[Cosmetic injectables in dental practice: legal aspects in the Netherlands]. / Cosmetische injectables in de tandheelkundige praktijk: juridische aspecten in Nederland.

A recent survey indicates 49% of this journal's subscribers endorse the administration of cosmetic injectables by properly trained dentists. Given the surging demand for cosmetic treatments, it's essential to establish clear guidelines and conventions defining the roles of the various healthcare professionals in various situations. There is, however, considerable discussion still and from a legal standpoint, the role of dentists within cosmetic medicine remains ambiguous. Under the Dutch Individual Healthcare Professions Act (Wet BIG), dentists are authorized to administer cosmetic injectables exclusively for dental purposes. However, based on the content of current dental training, one might argue that dentists' authorization could be extended to include facial injectable treatments in the entire face, in future. Presently, it is prudent for general practice dentists to abstain from cosmetic procedures with cosmetic injectables without a specific (aesthetic) dental objective.

[Cosmetic facial surgery: a bird's eye view]. / Cosmetische aangezichtschirurgie in vogelvlucht.

Surgical procedures that rejuvenate and/or harmonize the face are known for their long-lasting and clinically relevant positive effects on the psychological well-being and quality of life of the client. Despite the popularity of cosmetic injectables, facelift surgery remains the most powerful and durable treatment for restoring aging symptoms, especially in the female face. Skin correction of the upper eyelids is the most commonly performed aesthetic facial surgery. This article provides an overview of the most important cosmetic surgical procedures for the face, focusing on the facelift, neck lift, forehead lift, upper and lower eyelid correction, subnasal lip lift and rhinoplasty. The indications, contraindications, treatment techniques, advantages and disadvantages are explained. Due to the increasing demand for cosmetic treatments, it is important that dentists and oral and maxillofacial surgeons have knowledge of these procedures in order to provide optimal information, referral or treatment when desired.

[What is 'botox', what are fillers, and how safe are these cosmetic injectables?] / Wat is 'botox', wat zijn fillers en hoe veilig zijn deze cosmetische injectables nu eigenlijk?

Botulinum neurotoxin type A (BoNT-A, popularly referred to as 'botox') is a muscle-relaxant that is injected into the mimic facial muscles to soften wrinkles in more than two percent of Dutch women annually. A similar number of women undergo filler injections with hyaluronic acid hydrogels, used to counteract the aging appearance of the skin, or to create desired facial contours. Complications are generally mild in nature and rare (certainly compared to surgical complication rates) and include nodules, bumps and a temporary heavy feeling of the eyebrows. Vascular complications related to filler injections (1:7000) can potentially lead to unilateral blindness or skin necrosis. In the Netherlands, the risk of blindness over the past six years is estimated to be 1 in every 1.4 million filler injections. Permanent skin damage due to gangrene has never been reported in the Netherlands. In conclusion, BoNT-A and hyaluronic acid filler injections are safe procedures in the hands of appropriately trained healthcare professionals.

Revisiting hybrid breeding designs using genomic predictions: simulations highlight the superiority of incomplete factorials between segregating families over topcross designs.

KEY MESSAGE: Simulations showed that hybrid performances issued from an incomplete factorial between segregating families of two heterotic groups enable to calibrate genomic predictions of hybrid value more efficiently than tester-based designs. Genomic selection offers new opportunities to revisit hybrid breeding by replacing extensive phenotyping of hybrid combinations by genomic predictions. A key question remains to identify the best design to calibrate genomic prediction models. We proposed to use single-cross hybrids issued from an incomplete factorial design between segregating populations and compared this strategy with a conventional approach based on topcross evaluation. Two multiparental segregating populations of lines, each specific of one heterotic group, were simulated. Hybrids considered as training sets were generated using either (1) a parental line from the opposite group as tester or (2) following an incomplete factorial design. Different specific combining ability (SCA) proportions were simulated by considering different levels of group divergence and dominance effects for the simulated QTL. For the incomplete factorial design, for a same number of hybrids, we considered different numbers of parental lines and different contributions of lines (one to four) to calibration hybrids. We evaluated for different training set sizes prediction accuracies of new hybrids and genetic gains along three generations. At a given training set size, factorial design was as efficient (considering accuracy) as tester design in additive scenarios, but significantly outperformed tester design when SCA was present. The contribution number of each parental line to the incomplete factorial design had a small impact on accuracies. Our simulations confirmed experimental results and showed that calibrating models on hybrids between two multiparental populations is a cost-efficient way to perform genomic predictions in both groups, opening prospects for revisiting reciprocal recurrent selection schemes.

Hyperbaric oxygen therapy for dermal ischemia after dermal filler injection with calcium hydroxylapatite: a case report.

Dermal injection of fillers is a popular and relatively safe aesthetic procedure. Severe complications are rare, but they do occur. One of the most threatening complications after dermal filler injection is skin necrosis due to vascular occlusion. Different treatment options are available, including the use of hyperbaric oxygen (HBO2) therapy. A 46-year-old female received facial dermal filler injections with calcium hydroxylapatite at an aesthetic clinic. A few days after injection she developed a burning pain, numbness of the skin and white discoloration in the injected area. Two days after injection treatment was started with hyaluronidase and warm compresses. In addition, the patient received prednisolone, sildenafil and nifedipine. After the start of these treatments, the pain, numbness and discoloration of the skin persisted. Because of dermal ischemia and to improve healing she was referred for HBO2. Treatment consisted of 10 sessions of 100% oxygen for 90 minutes in a multiplace chamber at 2.5 atmospheres absolute pressure. During HBO2 the discoloration resolved, pain and numbness disappeared, and the tissue healed completely. After a six-month follow-up she had an excellent cosmetic outcome. Given the pathophysiologic mechanisms of vascular complications after dermal filler injection, HBO2 should be considered when treating these complications.

General and specific combining abilities in a maize (Zea mays L.) test-cross hybrid panel: relative importance of population structure and genetic divergence between parents.

KEY MESSAGE: General and specific combining abilities of maize hybrids between 288 inbred lines and three tester lines were highly related to population structure and genetic distance inferred from SNP data. Many studies have attempted to provide reliable and quick methods to identify promising parental lines and combinations in hybrid breeding programs. Since the 1950s, maize germplasm has been organized into heterotic groups to facilitate the exploitation of heterosis. Molecular markers have proven efficient tools to address the organization of genetic diversity and the relationship between lines or populations. The aim of the present work was to investigate to what extent marker-based evaluations of population structure and genetic distance may account for general (GCA) and specific (SCA) combining ability components in a population composed of 800 inter and intra-heterotic group hybrids obtained by crossing 288 inbred lines and three testers. Our results illustrate a strong effect of groups identified by population structure analysis on both GCA and SCA components. Including genetic distance between parental lines of hybrids in the model leads to a significant decrease of SCA variance component and an increase in GCA variance component for all the traits. The latter suggests that this approach can be efficient to better estimate the potential combining ability of inbred lines when crossed with unrelated lines, and limits the consequences of tester choice. Significant residual GCA and SCA variance components of models taking into account structure and/or genetic distance highlight the variation available for breeding programs within structure groups.

Dent and Flint maize diversity panels reveal important genetic potential for increasing biomass production.

KEY MESSAGE: Genetic and phenotypic analysis of two complementary maize panels revealed an important variation for biomass yield. Flowering and biomass QTL were discovered by association mapping in both panels. The high whole plant biomass productivity of maize makes it a potential source of energy in animal feeding and biofuel production. The variability and the genetic determinism of traits related to biomass are poorly known. We analyzed two highly diverse panels of Dent and Flint lines representing complementary heterotic groups for Northern Europe. They were genotyped with the 50 k SNP-array and phenotyped as hybrids (crossed to a tester of the complementary pool) in a western European field trial network for traits related to flowering time, plant height, and biomass. The molecular information revealed to be a powerful tool for discovering different levels of structure and relatedness in both panels. This study revealed important variation and potential genetic progress for biomass production, even at constant precocity. Association mapping was run by combining genotypes and phenotypes in a mixed model with a random polygenic effect. This permitted the detection of significant associations, confirming height and flowering time quantitative trait loci (QTL) found in literature. Biomass yield QTL were detected in both panels but were unstable across the environments. Alternative kinship estimator only based on markers unlinked to the tested SNP increased the number of significant associations by around 40% with a satisfying control of the false positive rate. This study gave insights into the variability and the genetic architectures of biomass-related traits in Flint and Dent lines and suggests important potential of these two pools for breeding high biomass yielding hybrid varieties.

Propranolol in a case series of 174 patients with complicated infantile haemangioma: indications, safety and future directions.

BACKGROUND: Infantile haemangioma (IH) is a benign, common and self-limiting tumour of infancy; only a minority of cases need active treatment. Currently, propranolol appears superior to classic treatments. OBJECTIVES: To document in a prospective study indications and side-effects of propranolol for complicated IH in a large patient group. METHODS: Analysis of prospectively collected data was performed on 174 patients with IH treated with propranolol in a tertiary referral centre from September 2008 to January 2012. RESULTS: The group consisted of children with a potentially threatening and/or complicated IH; the girl/boy ratio was 123/51, and the mean age at the start of treatment was 4·8 months. In 173 cases (99·4%), treatment was successful, as assessed nonquantitatively by clinical observation. This striking effect was characterized by immediate cessation of growth, softening, fading of the erythema and rapid induction of regression. The mean duration of treatment was 10·7 months. The most important adverse effects were hypotension (3·4%), wheezing (9·2%), nocturnal restlessness (22·4%) and cold extremities (36·2%). In one patient, propranolol was stopped. In 15 patients it was necessary to reduce the dose, although the lower dose was still effective. CONCLUSIONS: In this study, propranolol was effective and safe in almost all patients with complex IH. Administration of systemic medication to an infant with a benign condition requires careful consideration, as only a minority of patients with IH require an active medical intervention. A shift of the indication of propranolol for IH is evident, expanding its application for life-threatening situations or severe functional impairment to early prevention of disfigurement or cosmetically permanent sequelae. However, the indication for such an active approach should be determined by experienced physicians.

Maximizing the reliability of genomic selection by optimizing the calibration set of reference individuals: comparison of methods in two diverse groups of maize inbreds (Zea mays L.).

Genomic selection refers to the use of genotypic information for predicting breeding values of selection candidates. A prediction formula is calibrated with the genotypes and phenotypes of reference individuals constituting the calibration set. The size and the composition of this set are essential parameters affecting the prediction reliabilities. The objective of this study was to maximize reliabilities by optimizing the calibration set. Different criteria based on the diversity or on the prediction error variance (PEV) derived from the realized additive relationship matrix-best linear unbiased predictions model (RA-BLUP) were used to select the reference individuals. For the latter, we considered the mean of the PEV of the contrasts between each selection candidate and the mean of the population (PEVmean) and the mean of the expected reliabilities of the same contrasts (CDmean). These criteria were tested with phenotypic data collected on two diversity panels of maize (Zea mays L.) genotyped with a 50k SNPs array. In the two panels, samples chosen based on CDmean gave higher reliabilities than random samples for various calibration set sizes. CDmean also appeared superior to PEVmean, which can be explained by the fact that it takes into account the reduction of variance due to the relatedness between individuals. Selected samples were close to optimality for a wide range of trait heritabilities, which suggests that the strategy presented here can efficiently sample subsets in panels of inbred lines. A script to optimize reference samples based on CDmean is available on request.

The use of MapPop1.0 for choosing a QTL mapping sample from an advanced backcross population.

QTL detection is a good way to assess the genetic basis of quantitative traits such as the plant response to its environment, but requires large mapping populations. Experimental constraints, however, may require a restriction of the population size, risking a decrease in the quality level of QTL mapping. The purpose of this paper was to test if an advanced backcross population sample chosen by MapPop 1.0 could limit the effect of size restriction and improve the QTL detection when compared to random samples. We used the genotypic and phenotypic data obtained for 280 genotypes, considered as the reference population. The "MapPop sample" of 100 genotypes was first compared to the reference population, and genetic maps, genotypic and phenotypic data and QTL results were analysed. Despite the increase in donor allele frequency in the MapPop sample, this did not lead to an increase of the genetic map length or a biased phenotypic distribution. Three QTL among the 10 QTL found in the reference population were also detected in the MapPop sample. Next, the MapPop sample results were compared to those from 500 random samples of the same size. The main conclusion was that the MapPop software avoided the selection of biased samples and the detection of false QTL and appears particularly interesting to select a sample from an unbalanced population.

Pulsed dye laser treatment, a review of indications and outcome based on published trials.

INTRODUCTION: Pulsed dye laser (PDL) treatment is based on the principle of selective photothermolysis and is widely considered to be the treatment of choice for a variety of cutaneous vascular lesions. OBJECTIVE: To review the indications and outcome of PDL treatment and summarise new developments. METHOD: A literature-based study has been conducted entailing the review of publications over the period January 1993-December 2003 using the databases Medline and Cochrane CENTRAL. RESULTS: The PDL was found to be effective in port wine stain, facial telangiectasia, leg telangiectasia <0.5 mm, scars, hypertrophic scars and ulcerated haemangioma. DISCUSSION: Essential characteristics of lesions suitable for PDL treatment are discussed and guidelines are presented for future research.

Percutaneous removal of a knotted pulmonary artery catheter using a tracheostomy dilator.

STATEMENT OF FINDINGS: This case report describes removal of a knotted, subclavian, pulmonary artery catheter using a tracheostomy dilator. With this simple method an invasive procedure might be averted.

"Impossible" reversed radial forearm free flap in microsurgical reconstruction.

The reversed radial forearm free flap is described and patient histories are presented to illustrate its unique reconstructive versatility. The valvular orientation of the deep and superficial forearm veins should theoretically oppose the reversed flow in this flap, but the venous flow is not compromised. In comparison to the anterograde forearm free flap the vascular pedicle is longer and the donor defect generates less functional and cosmetic complications because it is located on the proximal forearm. In a review of the literature anatomical details of the venous drainage are presented. Different opinions on reverse flow in forearm flaps are discussed and a new theory is proposed.