Review Of Photographs Research Articles

Usefulness of picosecond pulse alexandrite laser treatment for nevus of Ota.

Recently, novel picosecond pulse duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that ps-lasers could be an alternative treatment for dermal pigmented lesions. We performed a retrospective review to evaluate the efficacy and safety of the ps-laser for nevus of Ota. A retrospective photographic review of 15 patients with nevus of Ota was performed (ages from 10 months to 65 yr). The patients were treated in the Ohshiro Clinic with a picosecond-domain 755 nm alexandrite laser (ps-Alex laser) from June 2015 to August 2017. Improvement was evaluated as the percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a four category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; and Excellent 75-100% improvement. Adverse events were also assessed. All patients obtained clinical improvement ranging from fair to excellent. All 5 patients whose primary treatment was the ps-Alex laser obtained excellent in 2-3 treatment sessions (average 2.5 sessions), and the average total treatment span was 10.0 months. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months of follow-up. Our results suggest that 755 nm ps laser treatment is efficacious for the treatment of nevus of Ota with minimum adverse events.

Poly-4-Hydroxybutyrate (P4HB) Scaffold Internal Support: Preliminary Experience with Direct Implant Opposition During Complex Breast Revisions.

The GalaFLEX scaffold is a mesh composed of resorbable poly-4-hydroxybutyrate (P4HB) monofilament fibers that aids in providing immediate internal soft tissue support, similar to that offered by an underwire bra, after breast reduction, lift, or augmentation. Our goal was to explore the possibility of using GalaFLEX as an internal support to prevent future sagging, predominantly in the lower pole of the breast. This preliminary study investigated GalaFLEX as a direct alternative to implants in a variety of complex revisional breast cases. Our intention was to establish a safety and efficacy profile in an effort to promote further investigation. A retrospective case series of 5 patients over 2 years were evaluated. Inclusion criteria were capsular contracture with concerns over soft tissue coverage and future ptosis, along with complicated muscle coverage deficits secondary to plane switching. A retrospective review of photographs taken at the most recent follow-up consistently showed retention of implant position and soft implants. Additionally, patients presented with a mean ± SD Baker Grade Contraction score of 2.8 ± 0.9189 preoperatively compared with a score of 1 ± 0 postoperatively. This preliminary study shows the initial safety of GalaFLEX but indicates the need for a multicenter, exhaustive study. Its versatility for complex revisional cases combined with acceptable aesthetic outcomes makes GalaFLEX an invaluable tool for plastic surgeons to consider.

El mimbre: una oportunidad de diversificación y desarrollo en las comunidades mam del Soconusco, Chiapas, México

El artículo presenta la determinación taxonómica de las plantas nativas empleadas en la producción del mimbre (fibra vegetal) y el conocimiento local (uso/manejo) del recurso en cinco comunidades del volcán Tacaná en la región Soconusco de Chiapas, México. La determinación taxonómica de las plantas se hizo con la revisión fotográfica del Dr. Thomas B. Croat, especialista en la taxonomía de Araceae. Se realizaron entrevistas semiestructuradas y a profundidad en las comunidades de estudio, y los datos se analizaron cuantitativa y cualitativamente. Las plantas útiles identificadas fueron Monstera acuminata K. Koch y Monstera deliciosa Liebm. El 22.4% de los informantes reportó conocimiento actual del mimbre y describen la fibra como un recurso nativo con valor cultural. Las plantas no tienen un manejo agronómico en las comunidades de estudio, sin embargo existe potencial para establecer un manejo diversificado con los cafetales locales. Monstera deliciosa es la especie con mayor posibilidad de éxito para volver a usarla y conservarla en tres comunidades, y resultó ser la especie más conocida por los entrevistados. Se concluye que el mimbre es un recurso natural potencial para el desarrollo económico de las comunidades mam.

Decision-Making Factors for Ulnar Nerve Transposition in Cubital Tunnel Surgery.

Background We designed a survey to ascertain the current perspectives of hand surgeons on the evaluation and management of ulnar nerve instability at the elbow. The secondary aim was to assess the concordance of hand surgeons on definitions of the terms "subluxated" and "dislocated" for classification of ulnar nerve instability. Methods A questionnaire, including demographic practice variables, cubital tunnel practice patterns, preoperative imaging and electrodiagnostic evaluation, and a series of standardized intraoperative photographs of ulnar nerve instability at the elbow were developed and distributed to the current American Society for Surgery of the Hand (ASSH) membership. Results A total of 690 (26.8%) members completed the survey; 84.2% of respondents indicated that they evaluate for ulnar nerve instability preoperatively with clinical examination, whereas only 6.1% indicated they routinely obtained dynamic ultrasound. Respondents indicated that the factors most strongly influencing their decision to proceed with anterior transposition of the ulnar nerve were subluxation on physical examination (89.6%), history consistent with ulnar nerve subluxation (85.8%), and muscle atrophy (43.2%). On review of clinical photographs, respondents demonstrated varying degrees of agreement on the terms "subluxated" or "dislocated" and recommendations for ulnar nerve transposition at intermediate degrees of ulnar nerve instability. Conclusion ASSH members routinely evaluate for ulnar nerve instability with history and clinical examination without uniform use of preoperative ultrasound, and nearly half of the time the decision to transpose the ulnar nerve is made intraoperatively. Definitions for the degree of ulnar nerve instability at the elbow are not uniformly agreed upon, and further development of a classification system may be warranted to standardize treatment.

Diagnostic Accuracy of Ophthalmoscopy vs Telemedicine in Examinations for Retinopathy of Prematurity

ImportanceExaminations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard. However, it is not known whether ophthalmoscopy is truly more accurate than telemedicine.ObjectiveTo directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard.Design, Setting, and ParticipantsThis multicenter prospective study conducted between July 1, 2011, and November 30, 2014, at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP.ExposuresEach examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by 3 independent telemedicine graders.Main Outcomes and MeasuresResults of both examination methods were combined into a consensus reference standard diagnosis. The agreement of both ophthalmoscopy and telemedicine was compared with this standard, using percentage agreement and weighted κ statistics.ResultsAmong the 281 infants in the study (127 girls and 154 boys; mean [SD] gestational age, 27.1 [2.4] weeks), a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine. Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% [95% CI, 71%-84%] vs 78% [95% CI, 73%-83%]; P > .99 [n = 165]), plus disease (74% [95% CI, 61%-87%] vs 79% [95% CI, 72%-86%]; P = .41 [n = 50]), and type 2 ROP (stage 3, zone I, or plus disease: 86% [95% CI, 80%-92%] vs 79% [95% CI, 75%-83%]; P = .10 [n = 251]), but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% [95% CI, 79%-91%] vs 73% [95% CI, 67%-78%]; P = .004 [n = 136]).Conclusions and RelevanceNo difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP, although, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP. With the caveat that there was variable accuracy between examiners using both modalities, these results support the use of telemedicine for the diagnosis of clinically significant ROP.

Abstract 67: Real-World Experience with 100 Consecutive Patients Undergoing Injection Adipocytolysis for Neck Contouring with ATX-101 (Deoxycholic Acid): An Updated Report with 2-Year Analysis

PURPOSE: In 2015, deoxycholic acid (DCA) injection was approved for treatment of mild-to-moderate convexity associated with submental fat. The efficacy and safety of submental DCA injection have been demonstrated in four phase 3 randomized controlled trials (RCTs), however, critical assessment of DCA injection in conventional clinical practice is lacking. In a previous report, we presented initial findings from our experience with 100 consecutive patients administered submental DCA. This study describes and evaluates real-world experience with submental DCA injection in a clinical practice setting, and provides an update to our previous report, accounting for additional treatment sessions during long-term follow-up. METHODS: This prospective, single-arm, observational study was conducted at a single clinic (private practice) between June 2015 and June 2017. Experience through February 2016 was previously published. The study involved 100 consecutive patients, aged between 18 and 80 years, seeking improvement in convexity/fullness associated with submental fat. Treatment involved DCA injection to the preplatysmal submental fat using an area-adjusted DCA dose of 2 mg/cm2, with up to 75 injections (0.2 mL per injection [maximum, 15 mL]) per treatment session for a maximum of 6 sessions. Treatment response was assessed using the clinician-reported submental fat rating scale CR-SMFRS (0 = absent; 1 = mild; 2 = moderate; 3 = severe; and 4 = extreme) and confirmed by independent physician review of photographs at 1 and 5 to 7 weeks posttreatment. Treatment response was defined as an improvement of ≥1 point. AEs, including injection-site AEs such as local edema, numbness, and tenderness were monitored at each follow-up visit. Patient demographics, response, and safety were compared between patients who underwent single versus multiple treatment sessions. RESULTS: Since the prior published report, 17 patients have undergone additional treatment sessions. Overall, one hundred patients have had 195 treatment sessions: 41, 36, 14, 6, 2, and 1 patient had 1, 2, 3, 4, 5, and 6 sessions, respectively. In the multiple-treatment-session (MTS) group, most (36/59 [61.0%]) patients had 2 sessions; 14 (23.7%) had 3 sessions, 6 (10.2%) had 4 sessions, 2 (3.4%) had 5 sessions, and 1 (1.7%) had 6 sessions. A mean (SD) of 6.7 (2.3) mL of DCA was administered per treatment session, with significantly more DCA administered to the MTS than single-treatment-session (STS) group (6.8 [2.3] vs 6.1 [2.2] mL/session; p = .049). Overall, 33 of 36 (91.7%) patients in the STS group and all 59 (100.0%) patients in the MTS group had an improved CR-SMFRS score by ≥1 point. Local edema, numbness, and tenderness were reported for a mean (SD) of 7.1 (5.1), 27.9 (11.3), and 3.5 (3.5) days post-treatment, respectively. CONCLUSIONS: Longer-term follow-up of submental DCA injections demonstrated that patients will likely require ≥2 sessions to achieve the desired aesthetic goal in a private practice setting. Both single- and multiple-treatment sessions were generally well tolerated. S.M. Shridharani:; Allergan.; Galderma.; Merz.; Sientra. G.M. Tisch: None.

Use of photograph-based telemedicine in postoperative wound assessment to diagnose or exclude surgical site infection.

This study aims to assess whether a clinician reviewing photographs of a wound was an acceptable substitute for clinical review in order to identify or exclude surgical site infection (SSI). We undertook a mixed methods study consisting of a qualitative public involvement exercise and a prospective, non-randomised, single-centre study of patients undergoing clean or clean-contaminated vascular surgery. For the qualitative study, two semi-structured focus group interviews were conducted. For the prospective study, patients were invited to attend a wound review at 5-7 days and 30 days postoperatively. At review, wounds were scored by a study nurse or doctor, according to the ASEPSIS scale. Anonymised wound photographs were taken and independently reviewed, and ASEPSIS scored by two independent investigators blinded to the original 'clinical review' ASEPSIS score. In the qualitative study, three female patients were interviewed across two dates. Emerging themes included the burden of SSI, hospital follow-up and telemedical follow-up. A total of 37 patients with a mean age of 61.14 years were included in the quantitative analysis. There was a total of 53 wound reviews. There was >85% agreement between photograph and clinical reviewers in all categories except erythema. The specificity of photograph review for diagnosis of SSI was 90%. The intraclass correlation coefficient for total ASEPSIS score was R=0.806 (95% CI 0.694, 0.881), indicating strong reliability between reviewers. Our data shows that, in the assessment of SSI, there is good correlation between face-to-face clinical and remote photographic review. Incorporating this method of wound assessment into a postoperative follow-up care pathway may save patients and clinicians from unnecessary hospital visits, particularly when conducting health research.

Inter- and intra-rater reliability and agreement in determining subcutaneous tumour margins in dogs.

The objective of this prospective study was to evaluate agreement and reliability of calliper-based measurements of locally invasive subcutaneous malignant tumours in dogs. Four raters measured the longest diameter of 12 subcutaneous tumours (7 soft tissue sarcomas and 5 mast cell tumours) from 11 client-owned dogs during 3 randomized, blinded measurement trials, both pre- and post-sedation. Inter- and intra-rater reliability was evaluated using intra-class correlation coefficient (ICC) and agreement was evaluated using Bland-Altman plots. Inter- and intra-rater reliability was good (ICC range of 0.8694-0.89520) and excellent (ICC range of 0.9720-0.9966), respectively. For agreement calculations, an a priori clinically relevant limit of agreement of 10 mm was set. Inter- and intra-rater agreement was unacceptable with inter-rater limits of agreement ranging from 15.9 to 55.6 mm and intra-rater limit of agreement ranging from 11.9 to 28.1 mm. Review of the measurement trial photographs revealed that calliper orientation changes were frequent, occurring in 9/12 (75%) and 8/12 (67%) pre- and post-sedation cases. No significant correlation was found between inter-rater measurement standard deviations and calliper orientation changes or dog body condition score. These findings suggest veterinarians may have poor agreement in determining the gross edge of tumours, which is expected to introduce bias and inconsistency in tumour staging, assessing response to therapy, and surgical margin planning. Due to the potential consequences for veterinary cancer patients, future studies are needed to validate the present findings.

Central round block repair of large breast resection defects: oncologic and aesthetic outcomes.

The central round block repair is a volume displacement technique to reconstruct large wide local excision (WLE) defects in breasts with moderate ptosis or hypertrophy. There are limited published data on the outcomes of this technique. Data were collected prospectively for 57 consecutive patients and follow up information obtained from patient records. The volume of breast resection was estimated geometrically from mammography. Aesthetic outcomes were assessed from clinical measurements and panel review of patient photographs. The median age was 51 [22-86] years and follow-up 5 (1.9-8.4) years. The median specimen resection weight was 50 [25-361] g and tumour size 25 [10-75] mm. Estimated volume of breast excised was 17.8% (6-31%). In total, 12/57 patients had incomplete margins: five patients had re-excision to achieve clear margins and seven required mastectomy. Two patients had local recurrence during the follow-up period, five developed distant metastases. Aesthetic data were completed for 35/50 patients. Twelve (34%) had no measurable asymmetry and 31 (89%) had a nipple position within 2 cm of the original height. Only two patients requested symmetrising surgery. Central round block reconstruction of large defects after WLE is a safe technique with good aesthetic outcomes. Contralateral symmetrising surgery is not usually required.

Accuracy and Reliability of a Handheld, Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema.

Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty. The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema. Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics. The sensitivity and specificity for detection of optic disc edema were 71.8-92.2% and 81.6-95.2%, respectively. Photos were found to be ungradable in 0-8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52-0.67] to 0.72 (95% CI: 0.66-0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63-0.92) to 0.82 (95% CI: 0.69-0.95). Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate-strong and strong within individual providers. Portable photography holds promise for use in remote screening of optic disc edema.

Gastric superficial neoplasia: high miss rate but slow progression.

Background and aims Gastric superficial neoplasia (GSN) is often overlooked at endoscopy because of difficulty in identifying it. The miss rate of GSN at endoscopy and the impact on clinical outcome of the missed GSN have not been fully elucidated. In this study, we investigated these issues. Methods Among 1462 endoscopically and pathologically diagnosed gastric cancers in our hospital from January 2011 to December 2014, previous records of esophagogastroduodenoscopy (EGD) were available for 198 lesions (index lesions) and were reviewed retrospectively. Among those, 157 lesions, which were diagnosed as GSN on the basis of their EGD findings at initial endoscopy, were analyzed. Progression was defined as advanced cancer in the index lesion. Results Among the 157 GSNs, 118 (75.2 %) had not been recorded in the previous EGD report but were evident upon review of endoscopic photographs for this study. Progression to advanced cancer was observed in only 13 (8.3 %) of the 157 GSNs during a mean interval of 41 months and as long as 96 months, and the rate of progression was similar in missed and not-missed lesions (8.5 % and 7.7 %, respectively). Cumulative incidence rates of progression of missed GSNs to advanced cancer were 0.8 %, 1.7 %, 4.2 %, and 7.6 % at 36, 48, 60, and 72 months after the initial EGD, respectively. Conclusions Our findings illustrate that GSNs are often missed at endoscopy but progress slowly in most cases. Even though the rate of progression to cancer is relatively low, rigorous attempts should be made to reduce the miss rate of GSNs at EGD.

Early Experience in 100 Consecutive Patients With Injection Adipocytolysis for Neck Contouring With ATX-101 (Deoxycholic Acid).

Deoxycholic acid (DCA) is approved for improvement in the appearance of moderate to severe convexity or fullness associated with submental fat. To assess early treatment experience with DCA injection in a clinical practice setting. In this single-center, prospective, single-arm, observational study, 100 consecutive patients seeking to decrease submental fullness received subcutaneous DCA (2 mg/cm) injections in the submental area (maximum of 6 sessions at ≥1 month intervals). Treatment response was assessed 1 and 5 to 7 weeks posttreatment using the clinician-reported submental fat rating scale (CR-SMFRS) and retrospective independent photograph review by 2 physicians. Overall, 100 patients had 152 treatment sessions (58, 33, 8, and 1 patients had 1, 2, 3, and 4 sessions, respectively). CR-SMFRS score improved by ≥1 point from baseline in 88 (88%) patients; of these, 46, 33, 8, and 1 patients had 1, 2, 3, and 4 sessions, respectively. Local edema, numbness, and tenderness were reported for a mean (SD) of 7.7 (5.3), 28.5 (11.4), and 3.5 (3.5) days, respectively. Two patients experienced marginal mandibular nerve paresis. Deoxycholic acid injection, a minimally invasive procedure for neck contouring, was effective and generally well tolerated in the private practice setting.

THE APPROPRIATION OF BUILT HERITAGE AND PRO-ENVIRONMENTAL BEHAVIOURS: A CASE STUDY OF LEED-CERTIFIED LOW-INCOME MULTIFAMILY HOUSING

This interdisciplinary research study explores the environmental awareness, attitudes and behaviours of residents of a low-income, Leadership in Energy and Environmental Design (LEED) certified, multifamily, heritage-listed housing development in the Midwest region of the United States. Through in-depth semi-structured face-to-face interviews and review of site photographs and online and archived news articles, the causal factors for and links between environmental behaviours, LEED and built heritage were explored. The findings reveal that the LEED features the residents valued in hierarchical order were: location, the building’s historic and renovated characteristics, its energy conservation system and the cleanliness and upkeep of the premises. The valued non-LEED features were security and privacy. Additionally, the findings show that residents possess a level of critical thinking and opinion pertaining to the importance of their residence as a restored building. The residents were highly aware of their own, their social group’s and the management’s behaviors and of the value of their property in terms of its historic significance and public image and presence in the neighborhood and among their social networks.

Medial canthal defects following tumour excision: To reconstruct or not to reconstruct?

ABSTRACTLaissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1–80 months) for LFS and 30 months (range 6–60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.

Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dye laser (PDL) and radiofrequency (RF) energy device

Pulsed dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Some PWS are recalcitrant to this modality. A number of reasons for PDL treatment resistance have been described, including inadequate heat generation. We evaluated PDL combined with radiofrequency (RF) energy into a single device to target larger and deeper blood vessels and overcome PDL resistance. This was an open-label, prospective, single-center investigation of a novel device combining RF energy with PDL conducted to treat recalcitrant PWS. Ten patients with 11 recalcitrant PWS were enrolled. Each PWS was divided into 5 treatment areas: PDL alone, RF alone, PDL+RF, RF+PDL, and untreated control. Patients underwent a maximum of 6 treatments, scheduled 4 to 6weeks apart with follow-up evaluation at 4 and 12weeks after the final treatment. Colorimetry and standardized digital photography were performed at all visits. Lesional biopsy specimens were collected for selected patients. Areas treated with RF followed by PDL and PDL followed by RF showed the greatest improvement based on blinded review of digital photographs, reaching statistical significance (P value<.05) at the 12-week follow-up evaluation when compared with baseline. Adverse events, including purpura, erythema, edema, scabbing, crusting, and blistering, resolved without sequelae; a small residual scar was noted in 1 patient. Small sample size and short follow-up period are limitations. Combined RF/PDL technology is promising for the treatment of recalcitrant PWS.

Photographs as Historic Documents: An Examination of Two of Evgenii Khaldei’s Budapest Photos

In a recent letter to the editor of Slavic Review, I took issue with the identification and interpretation of two photographs that appeared in an article titled “Heroes, Victims, Role Models: Representing the Child Soldiers of the Warsaw Uprising.” The scenes were mistakenly identified as taking place in wartime Warsaw. While various perspectives may be taken on how one uses and interprets photographs in other disciplines, as an historian, I believe it to be essential that a strict review of the photographs’ origin be examined since they may force us to come to different conclusions about the reality of historical events, and possibly perpetrators of crimes. The crux of my argument follows.

Efficacy of a Nutritional Supplement, Standardized in Fatty Acids and Phytosterols, on Hair Loss and Hair Health in both Women and Men

Introduction: Hair health concern is one of the most distressing conditions for a significant number of men and women of all ages. The unique current pharmacologic therapeutic options approved by Food and Drug administration (FDA) are finasteride and topical minoxidil; however, these treatments may have side effects and may work on just one cause of hair loss, without giving an exhaustive and complete results. Objective: The aim of this study was to evaluate the efficacy of a nutritional complex, combining omega 3-6-9, antioxidant, natural inhibitors of 5α-reductase and anti-inflammatory molecules in improving hair loss and hair health parameter such as volume, strength and reduction of greasiness. Methods: This study was made up of two phases. The in vitro experiment aimed at evaluating the capacity of the nutritional complex to lower the enzyme 5α-reductase activity in culture of human keratinocytes. The in vivo study was performed on 30 volunteers who experienced a 6 months treatment with the nutritional complex. The evaluation of hair loss and hair health parameter was performed by trichoscopy, global photograph review and subject’s assessment. Results: The in vitro study showed the capacity of the nutritional formulation to inhibit the total 5α-reductase comparable to finasteride and Serenoa repens. The global photograph assessment at T0 and T6 showed an increased hair density on 83.3% of subjects and the preliminary results were already visible just after three months. Moreover, the trichoscopy demonstrates an increase of hair diameter and hair density, an improvement of vascularization and a reduction of greasiness at the follicle level. The hair quality and hair loss reduction valued by the subjects showed positive results confirming the photographic outcomes. Conclusions: This study proves the action of nutritional complex components, s-sitosterosl with omega 3-6 complex from Serenoa repens, linseed, borage, wheat oils, pine bark and rye grass in inhibition of the total 5α- reductase. Furthermore, both the reduction of hair greasiness and the improvement of hair quality demonstrate that this formulation is not only effective against 5α-reductase but it also exerts its properties in a complete manner by restoring the physiologic condition of a healthy scalp. Moreover, it demonstrates the positive effects of this natural complex supplementation on overall scalp coverage. Visibly there is an improvement of vascularization, hair diameter and the reduction of hair loss perception.

Epidemiological study of hypertensive retinopathy in the primary care setting: Retrospective cross-sectional review of retinal photographs

Objective The objective is to estimate the prevalence and grading of hypertensive retinopathy in the primary care setting; examine the patient characteristics associated with hypertensive retinopathy; and examine the association of hypertensive retinopathy and other hypertension complications. Methods This is a retrospective cross-sectional study. Subjects included adult hypertensive patients with available and gradable retinal photographs. Results Two hundred fifty-six male hypertensive patients (34.3%) and 491 female hypertensive patients (65.7%) were included. The average duration of hypertension was 7.2 years, and 49.8% and 41.2% of patients were taking one or two antihypertensive medications respectively. Among 1491 qualified retinal photographs (744 right eye and 747 left eye), 24.9%, 62.6%, and 12.5% were classified as showing normal, mild, and moderate hypertensive retinopathy respectively. The three commonest retinal signs were generalized or focal arteriolar narrowing (650 cases, 43.6%), hard exudates (168 cases, 11.3%), and opacity (copper or silver wiring) of the arteriolar wall (166 cases, 11.1%). Patients older than 61 years, having hypertension for more than 15 years, or taking three or more antihypertensive medications were significantly associated with hypertensive retinopathy (P Conclusion In a primary care clinic in Hong Kong, 77.1% of hypertensive patients had hypertensive retinopathy. Advanced hypertensive retinopathy was the commonest target organ damage for hypertensive patients in a primary care clinic.

Retrospective analysis of translaminar, demographic, and physiologic parameters in relation to papilledema severity

ObjectiveSome case reports suggest that the translaminar pressure difference is important in cases of papilledema. The purpose of this study was to determine ocular, physiologic, and demographic factors associated with papilledema severity. DesignRetrospective, blinded study. ParticipantsPatients who had undergone a diagnostic lumbar puncture and had a diagnosis of papilledema in conjunction with idiopathic intracranial hypertension between 2004 and 2012 were included in the study. One-hundred and fifty-one patients were identified in initial screening. Sixty of 151 patients met all inclusion criteria, and 120 eyes were eligible for investigation. MethodsA retrospective review of optic nerve photographs by 2 masked experts was used to grade papilledema severity using the Modified Frisén Scale (MFS). Patients with any systemic or neurologic disease that could affect cerebrospinal fluid pressure (CSFP) were excluded. Patients on acetazolamide were excluded. Assessments within 1 MFS grade were averaged and correlated to intraocular pressure, CSFP, translaminar pressure differential, MFS, age, weight, height, and systolic and diastolic blood pressure. ResultsIn univariate and multivariate type 3 generalized estimating equation analyses, only age (Z = −2.70; p < 0.01) and sex (Z = 2.81; p < 0.0001) were significantly correlated with MFS. ConclusionsPapilledema severity decreased with advancing age and was higher for female sex. We found no association between severity of papilledema and CSFP, intraocular pressure, blood pressure, or any other physiologic parameter. Factors other than the translaminar pressure differential may be important in determining the severity of papilledema.

Development and Validation of a Grading Scale for Custom Ocular Prosthesis.

To develop a standardized and universally reproducible grading scale for artistic outcome of a custom ocular prosthesis. A retrospective review of photographs of patients with custom ocular prosthesis. From the ocularistry database of a tertiary eye care hospital, photographs of patients with custom ocular prosthesis (30 random photos with additional 18 repetitions, total n = 50) were selected. Two independent oculoplastic surgeons, on the basis of characteristics of limbus, vascularity, and pigmentation, graded these photos. The photos were adjusted for confounders like magnification and illumination, and both graders used the same display system. The surgeons were blinded to each other. The characteristics were graded on a scale of 0 to 2 and total score was calculated for each photo. Inter-observer and intra-observer agreement was calculated using the kappa statistic. The inter-observer kappa coefficient for the three characteristics (95% confidence interval) were as follows: limbus 0.7 (0.55-0.85), vascularity 0.76 (0.58-0.94), and pigmentation 0.6 (0.34-0.85). The intra-observer kappa coefficient for the first surgeon was as follows: limbus 0.88 (0.7-0.95), vascularity 0.88 (0.73-0.95), and pigmentation 0.82 (0.54-0.93). The intra-observer kappa coefficient for the second surgeon was as follows: limbus 0.8 (0.44-0.93), vascularity 0.55 (0.13-0.8), and pigmentation 0.76 (0.6-0.84). A good intra- and inter-observer agreement was demonstrated. In view of no existing grading for prosthesis, this is a unique system to objectively grade the outcome of custom ocular prosthesis and can be incorporated in ocularistry teaching modules for standardization of outcomes.