Real-World Study of Definisse Threads for Facial Reshaping in Indian Patients: REDEFINE FACE Study

INTRODUCTION

In recent years, thread lifting has gained popularity as a less invasive cosmetic surgery. It helps raise and realign sagging tissue. The newest thread type for thread lifting procedure is poly-lactic acid-polycaprolactone (PLCL) Definisse threads (RELIFE S.r.l., Florence, Italy). These are fourth-generation absorbable suspended barbed threads. Their double action involves an immediate elevating impact through mechanical action and, over time, the promotion of histological rejuvenating activity through inducing fibroblasts and the synthesis of elastin, hyaluronic acid, and collagen.

OBJECTIVES

The REDEFINE FACE study assessed the effectiveness and tolerance of Definisse threads in a real-world setting for facial reshaping in patients in India.

METHODS

This multicenter, retrospective observational research included patients treated with Definisse threads for face contouring.

RESULTS

Three hundred seventeen patients with a mean follow-up of 4.9 months and an average age of 48.6 years participated in the study. All patients underwent thread lifts using either a single or a combination of Definisse thread reshaping techniques. The Global Aesthetic Improvement Scale for Physicians and Subjects (PGAIS and SGAIS) reported improvement instantly following the treatment (mean score- 3.23 and 3.18, respectively). Improvements continued to enhance during the follow-up visits (mean score- 4.09 and 4.03, respectively). Following the procedure, 96% of patients on the PGAIS and SGAIS exhibited enhancement. Most procedure-related side effects were minor and went away on their own in a few days without the need for proactive care.

CONCLUSION

The results of this real-world analysis showed that the latest Definisse threads effectively achieve facial reshaping on patients in India and have both immediate and long-term effects. Treatment was generally well tolerated, and no patient experienced serious adverse events.

Practical Aspects of Acne Scar Management: ASAP 2024

Acne scars are one of the most common complications of acne. They can significantly affect the patient's quality of life. Often, several types of atrophic acne scars are observed simultaneously; therefore, consideration must be given to the type of scar while choosing the treatment modality. Effective treatment is not only important to prevent and improve acne scars but also crucial in preventing psychosocial effects. Treatment of acne scars requires an algorithmic approach that targets each component of the scars, and combination therapy on a patient-specific basis may offer the best chance for significant improvement. The goal of the current article is to discuss the practical aspects of management of atrophic acne scars using the vast modalities of treatment available. The panel of dermatologists and plastic surgeons, each one with at least 20 years of experience in acne scar treatment, participated in a series of 'Practical Aspects of Acne Scar Management' (ASAP) meetings: ASAP 2024. ASAP meetings were organized by "Scar Forum India" from March 2023 to July 2023 in four Indian cities (Mumbai, Delhi, Bengaluru, and Kolkata), each one for a duration of at least three hours. During these meetings and discussions, panelists reviewed and discussed the acne scar-related literature, their clinical experience in its management, available treatment options, along with recent advances. Consequently, a summary of the discussion and practical approach for the management of acne scars is developed. It was concluded that, though there is no specific guideline available to optimize acne scar management despite the multitude of treatment options, the best results can be achieved through the synergy of multiple treatment modalities and using the algorithmic approach.

Drip irrigation and sulphur fertilization influenced fodder yield, quality and water use efficiency of groundnut in arid region

Availability of ample and nutritious fodder for livestock is always a challenge in arid region. Choice of crops such as groundnut that can fulfil the requirement of fodder with its crop residues along with human needs can be a viable option to bridge the gap between availability and requirement of fodder. The fodder yield and quality largely depend on soil moisture and nutrient supply especially sulphur (S), a key nutrient for improving groundnut fodder quality. However, no researchers have given emphasis on coupling effect of drip irrigation (DI) and sulphur on fodder yield, quality, digestibility and water use efficiency (WUE). Therefore, the study was conducted to determine the effects of different regimes of DI and S on productivity and quality of fodder. Results revealed that higher regimes of DI i.e. 0.8 +1.0 PE(pan evaporation) and 1.0 PE level of irrigation along with 40 kg S ha-1 significantly improved the yield, primary quality traits (crude protein, ether extract and ash), digestibility indices and significant reduction in Fibers which indicates improvement in quality of fodder. Fodder productivity was 27.0 and 25.6% higher in 1.0 PE and 0.8+1.0 PE level of irrigation, respectively, as compared to 0.6 PE level (lower water regime) of irrigation, although 0.6 PE level of irrigation recorded higher WUE and was at par with 0.8 PE and 0.6 +1.0 PE level of DI. By changing the levels of DI from 1.0 PE to 0.8+1.0 PE, considerable water can be saved without affecting the yield and quality of fodder. Similarly, crop responded to S up to 60 kg ha-1 but at par with 40 kg S ha-1 indicating that application of extra S after 40 kg did not warrant any extra benefit in terms of fodder yield, WUE and quality of fodder. Thus, adjusting the PE levels of DI for water saving and optimal S application can be a sustainable strategy to improve the productivity and quality of groundnut fodder in arid region.

Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.

Improved NDVI based proxy leaf-fall indicator to assess rainfall sensitivity of deciduousness in the central Indian forests through remote sensing

Quantifying the leaf-fall dynamics in the tropical deciduous forest will help in modeling regional energy balance and nutrient recycle pattern, but the traditional ground-based leaf-fall enumeration is a tedious and geographically limited approach. Therefore, there is a need for a reliable spatial proxy leaf-fall (i.e., deciduousness) indicator. In this context, this study attempted to improve the existing deciduousness metric using time-series NDVI data (MOD13Q1; 250 m; 16 days interval) and investigated its spatio-temporal variability and sensitivity to rainfall anomalies across the central Indian tropical forest over 18 years (2001-2018). The study also analysed the magnitude of deciduousness during extreme (i.e., dry and wet) and normal rainfall years, and compared its variability with the old metric. The improved NDVI based deciduousness metric performed satisfactorily, as its observed variations were in tandem with ground observations in different forest types, and for different pheno-classes. This is the first kind of study in India revealing the spatio-temporal character of leaf-fall in different ecoregions, elevation gradients and vegetation fraction.

Cardiovascular risk assessment in patients with rheumatoid arthritis using carotid ultrasound B-mode imaging

Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that affects synovial joints and has various extra-articular manifestations, including atherosclerotic cardiovascular disease (CVD). Patients with RA experience a higher risk of CVD, leading to increased morbidity and mortality. Inflammation is a common phenomenon in RA and CVD. The pathophysiological association between these diseases is still not clear, and, thus, the risk assessment and detection of CVD in such patients is of clinical importance. Recently, artificial intelligence (AI) has gained prominence in advancing healthcare and, therefore, may further help to investigate the RA-CVD association. There are three aims of this review: (1) to summarize the three pathophysiological pathways that link RA to CVD; (2) to identify several traditional and carotid ultrasound image-based CVD risk calculators useful for RA patients, and (3) to understand the role of artificial intelligence in CVD risk assessment in RA patients. Our search strategy involves extensively searches in PubMed and Web of Science databases using search terms associated with CVD risk assessment in RA patients. A total of 120 peer-reviewed articles were screened for this review. We conclude that (a) two of the three pathways directly affect the atherosclerotic process, leading to heart injury, (b) carotid ultrasound image-based calculators have shown superior performance compared with conventional calculators, and (c) AI-based technologies in CVD risk assessment in RA patients are aggressively being adapted for routine practice of RA patients.

3-D optimized classification and characterization artificial intelligence paradigm for cardiovascular/stroke risk stratification using carotid ultrasound-based delineated plaque: Atheromatic™ 2.0

BACKGROUND AND PURPOSE

Atherosclerotic plaque tissue rupture is one of the leading causes of strokes. Early carotid plaque monitoring can help reduce cardiovascular morbidity and mortality. Manual ultrasound plaque classification and characterization methods are time-consuming and can be imprecise due to significant variations in tissue characteristics. We report a novel artificial intelligence (AI)-based plaque tissue classification and characterization system.

METHODS

We hypothesize that symptomatic plaque is hypoechoic due to its large lipid core and minimal collagen, as well as its heterogeneous makeup. Meanwhile, asymptomatic plaque is hyperechoic due to its small lipid core, abundant collagen, and the fact that it is often calcified. We designed a computer-aided diagnosis (CADx) system consisting of three kinds of deep learning (DL) classification paradigms: Deep Convolutional Neural Network (DCNN), Visual Geometric Group-16 (VGG16), and transfer learning, (tCNN). DCNN was 3-D optimized by varying the number of CNN layers and data augmentation frameworks. The DL systems were benchmarked against four types of machine learning (ML) classification systems, and the CADx system was characterized using two novel strategies consisting of DL mean feature strength (MFS) and a bispectrum model using higher-order spectra.

RESULTS

After balancing symptomatic and asymptomatic plaque classes, a five-fold augmentation process was applied, yielding 1000 carotid scans in each class. Then, using a K10 protocol (trained to test the ratio of 90%-10%), tCNN and DCNN yielded accuracy (area under the curve (AUC)) pairs of 83.33%, 0.833 (p < 0.0001) and 95.66%, 0.956 (p < 0.0001), respectively. DCNN was superior to ML by 7.01%. As part of the characterization process, the MFS of the symptomatic plaque was found to be higher compared to the asymptomatic plaque by 17.5% (p < 0.0001). A similar pattern was seen in the bispectrum, which was higher for symptomatic plaque by 5.4% (p < 0.0001). It took <2 s to perform the online CADx process on a supercomputer.

CONCLUSIONS

The performance order of the three AI systems was DCNN > tCNN > ML. Bispectrum-based on higher-order spectra proved a powerful paradigm for plaque tissue characterization. Overall, the AI-based systems offer a powerful solution for plaque tissue classification and characterization.

Prospective study of hypovitaminosis D in acute coronary syndrome

Background: Hypovitaminosis D has emerged as one of risk factors in coronary atherosclerosis either independently or in association with other factors though the causal relationship is not established. Aims: We aimed at finding out the prevalence of vitamin D deficiency in patients with acute coronary syndrome and to study if any association exists between them. Methods: This was a prospective study carried out on 50 hospitalized patients from urban habitations with acute coronary syndrome at Dr. D Y Patil Medical College, hospital Pune (India) during Oct 2012 to Sept 2013. The vitamin D status and other risk factors were studied in these cases and compared with normal control group having 50 subjects without any co-morbidity. Results: 58 % males showed hypovitaminosis D. Vitamin D levels were significantly low (OR3. [8;0.97-15.21];95%CI) in cases with hypertension (65.79%) and 60.53% cases with diabetes mellitus (OR4.6[1.02-19.8] 95%CI). BMI more (Mean 26.9 ± SD 4.95) in cases with low vitamin D levels; but weakly significant (p=0.061). Postprandial hyperglycemia and hypercholesterolemia were inversely associated with vitamin D levels. Acute coronary syndrome had weakly significant association (p=0.091) with hypovitaminosis D in our patients. Conclusion: Vitamin D deficiency was weakly associated with acute coronary syndrome.

Potential of native shrubs Haloxylon salicornicum and Calligonum Polygonoides for restoration of degraded lands in Arid Western Rajasthan, India

Shrub-induced soil property spatial heterogeneity is common in arid and semi-arid ecosystems and aids desertified land restoration. However, the effectiveness of this technique may rely on the plant species used and the habitat conditions present. To assess the degree to which planting two native species, Haloxylon salicornicum and Calligonum polygonoides, facilitates degraded land restoration, soil and herbaceous plant community properties were measured 7 years after planting. Soil samples were extracted at two depths (0-5 and 5-20 cm) from three sub-habitats, i.e., under the shrub canopy, from alleys between shrubs and from the open area. Shrub planting increased the quantity of silt + clay content (30-39 %); enhanced water holding capacities (24-30 %); increased the levels of organic carbon (48-69 %), available nitrogen (31-47 %), available phosphorus (32-41 %), and electrical conductivity (21-33 %); and decreased the pH (7-12 %) and bulk density levels (5-6 %) in the surface layer of soils beneath the canopy. Soil property changes were more significant at the surface (0-5 cm) than in the deeper layer (5-20 cm), and were more pronounced under H. salicornicum than under C. polygonoides. Furthermore, the density and biomass levels of herbaceous plants were 1.1 to 1.2 and 1.4 to 1.6 times greater, respectively, in the shrub alleys than in open area. H. salicornicum induced more robust soil amelioration and herbaceous plant facilitative properties than did C. polygonoides. Artificially planting these shrubs may thus be employed to restore degraded areas of arid regions.

A randomised controlled trial comparing StarClose and AngioSeal vascular closure devices in a district general hospital--the SCOAST study

AIMS

AngioSeal and StarClose are vascular closure devices (VCDs) that can be used following cardiac catheterisation via the femoral artery to achieve haemostasis. Both devices have been demonstrated to be superior to conventional manual pressure, which reduce time to haemostasis and time to patient ambulation. We sought to compare these devices in a prospective, randomised trial.

METHODS

Patients undergoing elective coronary angiography were randomised to receive either AngioSeal VIP or StarClose VCD with immediate postprocedure mobilisation. Bruising was recorded at 30 min, 60 min and at 1 week postprocedure. Patient satisfaction surveys were taken at 1 h and 1 week postprocedure. Complications for both groups were compared.

RESULTS

Four hundred and one patients were included. Arteriotomy closure was achieved in 144 of 208 (69.2%) patients randomised to AngioSeal and 134 of 193 (69.3%) patients randomised to StarClose (p = ns). There was no significant bruising in either group at either 30 or 60 min postprocedure. However, at 1 week, there was significantly more bruising in the AngioSeal group than the StarClose group (63.1 vs. 38.5cm2, p = 0.02). Patient satisfaction and pain perception with the procedure at closure were not significantly different between the groups. Deployment success and instant mobilisation rates were significantly lower for junior, as compared with senior, operators.

CONCLUSION

Achievement of haemostasis is similar with both AngioSeal and StarClose. The StarClose vascular closure device results in significantly less bruising at 1 week postprocedure as compared with AngioSeal, with no significant differences in complication rates. Patients' pain perception and satisfaction are similar with both VCDs.

Bioremediation of pulp and paper mill effluent by a novel fungal consortium isolated from polluted soil

Two basidiomycetous fungi (Merulius aureus syn. Phlebia sp. and an unidentified genus) and a deuteromycetous fungus (Fusarium sambucinum Fuckel MTCC 3788) were isolated from soils affected with effluents of a pulp and paper mill over several years. These isolates were immobilized on nylon mesh and the consortium was used for bioremediation of pulp and paper mill effluent in a continuously aerated bench-top bioreactor. The treatment resulted in the reduction of color, lignin and COD of the effluent in the order of 78.6%, 79.0% and 89.4% in 4 days. A major part of reductions in these parameters occurred within first 24h of the treatment, which was also characterized by a steep decline in the pH of the effluent. During this period, total dissolved solids, electrical conductivity and salinity of the effluent also registered marked decline. It is pertinent to note that this is the first report of bioremediation of pulp and paper mill effluent by an immobilized fungal consortium.

Seasonal variations in different physico-chemical parameters of the effluents of Century Pulp and Paper Mill, Lal Kuan, Uttarakhand

The present study was undertaken with the objective to study the characteristics of the effluent of Century Pulp and Paper Mill, Lalkuan (Uttarakhand) in different seasons. The variations in the physicochemical characteristics were observed and monitored up to 12 months at three different sites. Mean values of temperature, pH, chlorides and total phenols of the effluent were found below, whereas colour, BOD5, COD and lignin concentrations were above the minimum national standards (MINAS).

Management of acute atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia; despite many available guidelines the optimal management strategy remains elusive. The most common presentations of acute AF are palpitations, breathlessness, syncope, dizziness, chest pain, transient ischaemic attack (TIA) and stroke. Patients may need urgent electrical cardioversion (ECV) or pharmacological cardioversion (PCV) and long term anticoagulation therapy. This review aims to discuss some issues surrounding the early management of acute AF in the Acute Medical Unit.

Do Indo-Asians have smaller coronary arteries?

There is a widespread belief that coronary arteries are smaller in Indo-Asians. The aim of the present study was to compare the size of atheroma-free proximal and distal epicardial coronary arteries of Indo-Asians and Caucasians. We analysed normal coronary angiograms from 77 Caucasians and 39 Indo-Asians. The two groups were comparable for dominance of the coronary arteries. Indo-Asian patients had generally smaller coronary arteries, with a statistically significant difference in the mean diameters of the left main coronary artery, proximal, mid and left anterior descending, and proximal and distal right coronary artery segments. There was a non-significant trend towards smaller coronary artery segment diameters for the distal left anterior descending, proximal and distal circumflex, and obtuse marginal artery segments. However, after correction for body surface area, none of these differences in size were statistically significant. Thus, the smaller coronary arteries in Indo-Asian patients were explained by body size alone and were not due to ethnic origin per se. This finding nevertheless has important therapeutic implications, since smaller coronary arteries may give rise to technical difficulties during bypass graft and intervention procedures such as percutaneous transluminal coronary angioplasty, stents and atherectomy. On smaller arteries, atheroma may also give an impression of more severe disease than on larger diameter arteries.

Changes in renal function with percutaneous transluminal coronary angioplasty

There is concern about adverse effects on renal function in patients with prolonged cardiac intervention procedures, when contrast media is used. To investigate this further we studied changes in renal function in 104 patients (79 male, 25 female; mean age 59.2, SD 9.8) undergoing routine elective percutaneous transluminal coronary angioplasty (PTCA), where 28 (27%) patients had concomitant stent implantation. There was associated diabetes in 15 patients (14%) and previous hypertension in 44 (blood pressure >160/90 mmHg, 44%). None of the patients were known to have congestive heart failure at the time of procedure or chronic renal failure (defined as serum creatinine >200 pmol/l). There was no significant change in mean serum urea pre- and post-PTCA (mean change -0.04 mmol/l, paired t-test P=0.90). However, there was a small rise in serum creatinine pre- and post-PTCA of borderline significance (mean change +5.8 micromol/l, P=0.051). Of the whole cohort, 65 patients (63%) had a rise in mean serum creatinine, whilst 45 (43%) showed a rise in serum urea levels. This deterioration in renal function was related to a difference in the procedure duration, but there were no statistically significant differences in mean age or volume of contrast media (Iopamide 340) between patients with or without deterioration in renal function. Patients with a rise in serum creatinine had lower baseline (pre-PTCA) serum urea and serum creatinine levels. In patients undergoing stent implantation, there was a higher quantity of contrast media, screening time and procedure duration. There were no significant differences in age, pre-PTCA serum urea and creatinine levels, and mean change in serum urea or creatinine levels in patients with and without stent usage. Whilst severe renal dysfunction following PTCA is uncommon, we suggest that some caution is necessary during PTCA or other cardiac interventions where more complex or prolonged procedures necessitating large volumes of contrast media use.

Modification of glutamine synthetase in Bacillus brevis AG 4

The various forms of glutamine synthetase obtained from Bacillus brevis have been found to be antigenically identical. Alkaline phosphatase treatment of the fast moving form (GS4) reduced the electrophoretic mobility of the enzyme. Radiolabelling and autoradiographic studies have also indicated that 32P-incorporation is high in the form depicting high Rm value. Thus, it appears that these forms arise due to covalent modification of the enzyme involving a phosphate group.

Subcellular Localization of Zinc and Calcium in Bean (Phaseolus vulgaris L.) Tissues

Two bean (Phaseolus vulgaris L.) cultivars differing in growth responses to zinc were examined for differences in uptake and subcellular localization of (65)Zn during a 15-day growth period. The zinc-sensitive cultivar Sanilac showed initially a much higher rate of absorption, which declined after 24 hours. The zinc-tolerant cultivar Saginaw showed a slow but steady rate of absorption for 10 days. In roots as well as in stem callus tissues of both cultivars, three-fourths of the absorbed (65)Zn was localized in the "cytoplasmic" supernatant fractions (containing ribosomes and vacuolar sap). Very little (less than 7%) (65)Zn was localized in the cell wall fraction. There was a much greater proportion of the absorbed (65)Zn localized in root mitochondria and nuclei of the zinc-sensitive Sanilac than in the zinc-tolerant Saginaw. Stem callus tissues, however, did not show such cultivar differences in zinc accumulation at the sub-cellular level.Calcium-45 distribution in the cultivar Redkote showed preferential affinity for cell walls both in roots and stem cellus tissue. The percentage of absorbed (45)Ca associated with cell wall fractions of roots gradually increased with a corresponding decline in the percentage of radioactivity associated with the cytoplasmic fraction. At 15 days, 57% of the total (45)Ca in the roots was localized in the cell walls. A similar, albeit less pronounced, preferential (45)Ca sorption on cell walls occurred for the callus tissue. Calcium-45 also accumulated at later stages in the nuclear fraction, but there was no mitochondrial accumulation.