Volume Loss Research Articles

Case reports on hand prejuvenation: clinical outcomes in middle-aged women with hyaluronic acid filler plus lidocaine.

Hand rejuvenation with hyaluronic acid filler injections is gaining more attention for its ability to correct volume loss and improve skin quality. The hand dorsum is prone to loss of dermal elasticity and subcutaneous atrophy as individuals age, and administering hyaluronic acid fillers has become an option to restore the smoothness and youthful contour of the hand. The aim of this study is to demonstrate that injections with Definisse Touch Filler Plus Lidocaine are effective and safe for hand rejuvenation. Ten subjects underwent filler placement of 0.5 to 1.0 mL in the dorsal superficial lamina, which is devoid of sensory nerves and major skin vessels, using a blunt cannula via the fanning technique. Measurements were done before, immediately after, and 1 month after the treatment using validated aesthetic scales. There was a significant correction of volume loss immediately after the first treatment and an improvement in skin texture and topography 1 month after the procedure. No lasting or severe adverse effects were observed. To show significant and conclusive results, it is recommended to conduct further prospective, comparative, blinded studies in more subjects followed for longer periods (ie, 12 months or more). Objective analysis of volumetric changes using automated three-dimensional surface techniques is likewise beneficial. Injecting a low G-prime hyaluronic acid along the dorsal superficial lamina via cannula provides an effective and tolerable option for improving the appearance of aged hands.

Effect of theoretical volume fraction (TVF) of reinforcements on Al5083/SiC and Al5083/ZrB2 surface composites produced by friction stir processing

This study focuses on the effects of theoretical volume fraction (TVF) on the microstructure and mechanical properties of silicon carbide (SiC) and zirconium diboride (ZrB2) ceramic reinforced Al5083 surface composites (SC). Al5083-H111 was used as the base material (BM), SiC and ZrB2 were used as reinforcement materials, and TVFs were determined as 5, 10, 15, and 20% for SCs produced by the friction stirring process (FSP). Macrostructure, microstructure, X-ray diffraction (XRD) analysis and mechanical properties such as microhardness, tensile strength (UTS), and wear behaviour were characterised. When the TVF and AVF values of SiC and ZrB2 particles were compared, it was found that the AVFs were lower than the TVFs. Significant decreases in the changes in the SZ areas of SiC and ZrB2 particle SCs were detected depending on the reinforcement size. In the time-dependent axial load graphs of SiC and ZrB2 reinforced samples, load values ranging from 7800 to 8200 N were obtained and it was determined that these values were sufficient for friction heat, hydrostatic pressure, and plasticization in FSP. As a result of mechanical characterisation processes, the microhardness values and wear rates of ZrB2 reinforced SCs in the stir zone (SZ) were higher than SiC reinforced SCs. When the reinforcement particles were compared, it was observed that ZrB2 reinforced SCs exhibited higher microhardness and wear resistance than SiC reinforced SCs. As a result of all tests and investigations, it was determined that the ideal TVFs were 15% for SiC reinforced SCs and 5% for ZrB2 reinforced SCs. The microhardness value of ZrB2 reinforced SC with 20% TVF was 119.6 HV, while the UTS and volume loss values of ZrB2 reinforced SC with 5% TVF were found to be the highest values with 305.86 MPa and 1.83 mm3, respectively. Compared to BM, these values showed significant improvements in mechanical test results, especially in wear behavior. The results obtained showed an improvement of 55% in microhardness, 3.3% in UTS values, and 309% in wear behavior.

Long-Term Cerebellar Consequences of Post-traumatic Brain Injury Assessed by MRI With Diffusion Tensor Imaging

BACKGROUND AND OBJECTIVES: Post-traumatic brain injury (TBI) lesions, which combine brain atrophy and white matter injuries, can lead to progressive post-traumatic encephalopathy. However, the specific involvement of the cerebellum, which participates in cognitive, executive, and sensory functions, has been little studied. The aim of this work was to explore the long-term cerebellar consequences of severe TBI. METHODS: In this retrospective study, patients included were hospitalized for a severe TBI and reassessed after discharge with a clinical examination and a MRI with diffusion tensor imaging. Patients were compared with a population of healthy volunteers. For a subgroup of this cohort, we analyzed the evolution of late post-TBI lesions on MRI up to 10 years after TBI. RESULTS: Ninety-seven patients reassessed 5 [3; 6] years after the TBI were included. Volume loss was revealed in the whole cerebellum (P = .01) and especially in the anterior lobe (P < .005) with a decrease in grey matter volume (P = 6.10−3). The mean diffusivity was increased in 4 cerebellar areas which are the right lower, right upper, left lower, and left upper cerebellar peduncles while the fractional anisotropy was decreased in all studied areas (P < 10−3). The longitudinal analysis (n = 17 patients) showed no progression of MRI lesions beyond the acute phase. CONCLUSION: This work shows that even if direct cerebellar damage is rare, long-term post-TBI cerebellar lesions can be observed. Therefore, clinical correlates of cerebellar lesions should be considered more systematically.

Paracetamol overdose associated with cortical blindness-complicated acute leukoencephalopathy: a case report

Abstract Background Paracetamol is one of the most used antipyretics and analgesics among pediatrics, and its overdose is highly encountered among pediatrics especially in the pre-school age. While it is well-known that paracetamol overdose may lead to toxicities including severe hepatic toxicity, some recent reports have highlighted its “in situ” toxicity on brain tissue at high doses, even in the absence of hepatotoxicity. This can result in acute leukoencephalopathy (AL), coma, or even death. This report describes a case of a child who developed cortical blindness-complicated AL, following a paracetamol overdose. Case presentation An 18-month-old previously healthy girl accidentally ingested 300 mg/kg of paracetamol suspension. After ingestion, the child was in an initial bad condition that has gradually improved. Several days after ingestion, the patient lost her vision, and she remained blind since then despite a newer appreciation to light. The initial brain magnetic resonance imaging (MRI) suggested AL demonstrated as a faint high T2/fluid-attenuated inversion recovery (FLAIR) signal intensity in the cortical and subcortical regions of both parieto-occipital lobes with sulcal effacement and restricted diffusion. After around 3 months, the subsequent brain MRI showed involutional changes that were manifested as a brain volume loss in the same areas with evidence of gyri-form laminar necrosis in both parieto-occipital regions without restricted diffusion. Other brain MRI findings include right cerebral convexity hyperacute subdural hematoma with prominent subarachnoid spaces. Conclusions The child developed cortical blindness-complicated AL following a paracetamol overdose. It is well- known that AL may result from several toxins by their direct and/or indirect effect on the cerebral white matter. However, there is still no enough data in the literature clearly explaining the relation of paracetamol overdose to AL. The generally proposed effect of paracetamol on the brain is mainly justified by the excessive oxidative stress. Further studies at the cellular and genetic levels are still needed to investigate the exact association between paracetamol overdose and AL, as well as the underlying mechanisms involved.

Dynamic LIA advances hastened the demise of small valley glaciers in central Svalbard

Most small land-terminating glaciers in Svalbard have experienced large recession since the Little Ice Age (LIA) and today are thin, cold, and largely inactive. This likely contrasts to their LIA conditions, but the observational record from that time is sparse. We investigate the evolution of five small glaciers in central Nordenskiöld Land, Svalbard, from the LIA to 2019. Photogrammetric reconstructions and ground penetrating radar are used to reconstruct their geometric changes since 1936, and historical observation, photographs, and geomorphological mapping extend this history to before the 1900s. Our results show that from 1936 to 2019, the study glaciers on average lost 49.6% of their area and 77.4% ± 7.7% of their volume, with the greatest volume loss at Scott Turnerbreen of 91% ± 5%. Four out of these five glaciers strongly indicate a history of surge-like advances near the end of the LIA within one or two decades, and the rate of subsequent mass loss seems connected to their previous dynamics. This apparent switch to high activity during a period of rapid climatic change, could have implications for our understanding of past and future glacier evolution; climate change and highly dynamic glacier responses may be more connected than previously thought.

Evaluation of the physicochemical properties of intracanal medications used in traumatized teeth

Aim: The aim of the present study was to evaluate the solubility, flow and radiopacity of Calen (SS White Artigos Dentários Ltd, Rio de Janeiro, Brazil), Calen with zinc oxide (Calen/ZnO), calcium hydroxide + zinc oxide + 2% chlorhexidine (CH/ZnO/CHX), Calplus and Ultracal XS. Methods: 28 bovine incisor specimens were standardized, instrumented and filled with pastes with the aid of a centrix syringe. To assess solubility, the root canals of acrylic teeth (N = 10) were filled with the previously mentioned pastes and scanned by using micro–computed tomography before (initial) and after 7 days of immersion in ultrapure water. The solubility of each specimen was the difference between the initial and final volume. Flow properties were analysed according to the ISO 6876/2012 standard. Radiopacity was radiographically analysed by using Image J software. Data were submitted to analysis of variance and Tukey’s test (alpha 5%). Results: CH/ZnO/CHX and Calplus presented similar values regarding radiopacity. The group composed of Calen paste showed higher flow values. As for solubility, CH/ZnO/ CHX showed lower volume loss, but there was no statistical difference compared to other medications. Conclusion: The medication composed of calcium hydroxide, zinc oxide and 2% chlorhexidine is a suitable alternative for use in traumatized teeth.

Projected changes of Greenland’s periphery glaciers and ice caps

Abstract Rapid global warming has caused drastic mass loss in Greenland’s peripheral glaciers and ice caps (GICs), contributing to a rise of global sea levels. To better understand future changes under different emission scenarios, we used the Open Global Glacier Model to simulate glacier dynamics and runoff changes from 2015 to 2100. The results show that their area and volume will decrease by 38.88% (SSP1-2.6) to 60.84% (SSP5-8.5) and 47.56% (SSP1-2.6) to 67.10% (SSP5-8.5) by 2100, with regions that have larger glacierized areas and are farther from the ocean experiencing less volume loss. Meanwhile, the predicted surface mass balance of Greenland’s peripheral GICs in 2100 is −0.58 ± 0.92, −1.18 ± 1.13, −2.04 ± 0.79 and −3.16 ± 0.96 m w.e. a−1 under four emission scenarios. The runoff under higher emission scenarios is larger than that under lower emission scenarios, with peak water occurring later in regions that have larger glacierized areas and are farther from the ocean.

First application of the island divertor configuration in the J-TEXT tokamak

Abstract For the first time, an island divertor configuration was successfully implemented in the J-TEXT tokamak to improve heat exhaust and impurity control. The magnetic island is generated by applying external resonant magnetic perturbation fields, and the intersection between the edge island and the divertor target is then controlled by adjusting the edge safety factor qa, thereby achieving the island divertor configuration. The overall confinement is maintained in spite of the loss of the edge volume. The island divertor configuration significantly reduces peak heat-load on the divertor target by approximately 50% and improves impurity screening. Additionally, it effectively modulates radiation around the magnetic island's X-point, potentially enhancing the stability and control of radiative divertor operations. These findings highlight the island divertor configuration as a promising strategy for advancing heat exhaust and impurity control in tokamak operations.

Association Between Finger Plethysmographic Features and Impedance-Based Thoracic Fluid Content Measurement in a Lower Body Negative Pressure Model of Hemorrhagic Shock.

Timely identification of the need for lifesaving intervention in battlefield conditions may be improved through automated monitoring of the injured warfighter. Technologies that combine maximal noninvasive insight with minimal equipment footprint give the greatest opportunity for deployment at scale with inexperienced providers in forward areas. Finger photoplethysmography (PPG) signatures are associated with impending hemorrhagic shock but may be insufficient alone. Transthoracic impedance (TTI) monitoring is a complementary modality to PPG and able to identify volume loss and estimate functional cardiovascular parameters. We sought to understand how PPG features correlate with volume loss estimation from TTI during lower body negative pressure (LBNP) challenge. We hypothesized that features of the PPG waveform would correlate with thoracic fluid content (TFC) as measured by TTI. We obtained physiologic monitoring data from healthy adult subjects in LBNP hemorrhagic shock models after local Institutional Review Board and DoD Human Research Protection Office approval. Subjects were excluded for pregnancy, age >45 years, and conditions prohibitive of LBNP exposure. Subjects were instrumented with noninvasive sensors, including a finger PPG sensor and a TTI monitor. Subjects underwent a stepwise LBNP exposure program of -10 mmHg every 10 minutes and notified laboratory staff at first sign of near syncope, terminating the sequential program. TTI data were continuously streamed to a custom program written in MATLAB and time synchronized. To calculate PPG measures, we downsampled data to 250 Hz, screened, and parsed each beat. We featurized each beat to include a systolic, diastolic, and dicrotic notch peak, beat length and area under the curve (AUC), peak-to-peak systolic/diastolic interval, and leading/trailing slopes, all normalized to instantaneous heart rate. Thoracic fluid content was normalized to subjects' pre-LBNP baselines. We summarized all PPG features and the TFC using means (SD) generated as a subject average for each step. We used generalized estimating equation models to examine the relationship between TFC and PPG features while controlling for LBNP stage and subject. Thirty-two subjects were enrolled; 4 participants were excluded because of sensor malfunction. Twenty-eight subjects had a mean (SD) age of 25.11 (6.66) years. A total of 35.7% of subjects were female. Photoplethysmography analysis demonstrated a decreased systolic-diastolic peak interval, diastolic peak height, and beat AUC with decreased LBNP pressure. End-stage baseline normalized TFC showed an average decrease of 14.68% (±4.98%) (range: 7.54% to 27.69%). The strongest average correlations between stage TFC and PPG occurred in beat length (0.68) and normalized AUC (0.69). In generalized estimating equation models incorporating all stages, beat length, normalized AUC, and the systolic-diastolic interval were all significantly associated with time as a function of LBNP level (P < .001). Thoracic fluid content began decreasing at 12.8 (4.7) minutes, the normalized AUC decreased at 20.7 (7.2) minutes, the beat length decreased at 20.9 (7.0) minutes, and the systolic-diastolic time interval decreased at 30.6 (16.7) minutes. While both PPG features and impedance-based TFC trend congruently in the perishock state following LBNP exposure, peripheral pulse wave signals lag redistribution of thoracic fluid volume. Photoplethysmography features of beat length and normalized AUC may serve as a surrogate for TFC when direct thoracic sensing is not available.

Elovanoids, a Novel Class of Lipid Mediators, Are Neuroprotective in a Traumatic Brain Injury Model in Rats

Background: In the United States, traumatic brain injury (TBI) contributes significantly to mortality and morbidity. Elovanoids (ELVs), a novel class of homeostatic lipid mediators we recently discovered and characterized, have demonstrated neuroprotection in experimental stroke models but have never been tested after TBI. Methods: A moderate fluid-percussion injury (FPI) model was used on male rats that were treated with ELVs by intravenous (IV) or intranasal (IN) delivery. In addition, using liquid chromatography-mass spectrometry (LC-MS/MS), we examined whether ELVs could be detected in brain tissue after IN delivery. Results: ELVs administered intravenously 1 h after FPI improved behavior on days 2, 3, 7, and 14 by 20, 23, 31, and 34%, respectively, and preserved hippocampal CA3 and dentate gyrus (DG) volume loss compared to the vehicle. Whole-brain tractography revealed that ELV-IV treatment increased corpus callosum white matter fibers at the injury site. In comparison to treatment with saline on days 2, 3, 7, and 14, ELVs administered intranasally at 1 h and 24 h after FPI showed improved neurological scores by 37, 45, 41, and 41%. T2-weighted imaging (T2WI) abnormalities, such as enlarged ventricles and cortical thinning, were reduced in rats treated by ELV-IN delivery compared to the vehicle. On day 3, ELVs were detected in the striatum and ipsilateral cortex of ELV-IN-treated rats. Conclusion: We have demonstrated that both ELV-IN and ELV-IV administration offer high-grade neuroprotection that can be selectively supplied to the brain. This discovery may lead to innovative therapeutic targets for secondary injury cascade prevention following TBI.

Progressive development of soil arching and deformations in two- and three-dimensional trapdoor tests

In this study, two- and three-dimensional trapdoor tests were conducted using a newly developed trapdoor test device, to investigate the evolution of soil arching and fill deformation with different relative fill densities and fill heights. The test results show that the trapdoor settlements normalised by trapdoor width required for the soil arching ratios to reach minimum and ultimate values increased with fill height. In tests with dense fill, both the minimum and ultimate soil arching ratios were smaller compared to tests with loose fill at the same fill height. Two symmetrical slip surfaces developed from the trapdoor edges, with their inclination angles dependent on the dilatation angle of the sand. The proposed Gaussian distribution function with fitting parameters well matched the measured fill settlement profile. In the dense fill tests, the settlement trough’s width and volume loss induced by trapdoor settlement gradually decreased with fill elevation due to its strong shear dilation behaviour. Conversely, the loose fill exhibited weaker shear dilation behaviour, resulting in a larger settlement region. The settlement trough width and volume loss ratio, derived from the measured fill deformation, can be used to predict the fill deformation, including the surface settlement.

Wear properties of Al6061/SiC + B4C + TiC hybrid composites produced by vacuum infiltration method

Abstract In the study, hybrid metal matrix composite (HMMC) structures were produced by vacuum infiltration method (VIM) using Al6061 alloy and varying amounts of SiC, B4C, and TiC ceramic powder pairs. Age-hardening processes were applied to these HMMCs. After heat treatment, wear behavior was examined under different loads using the pin-on-disc test method. All Al6061 hybrid composites exhibited better wear performance than unreinforced Al6061. In the wear tests of composite samples, the lowest volume loss and therefore the highest wear resistance were obtained in Al6061 3 wt.% B4C + SiC composites under 5 N force. The lowest wear resistance due to the highest volume loss was determined in Al6061/1 wt.% TiC + B4C composites under 15 N force. Abrasive and adhesive wear characteristics were observed in field emission scanning electron microscopy(FESEM) images of worn surfaces. Additionally, wear debris, smearing, and deep grove formations were determined on the surface. In the EDS analysis performed on the worn surface, O and Fe elements were found in addition to the elements that are likely to be in the structure (such as Al, B, C, Ti, Si, and Mg). The wear tests caused the formation of oxide layers on the sample surfaces.

Plain language summary of the pivotal study of calcium hydroxylapatite with lidocaine for improvement of jawline contour

Summary What is this article about? A study (ClinicalTrials.gov identifier: NCT03583359) that tested whether an injectable filler treatment called calcium hydroxylapatite with lidocaine, or CaHA (+), could improve the shape of the jawline.How was the study in this summary conducted? Loss of jawline shape is a change to jawline appearance, like sagging or deflating, that occurs as people get older. A total of 123 participants received CaHA (+) injections on day 1 of the study (immediate treatment). Fifty-seven participants did not receive CaHA (+) until week 12 (delayed treatment). Jawline shape at week 12 was rated on a five-point scale (0 = no loss of shape or volume; 4 = extreme loss). Researchers also looked at participants’ satisfaction and self-reported improvement, ratings of how old participants thought they looked, and side effects.What were the results of the study? In the immediate treatment group, 76% of participants had improvement in jawline shape at week 12 (compared with 9% of participants in the delayed treatment group), which typically lasted approximately 8 months, and 94% self-reported improvement in jawline appearance. The participants were more satisfied with their jawlines and reported looking approximately 3 years younger at week 12 compared with before treatment. Regardless of sex or skin tone, side effects were categorized as mostly mild or moderate reactions, like lumps or bruising, at the site where CaHA (+) was injected.What do the results of this study mean? The results showed that CaHA (+) injections improved jawline shape in most participants and caused only mild or moderate side effects regardless of sex or skin tone, suggesting that CaHA (+) is safe and works well for diverse groups of patients.Who should read this article? This summary is for patients and others interested in learning about how CaHA (+) works, its safety, and its ability to improve jawline shape.Who sponsored this study? The study was sponsored by Merz North America, Inc.

Recognition and Management of Postpartum Hemorrhage

Abstract Postpartum hemorrhage (PPH) is an obstetric emergency and refers to excessive blood loss after birth. Loss of blood volume and oxygen-carrying capacity may lead to maternal hypovolemia and hypotension resulting in tissue hypoxia, the onset of anaerobic metabolism, and multiorgan failure. If timely and appropriate action is not taken, cardiac arrest and maternal death may occur. If the amount of blood loss exceeds 500 mL following a vaginal birth or 1000 mL during or following a cesarean section, it is termed PPH. Similar to any other surgical hemorrhage, PPH is classified into primary PPH (occurs within 24 hours of birth) or secondary PPH (between 24 hours and 12 weeks postpartum). PPH is a major contributor to maternal deaths worldwide, and it is estimated that a person dies because of PPH approximately every 5 minutes. Therefore, measures should be directed at prevention and early detection of PPH with prompt management. The prevalence of PPH varies globally and is influenced by location, socioeconomic factors, and the availability and quality of health care. The World Health Organization reported that PPH accounts for a quarter of global maternal deaths. The Mothers and Babies Reducing Risks through Audits and Confidential Enquiries report from the United Kingdom (2023) highlighted that despite rare mortality due to hemorrhage, the number of people dying of obstetric hemorrhage is not decreasing, particularly among people with abnormally invasive placentation. Additionally, substandard care was found to be responsible for more than 50% of deaths due to PPH in the United Kingdom. Therefore, it is vital that adequate healthcare infrastructure, trained and competent healthcare professionals, and immediate access to resources, interventions, and multidisciplinary teams are essential both in well-resourced and resource-restrained healthcare systems. Healthcare professionals must identify the potential risk factors for PPH and initiate preventive measures whenever possible. Additionally, they must respond swiftly if PPH occurs and ensure a multidisciplinary, multilayered approach for a synchronized response to optimize outcomes. This review article emphasizes the etiopathogenesis, diagnosis, and management of PPH based on current scientific evidence as well as international best practice recommendations.

HIV facial lipodystrophy treatment by polylactic acid – a literature review

Human immunodeficiency virus (HIV) is a disease that negatively affects the immune system, requiring chronic, regular antiretroviral therapy, associated with numerous side effects. Lipodystrophy is one of them and is a serious clinical, psychological and social problem for patients affected by the problem. Volume loss and the formation of deep tissue defects in the facial area are caused by skeletal resorption and the redistribution of fat compartments, which progress with age but are also significantly exacerbated prematurely in the course of HIV and applied antiretroviral therapy. For a large group of patients, this constitutes a significant cosmetic defect, often leading to discontinuation of necessary, antiretroviral treatment. Various forms of treatment for this condition are currently available worldwide, including the implantation of non-permanent tissue fillers, such as hyaluronic acid-based fillers, or autologous fat cell transplants. The use of polylactic acid in the treatment of lipodystrophy is a therapeutic method with proven efficacy, effectiveness and a high safety profile, which will be discussed in this article.

Hand Rejuvenation by Autologous Fat Grafting in Post-Hansen's Hand Atrophy: Aesthetic and Psychological Implications

Abstract Introduction Contemporary medical science has been using fat grafting in aesthetic and reconstructive procedures, consistently achieving successful outcomes. Hansen's disease, caused by Mycobacterium leprae, leads to hand deformities due to peripheral neuropathy, resulting in soft-tissue atrophy, volume loss, and compromised hand function. Tendon transfer surgery is a common remedy for functionality, but it often does not address aesthetic concerns and the patient's psychological impact of living with an atrophic hand. Autologous fat grafting can effectively address these concerns. Materials and Methods This prospective study evaluates the efficacy of fat grafting for hand rejuvenation in patients with Hansen's disease posttendon transfer surgery, focusing on aesthetic and psychological outcomes. We recorded data from 12 patients who underwent the procedure between 2015 and 2024. Using the Coleman technique, fat was harvested from the paraumbilical region of the abdomen and injected into various hand regions. Results Autologous fat grafting showed high patient satisfaction with significant improvements in hand contour, skin texture, and psychological health. The benefits of the procedure included improved self-esteem, enhanced quality of life, reduced social stigma, and psychological well-being. Conclusion Autologous fat grafting is a safe and effective technique for hand rejuvenation in patients with Hansen's disease, after functional treatment addressing both physical deformities and their psychological impacts. It could be considered one of the components in the comprehensive management of Hansen's disease–related hand deformities, significantly enhancing patients' overall quality of life.

Deferiprone in Alzheimer Disease

Interventions that substantially slow neurodegeneration are needed to address the growing burden of Alzheimer disease (AD) to societies worldwide. Elevated brain iron observed in AD has been associated with accelerated cognitive decline and may be a tractable drug target. To investigate whether the brain-permeable iron chelator deferiprone slows cognitive decline in people with AD. This phase 2, double-masked, placebo-controlled randomized clinical trial of 12-month duration was conducted at 9 sites in Australia between August 2, 2018, and April 1, 2023. Patients older than 54 years with amyloid-confirmed mild cognitive impairment or early AD (a Mini-Mental State Examination score of 20 or higher) were screened. Randomization was 2:1 and masked to participants and all study staff. Deferiprone 15 mg/kg twice a day or placebo administered orally for 12 months. The primary outcome was a composite cognitive measure assessed at baseline, 6 months, and 12 months using a neuropsychological test battery (NTB) of memory, executive function, and attention tasks. Secondary outcomes included change in brain iron burden measured by quantitative susceptibility mapping (QSM) magnetic resonance imaging (target engagement), brain volume changes (secondary efficacy measure), and adverse events (safety analysis). Of 167 patients screened for eligibility, 81 were included, with 53 randomly assigned to the deferiprone group (mean [SD] age, 73.0 [8.0] years; 29 male [54.7%]) and 28 to the placebo group (mean [SD] age, 71.6 [7.2] years; 17 male [60.7%]); 54 participants completed the study (7 [25.0%] withdrew from the placebo group and 20 [37.7%] from the deferiprone group). In an intention-to-treat analysis, participants in the deferiprone group showed accelerated cognitive decline on the NTB primary outcome (β for interaction = -0.50; 95% CI, -0.80 to -0.20) compared with placebo (change in NTB composite z score for deferiprone, -0.80 [95% CI, -0.98 to -0.62]; for placebo, -0.30 [95% CI, -0.54 to -0.06]). Secondary analysis revealed that this result was driven by worsening performance on executive function tests. The QSM confirmed that deferiprone decreased iron in the hippocampus compared with placebo (change in hippocampal QSM for deferiprone, -0.36 ppb [95% CI, -0.76 to 0.04 ppb]; for placebo, 0.32 ppb [95% CI, -0.12 to 0.75 ppb]; β for interaction = -0.68 [95% CI, -1.27 to -0.09]). Longitudinal hippocampal volume loss was not affected by deferiprone, but exploratory analysis of other brain regions revealed increased volume loss with deferiprone in frontal areas. The frequency of the adverse effect of neutropenia (4 participants [7.5%] in the deferiprone group) was higher than in similar studies (1.6%-4.4%). These trial findings show that deferiprone 15 mg/kg twice a day decreased hippocampal QSM and accelerated cognitive decline in patients with amyloid-confirmed early AD, suggesting that lowering iron with deferiprone is detrimental to patients with AD. ClinicalTrials.gov Identifier: NCT03234686.

Theoretical investigation of the resistance effect of embedded isolation piles on tunneling-induced lateral ground movements

This paper presents an isolation pile–soil lateral interaction model that considers not only the relative linear sliding at the pile-soil interface but also the pile group–soil interaction. The model allows for the calculation of the pile–soil interaction force using the elastic continuum method combined with the displacement compatibility relationship at the pile–soil interface, thus enabling the total lateral ground displacement to be obtained. The proposed method is validated by comparisons with the elastic foundation method (EFM) and the boundary element method (BEM). The advantages of the proposed method in calculating the lateral ground deformation resisted by isolation piles are demonstrated. The mechanical mechanism of the isolation pile’s lateral resistance effect on ground deformation can be summarized as follows: the combination of positive and negative resistance effects drives the lateral ground displacements along the depth direction from the original inhomogeneity caused by the tunnel excavation to a relatively homogeneous state. The soil parameters including Poisson’s ratio, internal friction angle and ground volume loss; the isolation pile parameters including the distance of the tunnel axis from the pile axis, the pile length, the buried depth of the pile top and the relative pile bending stiffness; and isolation pile–soil interface parameters including relative pile shaft–soil stiffness and relative pile tip–soil stiffness all exert a significant influence on the lateral resistance effect of the isolation pile. In light of that the resistance effects at different depths below the surface are not uniform, it is of the utmost importance to assess the resistance performance of the isolation pile in accordance with the location and lateral deformation requirements of the protected structure in actual engineering.

Application of 3D-printed resin guides for the removal of molar fiber posts.

To evaluate the digital guide technique for removing fiber posts from molars and compare it with the conventional microscope-assisted ultrasound method. Two mandibular dentition models, each comprising six extracted molars, were prepared. Two thick and straight canals distributed separately in the distal and mesial roots of each molar were selected for placing the fiber posts. The 24 posts in the two dentition models were removed using 3D-printed resin guides, or a microscope and an ultrasonic device. The time taken to remove the fiber post from each tooth was recorded. The volume loss, deviation values (angular deviation and horizontal and vertical deviations of the tip), and formation of microcracks before and after fiber post removal were determined using micro-computed tomography images. The digital guide technique took significantly less time than the microscope-assisted ultrasound technique (p < 0.05). No significant differences in horizontal and vertical tip deviations were observed between the two groups. The angular deviation and volume loss in the guide group were significantly lower than those in the ultrasound group (p < 0.05). New dentin microcracks were formed in the ultrasound group but not in the digital guide group. Using a 3D-printed resin guide plate can shorten the fiber post removal time and improve the stability and safety compared to the microscope-assisted ultrasound technique. 3D-printed resin guides can reduce the fiber post removal time and provide better stability and safety than the conventional method.

Safety and efficacy of the amino acid crosslinked hyaluronic acid in the treatment of temple hollowing.

Loss of volume in the temples is an early sign of aging and often gives the impression of a gaunt and emaciated appearance. The authors conduct a clinical study to investigate the safety and effectiveness of the amino acid crosslinked hyaluronic acid (ACHA) for the treatment of temple hollowing. 75 subjects with Temple Hollowing Scale (THS) from 2 to 4 were enrolled and assigned according to the ratio of 2 (ACHA group, n=50): 1 (no treatment control group, n=25). All subjects were assessed at the 12-month follow-up visit using the THS, Global Aesthetic Improvement Scale (GAIS), ultrasound, and three-dimensional scanning. Subjects were instructed to report any adverse events (AEs) within 14 days after the ACHA treatment. An average volume of 4.72±1.13ml was injected into the temples. We received 18 treatment-related AEs reported by 10 subjects. Compared with the control group, THS, GAIS, and soft tissue thickness were significantly improved in the ACHA group at 1 month, 6, and 12 months after injection. Three-dimensional scanning showed that ACHA could maintain a certain volume in the temple 12 months after ACHA injection. ACHA is an effective and safe hyaluronic acid for patients with minimal to severe temple hollowing.