Rejuvenation of the upper eyelid complex with autologous fat transplantation

BACKGROUND

Based on years of observation, it is apparent that the cosmetic surgical community has not adequately addressed the most significant "pathology" of aging. This is particularly true of the upper eyelid complex.

OBJECTIVE

This paper will focus on the necessity of volume restoration as an important tool to correct the deformities of aging or iatrogenia.

METHODS AND MATERIALS

The author has been performing volume restoration with autologous fat transplantation since 1986. He will present sample cases and discussion of the problem based on experience and archived literature (note: reference 1 includes over twenty additional references).

RESULTS

Results will be shown and discussed.

CONCLUSION

Volume restoration with autologous fat transplantation is an important and useful tool for correcting the appearance of the aging face, and in particular, the upper eyelid complex.

Glial growth factor-2 promotes the survival, migration and bromodeoxyuridine incorporation of mammalian neural crest cells in caudal neural tube explant cultures

Using an in vitro assay system, we found that GGF-2 increases the number of nascent trunk neural crest cells (NCC) present in the dorsal outgrowth derived from E12 caudal neural tube explants. Data is presented which suggests that this increased outgrowth was due to a combination of GGF-2 mediated effects, including its ability to promote (A) NCC survival by decreasing the percentage of NCC that undergo cell death via a mechanism involving DNA fragmentation, (B) the initial phases of NCC migration, (C) mitosis of peripherally migrating NCC. We also show that GGF-2 can promote the long-term survival of NCC in the absence of the neural tube. An immunohistochemical analysis indicates that NCC express erbB-2 and erbB-4 neuregulin receptors.

Early migratory rat neural crest cells express functional gap junctions: evidence that neural crest cell survival requires gap junction function

Gap junctions mediate crucial intercellular interactions during development. This study provides evidence that early migrating rat neural crest cells assemble functional gap junctions, as demonstrated by dye transfer following microinjection of single cells, which were phenotypically identified as neural crest cells by their expression of the low- affinity nerve growth factor receptor. An immunohistochemical analysis using connexin- specific antibodies revealed that migrating rat neural crest cells express the gap junction constituents connexins 43 (Cx 43) and Cx 46. We tested the hypothesis that gap junctions play an important role during early neural crest cell development by perturbing their function in migrating neural crest cells. Our data show that markedly decreasing gap junction communication between these neural crest cells in vitro with either 18alpha-glycyrrhetinic acid or anandamide decreases their survival, whereas oleamide, a less effective blocker of connexon function, had quantitatively less effect on neural crest cell death. This cell death was associated with the occurrence of DNA nicking as detected by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end-labelling (TUNEL) procedure, suggesting cell death via apoptosis. The effect of 18alpha-glycyrrhetinic acid and anandamide on neural crest cell survival was reversible and was not mimicked by the structurally related compounds glycyrrhizic acid and palmitoylethanolamide, respectively, which do not uncouple cells. These results indicate that gap junctions are necessary for the survival of spinal neural crest cells.

Correlation between electrocardiographic subtypes of anterior myocardial infarction and regional abnormalities of wall motion

BACKGROUND

Examination of the electrocardiogram is the most widely used means for diagnosis and early stratification of risk of acute myocardial infarction (AMI). The classical classification of the subtypes of anterior AMI is based on results of studies comparing the electrocardiograms recorded at various stages, mostly in the subacute or chronic stage of AMI, with autopsy findings. Reports regarding the correlation between electrocardiographic findings in the acute phase and regional abnormality of wall motion (AWM) detected by echocardiographic evaluation are sparse.

OBJECTIVE

To investigate the relationship between the electrocardiographic and two-dimensional echocardiographic findings regarding patients with their first anterior AMI.

DESIGN AND METHODS

We studied 58 patients, 44 men and 14 women of mean age 61.5 +/- 14.6 years, with their first anterior AMI who had undergone two-dimensional echocardiographic evaluation within 48 h of admission. Deviation of ST-segment trace from baseline was measured manually 0.06 s after the J point for all leads on the admission electrocardiogram. ST-segment elevation in the various leads was correlated to the incidence of regional AWM detected by echocardiography.

RESULTS

ST-segment elevations > or = 0.1 mV in V1 leads were found for 21 (36.2%) patients. Basal anterior, basal anteroseptal, and basal septal AWM were seen more often for patients with than they were for patients without ST-segment elevation in V1 (57 versus 16%, P=0.003; 43 versus 13.5%, P=0.03; 43 versus 11%, P=0.01 respectively). In contrast to ST-segment elevation in lead V1, the only statistically significant difference in prevalence in the presence of regional AWM between patients with (n = 48) and without (n = 10) ST-segment elevation > or = 0.2 mV in lead V2 was in the inferoapical region (87.5 versus 40%; P=0.003). ST-segment elevation > or = 0.1 mV in leads aVL and V5 was found for 11 (19%) and 23 (40%) patients, respectively. There was no correlation between either lateral or apical regional AWM and the presence of ST-segment elevation in the anterolateral leads except for mid-lateral AWM, which was more often detected for patients with than it was for patients without ST-segment elevation in aVL leads (36.3 versus 6.4%, P=0.026).

CONCLUSIONS

ST-segment elevation in lead V1 during the acute phase of anterior AMI is associated with a high incidence of regional AWM in the basal anterior, anteroseptal, and anterior regions, whereas ST-segment elevation in lead V2 is more often associated with AWM in the inferoapical region. ST-segment elevation in aVL leads is related to mid-lateral regional AWM.

Alcohol control and injury death in Alaska native communities: wet, damp and dry under Alaska's local option law

OBJECTIVE

This article tests whether different forms of community-level alcohol control significantly affect injury deaths in a population with extremely high injury mortality.

METHOD

The 1981 Alaska local option law provides a natural experiment for studying how implementation of community level controls may be associated with changes in injury deaths, most of which are alcohol-related, among Alaska Natives living in small communities. The study compares population and community-specific death rates under different levels of alcohol control for the 97 communities that passed restrictions between 1980 and 1993 with the death rates in the same communities during periods when no restrictions were in place.

RESULTS

Injury death rates were generally lower during periods when alcohol sales, importation or possession were restricted than when no restrictions were in place (wet). More restrictive controls (dry) significantly reduced homicides; less restrictive control options (damp) reduced suicides. Accident and homicide death rates fell, on average, by 74 and 66 per 100,000, respectively, for the 89 communities that banned sale and importation or possession. A control group of 61 small communities that did not change control status under the law showed no significant changes over time in accident or homicide death rates.

CONCLUSIONS

The changes in accidental and homicide death rates are statistically significant, although these reduced rates remain 2.5 to 7 times national death rates. The isolated nature of Alaskan villages may explain why alcohol control has more effect in Alaska than has been found in studies of Native Americans living in other states.

Approaches to detecting false positives in yeast two-hybrid systems

While many novel associations predicted by two-hybrid library screens reflect actual biological associations of two proteins in vivo, at times the functional co-relevance of two proteins scored as interacting in the two-hybrid system is unlikely. The reason for this positive score remains obscure, which leads to designating such clones as false positives. After investigating the effect of over-expressing a series of putative false positives in yeast, we determined that expression of some of these clones induces an array of biological effects in yeast, including altered growth rate and cell permeability, that bias perceived activity of LacZ reporters. Based on these observations, we identify four simple strategies that can assist in determining whether a protein is likely to have been selected in a two-hybrid screen because of indirect metabolic effects.

Oral contraceptive use and risk of gestational trophoblastic tumors

BACKGROUND

Gestational trophoblastic disease refers to a spectrum of rare benign and malignant gynecologic disorders whose pathogenesis is not well understood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational trophoblastic tumors. A multicenter case-control study of gestational trophoblastic tumors was undertaken to test this hypothesis.

METHODS

Telephone interviews were conducted with 235 case patients, including 50 with gestational choriocarcinoma, and 413 control subjects matched on recentness of pregnancy, age at pregnancy, and area of residence. Relative risks (odds ratios) were computed by conditional logistic regression. Reported P values are two-sided.

RESULTS

The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95% confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). The estimate was highest for women who used oral contraceptives during the cycle in which they became pregnant (relative risk = 4.0; 95% CI=1.6-10), but there was no consistent pattern according to the time interval since last use. Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95% CI=0.8-6.4) and 1.8 (95% CI=1.0-3.0), respectively. Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results.

CONCLUSIONS

This study, the largest to date, indicates that long duration of oral contraceptive use before conception increases the risk of gestational trophoblastic tumors. These findings may provide clues to the pathogenesis of this rare disease. Changes in use of oral contraceptives are not warranted, however, because the incidence attributable to oral contraceptive use is very low.

Community education for stroke awareness: An efficacy study

BACKGROUND AND PURPOSE

This study examined the effectiveness of a slide/audio community education program aimed at increasing knowledge of stroke risk factors, stroke warning signs, and action needed when stroke warning signs occur. The program targets audiences at higher risk for stroke, especially individuals who are black or >50 years of age.

METHODS

Subjects were 657 adults living in the community or in senior independent-living settings. The study examined the effectiveness of the program when presented alone and when accompanied by discussion (facilitation) led by a trained individual. Knowledge of stroke risk factors and warning signs was assessed using parallel pretests and posttests developed and validated specifically for the study.

RESULTS

ANCOVA indicated that neither pretesting nor facilitation had a significant effect on posttest measures of knowledge. Paired t tests of groups receiving both the pretest and posttest demonstrated significant increase in knowledge (mean increase, 10.87%; P<0.001). ANCOVA indicated that these gains in knowledge were similar across subjects of different sex, race, age, and educational level. No significant differences could be ascribed to facilitation.

CONCLUSIONS

The data indicate that the slide/audio program is effective in increasing knowledge of stroke risk factors, warning signs, and necessary action in subjects of varying ages, races, and education. Pretesting and facilitation did not significantly affect the short-term acquisition of information. The slide/audio program appears to offer a short, easily used educational experience for diverse communities, whether as a stand-alone program or with facilitated discussion.