardiography data were excluded. Results The study included 30 PAH patients and 28 healthy subjects for comparison. Myocardial work parameters (global work index, global constructive work, global wasted work and global work efficiency) were significantly different between PAH patient and healthy subjects. Between diagnosis and first reevaluation, myocardial work parameters showed improvement in most patients. However, patients without global wasted work improvement had a higher risk of estimated one-year mortality and a poorer transplantation-free survival. Conclusions Evaluating RV myocardial work at diagnosis and first reevaluation via TTE is feasible and can detect subclinical systolic dysfunction. Myocardial work parameters, and especially global wasted work appear to correlate with the prognosis of PAH patients, justifying larger-scale studies to confirm these findings and determine their prognostic value relative to other markers.

Myocardial strain and work parameter changes predict long term mortality and rehospitalization in an acute heart failure patient population after levosimendan use

Abstract Introduction Decompensated acute heart failure (HF) in patients with reduced ejection fraction (HFrEF) signifies a pivotal stage in the progression of chronic HF. This condition is closely linked to increased rates of rehospitalization and a higher risk of mortality and morbidity due to inadequate decongestion. Recently, the field of quantitative echocardiography has experienced significant advancements, particularly in myocardial work analysis (MWA), which measures the energy the heart uses during each cardiac cycle. Purpose This study aimed to investigate the immediate effects of levosimendan on myocardial mechanics and to determine if these effects can predict the composite endpoint of HF-related rehospitalization and cardiovascular mortality. Methods 60 patients with HFrEF have been enrolled in the present study (age: 63.8±14.1, 46 males, 25 ischemic HFrEF, 35 non-ischemic HFrEF). or all patients, detailed baseline echocardiography, including strain imaging and myocardial work analysis (MWA), was conducted. Follow-up echocardiography was performed an average of 13.1±12.5 days after levosimendan administration. The clinical follow-up period lasted 496±191 days. Results Before levosimendan administration there was no significant difference in baseline echocardiographic, strain imaging and MWA parameters between ischemic and non-ischemic HFrEF groups. After the drug administration, left ventricular global wasted work (179±89 Hgmm% vs. 319±220 Hgmm%, p &amp;lt;0.05) was higher in the ischemic HFrEF group compared to non-ischemic HFrEF group. Among advanced echocardiographic parameters, global longitudinal strain (GLS) showed no significant improvement, however out of the MWA parameters, global work index (376±215 Hgmm% vs. 460±272 Hgmm%, p &amp;lt;0.05) improved significantly. The prognostic role of hemodynamic and novel echocardiographic parameters has been also assessed. Kaplan-Meier analysis revealed that LV stroke volume index improvement of 0.145 ml/m2 (p=0.01), LVEF improvement of at least 10% or more (p=0.032), LV GLS improvement of 0.85% (p=0.018) and lastly global constructive work improvement of 100 Hgmm% or more (p=0.021) resulted in significantly better event-free survival during the follow up period. Conclusion Levosimendan administration produces substantial immediate effects on hemodynamic parameters, myocardial deformation, and MWA metrics. These alterations appear to hold significant long-term prognostic value for predicting the composite endpoint and event-free survival.

Long-Term Efficacy and Safety of a Hyaluronic Acid-Base Dermal Filler With Tri-Hyal Technology to Enhance Lip Volume

Abstract Background Interventions to enhance lip volume and shape are common aesthetic procedures to counter signs of ageing. Objectives This study aimed to assess the efficacy of Art Filler Lips (AFL), with or without retouching, at restoring lip shape and volume, tolerability and persistence over 18 months. Methods During this open-label study, AFL (≤2.0 mL) was injected into the upper, lower and/or both red lips and borders at baseline (D0). Subjects were evaluated at D21, when, if necessary, retouching was performed. Subjects were evaluated at D42, D90, D180, D270, D360, D450 and D540. The primary assessment was based on evaluation at D21 using the Medicis Lip Fullness Scale (MLFS). Satisfactory volume restoration was defined as an improvement of ≥1 point versus D0. Secondary outcomes were adverse events (AEs), and investigator- and subject-satisfaction rates based on Global Aesthetic Improvement Scores. Results Among 73 patients (97% female; 54.4±10.5 years), 56% of lips were injected without any retouch. Mean MLFS scores either for upper and lower lips separately or together, significantly improved by D21 for the subjects without retouching or D42 for those with (all p&amp;lt;0.0001). At D21/42, 99% of upper lips, 94% of lower lips and 96% of both lips showed satisfactory volume restoration. This proportion declined between D21/42 and D540. The most reported immediate AEs were swelling, sensitivity and pain and were mild to moderate, lasting less than 2 weeks. Conclusions AFL is well tolerated and produces a sustained objective and subjective lip volume restoration and shape.

Telemedicine/Telerehabilitation to Expand Enhanced Recovery After Surgery Interventions in Minimally Invasive Mitral Valve Surgery

Objectives: Having achieved a consolidated in-hospital experience with enhanced recovery after cardiac surgery, we explored the feasibility of expanding our protocol to pre-admission and post-discharge periods. Methods: A multidisciplinary team including cardiac surgeons, anaesthetists/intensivists, physiatrists, physiotherapists, perfusionists, nurses, psychiatrists, and engineers, elaborated a new therapeutic offer, based on current ERAS evidence and using telerehabilitation, to enhance preoperative communication and education and improve pre- and postoperative health and psychological state. Results: An institutional web-based platform for remote rehabilitation will host digital content that covers three main areas, including information and communication, prehabilitation and rehabilitation with the offer of respiratory and muscular exercises and aerobic activities, and psychological and patient experience evaluations. These interventions will be achieved through purposely developed video tutorials that present the hospital environments, the relevant healthcare personnel, and their role during the in-hospital patient’s journey, and illustrate tailored prehabilitation activities. A series of questionnaires will be administered to evaluate and follow the patient’s psychological state and collect patient-reported experience measures. The platform was activated in September 2024 and this service will initially involve 100 patients undergoing minimally invasive mitral valve surgery. A first review of compliance and engagement will be carried out after four months and a complete review of the results after the first year. Conclusions: ERAS is associated with improved surgical outcomes. A person-centred treatment should also address the health and psychological difficulties that patients face before hospitalisation and after discharge. Telemedicine is a valid tool to expand treatment and monitoring outside the hospital. This experience may give new insights into the feasibility and effectiveness of providing home-based remote interventions aimed at a global improvement in results throughout the overall cardiac surgery journey.

Injection of hyaluronic acid versus platelet rich plasma for treatment of vulvovaginal atrophy in post-menopausal females.

Female sexual dysfunction is highly prevalent among postmenopausal females approaching 50%, with vulvovaginal atrophy (VVA) being a cardinal sign. For decades, hormone replacement therapy was the only solution to relieve symptoms associated with this atrophy. However, it was limited by its serious side effects, raising the need for new treatment strategies. This study aims to compare the efficacy and safety of injection of hyaluronic acid (HA) versus platelet rich plasma (PRP) in post-menopausal females presented with VVA to improve female sexual dysfunction. Twenty post-menopausal females presented with VVA were randomly divided into two groups, 10 patients in each group. Both groups received three sessions of injections into the vulva and vagina, one month apart. Group I was injected with non cross linked HA while Group II received PRP injection. Subjective assessment was carried out through female sexual function index questionnaire and global aesthetic improvement scale.While objective assessment was carried out by measuring the labia majora length and reviewing the histopathological changes occurring in the vulva through skin biopsies before and after treatment. The change in vaginal thickness was estimated by transvaginal ultrasound. Results showed that both HA as well as PRP were effective in the treatment of post-menopausal vulvovaginal atrophy. However, HA showed more significant improvement in female sexual dysfunction. There were also higher values in vaginal wall thickness as measured by transvaginal ultrasound in favor of HA injected group. Histopathological assessment showed more collagen deposition in papillary dermis in HA treated group. No complications were reported in both groups.

A combination treatment protocol using PEGylated hyaluronic acid hydrogel, non-ablative laser and hyaluronic acid skin boosters for rejuvenation of the perioral area

Personalized treatment with a combination of aesthetic protocols targets the different root causes, contributing to the patient’s aesthetic concerns and optimizes outcomes. This report presents the outcomes of a new protocol combining PEGylated hyaluronic acid (HA) hydrogel, non-ablative laser, and non-crosslinked HA skin booster to rejuvenate the perioral area within a single treatment session. This was a retrospective analysis of medical data from subjects who had undergone treatment with the perioral rejuvenation protocol at Kalea Clinic in the Netherlands. All subjects had been treated with the 3-step protocol involving: (i) injection with PEGylated HA hydrogel 24 mg/ml to contour and shape the lips; (ii) full-face treatment with a non-ablative, fractional diode laser with a wavelength of 1470 nm to smooth and tighten the skin; and (iii) full-face mesotherapy treatment with injection of non-crosslinked HA (18 mg/mL) with 0.01% calcium hydroxyapatite, glycine, and L-proline to improve skin quality. Follow-up visits took place at 6 (Visit 1) and 12 weeks (Visit 2), at which point physicians and patients assessed lip fullness and skin wrinkling on separate validated rating scales. Additional subjective assessment of treatment results was performed by both physicians and patients using the 5-point Global Aesthetic Improvement Scale (GAIS). Physician and patient satisfaction with treatment results was also assessed. Data were analyzed retrospectively for 14 female subjects with a mean age of 39.1 years. At baseline, lip fullness was rated as moderate by 71% of physicians and 64% of patients. At visit 2, 71% of lips were rated as thick and 14% as full by both physicians and patients. The mean skin wrinkle score improved from 1.30 (visible wrinkles with clear indentation) at baseline to 0.79 (fine wrinkle, slight indentation) at Visit 2. Mean GAIS scores for both physicians and patients indicated appearance was ‘improved’ at Visit 1 (mean scores of 3.0 and 2.7, respectively) and ‘much improved’ at Visit 2 (mean scores of 2.4 and 2.3, respectively). All treatments in the protocol were well tolerated. Both physicians and patients were satisfied with the combination protocol, and all patients reported they would be ‘likely’ or ‘very likely’ to recommend it. The combination of three different treatment modalities (PEGylated HA hydrogel, non-ablative laser, and HA mesotherapy) in a single treatment session demonstrated effectiveness in rejuvenating lips and perioral area. The complementary treatments were tailored to the individual for a natural-looking effect.

Quantitative Evaluation of Improvement of Tear Trough With a Non-Cross-Linked Sodium Hyaluronic Compound: A Three-Dimensional and MRI Analysis.

Tear trough deformities are indicative of aging, progressively manifesting as pronounced infraorbital hollows. Although hyaluronic acid (HA) dermal fillers are favored for their safety and efficacy, quantifiable evidence of their effect of action still remains insufficient. To investigate the efficacy of non-cross-linked HA compound in tear trough enhancement. Twenty-one subjects with moderate to severe infraorbital hollows underwent a single treatment including subcutaneous to supraperiosteal injections of a non-cross-linked HA compound. The effectiveness was assessed through Allergan Infraorbital Hollows Scale (AIHS), satisfaction rates, the Global Aesthetic Improvement Scale (GAIS), and quantitative analyses via Canfield VECTRA 3D imaging and MRI measurements during the 6-month follow-up. A total of 0.67 ± 0.31 and 0.77 ± 0.42 mL of the non-cross-linked HA compound were injected into the left and right suborbital regions, respectively. Substantial improvements in AIHS were observed in 85.71% and 80.95% of subjects at 6 months posttreatment, as assessed by blinded evaluators and treating investigators, respectively. 3D imaging showed volume increases of 0.87 ± 0.32 (left) and 0.99 ± 0.45 mL (right). MRI analysis provided closely aligned results to the 3D analysis. The GAIS and satisfaction rate were 85.71%, 90.48% for treating investigators and were 90.48% and 95.24% for subjects 6 months posttreatment. The non-cross-linked HA filler demonstrated a safe and efficacious profile for the correction of infraorbital hollows with significant patient satisfaction and sustained outcomes up to 6 months posttreatment. These results support their clinical value in periorbital rejuvenation and reduction of infraorbital hollowing.

Improvement in Temple Hollowing with VYC-20L Hyaluronic Acid Filler: A Multicenter, Randomized Controlled Trial of Safety and Effectiveness.

Temple hollowing is characterized by the reduction of volume in the temporal fossa, which can result in a skeletonized look and contribute to an aged appearance. This study aimed to evaluate the safety and effectiveness of the VYC-20L injectable gel for improvement of temple hollowing. Adults with minimal, moderate, or severe temple hollows were randomized 2:1 to receive VYC-20L or no treatment. Participants were followed for 13 months for safety and effectiveness assessments. Treatment effectiveness was assessed by blinded evaluating investigators using the validated Allergan Temple Hollowing Scale (ATHS) and the Global Aesthetic Improvement Scale (GAIS), and by participants using GAIS, FACE-Q scales, and patient satisfaction questionnaires. Adverse events and injection site responses (ISRs) were monitored. At Month 3, 80.4% of the treatment group vs 13.5% of the untreated control group achieved a ≥1-grade improvement in both temples on the ATHS (P < 0.0001). The ATHS responder rate remained high throughout Month 13. The GAIS responder rates at Month 3 (responses of Improved or Much improved) were high in the treatment group, as assessed by the blinded evaluating investigator (83.8%) and participants (92.9%). Furthermore, satisfaction with Facial Appearance and Temples on the FACE-Q questionnaires increased significantly from baseline (both P < 0.0001). Adverse events and ISRs were mostly mild and consistent with the known safety profile of fillers. VYC-20L treatment showed favorable safety and effectiveness results in restoring temple volume, with significant aesthetic improvement and high participant satisfaction. Treatment effects lasted for over a year.

Stuck acupuncture combined with facial acupuncture for 22 cases of facial cosmetology

To observe the clinical efficacy of stuck acupuncture combined with facial acupuncture for facial cosmetology. A total of 22 female patients with symptoms of facial aging were treated with stuck acupuncture combined with facial acupuncture. Stuck acupuncture was applied at bilateral Taiyang (EX-HN5) through Xiaguan (ST7), Jiache (ST6) through Daying (ST5) and Yingxiang (LI20)，once a week. Facial acupuncture was applied at Yintang (GV24+), ashi points (nasolabial fold) and bilateral Yangbai (GB14), Quanliao (SI18), Sibai (ST2), Xiaguan (ST7), Dicang (ST4), Jiache (ST6), Daying (ST5), Renying (ST9), twice a week. Four weeks were required. The global aesthetic improvement scale (GAIS) score after treatment, wrinkle severity rating scale (WSRS) score before and after treatment were observed. The quantitative analysis of skin characteristics was performed before and after treatment. After treatment, of the 22 patients, 3 cases had complete improvement, 15 cases had obvious improvement, 4 cases had partial improvement, 0 case had no improvement. The WSRS score and scores of wrinkles, textures and pores were decreased compared with those before treatment (P<0.01). Stuck acupuncture combined with facial acupuncture could effectively improve the symptoms of facial aging.

Is More Always Better? - A Randomized Comparative Clinical Trial About the Impact of Polidyoxanone Threads Quantity for Facial Lifting

Abstract Background Minimally invasive aesthetic procedures, such as the use of polydioxanone (PDO) threads, are increasingly popular for facial rejuvenation. Objectives This study investigates the impact of the number of PDO threads on tissue displacement, volume changes, and patient satisfaction. Methods This randomized controlled trial involved 22 subjects seeking facial lifting using PDO threads. Participants were divided into two groups: G1 with 3 threads per hemiface and G2 with 6 threads per hemiface. 3D stereophotogrammetry was used to evaluate volumetric changes and tissue displacement at baseline, 20-, and 60-days post-treatment. Patient satisfaction was assessed using the Global Aesthetic Improvement Scale (GAIS). Results Significant volumetric changes were observed over time in both midface and lower face regions (p&amp;lt;0.05), but no significant intergroup differences were found (p&amp;gt;0.6). Tissue displacement showed statistical significance over time (p=0.039) but not between groups (p=0.821). GAIS scores did not differ significantly between groups or between patients and specialists. Adverse events were minor and transient, primarily involving pain. Conclusions The number of PDO threads used did not significantly influence sustained lifting outcomes or patient satisfaction. Initial improvements in volume and tissue displacement diminished by 60 days, suggesting that additional threads do not enhance long-term efficacy. Further studies with longer follow-up are needed to better understand collagen stimulation's potential role in lasting effects.

Canada HARMONY Study: Improvements in Patient Satisfaction With Facial Appearance and Psychological Impact of Combined Aesthetic Treatment

Abstract Background Panfacial treatment has the potential to positively impact psychosocial and emotional well-being. Objectives The Canada HARMONY study evaluated the satisfaction and psychosocial impact of comprehensive, multimodal aesthetic treatment of the face and submental area from the patient perspective. Methods Over 12 months, all patients (N=58) sequentially received treatment with hyaluronic acid (HA) fillers, onabotulinumtoxinA, and medical-grade skincare products, and eligible patients (n=13) also received ATX-101. The primary endpoint was the change from baseline on the FACE-Q Satisfaction with Facial Appearance Scale. Secondary endpoints included the following assessments: FACE-Q Expectations of Life Change, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales; Global Aesthetic Improvement Scale (GAIS); and the Periorbital Aesthetic Appearance Questionnaire (PAAQ). Safety was monitored throughout the study. Results Baseline FACE-Q Expectations of Life Change scores indicated realistic treatment expectations. Significant improvements from baseline were observed on the FACE-Q Satisfaction with Facial Appearance, Psychological Function, Social Function, Satisfaction with Skin, and Aging Appraisal Scales (P &amp;lt; 0.0001 for all endpoints). Most patients rated “Much Improved” on the GAIS. The mean PAAQ total score significantly improved from baseline by 32.6 (P &amp;lt; 0.0001). Most patients reported mild to moderate injection site responses, which had a mean time to resolution of &amp;lt;14 days. Conclusions Panfacial aesthetic treatment consisting of HA fillers, onabotulinumtoxinA, and ATX-101 improved patient-reported satisfaction, psychological function, social function, and aging appraisal across validated measures.

The synergistic effects of microcredit access and agricultural technology adoption on maize farmer’s income in Kenya

Addressing global food security demands urgent improvement in agricultural productivity, particularly in developing economies where market imperfections are perverse and resource constraints prevail. While microcredit is widely acknowledged as a tool for economic empowerment, its role in facilitating agricultural technology adoption and improving agricultural incomes remains underexplored. This study examines the synergistic effects of microcredit access and agricultural technology adoption on the incomes of maize farmers in Kenya. Using household-level data, we employ an endogenous switching regression framework to control possible endogeneity in access to microcredit. Our findings shows that microcredit access positively influences the adoption of advanced agricultural technologies. Key determinants, including marital status, use of fertilizer application, access to extension services, and cooperative membership, are identified as significant determinants of microcredit access. Notably, the Average Treatment Effect on the Treated (ATT) indicates a 40.52% increase in income among farmers who access microcredit, mainly driven by the timely adoption of high-quality seeds, improved agricultural technologies, and enhanced inputs. These results highlight microcredit’s role in promoting allocative efficiency and enhancing Total Factor Productivity (TFP) within agricultural systems. Robustness checks, including propensity score matching and sensitivity analyses, corroborate these findings. The study recommends the implementation of targeted financial policies and educational initiatives meant to promote credit access, encourage savings, and enhancing financial literacy, particularly for credit-constrained households. Integrating these measures could strengthen rural financial markets and drive sustainable agricultural development across the regions.

Novel Gel Formulation and Deep Injection Techniques for Lifting Effects in Cosmetic Dermatology.

In recent years, the field of aesthetic dermatology has witnessed a surge in demand for minimally invasive procedures aimed at rejuvenating aging skin. This study aims to address this demand by evaluating the effectiveness of the injectable gel in rejuvenating aging skin, particularly by targeting collagen regeneration and lifting effect. The study involved 43 participants who underwent three monthly injection sessions targeting retaining ligaments. The injections were administered deeply to ensure proper targeting. Follow-up assessments were conducted after each treatment session and three months after the final injection. Evaluation methods included subjective assessments by both patients and investigators using the Global Aesthetic Improvement Scale (GAIS), as well as objective assessments using a 3D photosystem to measure wrinkle conditions and vectors of traction. All participants completed the study, with no significant adverse effects observed apart from mild swelling at the injection sites. Despite the high viscosity of HA necessitating the use of a 27 G needle, the injection process was generally comfortable and minimally painful. Subjective evaluations revealed consistent improvements in skin appearance from the first application, which continued to increase throughout the study and remained high even 3 months post-treatment. Objective evaluations demonstrated significant improvements in wrinkle conditions and lifting effects, with a substantial increase in the standard deviation score for wrinkle conditions and the average traction vector length measuring 1.6 mm. The study findings confirm the safety and efficacy of the injectable formula, with high patient satisfaction, noticeable lifting effects, and significant improvements in wrinkle conditions. These results support the use of the injectable as a promising option for non-invasive skin rejuvenation treatments.

An Exploratory Study of PN HPT for Treating Postsurgical Atrophic and Depressed Scars.

Postsurgical atrophic scars tend to respond poorly to treatments, especially non-energy-based ones. Hydrophilic PN HPT (Polynucleotides High Purification Technology) injected intradermally is a non-energy-based option with an immediate volume-enhancing effect that indirectly improves the fibroblast synthesis of collagen and extracellular matrix. The PN HPT ingredient has the further benefit of a dermal "priming" effect that enhances the efficacy of other scar treatments. Verify retrospectively, with advanced techniques, the efficacy of PN HPT monotherapy as postsurgical scar treatment. Retrospective data collection in 18- to 65-year-old women with moderate-to-severe atrophic scars after mammary surgery undergoing a five-session intradermal treatment course with 0.75% PN HPT gel formulation in single-use syringes starting 6 months after surgery. Primary retrospective efficacy parameter: changes in scar morphology and symptom severity after three and 6 months (modified Vancouver Scar Scale, mVSS). Secondary efficacy parameters: roughness score 6 months after baseline (Antera 3D CS tridimensional skin analysis system) and Global Aesthetic Improvement Scale (GAIS, Investigator and Patient subscales) after three and 6 months. Total mean mVSS highly significantly improved from 11.2 ± 1.92 at baseline to 7.0 ± 1.68 and 6.9 ± 1.55 after three and 6 months, respectively; the mean Antera 3D CS roughness score improved from 13.5 ± 4.14 to 10.0 ± 3.49 after 6 months. After three and 6 months, the GAIS subscores for investigators and cohort subjects were identical (3.0 ± 0.81 and 3.0 ± 0.72, respectively). The photographic documentation supported the previous results. In monotherapy, the intradermal PN HPT ingredient seems to quickly and safely relieve the burden of postsurgical atrophic scars. However, the lack of a formal parallel control group is a severe limitation. The objective quantitative measurements confirmed the long-lasting benefits.

Facial Skin Quality Improvement After Treatment With CPM-HA20G: Clinical Experience in Korea.

Intradermal injection of CPM-HA20G, a low-viscoelasticity hyaluronic acid (HA) dermal filler with glycerol, has been shown to be effective for facial rejuvenation in Caucasians, but research in Asians is limited. This study aimed to evaluate the effectiveness and safety of CPM-HA20G in enhancing facial skin quality in Korean women using a protocol developed by local aesthetic experts. In this 24-week prospective, single-arm, open-label study, 20 women received CPM-HA20G injections in the immediate subdermal layer on the anterior cheek (1 mL per side; total 2 mL) in three sessions every 4 weeks. Evaluations included biophysical assessments covering the four emergent perceptual categories (EPCs) for skin quality and subjective assessment using the Global Aesthetic Improvement Scale. Significant improvements in skin glow (skin gloss, epidermal hydration), skin firmness (dermal elasticity, dermal hydration), skin surface evenness (average pore volume, pore area, pore density, pore count, maximum pore depth, total pore volume, skin roughness, sebum secretion, and skin depression volume), skin tone evenness (skin color brightness, skin redness), and transepidermal water loss were observed at Week 12 and Week 24 following the first injection with CPM-HA20G. Most subjects and investigators reported improvements in overall aesthetic appearance with the treatment, with a 100% improvement rating from both groups at Week 12. No serious adverse reactions were observed. Our study provides real-world insights into the effectiveness and safety of CPM-HA20G in improving facial skin quality in an Asian population, evaluated through both objective and subjective assessments.