Long-lasting Results Research Articles

Dry Needling and Management of Trigger Points with Low Back Pain: An Evidence to Practice Review

Low back pain is a common health concern. The development of myofascial trigger points due to low back pain can cause debilitating pain and loss of functional movement in patients. Dry needling is a minimally invasive procedure that has shown to be useful in the treatment of myofascial trigger points when used with other forms of treatment. However, the literature surrounding dry needling and myofascial trigger points in patients with low back pain is lacking. The guiding systematic review and meta-analysis sought to analyze the effectiveness of dry needling for patients with low back pain. The review utilized eight databases for randomized controlled trials and selected 11 of 784 articles for analysis based on inclusion and exclusion criteria. A 6-subgroup meta-analysis was conducted on these studies, and 6 of the 11 studies were found to have high risk of bias. The included studies used both pain measurements and functional measurements including the visual analogue scale (VAS), Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ). The studies did not include objective functional measurements. Overall researchers found a clinically meaningful decrease in outcome scores in the short-term, but there were no significant differences in pain or functional outcomes through long-term follow-up. This seems to correlate with the current literature on dry needling and its inflammatory effects on the body, suggesting that dry needling alone does not provide any long-term effect on myofascial trigger points in patients with low back pain. Dry needling should be combined with other treatments and high-quality rehabilitation to provide longer-lasting results and better treatment outcomes for patients with low back pain.

Innovative approach for tear trough deformity correction using higher G prime fillers for safe, efficacious, and long-lasting results: A prospective interventional study.

One of the most challenging areas for facial rejuvenation is the lower eyelid. Apart from the protruding orbital fat causing lower lid bags, a discrete entity called the "tear trough deformity" is distinguishable in this area. The objective of this study is to compare and evaluate the standard technique of tear trough deformity correction with the lateral injection technique using a high G prime filler to establish a guideline for the safe and effective correction of tear trough deformity. A prospective, double-blind, study was carried out from Dec 2017 to 2019 including 30 participants in the age range of 35-60years. The participants were divided into two groups of 15 patients each. In group A patients, conventional technique with a low G Prime filler was used, whereas in group B, lateral injection technique with a high G Prime filler was used. Marked improvement was seen in appearance and skin quality on both the sides in all the patients. As compared to our technique (lateral injections) where a mean of 0.5ml of filler was used to lift the cheek and reduce the tear trough, the standard technique (Mauricio de Maio's 3-point tear trough reshape technique) required a mean of 1.2ml of filler for the same. Post-procedure complications including bruising and Tyndall effect were much higher (statistically significant) using the standard medial technique for the correction tear trough. Aesthetically satisfying results for the tear trough correction are possible, without actually injecting the tear trough directly, based on the knowledge of the underlying anatomy.

Three-Flap Mastopexy with Reduction or Augmentation.

Many authors have studied breast ptosis and made contributions to the search for a procedure that allows its correction with long-lasting results and minimal scars. Collective evolution has allowed us to reach the point where we are today and will allow us to continue improving techniques in the future. The mastopexy procedure that we have used for the last 11 years, resulting from our surgical practice and countless observations at conferences, is a versatile procedure, applicable to different types of breasts and mastopexies with and without reduction or augmentation. Analysis and the clinical review of the patients and the records of the mastopexy cases that we operated on using the technique from January 2009 to March, 2020, are presented here. Using a periareolar approach for grade I ptosis and an inverted "T" approach for more severe ptosis, the excess skin is removed, and three flaps of breast tissue, superior, medial and lateral, are carved. A retromammary dissection is performed to anchor the end of the flaps, medial and lateral, to the pectoral aponeurosis, followed by invagination of these flaps to concentrate the breast tissue in the upper and central area of the breast. Closure of the wound is then performed, transforming its excess length into a short horizontal one, into the inframammary grove. Sixty-seven female patients, between 36 and 59 years old, underwent this procedure. Complications included hematoma (4%), overcorrection (4%), dehiscence (3.3%), residual ptosis (2.7%), pathological scarring (2.7%) and rotation folds (2%). Maximum follow-up was 8 years 2 months, mean follow-up 2 years 9 months, with satisfactory results for the patients and surgeon. The mastopexy procedure that we present here is a versatile technique, which can be applied to most cases requiring correction of ptosis. It provides the breast with proper shape, size and location with fewer scars. It is a logical, safe, efficient, reproducible procedure, which is easy to learn. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A CLINICAL STUDY TO EVALUATE THE SADYO SHOOLAHARA EFFECTIVENESS OF LAGHUPANCHAMOOLA KASHAYA WITH TRIVRUTH CHOORNAM IN GRIDHRASI (SCIATICA)

Gridhrasi is one among Vataja nanatmaja Vikara characterised by Sthabdhata, Ruk, Toda which radiates from buttock region, lumbar region, thigh, knee, calf muscles and legs. Gridhrasi is of two types viz Vataja and Vata Kaphaja Gridhrasi. Vataja Gridhrasi is characterized by severe pain and Vata Kaphaja Gridhrasi has symptoms viz Tandra, Gaurava and Aruchi. The signs and symptoms of Gridhrasi can be correlated to sciatica of modern medicine. Sciatica is characterized by constant aching pain felt in lumbar region which may radiate to the buttock, thigh, calf and foot and pain is experienced along the sciatic nerve pathway. It was a clinical study with a pre and post design in 30 patients who were diagnosed with Gridhrasi. After examination Laghupanchamoola Kashaya with trivruth choornam was given for 7 days. The assessment criteria were noted before and after treatment and on follow-up. Among the subjective and objective parameters, in the Overall effect of treatment in gridhrasi, out of 30 patients in this study, 15 patients (50%) got Mild effectiveness in shoola, and 15 patients (50%) got Moderate effectiveness in shoola. The overall effect of the treatment was 30.19%. Hence it can be concluded that Laghupanchamoola Kashaya with trivruth choornam is having mild improvement on symptoms of Gridhrasi and shows the long-lasting result. Keywords: Gridhrasi, Sciatica, Laghupanchamoola Kashaya, Trivruth choornam

Brand Betrayal: A Comprehensive Study to Examine the Indicators and Consequences of Brand Betrayal Towards Consumer Behavior

Abstract
 Brand betrayal is induced by the brand itself when it fails to fulfill its promised moral obligations and involves the type of behavior that fractures the strong self–brand connection with the consumers. Brand managers must come across several negative types of consumer behaviors that depict their sense of dissatisfaction. Additionally, the effort of a brand to reduce the effects of brand betrayal is reflected by the sheer amount of customer apologies and compensation paid to the affected consumers. Having a sound knowledge about the primary indicators of brand betrayal encourages the brand managers to take necessary measures to deal with the challenges of the negative consumer-brand relationship. The resultant revenge behaviors depicted by the consumers include different types of activities such as spreading negative word-of-mouth and avoiding the brand itself, customer incivility, etc. The existing literature on the consequences of brand betrayal is insufficient to build the novel theory around the construct and differentiate it from brand dissatisfaction. The current research in brand dissatisfaction argues that it is a more generalized construct than brand betrayal that becomes the immediate cause of brand avoidance. The effect of these consequences needs to be addressed by the marketing theorists and practitioners to strengthen the consumer-brand relationship and manage the longer-lasting results of negative consumer behaviors.

Clinical Validation of Superficial Lip Injections Utilizing Cohesive Polydensified Matrix Hyaluronic Acid-Based Soft Tissue Fillers.

A combination of optimal injection technique and dermal filler choice is key for improving lip architecture with natural and long-lasting results. To investigate the positioning of Cohesive Polydensified Matrix™ (CPM) hyaluronic acid (HA) fillers after superficial lip injections and document their tissue integration and effects on lip architecture and shape. Eligible patients underwent lip contouring and volumization using a superficial direct tissue action technique. All injections were performed with CPM-HA lip fillers using a 30G needle and retrograde microthreading. Total injected volume was 0.8-1.2 mL. High-resolution ultrasound (US) imaging, 3D surface scanning, and Global Aesthetic Improvement Scale (GAIS) assessments were performed before, and 1, 3 and 6 months post-injection to define the anatomy, positioning, longevity and patient satisfaction. Sixteen patients were injected (mean age, 33.2 years). US measurements revealed an increased skin–orbicularis oris muscle distance up to 1 month post-injection after which measurements returned to baseline values. This observation correlated with complete product integration into the surrounding tissue visualized by US at 3 months. An increased dry mucosa thickness (vermilion body) remained at 6 months, and GAIS scores revealed 70% of patients continued to experience visible lip improvements. 3D analyses revealed significantly increased total lip surface area at 3 months with increased Cupid’s bow distance, philtral height, and anterior upper lip projection. Superficial injection of CPM-HA fillers offers an effective and safe tool for improving lip architecture and volume. Results showed homogeneous dermal integration of the product and aesthetic outcomes maintained up to 6 months. J Drugs Dermatol. 2021;20(9):940-945. doi:10.36849/JDD.6011.

A Participatory Agrobiodiversity Conservation Approach in the Oases: Community Actions for the Promotion of Sustainable Development in Fragile Areas

Rural development policies today include significant directions towards ecological transition and sustainability. Biodiversity plays a fundamental role, especially in fragile environments. The North African oases, for example, are socio-ecological structures with delicate balances in terms of natural resources, where the activation of participatory conservation approaches appears today to be very useful, aiming at long-lasting results. This type of approach was applied in the oasis of El Hamma, in Tunisia. The socio-ecological analysis was carried out through semi-structured interviews with different stakeholders of the oasis. The results were used to activate focus groups and to identify, in a participatory way, a conservation strategy for the species and the varieties at risk of erosion or disappearing. From this research, a wide spread of non-traditional date palm and vegetables emerged in a very diverse social context. These products were recognized as highly significant in terms of traditional knowledge by all stakeholders. Therefore, a Maison des semences and a public conservation center for perennial species were created, representing the first step of a participatory conservation model. Seeds of 11 traditional annual species, 10 date palm varieties and, in perspective, many other fruit species and vegetable varieties have been introduced into conservation.

ВИКОРИСТАННЯ ПСИХОТЕРАПЕВТИЧНИХ МЕТОДІВ ПРИ СУПРОВОДІ ЕМОЦІЙНО ДЕПРИВОВАНИХ МОЛОДШИХ ШКОЛЯРІВ

Hardships experienced many times in the family and outside it in the past, have a negative impact on formation of children’s personality. Emotional deprivation is one of such factors. Long-term stay of elementary school children under emotional deprivation conditions results in a whole number of adverse effects. Being directly dependent on environment adverse changes and impacts emotional sphere is most vulnerable in this respect. The range of emotional deprivation adverse effects on elementary school children is quite wide: from mild emotional disorders that can be corrected with the help of correctional and developmental activities to severe mental disorders and diseases that require long-term treatment. Thus, the situation of emotional deprivation requires the use of prophylactic, corrective and rehabilitative actions. The purpose of the article is to reveal the features of psychotherapeutic methods application in arranging psychological follow-up of emotionally deprived elementary school children. To achieve the determined purpose we’ve applied a mix of speculative (analysis, synthesis, comparison and generalization) and empiric (observation, survey, talk, expert evaluations, testing, quantitative and qualitative evaluation of the results obtained) research methods. The results of the literature sources analysis let us sum up by saying that such methods as adaptation, socialization, learning, development, correction, counseling, psychotherapy, follow-up and rehabilitation may be applied to cope with children’s emotional deprivation. We consider follow-up to be the most effective and comprehensive method. The psychological follow-up model developed and tested by us includes support provided to foster families in the course of coping with children’s emotional deprivation adverse effects and is based on the system of working with foster children and parents, as well as on conducting joint classes involving parents and children. We’ve applied various psychological correction and development methods (talk, games, exercises, drawing, fantasizing and relaxation) in combination with psychotherapeutic methods (symbol drama, art therapy and positive psychotherapy) to conduct psychological follow-up of children. Effectiveness and efficiency of the emotionally deprived elementary school children psychological follow-up model developed by us has been tested on the ground of repetitive psychodiagnostic testing and comparing its results of control and experimental groups. The application of remedial methods in combination with psychotherapeutic methods has made it possible to obtain constant and long-lasting results in emotional deprivation evidences reducing and elementary school children emotional intelligence level raising.

Four-Flap Mammaplasty.

Any kind of breast shaping aims certain endpoints, and results are expected to be durable. We present a breast shaping technique with an anatomical basis, reproducible and long-lasting results. A total of 700 patients have been operated on with this technique. The age of the patients ranged between 18 and 62 with a mean of 33. The follow-up period ranged between 6 months and 15 years with a mean of 18 months. Results have been documented as follow-up notes and digital photography. Subjective rate of satisfaction was estimated by each patient at 6th month follow-up visit as a rating of the overall shape, healing period and final scars from 1 (poor) to 5 (very good). The amount of resection was between 50 and 300 grams (average 190 g) per each breast for mastopexy and 240-670 grams (average 430 g) per each breast for breast reduction. The average change in NAC position at the 6-month follow-up was 3.4 cm ranging between 2.8 and 6.5 cm. In 10 patients (1.4%), hematoma necessitating nonoperative follow-up was observed. In twelve patients (1.7%), wound dehiscence requiring secondary suturing was observed. In 32 patients (4.5%), minor delays in epithelialization were managed with local wound care. In 15 patients, revision of vertical scar was needed. Patients rated their satisfaction with points ranging between 10 and 15 with an average of 13.33. Four-flap mammaplasty results in good and durable cosmetic results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

CHARACTERISTICS OF THE FUNCTIONAL STATE OF THE MAXILLODENTAL SYSTEM ACCORDING TO THE ANALYSIS OF BIOELECTRICAL ACTIVITY OF MUSCLES IN PATIENTS WITH ASSOCIATED OCCLUSAL ABNORMALITIES WHICH REQUIRE COMPREHENSIVE TREATMENT

Malocclusions that have not been eliminated in time can cause complications such as periodontal diseases, TMJ and muscle dysfunctions.An objective indicator of functional disorders is the change of bioelectrical activity of masticatory muscles. The aim of our study was to estimate thefunctional state of maxillodental system in order to develop the individualized treatment and achievement of high functional and aestheticoptimum in patients with associated occlusal abnormalities who need complex treatment. All examined patients had deviations of the averageamplitude of bioelectrical activity of muscles, asymmetry in muscle function, bursts of spontaneous bioelectrical activity at rest, chewing cyclefragmentations, changes in rest and activity ratio during chewing. One of the most important criteria for the transition to the next stage of treatment isnormalization of bioelectrical activity of the muscles. Such approach allows to achieve stable and long-lasting functional results of the treatment.

Perioral volumization using a temperature controlled fractionated radiofrequency device

Cosmetic rejuvenation of the perioral area can be challenging due to a mix of skin laxity and volumetric loss. Current techniques including fillers, neurotoxins, and non-ablative and ablative resurfacing have several drawbacks and can create a stiff, box-shaped, unnatural appearance. Aside from filler, these techniques do not address deeper volume deficiency. Temperature controlled fractionated radiofrequency (FRF) provides consistent formation of new collagen, elastin, and hyaluronic acid. This has been reported to provide long-lasting results for the treatment of skin laxity and volume loss of the face and neck with a single treatment, but it has not been previously reported for perioral rejuvenation. We present a series of seven patients who were treated with perioral FRF, and we assessed their results objectively using a published, validated scale for lower face laxity. All of the patients in this case series showed improvement on the Facial Laxity Rating (FLR) scale after FRF treatment. This case series represents the first reported use of temperature controlled FRF for perioral rejuvenation. FRF is a promising option for low-risk, natural perioral rejuvenation with long-lasting results and few risks.

The Wide Suture Suspension Platysmaplasty, a revised technique for neck rejuvenation: A retrospective cohort study.

Restoration of an esthetic neck contour is an integral component of facial rejuvenation. The corset platysmaplasty and the suture suspension neck lift were introduced by Feldman in 1990 and by Giampapa in 1995, respectively. Both techniques are routinely used in current practice with satisfactory and long-lasting results. However, some patients who have undergone the suture suspension platysmaplasty report long-term discomfort, excessive neck tightening, and recurrence of deformity. To achieve an improvement in the Cervicomental (CM) angle and other parameters in patients with a difficult neck and to reduce the probability of long-term discomfort, excessive neck tightening, and a recurrence of deformity. The author developed a new technique that includes a very wide suture suspension with no interlocking. We hereby present a revised suture suspension technique-The Wide Suture Suspension Platysmaplasty. Between the years 2015 and 2017, the senior author performed 286 face and neck rejuvenation surgeries with or without blepharoplasty. Of these cases, 35 patients with a heavy neck were chosen for the new Wide Suture Suspension Technique. This was a single surgeon retrospective cohort study. Patients were photographed in a lateral view preoperatively and 6months postoperatively. Pre- and postoperative photographs were compared in four measured parameters: the cervicomental angle, the jowl angle, the horizontal distance between the mentum and the cervicomental angle and the vertical distance between the mentum and the cervicomental angle. The Wide Suture Suspension Platysmaplasty resulted in pleasing esthetics, with minimal complications in patients with difficult necks. The cervicomental angle decreased by 42° (P<.0001), the jowl angle increased by 12° (P<.0001), the horizontal distance between the mentum and the cervicomental angle rose by 12.4% and the vertical distance between the mentum and the cervicomental angle was reduced by 34.5%. The Wide Suture Suspension Platysmaplasty resulted in improved esthetics, as demonstrated by objective measurements. None of the patients in this series had any secondary intervention during the follow-up period. Particularly in the case of a difficult neck, surgeons should consider this technique.

Long-lasting results you and your patients will value

Long-lasting results you and your patients will value

Long-lasting results you and your patients will value

Long-lasting results you and your patients will value

When to Substitute a Missing Upper Lateral With a Canine: A Simplified Approach

Introduction: The upper lateral incisor is the most commonly missing tooth in the anterior segment. It leads to esthetic and functional imbalance for the patients. The ideal solution is the one that is most conservative and which fulfills the functional and esthetic needs of the concerned individual. Canine substitution is evolving to be the treatment of choice in most of the cases, because of its various advantages. These are special cases that need more time and effort from the clinicians due to space discrepancy in the upper and lower arches, along with the presentation of individual malocclusion. Aims and Objectives: Malocclusion occurring due to missing laterals is more complex, needing more time and effort from the clinicians because of space discrepancy, esthetic compromise, and individual presentation of the malocclusion. An attempt has been made in this article to review, evaluate, and tabulate the important factors for the convenience of clinicians. Method: All articles related to canine substitution were searched in the electronic database PubMed, and the important factors influencing the decision were reviewed. After careful evaluation, the checklist was evolved. Result: The malocclusions in which canine substitution is the treatment of choice are indicated in the tabular form for the convenience of clinicians. Specific treatment-planning considerations and biomechanics that can lead to an efficient and long-lasting result are also discussed. Conclusion: The need of the hour is an evidence-based approach, along with a well-designed prospective randomized control trial to understand the importance of each factor influencing these cases. Until that time, giving the available information in a simplified way can be a quality approach to these cases.

Moving from employee compliance to employee success in the cyber security domain

Organisations frequently use fear as a tool to bring employees in line with cyber security policies, assuming that it’s an effective way to assure compliance. But many people respond negatively and this approach can have the opposite effect to the one intended. Karen Renaud, Stephen Flowerday and Marc Dupuis look at how turning cyber security education into a game makes it more readily embraced by staff and can have deeper, longerlasting results.

Does Dry Needling Increase the Efficacy of Botulinum Toxin Injection in the Management of Post-Stroke Spasticity: A Randomized Controlled Study.

The purpose of the current study was to investigate the antispastic efficacy of dry needling in combination with botulinum toxin-A injections. Thirty stroke patients with elbow flexor spasticity were randomised into two groups; the patients treated with botulinum toxin-A injections and exercise into the BTX-A group, and patients treated with botulinum toxin-A injections, exercise, and dry needling in the BTX-A+Dry needling group. Spasticity was evaluated using the modified Ashworth scale and modified Tardieu scale before treatment, immediately after treatment, the third day after treatment, second week after treatment and at the third month after treatment. The upper extremity motor function was evaluated using the Fugl-Meyer upper extremity motor function scale. A statistically significant difference in all parameters was found after treatment in both groups compared to before treatment (p<0.05). In all evaluation parameters immediately after treatment, on the third day after treatment, the second week after treatment and the third month after treatment, a statistically significant difference in favour of the BTX-A+Dry needling group was achieved compared to before treatment (p<0.05). Dry needling combined with botulinum toxin-A injections performed over a total of four sessions with three-day intervals, contribute to the antispastic effect. Also combined therapy is more effective and provides longer-lasting results.

Using injectable fillers for midface rejuvenation

Treatment aimed at preventing and reversing the facial aging process has grown in popularity. The aging midface is defined by classic deepening of the nasolabial folds, formation of marionette lines around the mouth, and significant atrophy of deep facial fat. While surgical options have been investigated with satisfactory and long-lasting results, nonsurgical alternatives such as soft tissue fillers are a safe and effective strategy for facial rejuvenation. This review focuses on a variety of injectable fillers available for the treatment of the aging midface, including hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, and polymethyl methacrylate. Mechanism of action, relevant anatomy, indications/contraindications, technique, and any evidence of efficacy and safety are described. The benefits of injectable fillers include reduced patient discomfort and shorter recovery times. Understanding the advantages and limitations of injectable fillers for midface augmentation can allow providers to counsel and treat patients seeking care appropriately.

Minimally invasive predictable esthetic restorations using ceramic veneers: A case series

The dental profession is perpetually in the search of restorative options that fulfill the criteria of being natural in appearance and at the same time long-lasting. Technological advances in ceramics and adhesive techniques have made it possible to achieve natural esthetic results with conservative intervention for the rehabilitation of anterior teeth. Smiles can be transformed painlessly and conservatively with quick and long-lasting results with the appropriate use of the porcelain laminate veneers. The finished ceramic surface elicits excellent tissue response. In short, the current ceramic veneers are esthetically superior, conservative, and durable. The present article reports on three cases where ceramic veneers have been used for the esthetic correction of anterior teeth.

Treatment of “En Coupe De Sabre “ Linear Scleroderma. Soft Tissue Augmentation and Regeneration by Autologous Fat Transfer

Aim: Frontal linear scleroderma, also known as ‘‘en coup de sabre,’’ is a congenital deformity characterized by atrophy and furrowing of the skin of the front parietal area above the level of the eyebrows. In most cases it occurs as a single paramedian line that may be associated with hypoplasia of underlying structures and facial hemiatrophy. In case of a wide lesion many reconstructive strategies have been proposed. The modern approach is aimed at augmentation of the tissue deficiency by using lipostructure and tissue regeneration. Autologous fat transfer (AFT) seems to be an effective strategy to restore the normal volume and contour of the face while providing a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. Methods: In this report, we present a rare case of linear scleroderma en coupe de sabre which was successfully managed with three stages of autologous fat grafting. Conclusion: The proposed uses for ADSCs in tissue repair and regeneration are quite impressive. Recent works on ADSCs would suggest that adult cells may prove to be an equally powerful regenerative tool in treating congenital and acquired maxillofacial disorders. More importantly, physicians, researchers and international associations need to cooperate in informing clinicians about what practices are based on evidence and to encourage support of additional research. There is increasing interest in a possible therapeutic effect of ADSCs from processed lipoaspirate for a wide spectrum of clinical applications in the facial and craniofacial area. AFT can be used in any facial area where soft tissue is lacking or where there is scarring, producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine. However, more definitive studies are needed to answer specific questions regarding the best technique to be used and the role of ADSCs. Autologous fat grafting provides a safe and easy approach for the treatment of linear scleroderma en coup de sabre, long-term clinically satisfactory results can be obtained.