Aesthetic doctors' perception and attitudes toward tolerance in botulinum toxin.

BACKGROUND: Botulinum toxin is a crucial therapeutic tool with broad indications in both cosmetic and medical fields. However, the expanding cosmetic use and increased dosages of botulinum toxin have raised concerns about resistance, making it essential to study the awareness and management practices among healthcare professionals. METHODS: A survey was conducted among clinical physicians using botulinum toxin. The study investigated their experiences, awareness, and management practices related to toxin resistance. Real-time mobile app-based surveys were administered to clinicians attending the 45th International Academic Conference of the Korean Academy of Laser and Dermatology (KALDAT) on December 3, 2023. RESULTS: Among 3140 participants, 673 clinical physicians completed the survey. Of these, 363 clinicians (53.9%) reported experiencing botulinum toxin resistance. Regarding the resistance rate, 59.4% indicated less than 1%, 36% reported approximately 1%-25%, and 95.4% reported less than 25%. Efforts to prevent resistance included maintaining intervals of over 3 months (54.8%), using products with lower resistance potential (47.0%), employing minimal effective doses (28.2%), and minimizing re-administration (14.9%). CONCLUSION: In the South Korean aesthetic medicine community, a majority of clinical physician's report encountering botulinum toxin resistance. Given the potential loss of various benefits associated with resistance, there is a need to establish appropriate guidelines based on mechanistic studies and current status assessments. Educating clinicians on applicable guidelines is crucial.

Investigating the Mechanisms of Intradermal Injection for Easier "Skin Booster" Treatment: A Fluid Mechanics Approach to Determine Optimal Delivery Method.

Background: The use of "skin boosters" for rejuvenating aged skin is widely used. However, the accurate injection of the skin booster into the dermal layer remains a challenge due to the density of the dermis. The purpose of this study was to investigate the optimal mechanical variables of delivery that enabled correct targeting of the product to the dermis for optimal results. Methods: We investigated the impact of mechanical variables (syringe diameter, needle diameter and length, and viscosity of the skin booster) on the force required for intradermal injection in porcine skin. The correlation between these variables and the injection force was examined as well. Results: The results show that smaller syringe diameters, larger needle diameters, shorter needle lengths, and lower viscosity of the skin boosters reduce the injection force needed for intradermal injections. Conclusions: During the administration of skin booster injections, clinicians should take into account optimal conditions that facilitate intradermal injections, thus maximizing rejuvenating outcomes. Furthermore, manufacturers of skin boosters should formulate the products with decreased viscosity and provide the product in conjunction with appropriate needles and syringes, designed to optimize ease of injection.

Importance of dietary supplementation of soluble and insoluble fibers to sows subjected to high ambient temperatures during late gestation and effects on lactation performance.

Heat stress adversely affects sows' performance, which can be improved by applying proper nutritional strategies. This study was conducted to investigate the interactive effects of dietary fiber levels and sources on sows' reproductive performance, metabolic response during gestation, and the carry-over influence on litter performance in the lactation period during heat stress (average room temperature of 27.1 °C). Fifty-four multiparous sows (Landrace × Yorkshire; initial body weight of 236.3 ± 16 kg; 2, 3 and 4 parities) at d 90 of gestation were assigned to a 2 × 3 factorial arrangement (9 sows/treatment), involving 2 dietary fiber levels (4.5% and 6% crude fiber) and 3 dietary fiber sources (wheat bran [WB], palm kernel meal [PK], and beet pulp [BP]). Sows fed the BP diet had highest (P < 0.01) feed intake and constipation index and lowest (P < 0.01) farrowing duration. Piglet weight (P = 0.041) and litter weight (P < 0.01) at weaning were higher in sows in the BP treatment compared to PK treatment. Sows in the BP treatment showed the greatest (P < 0.01) digestibility of crude protein and neutral detergent fiber. The fecal concentration of acetate was the lowest (P < 0.01) in the PK treatment. Total short-chain fatty acid production was increased in the WB and BP treatments compared with the PK. Sows in the BP treatment showed the lowest (P = 0.036) hair cortisol. The blood insulin concentration of sows was higher (P = 0.026) in the high fiber (6%) treatment compared with the low fiber (4.5%) treatment at 90 min and 120 min after the meal. The concentration of phthalic acid, succinic acid, phenylethylamine, hydrocinnamic acid, iron, linoleic acid, glycerol, ketone, and formamide were increased (P < 0.05) in the BP treatment compared with the WB. The BP treatment with high soluble fiber content improved the constipation index, farrowing duration, and litter performance, while high insoluble fibers increased sows comfort and reduced stress factors including respiratory rate and rectal temperature. Therefore, both soluble and insoluble sources of fiber are necessary to be added to the diet of gestating sows.

Lateral facial thread lifting procedure with temporal anchoring in deep temporal fascia: Anatomical perspectives of superficial temporal artery.

INTRODUCTION: Thread lifting is a non-surgical cosmetic procedure that utilizes threads to lift and tighten sagging skin on the face. In Lateral face lifting with anchoring technique, the threads are inserted into the skin and anchored in place to provide support to the skin at artery free zone. This technique utilizes a long cog thread, allowing for stronger fixation points. The optimal location for thread anchoring is in the fascia of the treatment area. METHOD AND MATERIALS: The study was performed with twelve cadavers with twenty-four specimens of head from cadavers and was processed using phosphotungstic acid-based contrast enhancement micro-computed tomography and conventional computed tomography. The superficial temporal artery with branches of parietal and temporal were then observed with image Slicer program to analyze the safe anchoring place for the deep temporal fascia. The main branch was selected with diameter over 0.3 mm and less than 0.3 mm was regarded as arteriole. Additionally, a case of deep temporal tagging with the Secret Miracle (Hyundae Meditech Co., Ltd., South Korea) has been used for lifting procedures. RESULT: The main branch of the parietal branch located posteriorly was located mean of -13 mm (range of +5.5 mm to -23 mm). And the temporal artery ran most anteriorly had mean of 44 mm anteriorly (range of 32 to 59 mm). The safe area for the tagging is at the deep temporal fascia between the superior temporal line and inferior temporal line. The safe range of deep temporal fascia is a vertical line crossing tragus from 1 to 3 cm anteriorly. CONCLUSION: By analyzing the result of the superficial temporal artery of parietal and temporal branches the ideal tagging place for the thread anchoring area has been suggested.

Clinical Characteristics of Lichen Amyloidosis Associated with Atopic Dermatitis: A Single Center, Retrospective Study.

BACKGROUND: Lichen amyloidosis is a chronic pruritic skin disorder associated with atopic dermatitis, however, the pathogenetic link between these two conditions remains to be elucidated. Only limited research has been performed on patients diagnosed with both pruritic dermatological conditions. OBJECTIVE: This study aimed to analyze the clinical features of lichen amyloidosis associated with atopic dermatitis. METHODS: We conducted a matched case-control study of incident lichen amyloidosis with atopic dermatitis between March 2020 and February 2022. Among the 2,481 patients with atopic dermatitis, 20 patients diagnosed with lichen amyloidosis and atopic dermatitis were included as case patients, and 20 patients diagnosed with atopic dermatitis were enrolled as controls. The controls were matched to cases (1:1) by age and sex. We retrospectively reviewed the medical records of the patients. RESULTS: The prevalence of lichen amyloidosis associated with atopic dermatitis was approximately 0.8%, with a male:female sex ratio of 2.33:1. The recorded onset of lichen amyloidosis associated with atopic dermatitis was more common in adult patients, with moderate-to-severe atopic dermatitis. Lichen amyloidosis lesions in patients with atopic dermatitis were most commonly found on the extremities, sparing the head and neck region. The presence of lichen amyloidosis had no significant impact on severity of atopic dermatitis. CONCLUSION: In patients with lichen amyloidosis associated with atopic dermatitis, the clinical manifestations of lesions are similar to those of conventional lichen amyloidosis lesions in terms of morphology and regional distribution. Further research is required to elucidate the link between the pathogenesis of these two pruritic dermatological conditions.

Current practices and perceived effectiveness of polynucleotides for treatment of facial erythema by cosmetic physicians.

BACKGROUND: Polynucleotides (PN) are increasingly used for the treatment of facial erythema in the Republic of Korea. However, there are limited pre-clinical and clinical data on the efficacy of polynucleotides for facial erythema. In this study, we investigated the current practice and perceived effectiveness of polynucleotide treatment for facial erythema among cosmetic physicians. METHODS: By conducting a survey among clinicians who use PN in clinical practice, we explored the current practices and assessed the perceived effectiveness of polynucleotides in treating facial erythema. RESULTS: A total of 557 physicians who used polynucleotides for facial erythema participated in the survey. Polynucleotides were used by 84.4%, 66.4%, and 47.4% of physicians for facial erythema caused by inflammatory facial dermatosis, repeated laser/microneedle radiofrequency, and steroid overuse, respectively. Among those users, 88.1%, 90%, and 83.7% respectively in those same categories answered that polynucleotides were "highly effective" or "effective." Furthermore, they agreed that polynucleotides have the following properties: wound healing/regeneration (95.8%), protection of skin barrier (92.2%), hydration (90.5%), vascular stabilization (81.0%), and anti-inflammation (79.5%). CONCLUSION: Our findings showed that cosmetic physicians in the Republic of Korea have used PN as a part of combination treatment for facial erythema resulting from inflammatory facial dermatosis and repeated laser/ microneedle radiofrequency, rather than from steroid overuse. Also, most clinicians agreed that PN was effective for treatment of facial erythema. Given the lack of pre-clinical and clinical trial evidence, the empirical responses of practicing physicians provide useful information to guide clinical practice and further research.

A Pilot Genome-Wide Association Study Identifies Novel Markers of Metabolic Syndrome in Patients with Psoriasis.

BACKGROUND: Recent studies have reported that psoriasis is associated with the development of metabolic syndrome. Genome-wide association studies have been used to discover gene variant markers that occur frequently in case group in relation to specific diseases. OBJECTIVE: The aim of the present study was to investigate the variants of specific genes involved in metabolic syndrome associated with psoriasis. METHODS: A total of 95 psoriasis patients were recruited and divided into two groups: one with metabolic syndrome (38 patients) and the other without (57 patients). After genotyping, imputation, and quality checking, the association between the several single nucleotide polymorphisms and metabolic syndrome in psoriasis was tested, followed by gene set enrichment analysis. RESULTS: We found 76 gene polymorphisms that conferred an increased risk for metabolic syndrome in patients with psoriasis. Four single nucleotide polymorphisms (rs17154774 of FRMD4A, rs77498336 of GPR116, rs75949580 and rs187682251 of MAPK4) showed the strongest association between metabolic syndrome and psoriasis. The epidermal growth factor receptor protein was located at the center of the protein interactions for the gene polymorphisms. CONCLUSION: This study identified several previously unknown polymorphisms associated with metabolic syndrome in psoriasis. These results highlight the potential for future genetic studies to elucidate the development, and ultimately prevent the onset, of metabolic syndrome in patients with psoriasis.

Enhanced Cycling Performance of a Li-Excess Li2CuO2 Cathode Additive by Cosubstitution Nanoarchitectonics of Ni and Mn for Lithium-Ion Batteries.

The adoption of Li2CuO2 has drawn interest as a Li-excess cathode additive for compensating irreversible Li+ loss in anodes during cycling, which would move forward high-energy-density lithium-ion batteries (LIBs). Li2CuO2 provides a high irreversible capacity (>200 mAh g-1) in the first cycle and an operating voltage comparable with commercial cathode materials, but its practical use is still restricted by the structural instability and spontaneous oxygen (O2) evolution, resulting in poor overall cycling performance. It is thus crucial to reinforce the structure of Li2CuO2 to make it more reliable as a cathode additive for charge compensation. Pursuing the structural stability of Li2CuO2, herein, we demonstrate cosubstitution by heteroatoms, such as nickel (Ni) and manganese (Mn), for improving the structural stability and electrochemical performance of Li2CuO2. Such an approach effectively enhances the reversibility of Li2CuO2 by suppressing continuous structural degradation and O2 gas evolution during cycling. Our findings provide new conceptual pathways for developing advanced cathode additives for high-energy LIBs.

Proposal of facial pigmentary unit and facial hyperpigmentation type for Fitzpatrick skin types II-IV.

BACKGROUND: Studies on facial hyperpigmentation across different facial units are limiting. We aimed to analyze melanin pigmentation images to observe facial pigmentary demarcation lines (FPDLs) and suggest facial hyperpigmentation types for normal individuals. MATERIALS AND METHODS: 3D facial melanin pigmentation images of 173 volunteers were obtained and analyzed for the presence of FPDLs. Pigmentation severity was assessed for each of the thirteen facial pigment units. The images were then grouped according to a pattern of hyperpigmentation to suggest three facial hyperpigmentation types-dark spot, photoaging and post-inflammatory hyperpigmentation. RESULTS: Four groups of FPDLs including a novel group I were observed. Nasal, frontal, auricular were the darkest pigmented facial pigment unit, and the anterior neck was the least pigmented. The dark spot type was the most common facial hyperpigmentation type. The photoaging type and the PIH type showed age-dependent distribution, as the photoaging type was more common among the subjects over 40s, and the PIH type was more common in younger subjects. CONCLUSION: Facial hyperpigmentation among healthy individuals with Fitzpatrick skin types II-IV is often accompanied by FPDLs and categorized into three types. Each type is modeled after the pattern of pigmentation associated with certain dermatological disorders. The practical implications of facial hyperpigmentation types can be resourceful in various fields including prevention and treatment of pigmentary disorders.

An analysis of shapes and location of anterior hairline in Asian men.

An individual's first impression can be influenced by a number of esthetic factors, one of which is a natural hairline. The anterior hairline can be affected by various factors, such as race, age, forehead shape, and hair loss progression, similar to androgenetic alopecia. Information on the shape, hairline location on the forehead, and race are required to classify the anterior hairline. According to previous studies, the shape of the anterior hairline can be classified as round, M-shaped, rectangular, bell-shaped, or triangular. This study aimed to analyze the type of anterior hairline in Asian males without androgenetic alopecia. The subjects consisted of 461 males in China, Japan, Kazakhstan, Mongolia, the Philippines, South Korea, and Taiwan. We classified the shape of the anterior hairline into four types: M-shaped (M), rectangular (R), round (O), and wave-shaped (W). We classified the location of the anterior hairline into three types: high (H), middle (M) and low (L), according to the subjects' forehead ratio. Finally, we combined the shape and location types to devise a novel classification system for the anterior hairline type. The most common hairline types in our newly developed classification were MM (23.94%), RM (18.00%) and ML (11.04%). The least common types were OL (0.58%), OH (2.34%) and WH (2.74%). Our results will set standards for hairline shapes and locations, which will be helpful for evaluating hair loss treatment, establishing criteria and designs for reconstructive surgery, and developing camouflage makeups for the forehead hairline.

Changes in the neck tissue layers during pinch manipulation: Implications for lipolytic deoxycholate injections for double chin.

BACKGROUND: The skin of the neck is often pinched during minimally invasive esthetic procedures for the double chin using a lipolytic agent in order to facilitate injecting into the subcutaneous fat layer rather than under the platysma muscle. However, how the neck tissue layers move during the pinch manipulation is not well understood. AIMS: To determine which layer of the neck is lifted during pinching and to evaluate the usefulness of the pinch manipulation during injection therapy. METHODS: The pinched submentum of a living person was scanned using MRI, and ultrasonography was also performed in the same area in both resting and pressed states. At four sites on a fresh cadaver, the skin of the neck was pinched and the elevated neck skin was excised. The exposed areas were grossly examined. RESULTS: MRI scanning revealed that the pinch manipulation extended the subcutaneous fat layer and moved the platysma muscle to a deeper location. Ultrasonography revealed that the thickness of each layer of the neck was reduced when pressing the neck. In the cadaver examination, pinching resulted in part of the subcutaneous fat lifting, and this was removed when the lifted skin was cut, leaving the platysma muscle intact. CONCLUSIONS: When performing an esthetic procedure that involves injecting a lipolytic agent into the submental area, the pinch manipulation is a very useful technique for ensuring a safe procedure that avoids injecting into the deep layer under the platysma muscle.

Homogenizing Silicon Domains in SiOx Anode during Cycling and Enhancing Battery Performance via Magnesium Doping.

SiOx (x ≈ 1) is one of the most promising anode materials for application in secondary lithium-ion batteries because of its high theoretical capacity. Despite this merit, SiOx has a poor initial Coulombic efficiency, which impedes its widespread use. To overcome this limitation, in this work, we successfully demonstrate a novel synthesis of Mg-doped SiOx via a mass-producible physical vapor deposition method. The solid-state reaction between Mg and SiOx produces Si and electrochemically inert magnesium silicate, thus increasing the initial Coulombic efficiency. The Mg doping concentration determines the phase of the magnesium silicate domains, the size of the Si domains, and the heterogeneity of these two domains. Detailed electron microscopy and synchrotron-based analysis revealed that the nanoscale homogeneity of magnesium silicates driven by cycling significantly affected the lifetime. We found that 8 wt % Mg is the most optimized concentration for enhanced cyclability because MgSiO3, which is the dominant magnesium silicate composition, can be homogeneously mixed with silicon clusters, preventing their aggregation during cycling and suppressing void formation.

A computer vision-based approach for behavior recognition of gestating sows fed different fiber levels during high ambient temperature.

The objectives of this study were to evaluate convolutional neural network models and computer vision techniques for the classification of swine posture with high accuracy and to use the derived result in the investigation of the effect of dietary fiber level on the behavioral characteristics of the pregnant sow under low and high ambient temperatures during the last stage of gestation. A total of 27 crossbred sows (Yorkshire × Landrace; average body weight, 192.2 ± 4.8 kg) were assigned to three treatments in a randomized complete block design during the last stage of gestation (days 90 to 114). The sows in group 1 were fed a 3% fiber diet under neutral ambient temperature; the sows in group 2 were fed a diet with 3% fiber under high ambient temperature (HT); the sows in group 3 were fed a 6% fiber diet under HT. Eight popular deep learning-based feature extraction frameworks (DenseNet121, DenseNet201, InceptionResNetV2, InceptionV3, MobileNet, VGG16, VGG19, and Xception) used for automatic swine posture classification were selected and compared using the swine posture image dataset that was constructed under real swine farm conditions. The neural network models showed excellent performance on previously unseen data (ability to generalize). The DenseNet121 feature extractor achieved the best performance with 99.83% accuracy, and both DenseNet201 and MobileNet showed an accuracy of 99.77% for the classification of the image dataset. The behavior of sows classified by the DenseNet121 feature extractor showed that the HT in our study reduced (p < 0.05) the standing behavior of sows and also has a tendency to increase (p = 0.082) lying behavior. High dietary fiber treatment tended to increase (p = 0.064) lying and decrease (p < 0.05) the standing behavior of sows, but there was no change in sitting under HT conditions.

Comparison of hyaluronic acid filler ejection pressure with injection force for safe filler injection.

BACKGROUND: Owing to the increase in the number of medical procedures performed every year, the frequency of filler injection-related complications has also increased. Although slow, gentle injections with low pressure are usually considered to be safe, the differences in ejection pressure during a filler injection remain to be determined. This study aimed to identify the optimal pressure during filler injections and evaluate its capacity to overcome the arterial blood pressure and reflux the filler material. METHODS: Twelve combinations of four hyaluronic acid (HA) fillers with different rheological properties and three needles of different diameters were assessed to determine the force exerted by the injection model. The ejection forces corresponding to varying injection forces were measured and HA filler ejection pressures were calculated. RESULTS: The highest and lowest injection forces were achieved using 30- and 25-G needles, respectively. In accordance with the expected ejection force, high ejection pressure was achieved by administering the HA filler under a high injection force. Irrespective of the injection force, the ejection pressure was likely to be higher than the vascular pressure at the time of entry into the vessel, rendering the injection dangerous. CONCLUSION: During filler injection, penetration of blood vessels and intravascular injection can be avoided by approaching the target area gently using a cannula or needle.

Inhalation toxicity of polystyrene micro(nano)plastics using modified OECD TG 412.

Recently, there have been reports that many microplastics are found in the air, which has raised concerns about their toxicity. To date, however, only limited research has investigated the effects of micro(nano)plastics on human health, and even less the potential for inhalation toxicity. To fill this research gap, we investigated the potential inhalation toxicity of micro(nano)plastics using a modified OECD Guideline for Testing of Chemicals No. 412 '28-Day (subacute) inhalation toxicity study' using a whole-body inhalation system. Sprague-Dawley rats were exposed to three different exposure concentrations of polystyrene micro(nano)plastics (PSMPs), as well as control, for 14 days of inhalation exposure. After 14 days, alterations were observed on sevral endpoints in physiological, serum biochemical, hematological, and respiratory function markers measured on the samples exposed to PSMPs. However, no concentration-response relationships were observed, suggesting that these effects may not be definitively linked to exposure of PSMPs. On the other hand, the expression of inflammatory proteins (TGF-ß and TNF-α) increased in the lung tissue in an exposure concentration-dependent manner. The overall results indicate that 14-day inhalation exposure of PSMPs to rats has a more pronounced effect at the molecular level than at the organismal one. These results suggest that if the exposure sustained, alterations at the molecular level may lead to subsequent alterations at the higher levels, and consequently, the health risks of inhalation exposed micro(nano)plastics should not be neglected.

Muscle Antioxidant Activity and Meat Quality Are Altered by Supplementation of Astaxanthin in Broilers Exposed to High Temperature.

This study investigated the effect of dietary astaxanthin (AST) on the meat quality, antioxidant status, and immune response of chickens exposed to heat stress. Four hundred and eighty male broilers were assigned to four treatments including AST0, AST20, AST40, and AST80 with 0, 20, 40, and 80 ppm astaxanthin supplementation levels, respectively. There was a linear decrease of malondialdehyde (MDA) in leg muscle. Catalase and superoxide dismutase levels in the plasma were linearly increased. There was a linear increase in the level of total antioxidant capacity in the leg muscle. The 3-ethylbenzothiazoline-6-sulfonate reducing activity of leg muscle was significantly increased in the AST80 treatment. The AST40 treatment showed an increase in 2,2-diphenyl-1-picrylhydrazyl radical scavenging capacity of leg muscles. Breast meat redness and yellowness were linearly increased. The astaxanthin-supplemented treatments exhibited lower drip loss and MDA concentration of leg muscle compared with the AST0 treatment at days 3 and 9 of storage. Supplementation of 40 or 80 mg/kg astaxanthin significantly decreased heat shock protein (HSP)27, HSP70, tumor necrosis factor alpha, and interleukin-6 expression in the livers. The feather corticosterone was significantly lower in the astaxanthin-supplemented treatments than in the AST0 treatment. In conclusion, astaxanthin decreased the hyperthermic stress level and improved meat quality, and antioxidant status of chickens exposed to heat stress.

Development and Usability of a Virtual Reality-Based Filler Injection Training System.

PURPOSE: As filler procedures have increased in popularity, serious injection-related complications (e.g., blindness and stroke) have also increased in number. Proper and effective training is important for filler procedure safety; however, limitations exist in traditional training methods (i.e. anatomical illustrations and cadaver studies). We aimed to describe the development process and evaluate the usability of a virtual reality (VR)-based aesthetic filler injection training system. MATERIALS AND METHODS: We developed the virtual reality hardware for the training system and a short guide, with a lecture regarding safe filler injection techniques. One hundred clinicians who attended a conference tested the training system. Participants completed system usability scale (SUS) and satisfaction questionnaires. RESULTS: Nearly half of the participants were aged 35-50 years, and 38% had more than 5 years of aesthetic experience. The mean SUS score was 59.8 (standard deviation, 12.23), with no significant differences among the evaluated subgroups. Approximately 76% of participants provided SUS scores of more than 51, indicating acceptable usability. Participants aged 35-50 years were more likely to rate the system as having poor usability than were those aged < 35 years (odds ratio = 5.20, 95% confidence interval: 1.35-20.08). CONCLUSIONS: This study was the first to develop and explore the usability of a VR-based filler training system. Nearly three-fourths of participants indicated that the training system has an acceptable level of usability. However, assessments in precise target audiences and more detailed usability information are necessary to further refine the training system. LEVEL OF EVIDENCE IV: 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 .