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Sabrina Fabi,1 Tatjana Pavicic,2 André Braz,3 Jeremy B Green,4,5 Kyle Seo,6 Jani AJ van Loghem7 1Cosmetic Laser Dermatology, San Diego, CA, USA; 2Private Practice for Dermatology and Aesthetics, Munich, Germany; 3Division of the Policlínica Geral do Rio de Janeiro (PGRJ), Rio de Janeiro, Brazil; 4Skin Associates of South Florida, Miami, 5University of Miami Department of Dermatology, Miami, FL, USA; 6Seoul National University, Seoul, South Korea; 7Doctors Inc., Amsterdam, The Netherlands Abstract: The Merz Institute of Advanced Aesthetics Expert Summit was held in Prague, Czech Republic, from 19–20 November 2016. The meeting had a distinct advisory board character and invited aesthetic practitioners from all over the world to hear an international faculty present a range of keynote lectures and conduct live injection sessions with an emphasis on recent developments in combination aesthetic interventions for face and body rejuvenation and beautification. Aging is associated with changes in bones, muscles, ligaments, adipose tissue, and skin and, moreover, involves interactions among these tissue types. To achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected, which generally involves treatment with more than a single agent or technology. Presentations described innovative treatment algorithms for the face and body and focused on patients’ desires for natural-looking rejuvenation and how this requires a three-dimensional approach combining products that relax the musculature, volumize, and re-drape the skin. Besides treating the aging face, these procedures are increasingly used to enhance facial features as well as to delay facial aging in younger patients. The presentations covered patients from different ethnicities as well as the treatment of non-facial areas, with a particular focus on the use of Ultherapy® for skin lifting and tightening, and new aesthetic procedures such as Cellfina® and diluted Radiesse®. The current report provides a summary of key presentations from the meeting. Keywords: calcium hydroxylapatite, Cellfina, hyaluronic acid, incobotulinumtoxinA, Ultherapy

The Ka'u District of Hawaii is exposed to sulfurous air pollution called vog from the ongoing eruption of Kilauea Volcano. Increased volcanic activity in 2008 prompted an indoor air quality assessment of the district's hospital and schools. All indoor sulfur dioxide concentrations were above the World Health Organization's average 24-hour recommendation. Indoor penetration ratios were up to 94% of ambient levels and dependent upon building construction or the use of air-conditioning. Health-promotion efforts for vulnerable populations at the hospital and schools are under way to improve indoor air quality and respond to those affected by vog exposure. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is a chronic condition prevalent worldwide. Type 2 diabetes is the most common form of diabetes, comprising 90% to 95% of all cases. Over the last few decades, the importance of glycemic control and its impact on prevention of diabetes-related complications has been documented in multiple clinical trials. As most patients with type 2 diabetes will require pharmacologic intervention to achieve and maintain appropriate glycemic control, new medications targeting different aspects of the pathophysiology of type 2 diabetes have been a significant focus of research and development. During the last decade, multiple new medications for diabetes management have become available: these medications have novel mechanisms of action, differences in effectiveness, and varying side effect profiles which will be reviewed in this article. Some of these newer medications, such as the GLP.1 analogues and DPP.4 inhibitors, have become widely accepted as therapeutic options for the management of type 2 diabetes. Additional classes of glucose-lowering medications are expected to become available in the near future. This manuscript will summarize available data regarding these newer and prospective medications for the management of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Ultra-rapid-acting insulin analogs (URAA) are a further development and refinement of rapid-acting insulin analogs. Because of their adapted formulation, URAA provide an even faster pharmacokinetics and thus an accelerated onset of insulin action than conventional rapid-acting insulin analogs, allowing for a more physiologic delivery of exogenously applied insulin. Clinical trials have confirmed the superiority of URAA in controlling postprandial glucose excursions, with a safety profile that is comparable to the rapid-acting insulins. Consequently, many individuals with diabetes mellitus may benefit from URAA in terms of prandial glycemic control. Unfortunately, there are only few available recommendations from authoritative sources for use of URAA in clinical practice. Therefore, this expert consensus report aims to define populations of people with diabetes mellitus for whom URAA may be beneficial and to provide health care professionals with concrete, practical recommendations on how best to use URAA in this context., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: FG has served as an advisor for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Medtronic, Novo Nordisk, Roche Diabetes Care, Sanofi; has served as a research investigator for Eli Lilly, Novo Nordisk, Roche Diabetes Care; and has received grants from Eli Lilly and Roche Diabetes Care. TB served on advisory panels of Novo Nordisk, Sanofi, Eli Lilly, Boehringer Ingelheim, Medtronic, and Indigo Diabetes. TB received honoraria for participating on the speaker’s bureau of Eli Lilly, Novo Nordisk, Medtronic, Abbott, Sanofi, Aventis, AstraZeneca, and Roche. TB’s institution received research grant support from Abbott, Medtronic, Novo Nordisk, Sanofi, Novartis, Sandoz, and Zealand Pharma, Slovenian Research Agency, the National Institutes of Health, and the European Union. RMB has received research support, has acted as a consultant, or has been on the scientific advisory board for Abbott Diabetes Care, Ascensia, Bigfoot Biomedical, Inc., CeQur, DexCom, Eli Lilly, Embecta, Hygieia, Insulet, Medtronic, Novo Nordisk, Onduo, Roche Diabetes Care, Tandem Diabetes Care, Sanofi, United Healthcare, Vertex Pharmaceuticals and Zealand Pharma. RMB’s employer, nonprofit HealthPartners Institute, contracts for his services and he receives no personal income for these activities. TF has served on speaker panels for Amarin, AstraZeneca, Boehringer Ingelheim, Berlin Chemie, Cipla, Daiichi-Sankyo, Eli Lilly, Fortbildungskolleg, MSD, Novartis, Novo Nordisk, Sanofi, and Santis and has served on advisory panels for AstraZeneca, Atrogi, Bayer, Cipla, Diabetes Akademie Bad Mergentheim, Eli Lilly, Eysense, Fortbildungskolleg, Novo Nordisk, Pfizer, Sanofi, Remynd, and Roche. JBG receives research support from Merck Sharp and Dohme Ltd., Eli Lilly and Company, Boehringer Ingelheim, and Roche; and is a consultant for AstraZeneca, Novo Nordisk, Pfizer, Bayer, Anji, Boehringer Ingelheim, Eli Lilly and Company, Valo, and Vertex. CM serves or has served on the advisory panel for Novo Nordisk, Sanofi, Merck Sharp and Dohme Ltd., Eli Lilly and Company, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Imcyse, Insulet, Zealand Pharma, Avotres, MannKind, Sandoz, and Vertex. Financial compensation for these activities has been received by KU Leuven; KU Leuven has received research support for CM from Medtronic, Imcyse, Novo Nordisk, Sanofi, and ActoBio Therapeutics; CM serves or has served on the speakers’ bureau for Novo Nordisk, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, AstraZeneca, and Novartis. Financial compensation for these activities has been received by KU Leuven. CM is president of EASD. All external support of EASD is to be found on www.easd.org. HWR served as a consultant for and/or has received research support from Bayer, Boehringer Ingelheim, Eli Lilly, Inversago, Medtronic, Merck, MSD, Novo Nordisk, Pacira, and Sanofi. OS is founder and CEO of Sciarc GmbH. OS served on speaker panels and/or on advisory panels for Abbott, Bayer, Boehringer Ingelheim, Eli Lilly, Glooko, LifeScan, Lilly, Mannkind, Sanofi, and Woerwag. EGW has received personal fees from Abbott, AstraZeneca, Dexcom, Eli Lilly, Embecta, Glooko, Insulet, Medtronic, Novo Nordisk, Roche, Sanofi, and Ypsomed and research support from ABCD, Abbott, Diabetes UK, Embecta, Insulet, Novo Nordisk, and Sanofi.

Background: In the EMPA-KIDNEY trial, empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, had positive cardiorenal effects in patients with chronic kidney disease who were at risk for disease progression. Post-trial follow-up was designed to assess how the effects of empagliflozin would evolve after the discontinuation of the trial drug., Methods: In the active trial, patients with chronic kidney disease were randomly assigned to receive either empagliflozin (10 mg once daily) or matching placebo and were followed for a median of 2 years. All the patients had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m 2 of body-surface area or an eGFR of at least 45 but less than 90 ml per minute per 1.73 m 2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Subsequently, surviving patients who consented were observed for 2 additional years. No trial empagliflozin or placebo was administered during the post-trial period, but local practitioners could prescribe open-label SGLT2 inhibitors, including open-label empagliflozin. The primary composite outcome was kidney disease progression or cardiovascular death as assessed from the start of the active-trial period to the end of the post-trial period., Results: Of the 6609 patients who had undergone randomization in the active trial, 4891 (74%) were enrolled in the post-trial period. During this period, the use of open-label SGLT2 inhibitors was similar in the two groups (43% in the empagliflozin group and 40% in the placebo group). During the combined active- and post-trial periods, a primary-outcome event occurred in 865 of 3304 patients (26.2%) in the empagliflozin group and in 1001 of 3305 patients (30.3%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.72 to 0.87). During the post-trial period only, the hazard ratio for a primary-outcome event was 0.87 (95% CI, 0.76 to 0.99). During the combined periods, the risk of kidney disease progression was 23.5% in the empagliflozin group and 27.1% in the placebo group; the risk of the composite of death or end-stage kidney disease was 16.9% and 19.6%, respectively; and the risk of cardiovascular death was 3.8% and 4.9%, respectively. There was no effect of empagliflozin on death from noncardiovascular causes (5.3% in both groups)., Conclusions: In a broad range of patients with chronic kidney disease at risk for progression, empagliflozin continued to have additional cardiorenal benefits for up to 12 months after it was discontinued. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EuDRACT number, 2017-002971-24.)., (Copyright © 2024 Massachusetts Medical Society.)

Psychiatry lags in adopting etiological approaches to diagnosis, prognosis, and outcome prediction compared to the rest of medicine. Etiological factors such as childhood trauma (CHT), substance use (SU), and socioeconomic status (SES) significantly affect psychotic disorder symptoms. This study applied an agnostic clustering approach to identify exposome clusters "Exposotypes (ETs)" and examine their relationship with clinical, cognitive, and functional outcomes. Using data from individuals with psychotic disorders (n=1,350), and controls (n=623), we assessed the relationship between the exposotypes and outcomes. Four exposotypes were identified: ET1 characterized by high CHT and SU; ET2, high CHT; ET3, high SU; ET4, low exposure. Compared to ET4, ET1 demonstrated higher positive and general symptoms, anxiety, depression, impulsivity, and mania; ET2 had higher anxiety, depression, and impulsivity; ET3 had better cognitive and functional outcomes with lower negative symptoms. Intracranial volume was largest in ET3, and smallest in ET2. No group differences in schizophrenia polygenic risk scores were found. The age of onset was 5 years earlier in ET1 than in ET4. These findings provide insight into the complex etiological interplay between trauma, and SU, as well as their unique effects on clinical symptoms, cognition, neurobiology, genetic risk, and functioning.

Background and Hypothesis: Finerenone, a selective nonsteroidal MRA, and SGLT2is both reduce CKD progression and improve kidney/CV outcomes. The CONFIDENCE study (NCT05254002; EudraCT 2021-003037-11) hypothesis is that early combination of finerenone and empagliflozin, a SGLT2i, is superior to either drug alone in reducing UACR over 6 months., Methods: CONFIDENCE is an ongoing, fully enrolled, randomized, controlled, double-blind, multicentre phase 2 clinical trial in adults (≥18 years of age) with CKD and T2D, eGFR of 30 to 90 ml/min/1.73 m2, and UACR of ≥100 to <5000 mg/g. Participants taking the clinically maximum tolerated dose of a renin-angiotensin system inhibitor for >1 month at screening were eligible. Participants were randomized 1:1:1 to once daily finerenone plus empagliflozin, finerenone plus placebo, or empagliflozin plus placebo; doses were 10 mg once daily for empagliflozin and 10 or 20 mg once daily for finerenone, depending on eGFR at baseline. Randomization was stratified by eGFR (< or ≥60 ml/min/1.73 m2) and UACR (≤ or >850 mg/g). The primary efficacy outcome is the relative change in UACR from baseline at Day 180., Results: There were 818 participants randomized across 143 sites from 14 countries between July 2022 and August 2024. Mean eGFR (ml/min/1.73 m2 [SD]) was 54.2 (17.1). Median UACR (mg/g [IQR]) was 583 (292, 1140). Mean HbA1c (% [SD]) was 7.3 (1.2). Mean systolic/diastolic BP (mmHg) was 135.2/77.3. GLP-1 RAs and insulin were used by 182 (23%) and 313 (39%) participants, respectively. Atherosclerotic CV disease, diabetic retinopathy, and a history of heart failure were present in 223 (28%), 126 (16%), and 30 (4%) participants, respectively., Conclusions: The CONFIDENCE trial enrolled a diverse population with CKD and T2D and will determine the impact of simultaneous initiation of combination finerenone and a SGLT2i versus individual therapy on potentially mitigating the progression of CKD in people with T2D. Trial registration number: Clinicaltrials.gov NCT05254002; EudraCT 2021-003037-11., (© The Author(s) 2025. Published by Oxford University Press on behalf of the ERA.)

Background: Microfocused ultrasound with visualization (MFU-V) is widely used in aesthetic medicine for skin tightening and rejuvenation. However, its role in regenerative aesthetics and its precise mechanism of action are not fully understood., Objective: This narrative review aims to contextualize and articulate the mechanism of action of MFU-V, evaluate its role in regenerative aesthetics, and assess its effectiveness based on existing clinical, histological, and skin-mechanical studies., Methods: A comprehensive literature search was performed to collect and analyze studies on MFU's biological mechanisms, clinical outcomes, and impact on extracellular matrix (ECM) regeneration. The review integrates findings from clinical trials, histological analyses, and biomechanical assessments to provide a cohesive understanding of MFU-V's role in aesthetic medicine., Results: MFU-V emits focused ultrasound energy that penetrates multiple skin layers and the superficial musculoaponeurotic system, creating localized thermal coagulation points. These points initiate biological responses that recruit fibroblasts and stimulate the production of new collagen and elastin fibers. Enhanced ECM protein synthesis leads to significant improvements in skin biomechanics and quality, reducing skin laxity and enhancing appearance. Clinical studies support these findings, showing improvements in skin firmness and texture following MFU-V treatment., Conclusion: Through analyzing the underlying biological mechanisms and the observable clinical outcomes, this narrative review sets the stage for a comprehensive understanding of the mechanism of action and role of MFU-V in regenerative aesthetics., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Despite the recognition by key guidelines that achieving early glycaemic control has important benefits in individuals with type 2 diabetes (T2D) and that addressing excess adiposity is one of the central components of comprehensive person-centred T2D care, a substantial proportion of individuals with T2D do not meet their metabolic treatment goals. Prior treatment paradigms were limited by important treatment-associated risks such as hypoglycaemia and body weight gain. Therefore, a more conservative, sequential approach to treatment was typically utilized. One potential consequence of this approach has been a missed opportunity to achieve a 'legacy effect', where early treatment to reach glycaemic targets is associated with enduring long-term benefits in T2D. Additionally, while previous treatment approaches have addressed core defects in T2D, including insulin resistance and β-cell function decline, they have been unable to address one of the underlying causal abnormalities-excess adiposity. Here, we review currently available evidence for the beneficial long-term effects of early glycaemic control and management of body weight in people with T2D and discuss potential next steps., (© 2025 Eli Lilly and Company and The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Background: Retinol isotope dilution (RID) equations are used to predict vitamin A total body stores (TBS). Including population-based ("super-subject") modeling with RID provides group-specific values for the equation coefficients., Objectives: The objective was to test an approach that would accommodate a limited super-subject sample size without compromising accuracy in RID predictions of TBS., Methods: We used Simulation, Analysis and Modeling software to simulate fraction of dose in plasma (FD p ) at 16 times from 3 h to 56 d after tracer ingestion in 20 theoretical adults. Then, we modeled geometric mean FD p ("full dataset") to determine group mean TBS and the coefficients Fa (FD in stores) and S (specific activity in plasma/stores) in the RID equation TBS (μmol) = FaS/plasma retinol specific activity. Using the same FD p data, we also generated 4 datasets with reduced subject numbers at times other than that designated for RID (day 21). Then, we adjusted individual FD p using the ratio (individual FD p on day 21/mean FD p on day 21; "adjusted datasets"), modeled each, and determined TBS and FaS for comparison with the full dataset values., Results: Mean ratio of model-predicted TBS for adjusted/full dataset was 0.962 (range: 0.920-1.06) and for FaS, it was 0.945 (day 14), 0.971 (day 21), and 0.984 (day 28)., Conclusions: For these theoretical data, adjusting individual FD p values based on relationship to the group mean FD p at an appropriate time (21 d) maintains the accuracy of model predictions of TBS and the RID composite coefficient FaS. If these results are confirmed using real data, values for FaS determined in a small super-subject study can be applied to confidently predict TBS by RID in that group's individuals. This approach will be especially useful when resources are limited for studies of vitamin A status in community settings., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2025 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Individuals with psychosis symptoms are at high risk for suicidal ideation and attempts. The prevalence and correlates of suicidal ideation and attempts in clinical high risk for psychosis (CHR-P) have yet to be clarified. This study reports on the prevalence and clinical correlates of suicidal ideation and attempts in a clinical CHR-P sample., Method: Participants (n = 135) included CHR-P clients at a CHR-P community specialty clinic, who participated in a clinical assessment between 2017 and 2022. Assessments measured attenuated psychosis symptoms, suicidal ideation and attempts, clinical covariates, and functioning. Frequency analyses assessed the prevalence of lifetime suicidal ideation and attempts and t-test and Chi-square identified clinical correlates. Logistic regression assessed the relationship between significant clinical correlates and lifetime suicide attempts., Results: Sixty-five percent of participants at CHR-P endorsed lifetime suicidal ideation, while 22.2% reported at least one lifetime attempt. Correlates for lifetime suicidal ideation included self-reported gender expansive identity, hopelessness, depression, trauma, obsessive compulsive symptoms, insight: reflectiveness, trauma diagnoses, mood disorder diagnoses, and perceptual abnormalities/hallucinations. Significant correlates for lifetime suicide attempts included self-reported hopelessness, depression, trauma diagnosis and mood disorder diagnosis., Conclusion: CHR-P clients are at a higher risk for suicidal ideation and attempts compared to the general population. Correlates of suicidal ideation and attempts may be diagnostically heterogeneous and therefore interventions should be tailored to specific clinical needs. Clients with trauma-disorder diagnoses may be at highest risk for suicidal ideation and attempts. Continued intervention and longitudinal research is needed to clarify causal risk factors and establish evidence-based treatments for suicidal ideation and attempts in CHR-P., (© 2024 John Wiley & Sons Australia, Ltd.)

Background: Neuromodulator injections are minimally invasive procedures performed across the globe. Despite their ubiquity, there is a dearth of information on whether and how needle tips used for neuromodulator procedures are deformed after repeated injections., Objective: We investigated the magnitude of needle tip deformation following sequential injection passes (3×, 5×, and 10×) during facial neuromodulator injections with three commonly used needle sizes (30G, 31G, and 32G)., Methods: Neuromodulator was administered for four different aesthetic indications. Each collected needle was mounted and imaged in a Philips XL-30 Scanning electron microscope. Images were processed using ImageJ photo analysis software., Results: Forty-five needle tips were investigated. When comparing the facial regions of interest, a statistically significant difference in deformation percentage was found when injecting 10× (p = 0.044) with greatest damage after injecting the glabella (38.4%), followed by lateral canthus (27.9%), forehead (27.5%), and midface (23.1%). Independent of facial region targeted, the mean percentage of needle deformation at 3× was 14.8%, at 5× 19.6%, and at 10× 29.2% with p < 0.001. Smaller needle size corresponded to smaller percentage of damage., Conclusion: Exchanging needles after more than five injection passes will minimize needle deformation and likely increase injection precision., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: SGLT-2i and GLP-1RA are recommended for persons with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD); for those prescribed, little is known about reasons for discontinuation., Methods: From the COORDINATE-Diabetes randomized trial database, the frequency and reasons for discontinuation of SGLT2i or GLP-1RA were analyzed., Results: 1045 participants were enrolled 7/2019 to 5/2022; 290 (27.8%) were prescribed SGLT-2i of whom 67 (23.1%) discontinued; and 118 (11.3%) were prescribed GLP-1RA of whom 38 (32.2%) discontinued. Race, age and sex did not differ among those discontinuing either class. Medicare was more common among those discontinuing vs persisting with SGLT-2i (71.4 vs. 58.1%; p=0.058) and GLP-1RA (71.1 vs. 49.4%); p=0.027). Cost, side effects, and patient choice were common reasons for discontinuation., Conclusion: Up to one-third of participants discontinued either an SGLT-2i or GLP-1RA within 12 months of initiating. Efforts to address modifiable contributors to discontinuation are required., Competing Interests: Conflict of interest AJN: Advisory board panel/consulting for Amgen, Boehringer Ingelheim, Eli Lilly, GSK, Merck, Novartis, Novo Nordisk, Sanofi, VAXXINITY. Grants from National Heart Foundation of Australia, Diabetes Australia and the Royal Australasian College of Physicians.; LK – None; DKM - Personal fees from Novo Nordisk, Lilly USA, Pfizer, Boehringer Ingelheim, NewAmsterdam, AstraZeneca, CSL Behring, Esperion, Bayer, Lexicon, Altimmune, Esperion, Intercept Pharmaceuticals, Amgen, Neurotronics, Applied Therapeutics, Merck & Co. ML – None; HRA – None; LW – None; RDL - Grants and personal fees from Bristol-Myers Squibb and Pfizer, personal fees from Boehringer Ingelheim, Novo Nordisk, and Bayer AG and grants from Amgen Inc, GlaxoSmithKline, Medtronic PLC, and Sanofi Aventis; RP-B - Research support (to the University of Michigan) from AstraZeneca, and grant support from the National Institutes of Health (NIDDK-1-R01-DK-107956-01, UC4 DK101108); MAC - Consulting fees from AstraZeneca, Boehringer Ingelheim, Edwards Lifesciences, Merck, and Sanofi-Aventis. He has received research funding (nonsalary) from Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, GlaxoSmithKline, Novartis, and Takeda and research funding (salary) from Novo-Nordisk; VRA - Consulting fees from Duke University, Liberum, Novo Nordisk, and Sanofi; research grant support paid to her institution from Applied Therapeutics, Fractyl/Premier, Novo Nordisk, and Sanofi; and her spouse was/is an employee of Merck and Janssen; MLM - Consulting fees from Boehringer Inhelheim and Novo Nordisk; CRR – None; IL - Grant support from Merck, Mylan, Novo Nordisk, Pfizer and Sanofi, personal fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Intarcia, Janssen, Mannkind, Novo Nordisk, Sanofi, TARGETPharma and Valeritas; and non-financial support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Novo Nordisk, Pfizer and Sanofi; JKK – None; AP - Supported by the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute of Aging GEMSSTAR Grant (1R03AG067960-01), and Applied Therapeutics; has served on the advisory board for Roche Diagnostics; and has received nonfinancial support from Pfizer and Merck; TG - Employee of Boehringer Ingelheim; JP - Employee of Boehringer Ingelheim; AW - Employee of Lilly Pharmaceuticals; CS - Employee of Lilly Pharmaceuticals; JBG - Grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Sanofi, and personal fees from AstraZeneca, Merck, Boehringer‐Ingelheim, Sanofi/Regeneron, and NovoNordisk; CBG - Research grants and consulting/speaker fees from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceutica Products, L.P., and Pfizer, research grants from AKROS, Apple, AstraZeneca, Daichii-Sankyo, US Food & Drug Administration, GlaxoSmithKline, Medtronic Foundation, and Novartis Pharmaceutical Company, consulting/speaker fees from Abbvie, Bayer Corp US, Boston Scientific Corp, CeleCor Therapeutics, Correvio, Espero BioPharma, Medscape, Medtronic Inc., Merck, National Institutes of Health, NovoNordisk, Rhoshan Pharmaceuticals, and Roche Diagnostics; NJP - Grants from Alnylam, Amgen, Bayer, Boehringer Ingelheim, Eggland's Best, Eli Lilly, Novartis, Novo Nordisk, Merck; Amgen, Bayer, Boehringer Ingelheim, CRISPR Therapeutics, Eli Lilly, Esperion, AstraZeneca, Merck, Novartis, and Novo Nordisk; Executive Committee member for trials sponsored by Novo Nordisk and by Amgen and by AstraZeneca; DSMB for trials sponsored by J + J and Novartis; Medical advisory board for Miga Health., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: Glabellar contraction patterns were introduced to the scientific literature to help guide glabellar neuromodulator injection algorithms. However, the relationship between the underlying musculature and its influence on these glabellar contraction patterns is unclear., Objectives: The aim of this study was to identify by magnetic resonance imaging (MRI) glabellar muscle parameters that display an influence on the distribution of individual glabellar contraction patterns., Methods: Thirty-four healthy young individuals of Caucasian Polish descent were investigated (17 females, 17 males) with a mean age of 23.6 years and a mean BMI of 22.8 kg/m2. MRI-based measurements of length, thickness, width, and surface area of procerus, corrugator supercilii, orbicularis oculi, and frontalis muscles were conducted., Results: Unadjusted models revealed that there was no statistically significant difference between the 5 glabellar contraction types and the investigated muscle parameters, indicating that, independent of the skin rhytid pattern, the underlying musculature was not different between the investigated groups in this sample, with all P ≥ .102. Adjusted models revealed that sex was the most influential factor, with males generally displaying higher values for the investigated parameters than females., Conclusions: The results of this study reveal that, based on the MRI parameters investigated and the investigated cohort, there does not appear to be a strong relationship between glabellar contraction patterns and underlying glabella muscle anatomy. Utilizing glabellar contraction patterns to design neuromodulator treatment algorithms may be of variable clinical merit., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Aesthetic neuromodulator injections of the upper face are frequently performed to temporarily block muscular actions of the periorbital muscles to ultimately reduce skin rhytids. However, the adverse event rate in the literature for toxin-induced blepharoptosis ranges from 0.51% to 5.4%., Objective: To identify access pathways by which injected neuromodulator product can travel from extra- to intra-orbital and therefore affect the levator palpebrae superioris muscle., Methods: Nine non-embalmed human body donors were investigated in this study with a mean age at death of 72.8 (16.1) years. The 18 supraorbital regions were injected in 28 times (14 for supratrochlear and 14 for supraorbital) with 0.5 cc, whereas eight cases (four for supratrochlear and four supraorbital) were injected with 0.1 cc of colored product. Anatomic dissections were conducted to identify structures stained by the injected color., Results: The results of this injection- and dissection-based study revealed that both the supratrochlear and the supraorbital neurovascular bundles are access pathways for injected neuromodulator products to reach the intra-orbital space and affect the levator palpebrea superioris muscle. Out of 36 conducted injection passes, seven (19.44%) resulted in affection of the sole elevator of the eyelid of which 100% occurred only at an injection volume of 0.5 cc and not at 0.1 cc., Conclusion: Clinically, the results indicate that a low injection volume, a superficial injection for the supraorbital location, and angling the needle tip away from the supratrochlear foramen (toward the contralateral temple) when targeting the corrugator supercilii muscles, can increase the safety profile of an aesthetic toxin glabellar treatment., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Children attending school/daycare are at high risk of acute respiratory tract infections. EpiCor TM postbiotic, derived from yeast fermentate, has been demonstrated to improve immune function in adults, reducing the incidence of cold/flu-like or allergy symptoms. As such, studies are warranted in children as available pharmaceutical options have unwanted side effects., Methods: Two-hundred and fifty-six children aged 4-12 years attending school/daycare were randomized to either EpiCor or Placebo for 84 days during the 2022-2023 flu season in Ontario, Canada. The Canadian Acute Respiratory Illness and Flu Scale (CARIFS) and study diary assessed the incidence and severity of cold/flu symptoms and the use of cold/flu medications. Adverse events were recorded., Results: Total CARIFS severity scores, 'sore throat' and 'muscle aches or pains' symptom scores in the EpiCor group were significantly lower compared to Placebo during incidences of cold/flu (P ≤ 0.05). Participants taking Placebo were 1.73 times more likely to use cold/flu medication compared to those receiving EpiCor (P = 0.04). The incidence of cold/flu symptoms was not significantly different between groups. EpiCor was found to be safe and well-tolerated., Conclusions: EpiCor supplementation resulted in significantly lower cold/flu symptom severity and less cold/flu medication usage than Placebo demonstrating a beneficial effect on immune function in children., Impact: Children are at high risk of acquiring cold/flu infections and safe and efficacious mitigating regimens are lacking. Children supplemented daily with 500 mg EpiCor TM postbiotic derived from yeast fermentate had significantly lower overall cold/flu symptom severity, and severity of sore throat and muscle aches or pains over the 84-day supplementation period. EpiCor supplementation resulted in decreased use of traditional cold/flu medication. Daily supplementation with 500 mg of EpiCor for 84 days was safe and well tolerated by healthy children aged 4-12 years attending school or daycare., Competing Interests: Competing interests: V.G.C, J.G, N.P, J.D.S. are employees of Cargill Limited c/o Cargill Inc., R.S, M.M, D.C.C, H.A, E.D.L are employees of KGK Science Inc., M.E is a faculty member at Western University. All authors declare no competing interests. Ethical and regulatory approval: This randomized, double-blind, placebo-controlled, parallel study was conducted at KGK Science Inc. (London, Ontario, Canada) from September 2022 to April 2023. The study was reviewed by the Natural and Non-Prescription Health Products Directorate (NNHPD), Health Canada, Ottawa, Ontario and approved on March 03, 2022. Ethics approval was granted on June 17, 2022, by the Institutional Review Board Services (Aurora, Ontario, Canada; Pro00063328). The trial followed CONSORT guidelines for randomized controlled trials20 (Supplementary Table 2) and written informed consent was obtained from all participants prior to the initiation of any study procedures. The study was registered with Clinicaltrials.gov (NCT05492370). Informed consent: Each participant and their parent(s) or legal guardian gave written informed consent to participate in the study., (© 2024. The Author(s).)

Introduction: Atrial fibrillation and flutter (AF) are common in patients with type 2 diabetes and are associated with worse outcomes., Methods: Harmony Outcomes was a multicenter, event-driven, double-blind, placebo-controlled trial comparing the effects of albiglutide, a glucagon-like peptide-1 (GLP1) receptor agonist, with placebo on a composite of major adverse cardiac events (MACE; non-fatal myocardial infarction; non-fatal stroke and cardiovascular death) in 9,463 patients aged >40years with type-2 diabetes and established cardiovascular disease. Herein, the cardiovascular effects of albiglutide in patients with and without AF, as well as the effects on AF events during follow-up, were analyzed., Results: Patients with a history of AF (8.9%) exhibited a higher event rate for the primary composite MACE endpoint during 1.6 years of follow-up (12.7 vs. 6.3 events/100 person-years, adjusted hazard ratio (aHR)1.41 (95% Confidence Interval (CI)1.14-1.74, p=0.001). Treatment with albiglutide reduced the occurrence of the primary endpoint irrespective of history of AF at baseline (history of AF: aHR0.83 (0.58-1.19), no history of AF: aHR0.77 (0.66-0.90); pinteraction=0.71). During follow-up, 239 patients (2.5%) experienced an AF event. Overall, Albiglutide was associated with numerically fewer AF events (108 vs 131; HR 0.82 (0.63-1.06, p=0.12), irrespective of baseline history of AF (pinteraction=0.92)., Conclusions: In patients with type 2 diabetes, treatment with albiglutide, compared to placebo, reduced the risk of cardiovascular events irrespective of history of AF. Further, albiglutide treatment did not increase AF adverse events but was associated with a trend to a lower rate of AF events during follow-up without reaching statistical significance., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: A well-defined jawline improves overall facial aesthetics, motivating patients to seek jawline augmentation., Objectives: In this study we evaluated the safety and effectiveness of the hyaluronic acid injectable gel VYC-25L for restoring jawline definition., Methods: In a US multicenter, evaluator-blinded study adults with grade 2 (moderate) or 3 (severe) Allergan Loss of Jawline Definition Scale (ALJDS) scores were randomized. Participants were randomized to the VYC-25L treatment group or control group at study onset, with 12-month follow-up. The control group had the option to receive treatment after 6 months (primary endpoint completion). Effectiveness measures included Month 6 ALJDS responders rate (proportion of participants with ≥1-grade improvement from baseline on both sides), FACE-Q Satisfaction With Lower Face and Jawline scores, and Global Aesthetic Improvement Scale (GAIS) responders (improved/much improved) as assessed by the investigator and participants. Injection site responses (ISRs) and adverse events (AEs) were monitored., Results: At Month 6, ALJDS responder rates were 69.0% vs 38.0% in the VYC-25L treatment (n = 157) and control (n = 49) groups, respectively (P = .0001). In the VYC-25L treatment group, FACE-Q scores improved by a mean of 45.9 points from baseline at Month 6 (P < .0001). Furthermore, 88.4% and 89.0% of participants in the VYC-25L treatment group were GAIS responders at Month 6 by participant and investigator assessment, respectively. Most ISRs were mild or moderate and resolved within 2 weeks. Most treatment-related AEs were mild and resolved within 1 week., Conclusions: VYC-25L safely and effectively restores jawline definition through 1 year., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)

Patients with chronic kidney disease (CKD) are at risk of progressive loss of kidney function, heart failure, and cardiovascular death despite current proven therapies, including renin-angiotensin system inhibitors (RASi), sodium glucose co-transporter-2 inhibitors (SGLT2i), and statin-based regimens. RASi and SGLT2i reduce risk of CKD progression irrespective of primary cause of kidney disease, suggesting they target final common pathways. Targeting aldosterone overactivity with a nonsteroidal mineralocorticoid receptor antagonist (MRA) also reduces cardiorenal risk in patients with albuminuric diabetic kidney disease already treated with RASi. Together, these observations provide the rationale for trials to assess effects of inhibiting the aldosterone pathway in a broader range of patients with CKD, including those with non-diabetic causes of CKD or low albuminuria. Aldosterone synthase inhibitors (ASi) have emerged as an alternative to MRAs for aldosterone pathway inhibition. Phase II data from 586 patients with albuminuric CKD have shown that 10 mg of an ASi, vicadrostat (BI 690517), reduced urine albumin-to-creatinine ratio by ∼40% compared to placebo with or without concurrent empagliflozin treatment. MRA and ASi increase risk of hyperkalaemia. Combining their use with an SGLT2i may mitigate some of this risk, improving tolerability, and allowing a wider range of patients to be treated (including those with higher levels of blood potassium than in previous trials). The EASi-KIDNEY (NCT06531824) double-blind placebo-controlled trial will test this approach by assessing the safety and cardiorenal efficacy of vicadrostat in combination with empagliflozin in ∼11,000 patients with CKD. It will be sufficiently large to assess effects in patients with and without diabetes separately., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Background: Limited data are available on vitamin A kinetics and total body stores (TBS) in women. Such information can be obtained using compartmental modeling and retinol isotope dilution (RID)., Objectives: Objectives were to apply population-based ("super-subject") modeling to determine retinol kinetics in nonpregnant Ghanaian women of reproductive age and to use RID to predict TBS in the group and its individuals., Methods: Women ( n = 89) ingested a dose of [ 2 H 6 ]retinyl acetate and blood samples (3/woman) were collected from 6 h to 91 d, with all participants sampled at 14 d, about half at either 21 or 28 d, and each at one other time. Composite data (plasma retinol fraction of dose; FD p ) were analyzed using Simulation, Analysis and Modeling software to obtain kinetic parameters, TBS, and other state variables as well as model-derived values for the RID composite coefficient FaS . The latter were used in the RID equation TBS (μmol) = FaS × 1/SA p (where SA p is plasma retinol specific activity) to predict TBS at various times., Results: Model-predicted TBS was 973 μmol ( n = 87). Geometric mean RID-predicted TBS was 965, 926, and 1006 μmol at 14, 21, and 28 d, respectively, with wide ranges [for example, 252-3848 μmol on day 14 ( n = 86)]; TBS predictions were similar at later times. Participants had a mean 2 y of vitamin A in stores and estimated liver vitamin A concentrations in the normal range. Model-predicted vitamin A disposal rate was 1.3 μmol/d and plasma recycling number was 37., Conclusions: Super-subject modeling provides an estimate of group mean TBS as well as group-specific values for the RID coefficient FaS ; the latter can be used to confidently predict TBS by RID for individual participants in the group under study or in similar individuals at 14 d or more after isotope ingestion., Trial Registration Number: Trial is registered (NCT04632771) at https://clinicaltrials.gov., (© 2024 The Author(s).)

Background: Calcium hydroxyapatite (CaHA)-carboxymethylcellulose (CMC)+ has unique properties that make it optimal for lifting, contouring, and defining the jawline. This long-term follow-up of a randomized, multicenter, rater-blinded trial reports efficacy and safety of CaHA-CMC(+) through 48 and up to 60 weeks post-treatment., Methods: Eligible patients were randomized (2:1) to the treatment or the control/delayed treatment group to receive CaHA-CMC(+) injections in both jawlines. While touch-ups were permitted 4 weeks post-treatment for both groups, only the treatment group was eligible for optional retreatment after 48 weeks. The primary outcome was ≥1-point improvement on both jawlines on the Merz Jawline Assessment Scale (MJAS); secondary endpoints included the Subject Global Aesthetic Improvement Scale (SGAIS) among others. Post hoc analysis included pooling up to 48-week data from the combined treatment and control/delayed groups and 60-week data for the treatment group., Results: Overall, 175 received treatment. MJAS responder rates were 77.9%, 78.7%, and 62.9% at 12, 24, and 48 weeks post-treatment, respectively. Responder rate on the MJAS at 60 weeks was 74.6% for those who received retreatment and 43.5% for those patients who received only the initial and touchup treatments. SGAIS scores demonstrated 93.4%, 85.6%, and 68.5% of patients rated themselves very much improved after 12, 24, and 48 weeks, respectively. Adverse events consisted of procedure or CaHA-CMC(+)-related events that were mostly resolved and overwhelmingly mild., Conclusions: CaHA-CMC(+) produced clinically meaningful and long-lasting improvements in jawline contour and was well tolerated in patients through 60 weeks., Trial Registration: ClinicalTrials.gov Identifier: NCT03583359., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: As currently applied, the paired retinol isotope dilution (RID) test, which is used to assess the impact of a vitamin A intervention on vitamin A total body stores (TBS), requires 2 doses of stable isotope-labeled vitamin A., Objectives: The objectives of this study were to evaluate use of a single isotope dose (4 μmol) to assess TBS by RID before and after intervention in theoretical children with low/moderate TBS., Methods: We selected 6 theoretical children with assigned values for TBS ranging from 82 to 281 μmol. Using Simulation, Analysis and Modeling software, we simulated the variable [plasma retinol specific activity (SA p )] and coefficients (Fa and S) used in the RID equation TBS (μmol) = FaS × 1/SA p in both the unsupplemented steady state at day 14 postdosing and during the subsequent 4 mo without or with vitamin A supplementation [2.8 μmol retinol/d (801 μg retinol activity equivalents/d)]., Results: Fraction of dose in plasma on day 150 compared with day 14 was similar in the unsupplemented and supplemented conditions [geometric mean, 32% (range, 20%-48%) and 30% (20%-48%), respectively] and simulated values for FaS were similar under the 2 conditions. After 2 and 4 mo of daily vitamin A supplementation with 2.8 μmol/d, TBS was 78% and 128% higher, respectively, than without supplementation., Conclusions: Results indicate that the paired RID method can successfully be done using a single 4 μmol dose of stable isotope. Furthermore, because values for the RID coefficient FaS were similar in the unsupplemented and vitamin A-supplemented conditions, these results in theoretical children indicate that FaS determined by population ("super-subject") modeling of steady state vitamin A kinetic data could be used to predict TBS by RID after a vitamin A intervention in individuals from the same or a similar group., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

The spectrum of cardiorenal and metabolic diseases comprises many disorders, including obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), dyslipidemias, hypertension, and associated comorbidities such as pulmonary diseases and metabolism dysfunction-associated steatotic liver disease and metabolism dysfunction-associated steatohepatitis (MASLD and MASH, respectively, formerly known as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis [NAFLD and NASH]). Because cardiorenal and metabolic diseases share pathophysiologic pathways, two or more are often present in the same individual. Findings from recent outcome trials have demonstrated benefits of various treatments across a range of conditions, suggesting a need for practice recommendations that will guide clinicians to better manage complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. To meet this need, we formed an international volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM 2.0 Practice Recommendations, an updated and expanded revision of a previously published multispecialty consensus on the comprehensive management of persons living with DCRM. The recommendations are presented as 22 separate graphics covering the essentials of management to improve general health, control cardiorenal risk factors, and manage cardiorenal and metabolic comorbidities, leading to improved patient outcomes., Competing Interests: Declaration of competing interest None of the Task Force members received monetary renumeration for their contributions to the creation or writing of this consensus document. See the Supplementary Appendix for full declarations of competing interests for each author., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Hypothesis: Hyperuricaemia and gout are common in chronic kidney disease (CKD). We aimed to assess the effects of sodium-glucose co-transporter-2 (SGLT2) inhibition on uric acid (urate) and gout in patients with CKD., Methods: The EMPA-KIDNEY trial randomised 6609 patients with CKD (estimated glomerular filtration rate [eGFR] ≥20 and <90 mL/min/1.73m2) to receive either empagliflozin 10 mg daily or matching placebo over a median of two years follow-up. Serum uric acid was measured at randomisation then 2 and 18 months of follow-up and the effects of empagliflozin were analysed using a pre-specified mixed model repeated measures approach. Participant-reported gout events were analysed in Cox regression models (first events) with the Andersen-Gill extension (total events). A post-hoc composite outcome included new initiation of uric acid lowering therapy or colchicine. EMPA-KIDNEY primary and kidney disease progression outcomes were also assessed in subgroups of baseline serum uric acid., Results: Baseline mean ± SD serum uric acid concentration was 431±114 µmol/L. Allocation to empagliflozin resulted in a study-average between-group difference in serum uric acid of -25.6 (95%CI -30.3,-21.0) µmol/L with larger effects in those with higher eGFR (trend P < 0.001) and without diabetes (heterogeneity P < 0.001). Compared to placebo, empagliflozin did not significantly reduce first or total gout events (HR 0.87, 95%CI 0.74-1.02 for the 595 first events, and 0.86, 0.72-1.03 for the 869 total events) with similar hazard ratios for the post-hoc composite and across subgroups, including by diabetes and eGFR. The effect of empagliflozin on the primary outcome and kidney disease progression outcomes were similar irrespective of baseline level of uric acid., Conclusion: SGLT2 inhibition reduces serum uric acid in patients with CKD with larger effects at higher eGFR and in the absence of diabetes. However, the effect on uric acid is modest and did not translate into reduced risk of gout in EMPA-KIDNEY., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Background: Botulinum toxin type A (BoNTA) is standard of care for glabellar lines ameliorization. DaxibotulinumtoxinA for Injection (DAXI) is a new BoNTA with a unique formulation representing the latest advancement in BoNTA technology. There is an unmet need for patients to understand the full potential of BoNTA treatment and new technologies., Objective: To update clinical data supporting the use of DAXI for glabellar lines within the context of clinical experience., Materials and Methods: A narrative review of the literature and summary of clinical experience with DAXI., Results: The DAXI clinical trial program reflects clinical experience post-FDA approval, with DAXI demonstrating rapid onset, high patient response rates, and extended treatment duration versus conventional BoNTAs. Clinical observations suggest that DAXI has limited diffusion from the injection site, enabling more localized control of muscle activity and greater improvements in wrinkle severity. DAXI enables practitioners to exert greater finesse in their injections and in predicting changes to eyebrow shape and position and achieve improvement in skin quality., Conclusion: Advances in BoNTA technology can provide patients with greater options for treatment outcomes. The potential for enhanced localized effects with DAXI may contribute to more precise and targeted effects on muscle activity and additional aesthetic benefits to patients., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Hyaluronic acid injections are increasingly administered for correction of infraorbital hollows (IOHs)., Objectives: The objective of this study was to examine the effectiveness (IOH correction) and safety of Restylane Eyelight hyaluronic acid (HAEYE) injections., Methods: Patients with moderate/severe IOHs, assessed with the Galderma infraorbital hollows scale (GIHS), were randomized to HAEYE injections (by needle/cannula) (Day 1 + optional Month 1 touch-up) or no-treatment control. The primary endpoint was blinded evaluator-reported Month 3 response, defined as ≥1-point GIHS improvement from baseline (both sides, concurrently). Other endpoints examined investigator-reported aesthetic improvement on the Global Aesthetic Improvement Scale (GAIS), patient-reported satisfaction (FACE-Q satisfaction with outcome; satisfaction questionnaire), and adverse events., Results: Overall, 333 patients were randomized. Month 3 GIHS responder rate was significantly higher for HA-EYE (87.4%) vs control (17.7%; P < .001), and comparable between HA-EYE-needle and HA-EYE-cannula groups (P = .967). HAEYE GAIS responder rate was 87.5-97.7% (Months 3-12). Mean FACE-Q Rasch-transformed scores were 64.3-73.5 (HAEYE) vs 14.1-16.2 (control) through Month 12. Patients reported looking younger (≥71%) and less tired (≥79%) with reduced undereye shadows (≥76%) and recovered within 3-5 hours posttreatment. Efficacy was maintained through Month 12 (63.5% GIHS responders) and through Month 18, after Month 12 retreatment (80.3% GIHS responders; 99.4% GAIS responders; FACE-Q scores 72.5-72.8). Forty patients (12.7%) reported typically mild adverse events (4.9% HAEYE-needle; 20.9% HAEYE-cannula)., Conclusions: HAEYE treatment was effective in correcting moderate/severe IOHs at the primary endpoint (Month 3). Efficacy was sustained through Month 12 after first treatment for 63.5% and through Month 18 for 80.3% (after 1 retreatment) with needle or cannula administration. Safety outcomes were reassuring., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: Neuromodulator treatments of the perioral region are increasingly popular and aim to modulate the position of the modiolus. The predominantly targeted muscle is the depressor anguli oris (DAO) which allows for the modiolus to reposition cranially once temporarily relaxed., Objectives: The aim of this study was to identify the precise anatomic position of the DAO in relation to the marionette line, thereby increasing precision and reducing adverse events during neuromodulator treatments., Methods: A total of n = 80 DAO muscles were investigated in n = 40 healthy, toxin-naïve volunteers (11 males, 29 females) with a mean [standard deviation] age of 48.15 [15] years and a mean BMI of 24.07 [3.7] kg/m2. The location of the DAO in relation to the labiomandibular sulcus, and its depth, extent, and thickness were investigated with high-frequency ultrasound imaging., Results: The skin surface projection of the labiomandibular sulcus separates the DAO into medial and lateral portions. The distance between skin surface and muscle surface was on average 4.4 mm, with males having a greater distance (P < .001) and higher BMI being an important influencing factor for a greater distance (P < .001). The thickness of the DAO was on average 3.5 mm, with a range of 2.8 to 4.8 mm and with females having thinner muscles compared with males (P < .001). The most favorable injection depth was calculated to be 6.1 mm for intramuscular product placement., Conclusions: Understanding the perioral anatomy and the influence of age, sex, and BMI will potentially allow injectors to increase the efficacy and duration of neuromodulator treatments while expertly managing adverse events., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Inadequate vitamin A (VA) intake is common among lactating women in many communities worldwide, but high-dose VA supplementation for postpartum women is not recommended by the World Health Organization as an effective intervention., Objectives: To simulate the impact of VA intake via diet and daily VA supplements on VA total body stores (TBS) and balance in theoretical lactating women with low/moderate TBS., Methods: We studied 6 theoretical subjects with assigned values for TBS from 219-624 μmol. Using Simulation, Analysis, and Modeling software and a previously published compartmental model for whole-body VA metabolism, we simulated TBS over 6 mo of established lactation for each subject under 4 conditions: 1) prelactation VA intake was increased to maintain VA balance (L SS ); 2) prelactation VA intake was maintained (NL SS ); 3) VA intake was the same as 2) but a daily VA supplement (2.8 μmol/d) was added (NL SS +S); and 4) VA intake was as 1) and the daily VA supplement was included (L SS +S)., Results: To compensate for the loss of VA via milk while VA balance was maintained (L SS ) over 6 mo of lactation, VA intake had to increase by 0.8-1.87 μmol/d (n = 6) compared with NL SS . Over 6 mo of NL SS treatment, VA balance was negative (geometric mean, -0.77 μmol/d) compared with L SS , whereas balance was positive under NL SS +S and L SS +S conditions (0.75 and 1.5 μmol/d, respectively). For L SS , the proportion of total VA disposal was 37% via breastmilk, 32% from VA stores, and 32% from nonstorage tissues., Conclusions: Adding a daily VA supplement (2.8 μmol/d) to the diet of lactating women with suboptimal VA intake may effectively counterbalance the negative VA balance resulting from the output of VA via breastmilk and thus benefit both mother and infant by maintaining or increasing VA stores and breastmilk VA concentration., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Despite extensive evidence related to the prevention and management of type 2 diabetes (T2D) and its complications, most people at risk for and people who have diabetes do not receive recommended guideline-based care. Clinical implementation of proven care strategies is of the utmost importance because without this, even the most impressive research findings will remain of purely academic interest. In this review, we discuss the promise and challenges of implementing effective approaches to diabetes prevention and care in the real-world setting. We describe successful implementation projects in three critical areas of diabetes care-diabetes prevention, glycemic control, and prevention of diabetes-related complications-which provide a basis for further clinical translation and an impetus to improve the prevention and control of T2D in the community. Advancing the clinical translation of evidence-based care must include recognition of and assessment of existing gaps in care, identification of barriers to the delivery of optimal care, and a locally appropriate plan to address and overcome these barriers. Care models that promote team-based approaches, rather than reliance on patient-provider interactions, will enhance the delivery of contemporary comprehensive diabetes care., (© 2024 by the American Diabetes Association.)