Clinical and histological evaluation of a single high energy microwave treatment for primary axillary hyperhidrosis in Asians: A prospective, randomized, controlled, split-area comparative trial.

BACKGROUND AND OBJECTIVES: Microwave treatment is an effective non-invasive treatment option for primary axillary hyperhidrosis (PAH), but the treatment parameters vary and no histopathological studies have been performed to validate clinical outcomes. This study investigated its efficacy and safety and histopathological changes after a single microwave treatment at the maximum energy level for PAH in Asians. MATERIALS AND METHODS: A prospective, clinical, and histological split-area randomized controlled trial (RCT) was performed in Japan. Twenty-six subjects underwent a single microwave treatment at the maximum energy level 5 (5.8 GHz/axilla) on the randomized side of axillae. The primary outcome was the mean difference between both sides in the improvement of modified single-underarm Hyperhidrosis Disease Severity Scale (msHDSS) scores over the course of the 12-month study period from baseline. The secondary outcomes were; the percentage of responders with at least a 2-point drop in the msHDSS score of 3 or 4 group or with a 1-point drop in the msHDSS score of 2 group; the percentage of responders with at least a 75% reduction in sweat weight over 12 months; recurrence rate; and adverse effects. We also performed a histological assessment for 13 selected subjects. RESULTS: Twenty-four subjects completed the study. There were statistically significant differences in improvement of msHDSS scores between the microwave-treated and control sides (P < 0.05) from baseline at 0.5, 1, 3, 6, and 12 months. In the msHDSS score of 3 or 4 group, the percentage of responders with at least a 2-point drop on the microwave-treated side versus control side was 72.2 versus 11.1% (P < 0.05) at 1 month, 83.3 versus 5.6% (P < 0.05) at 3 months, 61.1 versus 38.9% (P = 0.317) at 6 months and 38.9 versus 16.7% (P = 0.264) at 12 months. The percentage of responders with at least a 75% reduction in sweat weight on the microwave-treated side versus control side was 75.0 versus 37.5% at 1 month, 75.0 versus 29.2% at 3 months, 83.3 versus 50.0% at 6 months and 70.8 versus 33.3% at 12 months (all P < 0.05). Recurrence on the microwave-treated side was observed in 4.2% and 12.5% of 24 subjects at 3 and 12 months, respectively. No serious side-effects were noted. Histology showed the diameter and density of secretory eccrine glands and nerve fiber lengths around eccrine glands were significantly decreased after treatment compared to baseline (P = 0.002, 0.027, 0.003, respectively). CONCLUSIONS: A single-session microwave treatment at the maximum energy level significantly improved the PAH of Japanese patients and had minimal side effects. This technique demonstrates that diminished size of secretory eccrine glands and nerve fiber degeneration could be useful markers for predicting the efficacy of the treatment. Lasers Surg. Med. 9999:1-8, 2019. © 2019 Wiley Periodicals, Inc.

Beneficial effects of medical advice provided to elderly persons under the anti-aging health check-up system at Tokai University Tokyo Hospital.

OBJECTIVE: Tokai University Tokyo Hospital implemented its holistic anti-aging health check-up system in June 2006. This system is characterized by more than 70 check items and the provision of individual post-diagnostic advice of far greater detail than an ordinary health check-up. We analyzed aging-related changes in subjects who had completed their second check-up in order to determine the difference before and after coaching type of medical advice. SUBJECTS AND METHODS: Twenty-five recipients of the anti-aging health check-up at Tokai University Tokyo Hospital between June 2006 and April 2008 were included (15 males 10 females, mean age 65.1 ± 9.6 years, average check-up interval 12.5 ± 1.6 months). Based on the results of the first check-up, written advice on issues including diet, exercise, rest (sleep), smoking, alcohol intake, and supplements was provided by nutritionists, supplement advisers, and trainers specializing in Sports Medical Science in Tokai University. Besides this, doctors specializing in anti-aging medicine provided comprehensive coaching. Changes in BMI, abdominal girth at navel level, pressure wave velocity (PWV) and serum levels of total cholesterol (TC), HDL cholesterol (HDL-C), adiponectin (Adi) and free testosterone (in males) were expressed as % basal change and compared in the first and second check-ups. RESULTS: A year after the coaching, Adi and HDL-C both increased significantly while PWV tended to decrease. However, BMI and abdominal girth were unchanged. DHEA-S showed a rising trend while free testosterone also increased significantly. CONCLUSIONS: These results indicate that the coaching type of medical advice provided in the anti-aging health check-up potentially mitigates aging-related detrimental changes, bringing some benefits to elderly persons.

Novel technique of follicular unit extraction hair transplantation with a powered punching device.

BACKGROUND: A follicular unit extraction (FUE) method has been developed as one type of follicular unit transplantation (FUT) surgery that is a widely accepted hair restoration technique. Although FUE is considered to be more time consuming, depending on the operator's skill, and there are restrictions on patient candidacy, FUE has many advantages, including a small donor wound, less pain, and a slender graft without extra surrounding tissue. OBJECTIVE: To propose a novel powered FUE (P-FUE) technique. MATERIALS AND METHODS: To compare harvesting time and graft transection rate, FUE surgery was performed by manual FUE and P-FUE on male patients with alopecia. RESULTS: The P-FUE method had a shorter harvesting time (6.0 minutes for 100 grafts; 14.2 minutes for manual FUE) and lower graft transection rate (5.4% vs 17.3% with manual FUE). For 40 P-FUE cases, mean harvesting time for 100 grafts was 8.9+/-1.3 minutes. In 10 validated cases, the transection rate was 5.5%. Although there were limitations on patient selection with manual FUE, there were no restrictions on patient candidacy with the P-FUE method. CONCLUSION: The P-FUE method is a novel FUE procedure with many advantages over the conventional FUE technique.

Histologic and photonic evaluation of a pulsed Nd:YAG laser for ablation of subcutaneous adipose tissue.

Although various lasers are available, few of them are applicable in liposculpture. Laser interaction with fat tissue has not also been well documented. The aim of our study was to gather basic data on laser absorption in fat tissue and to analyze the relationship between laser energy and lipolysis for development of a more effective laser system. The transmittance rate in human fat specimens was measured by a spectrophotometer to determine the optimum wavelength. The absorption coefficient was used to evaluate laser absorption at a wavelength of 1064 nm. Areas of heat degeneration and evaporation were measured by scanning electron microscopy. The relation between laser energy and the areas was analyzed statistically among low-power and high-power groups and controls. Energy dispersion at the fiber tip was investigated and analyzed statistically using the far field pattern. A graph of the absorption rate at wavelengths from 400 to 2400 nm showed a peak near 1700 nm and increases at wavelengths over 2000 nm. The formula gave as an absorption coefficient of 0.4 cm(-1), and involvement of the photo-acoustic effect and non-linear effect with short-pulse and high-peak energy was suggested. Findings of tissue evaporation, destruction, heat coagulation, and rupture of cell membrane were more frequently seen in irradiated specimens than in controls in scanning electron microscopy. The destroyed area in the low-power irradiated groups was significantly larger than that of controls in the statistical analysis. The affected area in the high-power irradiated groups was significantly larger than that of low-power specimens. Energy was concentrated at the tip with laser coherency. Energy at the oblique-cut tip was statistically lower than that at the normal tip, revealing that durability and maintenance of the fiber tip is essential to maintain energy levels in clinical practice. This study is the first to demonstrate the histologic and photonic relationship of energy absorption and lipolysis using a pulsed Nd:YAG laser. The results will be useful for research and development of a more effective laser system for liposculpture.

Salvage operations of free tissue transfer following internal jugular venous thrombosis: a review of 4 cases.

The internal jugular vein (IJV) is used as the optimal recipient for free-tissue transfer in reconstruction following modified radical neck dissection. Some reports documented rare cases of flap compromise following IJV thrombosis, but large sample studies are few. We present cases of emergent exploration and an analysis of factors to improve salvage rates of compromise due to IJV thrombosis. From a survey of 756 patients, four developed congestion due to IJV thrombosis and returned to the operating room. A restrospective analysis was made from the case records. This represents a rate of 0.5% for the entire series. Three flaps survived,and one failed. Detection of compromise ranged from 7-25 h postoperatively. All four IJVs recovered to provide adequate drainage after thrombectomy. While flap compromise following IJV thrombosis is rare, careful observation and early exploration are crucial for salvage, as in other microvascular venous crises.

Histologic evaluation of the pulsed Nd:YAG laser for laser lipolysis.

BACKGROUND AND OBJECTIVES: Laser lipoplasty with pulsed Nd:YAG laser, widely used in Europe and Latin America, has recently been introduced in Japan and the USA. We report histologic analyses of the effects of the laser on human fat tissue. STUDY DESIGN/MATERIALS AND METHODS: Freshly excised human skin and subcutaneous fat were irradiated with the pulsed Nd:YAG laser (SmartLipo, DEKA, Italy). A 1,064 nm laser at 40 Hz and 150 mJ and 100 microseconds-long pulses were used. Methods of exposure were the same as in the clinical application. In the control group, the specimens were cannulated by the handpiece without irradiation. The tissue was studied by scanning electron microscopy and hematoxylin eosin staining. RESULTS: Scanning electron microscopy after irradiation showed greater destruction of human adipocytes than in the control. Degenerated cell membrane, vaporization, liquefaction, carbonization, and heat-coagulated collagen fibers were observed. CONCLUSIONS: Our study showed that the SmartLipo appeared to be histologically effective for destruction of human fat tissue.

Deficiency of inducible nitric oxide synthase exacerbates hepatic fibrosis in mice fed high-fat diet.

The role of inducible nitric oxide synthase (iNOS) in the progression of fibrosis during nonalcoholic steatohepatitis remains to be elucidated. This study examined the role of iNOS in the progression of fibrosis during steatohepatitis by comparing iNOS knockout (iNOS(-/-)) and wild-type (iNOS(+/+)) mice that were fed a high-fat diet. Severe fatty metamorphosis developed in the liver of iNOS(+/+) and iNOS(-/-) mice. Fibrotic changes were marked in iNOS(-/-) mice. Gelatin zymography showed that pro MMP-2 and pro MMP-9 protein expressions were more highly induced in iNOS(+/+) mice than in iNOS(-/-) mice. Active forms of MMP-2 and MMP-9 were clearly present only in the liver tissue of iNOS(+/+) mice. In situ zymography showed strong gelatinolytic activities in the liver tissue of iNOS(+/+) mice, but only spotty activity in iNOS(-/-)mice. iNOS may attenuate the progression of liver fibrosis in steatohepatitis, in part by inducing MMP-2 and MMP-9 expression and augmenting their activity.

Ultrasonic tissue characterization of photodamaged skin by scanning acoustic microscopy.

The aim of this study was to ultrasonically characterize photodamaged skin of the elderly at the microscopic level using scanning acoustic microscopy which showed two-dimentional distribution of sound speed in the skin section. We confirmed that the expression level of the elastin gene was increased in the preauricular skin (photodamaged area), compared with postauricular skin (photo-protected area). The expression level of the procollagen gene was also increased in the preauricular skin compared with postauricular skin. The preauricular skin showed higher sound speed in the papillary dermis (Grenz zone). The site of progressive solar elastosis showed a somewhat sound speed velocity than that of the Grenz zone. Immunohistochemical staining showed conserved deposition of collagen in the Grenz zone even in the more photodamaged preauricular skin. These results suggest that fibrosis in the Grenz zone compensates tissue strength with the progress of solar elastosis. The sound speed analysis of skin will provide important information on heterogeneous mechanical changes in the skin during the process of photoaging.

Soft tissue giant cell tumor of low malignant potential.

Giant cell tumor of soft tissue (GCT-ST) is a rare tumor first described in 1972 by Salm and Sissons, followed shortly by Guccion and Enzinger. This tumor has been considered to be synonymous with the giant cell variant of malignant sarcoma with frequent local recurrence and metastasis. Recently GCT-ST has been described as a distinct entity of relatively benign prognosis, yet lacking marked atypia and pleomorphism, even in the presence of mitotic activity and vascular invasion. Now some authors think that GCT-ST represents the soft tissue analog of giant cell tumor of bone because of their histological and immunohistochemical similarity. Some reports documented these pathological new findings, but clinical case reports with description of imagings and surgery on the basis of these knowledge are very few. The authors describe the clinical, radiological, morphologic and histopathologial features of a case of GCT-ST occurring primarily in the subcutaneous tissue of the thigh with a review of the literature.

Influences of different palatoplasties on palatal growth and speech development: comparison between Osada's two-stage palatoplasty and one-stage mucosal flap procedure.

Palatal growth and articulation in two different palatal closure techniques, Osada's two-stage procedure and the conventional one-stage procedure, were evaluated in 12 patients. Osada's procedure (hard palate closure using a vomer flap with complete closure of the raw surface by a full thickness skin graft) is a two-stage operation that consists of early soft palate closure at the time of lip closure (3 to 6 months of age). The palatal sizes and the depth of the palatal arch were significantly greater in the two-stage group than in the one-stage group at 1 year of age and, 3 to 5 years of age. There were no differences between the two groups at the velopharyngeal closure evaluation after hard palate closure and at final speech evaluation. Osada's two-stage palatoplasty has many advantages and we believe that this is one of the most recommendable procedures at present.

Induction of vascular endothelial growth factor by fibrin as a dermal substrate for cultured skin substitute.

In the initial phase of wound healing, endogenous fibrin clots are known to form a provisional matrix and to promote angiogenesis. Growth factors such as vascular endothelial growth factor (VEGF) increase in wounds to stimulate angiogenesis. However, it remains unknown whether VEGF is induced when fibrin is used as a dermal substrate for cultured skin substitutes. The authors investigated the effect of fibrin gel as a dermal substrate for a cultured skin substitute, using human keratinocytes and dermal fibroblasts. A collagen-cultured skin substitute was also examined for comparison. VEGF in the culture supernatant in both types was measured by enzyme-linked immunosorbent assay, and VEGF mRNA was determined semiquantitatively by reverse-transcriptase polymerase chain reaction after 2 days of incubation. Experiments were performed using 12 cultured skin substitutes: four for histologic examination before transplantation, four for VEGF assay in vitro, and four for the transplantation to athymic mice. Three independent experiments were performed for each step. VEGF concentration in the fibrin-cultured supernatant was 84.3 +/- 11.8 pg/ml, whereas it was 27.8 +/- 4.68 pg/ml in the case of the collagen substrate. The relative levels of VEGF mRNA were 1.088 +/- 0.100 and 0.698 +/- 0.226, respectively. In in vivo transplantation, the fibrin-type cultured skin substitute showed an excellent take on the wound bed, and a normally proliferating keratinocyte layer with emergence of vascular endothelial cells in the transplanted floor was seen 3 days after transplantation. Vascular endothelial cells, which were identified using alkaline phosphatase stain, were significantly increased in the fibrin-type cultured skin substitute. The use of fibrin as a dermal substrate for cultured skin substitute increases the secretion of VEGF, improves regeneration of mature epidermal structure after in vivo transplantation, and promotes the migration of vascular endothelial cells.