Short Downtime Research Articles

Effectiveness and safety of the modified multiple mode procedures versus traditional multiple mode procedures on treating facial atrophic acne scars: a propensity score matching retrospective cohort study.

Multiple mode procedures (MMP) of fractional CO2 laser provide higher efficacy and shorter downtime in treating acne scars, compared to traditional fractional CO2 laser therapy. This study aims to evaluate the effectiveness and safety of modified MMP integrated with fractional microneedle radiofrequency (FMR), ultra-pulse CO2 laser and fractional CO2 laser in treating acne scars. A retrospective analysis of 162 acne scar patients treated with MMP or modified MMP was conducted. Acne scars were evaluated using the Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) grading scale, modified Manchester Scar Scale (mMSS), and Global Assessment Scale (GAS). Baseline variables were balanced with propensity score matching (PSM) to improve the comparability of treatment effectiveness and safety between groups. Among 162 patients with facial acne scars, 68 were treated with modified MMP and 94 with traditional MMP. After PSM, both groups had 55 patients with comparable baseline characteristics (P > 0.05). The ECCA score decreased more significantly in the modified MMP group (60%±11%) than in the MMP group (45%±16.6%, P < 0.001). The modified MMP group also had higher mMSS color score (2.6 ± 0.7 vs. 2.1 ± 0.9, P = 0.005), greater reduction in pore size and skin laxity (P < 0.001), shorter postoperative erythema duration (22.2 ± 4.0 vs. 31.3 ± 3.7 days, P < 0.001), but higher pain scores (Visual Analogue Scale, VAS: 6.7 ± 1.6 vs. 3.8 ± 0.8, P < 0.001). Modified MMP is more effective than traditional MMP in treating acne scars, especially for patients with large pores and skin laxity.

Aqua Breast Augmentation (ABA): Hydrodissection Breast Augmentation Technique.

Breast augmentation is a prevalent procedure in plastic surgery. In this article we present the Aqua Breast Technique (ABA), an approach aimed at enhancing patient satisfaction and reducing downtime. This technique leverages tumescent anesthesia and a small incision in the inframammary fold, avoiding electrocautery and surgical drains, to fulfill the growing demand for painless procedures with minimal recovery periods. The study retrospectively analyzed 238 patients who underwent breast augmentation using the ABA technique at Instituto Rubi between 2021 and 2024. The ABA protocol involves detailed preoperative design, local anesthesia, a precise 3-centimeter incision, careful dissection, and specific postoperative care, emphasizing hydrodissection for tissue separation and the use of smooth round silicone implants through a Keller funnel. The application of the ABA technique to 238 patients, with a mean follow-up time 14months. Ten patients required surgical intervention due to complications. Hematoma and infection rates were 0.42%, while capsulectomies were required in 2.1% of cases. Aqua Breast Augmentation technique has been successfully applied as ahydrodissection-based breast augmentation technique method, with low complication rates, short downtime, and reduced postoperative pain. Level V, therapeutic study. 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 .

Comparison of Microwave-Based Therapy and Negative-Pressure Suction-Curettage for Axillary Hyperhidrosis and Bromhidrosis: A Retrospective Analysis.

Axillary hyperhidrosis and bromhidrosis are common clinical diseases, affecting the patients' work and life. Negative-pressure suction-curettage is the most popular treatment now, but challenged by a new microwave-based therapy (MiraDry). We intend to compare the safety and efficiency of the 2 treatments. A retrospective analysis of 39 female patients with both primary hyperhidrosis and bromhidrosis was conducted. Seventeen patients were treated with MiraDry, and 22 underwent negative-pressure suction-curettage. The postoperative follow-up program included sweat and odor assessments, satisfaction measurement, safety evaluation, and recurrence assessment at different time points until 12 months. Both treatments showed a significant reduction (P < 0.05) in HDSS score and odor level at 6 and 12 months compared with the baseline. No significant difference in relative reduction was observed between the 2 groups. The satisfaction score of the microwave-based therapy group was higher than that of the negative-pressure suction-curettage group, but no statistical difference was found. The difference in the recurrence rate and complication rate between the groups did not reach significance. Microwave-based therapy is a noninvasive treatment with durable effects, low risks, shorter downtime, good appearance, and high satisfaction for axillary hyperhidrosis and bromhidrosis.

Evaluation of a Novel Ablative 1940 nm Pulsed Laser for Skin Rejuvenation.

Skin rejuvenation is a widely sought-after goal, prompting advancements in laser technology for noninvasive and effective treatments. Ablative lasers, in particular, have evolved to address diverse skin concerns, with fractional ablative lasers offering better-tolerated outcomes. The introduction of a novel ablative Thulium pulsed laser, based on Thulium-doped Yttrium aluminum Perovskite (Tm:YAP) crystal, delivers precise and controlled skin rejuvenation by allowing customization of ablative microcolumns. A pilot in vivo study was conducted on the abdominal skin of a live female pig. Using the Laser Team Medical (LTM) prototype laser, treatments were administered with varying coagulation settings (minimal and maximum) and energies (32, 80, 120, and 160 mJ per microcolumn). Biopsies were harvested, fixed, and stained for subsequent analysis. The penetration depth and width of the microcolumns were evaluated. Low coagulation settings produced ablative microcolumns with thermal affected zones of 160 µm width, while high coagulation settings resulted in wider zones of 400-530 µm. The ablation cavities' width was estimated to be less than 100 µm in both settings. The novel 1940 nm pulsed laser demonstrated superior microcolumn properties, offering potential advantages such as shorter downtime and increased efficacy compared to existing fractional ablative lasers. This study presents encouraging preliminary results regarding the efficacy and safety of the first ablative 1940 nm pulsed laser. The results show ablative microcolumns thinner than the counterpart devices, showing the device safety and potential higher efficacy along with short downtime. The LTM novel ablative 1940 nm pulsed laser holds immense potential for enhancing skin rejuvenation treatments due to its superior microcolumns properties. The versatility of this laser can open new treatment procedures and may extend to different areas of dermatology.

Using an intense pulsed light (IPL) module for the treatment of pigmented lesions.

Pigmented lesions are largely benign and may lead to extreme distress. Various light and lasers may be used to treat pigmentation, often Q-switched lasers are considered the method of choice, while intense pulsed light (IPL) devices may offer a less invasive treatment with a shorter downtime. The purpose of this study is to evaluate the safety and efficacy of a narrowband IPL module for the treatment of pigmented lesions. A retrospective study of 20 patients with pigmented lesions underwent treatment with an IPL module. Treatment was assessed by blinded evaluation of clinical photographs using a GAIS scale of 0-10, as well as through patient satisfaction ratings on a scale of 0-10. Throughout the treatment, pain levels and adverse events were monitored. The mean GAIS score was 7.55 ± 1.15 (mean ± SD), and the mean patient satisfaction score was 7.3 ± 1.26 (mean ± SD). There was a strong positive correlation between GAIS and patient satisfaction scores (r = 0.83), and no significant difference between them (p-value = 0.516). The number of treatments did not significantly affect GAIS and patient satisfaction scores (p-values 0.364 and 0.126). Additional positive unexpected outcomes were improved skin firmness and reduced wrinkles. The results of the study indicate that the IPL module is both safe and effective in treating pigmented lesions and may have the potential to stimulate collagen production.

Ingrown Toenails: A Survey Among Dermatologists on Current Treatments.

To date, there is no formal consensus on how to treat ingrown toenails. Despite the risk of causing irreparable damage to the nail, highly invasive procedures are still common. Less-invasive, matrix-directed techniques with shorter downtime and high cure rates exist, but, perhaps because of a lack of awareness, appear not to have been universally adopted. The authors' study sought to generate data on common practices in the treatment of ingrown toenails. The authors developed and conducted an online survey to ask dermatologists/dermatosurgeons how they would proceed in 9 different cases of ingrown toenails based on photographs. The authors received 154 replies. Nonsurgical interventions, including advice on nail care/foot baths/ointments/wraps/padding, were always the most frequently chosen option. Removal of the lateral nail plate followed by chemical partial matricectomy (phenolization) was the most or second-most frequently chosen surgical intervention. The answers were highly heterogeneous, and there was no unanimity based on morphology alone. Except for a preference for nonsurgical interventions, the authors could not identify any clear treatment standards. The heterogeneity of treatment approaches suggests the need for a guideline.

Chest compression quality and patient outcomes with the use of a CPR feedback device: A retrospective study

Feedback devices were developed to guide resuscitations as targets recommended by various guidelines are difficult to achieve. Yet, there is limited evidence to support their use for in-hospital cardiac arrests (IHCA), and they did not correlate with patient outcomes. Therefore, this study has investigated the compression quality and patient outcomes in IHCA with the use of a feedback device via a retrospective study of inpatient code blue activations in a Singapore hospital over one year. The primary outcome was compression quality and secondary outcomes were survival, downtime and neurological status. 64 of 110 (58.2%) cases were included. Most resuscitations (71.9%) met the recommended chest compression fraction (CCF, defined as the proportion of time spent on compressions during resuscitation) despite overall quality being suboptimal. Greater survival to discharge and better neurological status in resuscitated patients respectively correlated with higher median CCF (p = 0.040 and 0.026 respectively) and shorter downtime (p < 0.001 and 0.001 respectively); independently, a higher CCF correlated with a shorter downtime (p = 0.014). Overall, this study demonstrated that reducing interruptions is crucial for good outcomes in IHCA. However, compression quality remained suboptimal despite feedback device implementation, possibly requiring further simulation training and coaching. Future multicentre studies incorporating these measures should be explored.

A Contemporary Study of Pre-hospital Traumatic Cardiac Arrest: Distinguishing Exsanguination From Non-exsanguination Arrest With a Review of Current Literature.

Background Traumatic cardiac arrest (TCA) remains a challenging problem in terms of diagnosis and management. This is due to difficulty distinguishing the TCA cause and therefore understanding the pathophysiology. The goal of this study was to analyze a contemporary series of TCA patients and classify the causes of TCA into exsanguination (EX) arrest and non-exsanguination (non-EX) arrest. Methods This was a retrospective review of patients suffering TCA during 2019 at a level I trauma center. We excluded patients whose arrests were from medical causes such as ventricular fibrillation, ventricular tachycardia, pulmonary embolus, etc., hanging, drowning, thermal injury, outside transfer, and pediatric patients (age <13 as this is our institutional definition for pediatric trauma patients). We reviewed pre-hospital run-sheets, hospital charts including autopsy findings, and classified patients into EX and non-EX TCA. We defined a witnessed arrest (WA) using the traditional outside hospital cardiac (non-trauma) arrestdefinition. Outcomes included the incidence of EX arrest, survival to discharge, and hospital costs. Descriptive statistics were used.Significancewas set atp< 0.05. Results After exclusion, 54 patients suffered TCA with a mean age of 45.9 (±19.8) years.Eighty-three percent of patients were male. The average cost per TCA was ~$16,000. Of the 54 TCAs, 26 (48%) were WA, with one (1.85%) survivor (no non-WA TCA patients survived). Twenty-two (41%) patients died from EX-arrest; 59% penetrating vs. 28% blunt (p= 0.03). The one EX-arrest survivor was a 19-year-old gunshot wound to the leg whose arrest was witnessed, with a short downtime, and the cause of arrest (bleeding leg wound) was quickly reversible. Conclusion We classified 41% of TCAs to have died from EX-arrest with only a 1.85% survival rate. This study calls for a TCA pre-hospital registry with accurate and consistent data definitions and collection. The registry should capture the cause of arrest for future research, management decision-making, and prognostication.

Management of migrated hyaluronic acid dermal filler with a delayed presentation

Hyaluronic acid (HA)-based dermal fillers are extremely popular among many seeking aesthetic treatment due to the short downtime and immediate results. Although HA is biodegradable, the body can still mount immune responses to this foreign body and molecules can persist in the system for longer than anticipated, resulting in complications months or years after the initial injection. We report a rare case of a 47-year-old Caucasian female who presented to us with bilateral lid swelling secondary to migration of her dermal filler and how she was successfully managed three years post administration with the injection of hyaluronidase along with histopathological results.

PROCESSUAL BENEFITS OF PREDICTIVE MAINTENANCE IN THE MIDMARKET

Background: Industrialization has given rise to numerous new topics for companies. In the age of Industry 4.0, predictive maintenance represents an opportunity to reduce machines' downtime and enable companies to gain competitive advantages. For this purpose, sensors are installed in machines, and the data of individual parts is constantly monitored and evaluated. By detecting possible failure risks of individual parts at an early stage, they can be replaced before the downtime occurs, thus preventing a long downtime. A shorter downtime can bring further positive aspects in multiple terms. A lot is written in the literature about the general advantages of predictive maintenance, but there is no particular focus on the German midmarket sector. Aims: The aim of this paper is to find out how midsize companies perceive the processual benefits of predictive maintenance. Methods: A standardized questionnaire with four questions is developed. Sample: Answers from 104 respondents are evaluated. Results: The results show that a large proportion of the respondents expect added value. Conclusion and Implications: The research in this paper shows that the added value generated by predictive maintenance is not limited to multinational corporations but can also be realized in medium-sized companies.

Picosecond lasers in dermatology

The picosecond laser is one of the latest laser systems in dermatology and was originally developed to optimize tattoo removal. Advances in this technology has expanded the use of the picosecond laser to numerous other indications. This article provides an overview of the technical background as well as the indications of the picosecond laser in dermatological laser medicine and elucidates the possibilities and limits of this laser system. The article is based on areview of the current literature as well as experience from clinical practice in auniversity laser department. The picosecond laser enables aparticularly gentle and effective treatment due to ultra-short pulses and the principle of laser-induced optical breakdown. Compared to Q‑switched lasers, the picosecond laser has fewer side effects and is associated with lower pain intensity and shorter downtime. In addition to the removal of tattoos and pigmentary disorders, it is also used in the treatment of scars and rejuvenation. The picosecond laser has awide range of indications in dermatological laser medicine. The current data indicate that the laser is an effective method with few side effects. Further prospective studies have to be conducted to assess the efficacy, tolerability and patient satisfaction in an evidence-based manner.

Laser Carbon Peel: New Armamentarium for Inflammatory Acne.

There is an increasing interest in procedures to improve skin quality in acne patients with a short downtime. Off late, carbon peel laser technique which uses topical carbon suspension combined with Q-switched Nd:YAG laser treatment has gained popularity. The main advantages of this procedure are easy to perform and it requires less than 30 minutes.

Minimally invasive catheters in varicose vein treatment : New gold standard?

Endovenous procedures are commonly used for varicose vein treatment. Types, functionality, and significance of endovenous devices. To describe the different endovenous devices, their mode of action, inherent risks and efficacy according to the literature. Long-term data confirm that endovenous procedures are equally effective as open surgery. Postoperative pain is minimal and downtime shorter after catheter interventions. Catheter-based endovenous procedures increase the diversity of varicose vein treatment options. They are preferred by patients due to less pain and shorter downtime.

Medical nose reshaping: current evidence behind techniques

The nose, centrally located on the face, plays a crucial role in facial aesthetics. Any imbalance in its length, width, tip position, or a gross deformity, such as dorsal hump and deviation, can significantly affect the overall facial harmony, which is thus a major concern for patients. When it comes to minor deformities, they have been treated with hyaluronic acid, toxin injection, and thread insertion since 2005. This study has originally been carried out to review the published medical literature on the non-surgical techniques for Medical Nose Reshaping (MNR): a PubMed search was carried out in December 2020 using the search terms: “Nose [and] filler”, “Nose [and] botulinum toxin” and “Nose [and] thread”. A large number of studies were identified and reviewed, and it was found that rhinoplasty remains the gold standard to correct nose defects; nevertheless, MNR is gaining popularity due to its minimal invasiveness, short downtime, and the market availability of different injectables, toxins, and threads. This study aims to provide an evidence-based approach to guide the use of non-surgical techniques for MNR by reviewing published medical literature and drawing on the authors’ experience.

Research on Safety Resilience Evaluation Model of Data Center Physical Infrastructure: An ANP-Based Approach

With the development of the digital economy, the number and scale of data centers are expanding rapidly. Data centers are playing an increasingly important role in social and economic development. However, a short downtime of a data center may result in huge losses. The safety management of data centers’ physical infrastructure is of great significance to address this concern. We applied resilience theory to the safety management of data center physical infrastructures. We analyzed the resilience connotation and evaluated the system resilience using the resilience indexes. The data center infrastructure was regarded as a system of systems. Through theoretical analysis, the resilience framework of data center infrastructures was established, which formed the main dimensions of resilience assessment. The Delphi method determined the resilience indices, and the ANP method was adopted to set up the evaluation model. The results revealed the important indexes affecting data center infrastructure system safety resilience. Based on the findings, this paper argues for improving redundancy and adaptability, paying attention to the resilience management of energy flow and thermal flow, and establishing an automatic systematic data management system. These suggested measures would not only effectively make contributions to the data center infrastructure safety management theory but also provide an important reference for construction industry practices.

Flexibility as the Key to Stability: Optimization of Temperature and Gas Feed during Downtime towards Effective Integration of Biomethanation in an Intermittent Energy System

Biological methanation is the production of CH4 from CO2 and H2. While this approach to carbon capture utilization have been widely researched in the recent years, there is a gap in the technology. The gap is towards the flexibility in biomethanation, utilizing biological trickling filters (BTF). With the current intermittent energy system, electricity is not a given surplus energy which will interfere with a continuous operation of biomethanation and will result in periods of operational downtime. This study investigated the effect of temperature and H2 supply during downtimes, to optimize the time needed to regain initial performance. Short (6 h), medium (24 h) and long (72 h) downtimes were investigated with combinations of three different temperatures and three different flow rates. The results from these 27 experiments showed that with the optimized parameters, it would take 60 min to reach 98.4% CH4 in the product gas for a short downtime, whereas longer downtimes needed 180 min to reach 91.0% CH4. With these results, the flexibility of biomethanation in BTFs have been proven feasible. This study shows that biomethanation in BTFs can be integrated into any intermittent energy system and thereby is a feasible Power-2-X technology.

Platelet-rich plasma versus carboxytherapy in the treatment of periorbital dark circles: A split-face study.

Periorbital hyperpigmentation is a recurrent problem in dermatologic clinics that affect the patients' quality of life and their psychological status. Platelet-rich plasma (PRP) may serve as a source of different growth factors which may reduce the pigmentation in this problem. Carboxytherapy is carbon dioxide infusion into human tissue for therapeutic purposes. To evaluate and compare the clinical efficacy of PRP and carboxytherapy in the treatment of periorbital dark circles (PODC). Histopathological evaluation was also done. Split-face study of 23 patients with PODC treated with PRP at the right side and carboxytherapy at the left side. Patients received four sessions; one session/week. Final follow-up evaluation was done 3 months after the last session by clinical and histopathological assessment. PRP showed significant better response (p=0.002), shorter downtime, and tolerable side effects than caboxytherapy. Reduction in area percent of melanin after PRP injections showed 46.6% improvement, while after carboxytherapy, it showed only 14.3% improvement. The present study showed that PRP is more effective and tolerable than caboxytherapy in the treatment of PODC.

Bilateral Gluteal Augmentation With Hyperdilute Calcium Hydroxylapatite Microspheres Performed Using the Bella Vida Instant Brazilian Butt Lift (BBL)™.

For decades, aesthetic medical procedures have sought to improve patient appearance, comfort, and self-confidence. In more recent years, a growing interest in body contouring cosmetic procedures has emerged, in large part due to increased transparency in procedures and improved outcomes with minimally invasive procedures. Notably, several biostimulatory fillers have emerged as a suitable treatment modality due to their relatively low cost, low pain, short downtime, high tunability, and sustained biostimulatory effect. One volumizing biostimulatory filler, Radiesse® (Merz Aesthetics, Frankfurt, Germany), consists of calcium hydroxylapatite microspheres suspended in a carboxymethyl cellulose gel. When injected, Radiesse immediately volumizes the injection site and initiates neocollagenesis and neoelastogenesis. One technique, the Bella Vida Instant Brazilian Butt Lift (BBL)™, is a fast, safe, and minimally invasive alternative to surgical gluteal augmentation that accomplishes morphological remodeling, increases volumization, and improves shape and patient satisfaction. This technical report provides the clinical basis, materials, and methods for implementing the Bella Vida Instant BBL™ in aesthetic practices.

Effectiveness of jawline, jaw angle, and marionette lines correction in combination with double needles threads (APTOS) and a collagen-stimulating dermal filler (ELLANSE): An innovative technique.

Facial aging is a multifactorial process in which considerable changes occur in different face structures. Thread lifting is one of the most common minimally invasive treatments related to facial rejuvenation. This study aimed to evaluate the efficacy and safety of jawline, jaw angle, and marionette lines correction in combination with APTOS threads and ELLANSE M types through an innovative technique. In this prospective chart review study, 50 patients with ptosis candidates for lower face correction were included between October 2019 and February 2020. To perform correction of the jawline, jaw angle, and marionette lines, APTOS thread (LLN2GS) and ELLANSE M type were used through an innovative technique. The efficacy (6 and 12months after the surgery) and safety (1, 6, and 8weeks after the surgery) were assessed by two surgeons independently. Data were analyzed by SPSS ver. 22 for windows (IBM Inc.). In this study, 50 patients (4male and 46 female) with Mean±SD age of 53.84±10.79years old (Range: 42years) were included. Regarding the results, patients' level of satisfaction (improved to excellent levels) increased from 74% at 6months after the surgery to 86% at 12months after the surgery. Moreover, the level of satisfaction obtained from surgeons (improved to excellent levels) decreased from 96% to 86% at 6 and 12months after the surgery, respectively. Based on the results, there were substantial and perfect agreements between the surgeon and the independent surgeon to evaluate the surgery efficacy of facial rejuvenation 6 and 12months after the surgery. No side effects were reported 6 and 8weeks after surgery. Regarding the results, due to rare complications, deep satisfaction, and short downtime, the correction of the lower face in combination with APTOS thread (LLN2G) and ELLANSE M type through our innovative technique be considered an efficient and safe treatment.

Improving the outcome of treating striae gravidarum by combined therapies using topical β-glucan and 1565-nm non-ablative fractional laser: A prospective randomized vehicle-controlled parallel group study.

Striae gravidarum (SG) is a kind of dermal scar associated with psychosocial and therapeutic challenge. Topical reagents and non-invasive laser are more preferred than invasive procedures for less pain and shorter downtime. However, there are few studies on comparing and combining these two modalities. The aim of the present study was to evaluate the efficacy and tolerance of a topical regimen containing β-glucan, 1565-nm non-ablative fractional laser (NAFL; ResurFX), and combination of them for SG. A total of 128 unilateral abdomens from 64 subjects were randomly divided into four strategies and were followed up for 12 weeks: topical vehicle (Veh); topical β-glucan (B); 1565-nm NAFL combined topical vehicle (NAFL); 1565-nm NAFL combined topical β-glucan (B + NAFL). NAFL was applied three times with a 4-week interval. Topical reagent was applied b.i.d. for 12 weeks. Global Aesthetic Improvement Scale (GAIS) scores were assessed by blinded physician according to standard photograph, and by subjects at 12th week. The degree of SG atrophy was assessed by blinded physician before treatment and at the 12th week according to a standard 5-point scale. Collagen remodeling was evaluated by histological analysis and all adverse effects were recorded. A total of 56 women (112 unilateral abdomens) completed all study. The GAIS scores by blinded physician showed greater improvement in NAFL as compared with β-glucan, and by subjects showed greater improvement in β-glucan as compared with vehicle. In terms of striae atrophy scale, the improvement of SG atrophy was more prominent in NAFL compared to β-glucan, and in β-glucan + NAFL compared to Veh + NAFL. All treatments were well tolerated. Topical β-glucan regimen can mildly improve SG. NAFL showed better results than topical β-glucan regimen. The combined strategy may further improve the SG atrophy compared with single treatment strategy.