Search

Peri-implantitis is an infectious disease that causes inflammation of the tissue surrounding an implant. The aim of this systematic review of the literature is to assess the effect of the use of lasers in the nonsurgical treatment of peri-implantitis in order to estimate its benefits compared with conventional therapies. The review's protocol has been registered on PROSPERO international prospective register. The research strategy was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were as follows: in vivo studies, written in English, measurements of clinical parameters, minimum follow-up at 6 months and with nonsurgical control group, studies about photodynamic therapy, randomized clinical trial, and clinical trial. Electronic (on PubMed, Cochrane, Latin American and Caribbean Health Sciences Literature, and Report Evidence-based Practice Centers databases) and manual searches (in articles' references) were conducted until July 2021. Risk of bias was assessed for each reference thanks to the Cochrane Collaboration's tool. A total of 12 randomized clinical trials, with a high level of evidence, were selected and investigated in this systematic review. A table summarizes data extracted from these articles. It appears that the parameters improve favorably by using lasers, but without any significant difference. In accordance with the analysis of studies, our results show that laser therapy with specific characteristics allows to obtain beneficial therapeutic effects on wound healing in the short and the medium-term concerning the clinical parameters in the nonsurgical treatment of peri-implantitis. Concerning its long-term usefulness, it has yet to be confirmed. However, its benefits remains limited since the results agree that the effects of the laser are similar to those obtained by using conventional therapy. [ABSTRACT FROM AUTHOR]

Abstract Purpose To compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture. Methods We performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS). Results There were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P

Purpose: To compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture. Methods: We performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS). Results: There were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD − 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed. Conclusions: The results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery. [ABSTRACT FROM AUTHOR]

Abstract Serial casting as one of the applications to treat early-onset scoliosis has been reported efficiently to improve deformity, but no report has focused on the efficacy of braces in the treatment of congenital early-onset scoliosis and comparison with progressive idiopathic early-onset scoliosis. Patients with progressive EOS treated with braces in our institution with a minimum of 4 years follow-up were reviewed. Two groups according to the etiological diagnosis were analyzed and compared: the congenital scoliosis (CS) group and idiopathic scoliosis (IS) group. The success cases and the failure cases were also compared. 27 patients with an average main Cobb angle of 38.19° (20–55) underwent initial bracing at an average age of 55.7 months (24–108), the average follow-up time was 76.19 months (49–117). In IS group the main Cobb angle was corrected to 18.69 ± 12.06° (48.61%) following the first bracing; the final Cobb angle was 23.08 ± 22.15°(38.76%) after brace removal. In CS group the main Cobb angle was corrected to 33.93 ± 10.31°(17.1%) following the first bracing and 37.93 ± 14.74°(3.53%) after brace removal. Both coronal chest width and T1-T12 height increased dramatically from pre-bracing to the last follow-up. Patients diagnosed as IS tended to have a better result in main Cobb angle correction than that of CS (P = 0.049). By the time of last follow-up, 8 patients had undergone surgery, and the operation time was postponed by 68.88 ± 26.43 months. For patients with progressive early-onset scoliosis, bracing is an efficient nonsurgical alternative to casting, and some of them can be cured; if not, eventual surgical intervention can be delayed for a period of time without restrictions on the thoracic cavity.

Abstract This case report describes an 80-year-old man who presented with a growing erythematous nodule with erosion, measuring 0.6 cm × 0.6 cm, on his right temple. This lesion was later diagnosed as atypical fibroxanthoma (AFX). Instead of undergoing Mohs surgery, the gold standard treatment, the patient opted to pursue a topical treatment regimen because of financial costs associated with surgical removal and repair. This topical regimen consisted of tazarotene cream, imiquimod cream, and 5-fluorouracil solution, applied for 30 days. The patient was directed to use this combination 5 days per week for 6 weeks. The specified dosage for each medication was a fifth of a packet of imiquimod 5% cream, an equivalent amount of tazarotene 0.1% cream, and a single drop of 5-fluorouracil 2% solution. These were combined on a bandage and placed on the lesion overnight. Following the treatment, a 3-week post-application examination revealed an erosion, 1.0 cm × 0.9 cm, amidst erythema. A subsequent incisional biopsy with histopathology and stains for CD10 and CD99, 3 weeks after treatment, and three punch biopsies with histopathology and stains for CD10 and CD99, 1-year post-treatment, confirmed the absence of AFX. AFX is a superficial variant of pleomorphic dermal sarcoma (PDS), which shares histologic similarities, yet the exact relationship between AFX/PDS and undifferentiated pleomorphic sarcoma is still not well understood. Previous studies have indicated a genomic similarity between AFX/PDS and cutaneous squamous cell carcinoma (cSCC), which suggests the potential efficacy of cSCC-targeted treatments for AFX/PDS. This case marks the first recorded instance of successful topical medical treatment of AFX, offering an alternative for patients who may opt out of surgical intervention. Continued research to assess the broader efficacy of this approach is encouraged.

The effectiveness of dexamethasone in managing chronic subdural hematoma (cSDH) patients remains uncertain although the drug is widely used in this condition. The present systematic review aims to understand the role of dexamethasone in reducing the need for surgery in cSDH patients. This study was conducted as per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the electronic databases of PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (the Cochrane Library), and ScienceDirect with a predefined search strategy. The population consisted of cSDH patients older than 18 years and treated primarily with dexamethasone. The primary outcome was the need for surgery after dexamethasone therapy in cSDH patients. The meta-analysis of a group of patients was done with the invariance method to estimate the pooled odds of the requirement for surgery after dexamethasone therapy. In the studies with a one-to-one comparison of dexamethasone with placebo/observation, the Mantel–Haenszel statistics were used to determine the odds of surgery. The quality of the studies was assessed with the Newcastle–Ottawa scale (NOS) and the Cochrane risk of bias tool was used to assess the risk of bias in randomized studies. In total, 598 studies were obtained from the database search and after applying the inclusion and exclusion criteria, 10 studies were finally selected for the qualitative and quantitative synthesis. One of the 10 studies was a randomized controlled trial (RCT), while the rest were observational studies. There were 653 patients who received the primary dexamethasone therapy. Of these, 388 patients did not require surgery, while 256 needed surgeries after the therapy. The pooled estimate of requirement for surgery after dexamethasone therapy was 0.41, with a 95% confidence interval of 0.37 to 0.45. A meta-analysis of the one-to-one comparison from three included studies showed a higher need of surgery in the (comparator) placebo/observation group than in the dexamethasone group with odds ratio of 7.16 (95% confidence interval: 2.21–23.13, with p = 0.0001). In addition, we identified the gaps in literature, and the complications and mortality reported in the studies. Dexamethasone is effective in reducing the requirement for surgery in some selected cSDH cases, although many patients still require surgical intervention. [ABSTRACT FROM AUTHOR]

Proximal humerus fracture (PHF) is a common fragility fracture in older adults and can have a substantial impact on upper limb function. Although most patients with PHF can be treated nonsurgically, it is unknown whether older adults benefit from supervised exercise therapy after PHF. Therefore, the objective of this trial was to investigate whether 10 weeks of physiotherapist-supervised exercises once a week were superior to 10 weeks of unsupervised home-based exercises in older adults with a nonsurgically treated displaced 2-part PHF. This was designed as an assessor-blinded, prospective, randomized controlled trial and took place in 3 Nordic countries. In total, 72 patients (≥60 years) with nonsurgically treated displaced 2-part PHF were randomized to either physiotherapist-supervised exercises once a week for 10 weeks, combined with daily home-based exercises, or to 10 weeks of daily unsupervised home-based exercises. The primary outcome measure was the Disability of the Arm, Shoulder, and Hand (DASH) with a primary endpoint at 3 months. Secondary outcomes were DASH (at 12 months), Constant-Murley Score, the 15D-instrument, Visual Analog Scale, General Self-Efficacy Scale, and Pain Catastrophizing Scale, with follow-up visits after 3 and 12 months. Non-union and patient death within 3 months were counted as complications. The mean age of the patients in both groups was 72 years. At 3 months follow-up, the mean DASH score in the supervised group was 25.9 (SD 16.0) compared to 22.4 (SD 18.9) in the unsupervised group. The mean between-group difference (3.5, 95% CI -5.0 to 12.5) was not clinically relevant. None of the secondary outcome measures presented any clinically relevant or statistically significant between-group differences at 3 or 12 months follow-up. One patient in the supervised group and 3 in the unsupervised group were diagnosed with non-union. One patient from each group died before 3 months follow-up. This trial provides no evidence that supervised exercises are superior to unsupervised home-based exercises in improving functional outcome or health-related quality of life in older patients with a nonsurgically treated 2-part PHF. Further, our results suggest that most older adults with a nonsurgically treated 2-part PHF can perform home-based exercises without the supervision of a physiotherapist. [ABSTRACT FROM AUTHOR]

This case report describes an 80-year-old man who presented with a growing erythematous nodule with erosion, measuring 0.6 cm × 0.6 cm, on his right temple. This lesion was later diagnosed as atypical fibroxanthoma (AFX). Instead of undergoing Mohs surgery, the gold standard treatment, the patient opted to pursue a topical treatment regimen because of financial costs associated with surgical removal and repair. This topical regimen consisted of tazarotene cream, imiquimod cream, and 5-fluorouracil solution, applied for 30 days. The patient was directed to use this combination 5 days per week for 6 weeks. The specified dosage for each medication was a fifth of a packet of imiquimod 5% cream, an equivalent amount of tazarotene 0.1% cream, and a single drop of 5-fluorouracil 2% solution. These were combined on a bandage and placed on the lesion overnight. Following the treatment, a 3-week post-application examination revealed an erosion, 1.0 cm × 0.9 cm, amidst erythema. A subsequent incisional biopsy with histopathology and stains for CD10 and CD99, 3 weeks after treatment, and three punch biopsies with histopathology and stains for CD10 and CD99, 1-year post-treatment, confirmed the absence of AFX. AFX is a superficial variant of pleomorphic dermal sarcoma (PDS), which shares histologic similarities, yet the exact relationship between AFX/PDS and undifferentiated pleomorphic sarcoma is still not well understood. Previous studies have indicated a genomic similarity between AFX/PDS and cutaneous squamous cell carcinoma (cSCC), which suggests the potential efficacy of cSCC-targeted treatments for AFX/PDS. This case marks the first recorded instance of successful topical medical treatment of AFX, offering an alternative for patients who may opt out of surgical intervention. Continued research to assess the broader efficacy of this approach is encouraged. [ABSTRACT FROM AUTHOR]

Background: Pigmented lesions are largely benign and may lead to extreme distress. Various light and lasers may be used to treat pigmentation, often Q‐switched lasers are considered the method of choice, while intense pulsed light (IPL) devices may offer a less invasive treatment with a shorter downtime. Objective: The purpose of this study is to evaluate the safety and efficacy of a narrowband IPL module for the treatment of pigmented lesions. Methods: A retrospective study of 20 patients with pigmented lesions underwent treatment with an IPL module. Treatment was assessed by blinded evaluation of clinical photographs using a GAIS scale of 0–10, as well as through patient satisfaction ratings on a scale of 0–10. Throughout the treatment, pain levels and adverse events were monitored. Results: The mean GAIS score was 7.55 ± 1.15 (mean ± SD), and the mean patient satisfaction score was 7.3 ± 1.26 (mean ± SD). There was a strong positive correlation between GAIS and patient satisfaction scores (r = 0.83), and no significant difference between them (p‐value = 0.516). The number of treatments did not significantly affect GAIS and patient satisfaction scores (p‐values 0.364 and 0.126). Additional positive unexpected outcomes were improved skin firmness and reduced wrinkles. Conclusion: The results of the study indicate that the IPL module is both safe and effective in treating pigmented lesions and may have the potential to stimulate collagen production. [ABSTRACT FROM AUTHOR]

Background: Keloids are benign proliferative scars that form as a result of dysregulated growth and collagen deposition in response to cutaneous injury. Laser therapies have emerged as promising options for the treatment of keloids, with performance varying by laser type and lesion characteristics. Purpose: To assess the combined continuous wave and repetitive fractionated CO2 laser treatment of keloids. Methods: A retrospective chart review of 22 cases of keloid scars treated with combined CO2 laser modes. A single session of continuous wave followed by five sessions of fractional delivery. Efficacy was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale. The Numeric Rating Scale was used to assess patient satisfaction and pain. Results: Most patients were female (77.3%) with skin type IV (72.7%), age was 24.3 ± 9.3 years, most keloids were located on the earlobe (56.5%) or arm or hand (17.4%), size ranged from 5 to 10 cm, and time since injury ranged from 3 months to 35 years. No serious adverse events were reported. At 6 months, significant improvements from baseline occurred in all characteristics, scar color (4.8 ± 2.8 to 1.9 ± 1.1), rigidity (5.0 ± 2.8 vs. 5.4 ± 2.8), thickness (5.4 ± 2.8 vs. 2.0 ± 1.1), and irregularity (5.9 ± 2.4 vs. 1.9 ± 0.9). The Vancouver scores followed a similar trend. Patient‐rated overall improvement from 37 ± 17.6 at baseline to 16.1 ± 8.5 at 6 months, and improvement in associated pain and pruritus. Conclusion: Combination of two ablative laser delivery modes within a single laser platform provided for effective and safe keloid management and left patients highly satisfied. [ABSTRACT FROM AUTHOR]

Background: IPL devices emit a wide range of wavelengths that can be absorbed by different chromophores in the skin. Selective destruction of a specific chromophore with minimal side effects is controlled by wavelength, pulse duration, and fluence. Aim: This study aims to evaluate the treatment of vascular and pigmented lesions using narrow‐band Intense Pulsed Light (IPL) with Advanced Fluorescence Technology (AFT), which offers more efficient energy usage per pulse to increase safety, and improve clinical outcomes. Methods: A retrospective analysis of data from 100 patients treated with narrow‐band IPL for vascular and pigmented lesions. Efficacy was measured by the Global Aesthetic Improvement Scale (GAIS) and Patient Satisfaction Scale (0–10). Safety was assessed by evaluating pain levels and adverse events. Results: Mean GAIS scores were 8.02 ± 0.84 for vascular and 8.14 ± 0.9 for pigmented lesions with no significant difference between groups (p=0.49, α=0.05). Patient satisfaction correlated with GAIS scores (correlation coefficient 0.8). No pain was reported and two patients experienced temporary and transient side effects. Conclusion: Overall, the advanced IPL treatments provided favorable outcomes for vascular and pigmented lesions. [ABSTRACT FROM AUTHOR]

Key Clinical Message The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. Abstract The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery.

The goal of this overview was to systematically verify the best available literature on surgical and nonsurgical treatments of peri-implantitis to determine evidence-based treatment protocols for peri-implantitis. Three databases (MEDLINE/PubMed, Web of Science, and Cochrane Library/Evidence) were searched by two independent reviewers, including systematic reviews (SRs) that involved randomized controlled trials (RCTs). The search was limited to articles between January 2014 to January 2021 with an English language restriction. In total, 437 articles were initially found, of which only 34 were selected for full-text reading. Nine SRs were included in this study, enrolling 59 different RCTs. Some studies investigated both surgical and nonsurgical techniques, while others focused on only one approach or the other. In total, six of the studies included nonsurgical techniques, and eight included surgical techniques (ie, augmentative, regenerative, and corrective/resective techniques). Nonsurgical interventions appeared to offer some degree of clinical improvements, especially in bleeding on probing levels, but they were not enough to fully treat peri-implantitis. Whereas surgical techniques seemed to be more effective in improving overall clinical parameters, especially probing depth, bleeding on probing, and to some extent, marginal bone level, no specific surgical technique or material (graft or membrane) had a clear advantage over others. Therefore, resective surgical and implantoplasty techniques demonstrated significant improvements in clinical parameters. Although surgical interventions are more indicated to treat peri-implantitis than nonsurgical procedures, the predictability is still a concern due to titanium particles scattered within the local tissue. [ABSTRACT FROM AUTHOR]

Under current development is Nanosense, a medication designed for the nonsurgical treatment of superficial cancer via pulsed laser ablation of nanoparticles (PLAN). Nanosens is a stable dispersion of phthalocyanine zinc nanoparticles in a physiological solution. The technology for obtaining stable dispersions of zinc phthalocyanine ensures a shelf life of over two years. This article presents preliminary data from preclinical studies of the Nanosens formulation. Results were obtained on the effectiveness, pharmacokinetics, and biodistribution of the Nanosens drug in mice, as well as toxicity and allergy studies. When tested at therapeutic doses (1 TD = 7 mg/kg) ranging from 1 to 10 TD for acute toxicity and from 1 to 30 TD for chronic toxicity, no signs of intoxication leading to death were observed in animals. However, at the maximum dose, individual organs and tissues exhibited a blue coloration. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines. Background: Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age‐related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable. Methods: PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand‐seached for additional relevant publications between 2005‐2020. A combination of these terms was performed uing Boolean operators and MeSH terms. Results: Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta‐analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies. Conclusions: The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment. [ABSTRACT FROM AUTHOR]

Dachshunds are at significant risk of experiencing thoracolumbar intervertebral disk herniation (IVDH) during their lifetimes. Standard of care includes advanced imaging, surgical intervention, and postoperative rehabilitation. Conservative management is commonly recommended for cases where the standard of care is declined, and little is known about the prognosis of treatment with conservative management and rehabilitation (nonsurgical rehabilitation). This retrospective cohort study assessed 12-week functional outcome and recurrence of clinical signs in 40 dachshunds with T3-L3 myelopathy presumed to be due to Hansen's Type I disc herniation, treated with nonsurgical rehabilitation. The overall prognosis was good with 34 of 40 (85.0%, 95% CI 70.2-94.2) dachshunds achieving functional pet status by 12 weeks postinjury. Modified Frankel Score at presentation was significantly (p < 0.001) higher in dogs with a positive 12-week outcome compared to dogs that did not recover by 12 weeks. All 27 dogs with motor function at presentation had a positive outcome. Of the 9 dogs exhibiting paraplegia with intact deep nociception at presentation, 7 dogs (77.8%) had achieved a positive outcome by 12 weeks. None of the 4 dogs persistently lacking deep nociception had a positive outcome. Among 27 dogs with a positive outcome for whom follow-up records were available, the 1- and 2-year recurrence rates for T3-L3 myelopathy were 5 and 11%, respectively. Nonsurgical rehabilitation should be considered in dachshunds with mild to moderate T3-L3 myelopathy or in severe cases when advanced imaging and surgical intervention are not possible.

The surgical evacuation is considered as the first choice of treatment for symptomatic chronic subdural hematoma. Since anticoagulation is considered a risk factor and any ongoing anticoagulation treatment is ceased once the diagnosis is confirmed, the data regarding the course of these cases under ongoing anticoagulant treatment remains extremely limited. A 73-year-old female was given antiplatelet treatment for ischemic stroke for right hemiparesis and dysarthria despite an existing, but unrecognized chronic subdural hematoma. The hematoma was discovered after 4 weeks following antiplatelet treatment, but in a smaller volume. As routine practice, antiplatelet treatment was ceased, and the hematoma completely resolved within 2 weeks. This case demonstrates that some patients with chronic subdural hematoma for whom continuation of anticoagulation is essential, can be observed closely if hematoma volume is small, and no midline shift is present since spontaneous resolution may occur. [ABSTRACT FROM AUTHOR]

Abstract Background There are different types of ear molding devices on the market. However, due to high cost, the wide application of the ear molding is hindered, especially for children with bilateral congenital auricular deformities (CAD). This study is designed to correct the bilateral CAD with the flexible use of Chinese domestic ear molding system. Methods Newborns diagnosed with bilateral CAD were recruited in our hospital from September 2020 to October 2021. For each subject, one ear wore a set of domestic ear molding system, while the contralateral ear used only matching Retractor and Antihelix Former. Medical charts were reviewed to collect data on the types of CAD, the incidence of complications, the initiation and duration of treatment, as well as the satisfaction after treatment. Treatment outcomes were graded into three levels: excellent, good, and poor, according to the improvement of auricular morphology evaluated by both doctors and parents, respectively. Results A total of 16 infants (32 ears) were treated with the Chinese domestic ear molding system, which contains 4 cases with Stahl’s ear (8 ears), 5 cases with Helical rim deformity (10 ears), 3 cases with Cup ear (6 ears), 4 cases with Lop ear (8 ears). All infants accomplished the correction completely. Both parents and doctors were satisfied with the outcomes. No obvious complication was observed. Conclusions Ear molding is an effective nonsurgical treatment for CAD. Molding with Retractor and Antihelix Former is simple and effective. Domestic ear molding system can be flexibly used in correcting bilateral CAD. With this approach, infants with bilateral CAD will benefit more in the near future.

The optimal treatment algorithm for patients with degenerative lumbar spondylolisthesis has not been clarified. Part of the reason for this is that the natural history of degenerative spondylolisthesis (DS) has not been sufficiently studied. Comprehension of the natural history is essential for surgical decision making. We aimed to determine 1) the proportion of patients that develop de novo DS during follow-up; and 2) the proportion of patients with progression of preexistent DS by conducting a systematic review and meta-analysis of the literature. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Ovid, EMBASE, and the Cochrane Library were searched from their inception through April 2022. Demographic values of the study populations, grade of slip, rate of slippage before and after the follow-up period, and percentage of patients with slip in the populations at baseline and after follow-up were the extracted parameters. Of the 1909 screened records, eventually 10 studies were included. Of these studies, 5 reported the development of de novo DS and 9 reported on the progression of preexistent DS. Proportions of patients developing de novo DS ranged from 12% to 20% over a period ranging from 4 to 25 years. The proportion of patients with progression of DS ranged from 12% to 34% over a period ranging from 4 to 25 years. Systematic review and metanalysis of DS on the basis of radiologic parameters revealed both an increasing incidence over time and an increasing progression of the slip rate in up to a third of the patients older than 25 years, which is important for counseling patients and surgical decision making. Importantly, two thirds of patients did not experience slip progression. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs (“red flags”) indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.

Approximately 15% of married couples undergo a fertility examination. Approximately half of the infertility cases have a male factor. Numerous advances have been made in reproductive medicine in the last few years. Infertile couples who previously were considered untreatable now have a chance at genetic paternity. Although it is possible to solve the problem with assisted reproductive techniques in cases with severe male factor, applying these treatment methods to all infertile partners is extra treatment, the cost increases, and rare but serious risks such as ovarian hyperstimulation may occur in the female partner. Prior to any andrological treatment, a serious diagnostic work-up should be performed and treatment should be individualized, providing adequate treatment options in selected cases. Primarily, specific therapeutic therapy directed against the etiological cause of infertility should be attempted. Specific medical treatment of infertility is based on identifying the causes of reversible infertility and treating it with appropriate drugs. Infertility causes such as hormonal disorders, i.e. congenital hypogonadotropic hypogonadism, hyperprolactinemia, genital tract infections, and sexual dysfunctions can be easily diagnosed and successfully treated with medical methods that do not require surgery. In this review, reversible causes of male infertility and nonsurgical specific medical treatment methods are discussed in the light of the current literature.

Background: There are different types of ear molding devices on the market. However, due to high cost, the wide application of the ear molding is hindered, especially for children with bilateral congenital auricular deformities (CAD). This study is designed to correct the bilateral CAD with the flexible use of Chinese domestic ear molding system. Methods: Newborns diagnosed with bilateral CAD were recruited in our hospital from September 2020 to October 2021. For each subject, one ear wore a set of domestic ear molding system, while the contralateral ear used only matching Retractor and Antihelix Former. Medical charts were reviewed to collect data on the types of CAD, the incidence of complications, the initiation and duration of treatment, as well as the satisfaction after treatment. Treatment outcomes were graded into three levels: excellent, good, and poor, according to the improvement of auricular morphology evaluated by both doctors and parents, respectively. Results: A total of 16 infants (32 ears) were treated with the Chinese domestic ear molding system, which contains 4 cases with Stahl's ear (8 ears), 5 cases with Helical rim deformity (10 ears), 3 cases with Cup ear (6 ears), 4 cases with Lop ear (8 ears). All infants accomplished the correction completely. Both parents and doctors were satisfied with the outcomes. No obvious complication was observed. Conclusions: Ear molding is an effective nonsurgical treatment for CAD. Molding with Retractor and Antihelix Former is simple and effective. Domestic ear molding system can be flexibly used in correcting bilateral CAD. With this approach, infants with bilateral CAD will benefit more in the near future. [ABSTRACT FROM AUTHOR]

If treatment can restore the patient’s function while maximizing aesthetics, prosthodontic rehabilitation of edentulous patients may be the most satisfying. A prosthesis may change a person’s appearance by enhancing or detracting from their natural features. Patients with various ridge morphologies are encountered frequently in dental practice. Due to the requirement for surgical correction, the fabrication of conventional complete dentures in patients with labially inclined premaxilla and maxillary labial undercuts is challenging. Complete dentures made without surgical intervention have compromised aesthetics, which may have long-term unfavourable psychological effects on patients who are edentulous. In order to achieve comprehensive rehabilitation with the greatest consideration for aesthetics, this article describes nonsurgical treatment modalities for proclined premaxilla in completely edentulous patients. [ABSTRACT FROM AUTHOR]

• We review rapid advances in diagnostic and nonsurgical treatments for early-stage lung cancer, focusing on accuracy, reduced invasiveness, and outcomes. • Liquid biopsies offer non-invasive diagnosis and monitoring, but aren't standardized or guideline-anchored yet. • Advanced navigation techniques enable accurate biopsy of small lung lesions with a very low pneumothorax risk. • SBRT is the standard non-invasive treatment for inoperable early-stage lung cancer with low toxicity and excellent control. • Endobronchial/percutaneous ablation using microwave or pulse-field electroporation is an option for patients unsuitable for surgery or SBRT. This paper highlights developments in diagnostic and nonsurgical local treatment modalities that have changed the management of early-stage lung cancer. These innovations aim to enhance diagnostic accuracy, minimize invasiveness, and improve patient outcomes. Liquid biopsies are emerging as promising tools for non-invasive diagnosis and monitoring, enabling earlier intervention without being standardized yet as well as not yet anchored in the guidelines. Endobronchial navigation has emerged as an innovative tool. By combining electromagnetic or GPS-like technology with 3D imaging and a steerable catheter, it enables accurate biopsy of small, peripheral lesions that were once challenging to sample, with a very low pneumothorax rate. Regarding nonsurgical treatments, stereotactic body radiotherapy (SBRT) continues to shine as a non-invasive local treatment modality for early-stage lung cancer and is the guideline-recommended standard-of-care for inoperable patients and patients refusing the risk of surgical resection. The low toxicity and excellent local control has made it an attractive alternative to surgery even in fitter patients. Percutaneous ablative techniques utilising energies such as microwave or pulse-field electroporation are options for patients who are not candidates for surgery or SBRT. Bronchoscopic ablation delivers the same energies but with a very lower pneumothorax rate and it is therefore also open to patients with multiple and bilateral lesions. [ABSTRACT FROM AUTHOR]

This case report describes the long-term follow-up of a patient with localized aggressive periodontitis over a 30-year period. A 16-year-old woman was referred for periodontal assessment after starting orthodontic treatment. The patient was treated initially by combined nonsurgical and antimicrobial therapy, and autotransplantation of maxillary third molars in place of maxillary first molars, followed by a regular supportive periodontal treatment program. This challenging case demonstrated that elimination of putative bacterial pathogens and long-term supportive periodontal treatments provide an effective treatment modality for localized aggressive periodontitis. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Surgical treatment of acetabular labral tears has been explored in multiple studies, while there is a lack of research on the effectiveness of conservative methods. Focused Clinical Question: To what extent can nonsurgical treatment produce symptomatic or functional improvements in athletes with an acetabular labral tear? Summary of Search, Best Evidence Appraised, and Key Findings: The literature was searched for studies of patients with confirmed acetabular labral tears who participated in any level of sport. Four studies were located, all of which were included. Clinical Bottom Line: The research discussed in this review agreed that conservative management of acetabular labral tears produced measurable improvements in pain and function among the athletes studied, including their ability to participate in sport activities. Based on these findings, it appears that conservative management is effective at rehabilitating athletes with acetabular labral tears. However, this method should not be applied to every athlete based on the low strength of current research. Treatment plans should be decided upon on a case-by-case basis. Strength of Recommendation: The studies located were of low quality. The highest Oxford Center for Evidence-Based Medicine Level of Evidence achieved was 4. Higher level studies must be conducted before the conclusions of this research can be applied clinically with assertion. Strength of recommendation is level 3. [ABSTRACT FROM AUTHOR]

Basal cell carcinoma (BCC) is the most common form of nonmelanoma skin cancer. Surgery, including Mohs micrographic surgery, is considered the gold standard for the management of BCC, yet some patients may be unable to undergo surgery. This article describes effective nonsurgical options for treating superficial BCCs as well as some nodular and infiltrative BCCs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trauma performance improvement programs are required by the American College of Surgeons to review all nonsurgical admissions if the annual rate exceeds 10%. These reviews can have varying consistency between reviewers, are time consuming, and the consequent aggregate data are difficult to evaluate for trends. OBJECTIVE: This study set forth to standardize nonsurgical admission review through validation of the Nelson tool, which is a published objective scoring tool to determine the appropriateness of nonsurgical admissions. We hypothesized that implementation of this tool would facilitate earlier identification of events resulting in meaningful intervention and a reduction of inappropriate nonsurgical admissions. METHODS: The Nelson tool and scoring was integrated into the nonsurgical admission review process. A customized audit filter and report were built in the trauma registry. Data were reviewed with respect to scores and admitting service. Statistical analysis included using analysis of variance and t tests to examine differences between admitting services, χ2 test of independence or Fisher's exact to test the association of categorical variables, and ordinal logistic regression to test the ability of the total Nelson tool to predict appropriateness of admission. RESULTS: Using the Nelson tool, scores resulted in appropriate admission service in over 90% of cases. Implementation of the tool resulted in a decreased performance improvement workload with a 78% reduction in nonsurgical admission cases required to go to secondary level of review. CONCLUSIONS: Utilization of a validated scoring tool decreases performance improvement workload without compromising patient safety. [ABSTRACT FROM AUTHOR]

Objective: To evaluate nonsurgical management outcomes of cleft palate (CP) in dogs and identify any association between cleft size, prevalence of clinical signs, and quality of life (QoL)., Methods: 65 dogs treated conservatively for CP from January 2006 through December 2023 were retrospectively identified. Diet, activity, medical history, and QoL were recorded for dogs that survived to the transition to solid food. Results were compared to those from 24 control dogs. Measurements of cleft area, width, and percentage of the hard palate occupied by the cleft were made with the use of calibrated photographs. Clefts were divided into 3 types: wide throughout, wide rostrally, and slit throughout., Results: Sneezing was the most frequent clinical sign (43 of 65 over the past month, 34 of 65 when most affected). There was a greater frequency of material lodging in the cleft in the wide-throughout clefts (13 of 16 dogs) compared to the slit-throughout clefts (7 of 19 dogs). Veterinary removal of material was required in 10 of 68 episodes (7 of 31 dogs). There was no correlation between cleft size and prevalence of clinical signs or QoL. Sixty-three percent of dogs had a perfect QoL on a weighted scale, while 83.3% had a perfect score on a visual analog scale. Sixty-four of 65 owners would adopt another dog with a CP., Conclusions: Measures of QoL were favorable among dogs treated conservatively for CP., Clinical Relevance: Conservative management appears to be a viable option for treatment of CPs in some dogs.

Tahera Bhojani-Lynch,1 Anne Deckers,2 Ohan Ohanes,3 Kevin Poupard,4 Pauline Maffert4 1The Laser and Light Clinic, Loughborough, UK; 2Centre Médical Esthétique Eureka, Dalhem, Belgium; 3Swiss Care Cosmetic & Laser Clinic, London, UK; 4Clinical Development Department, Teoxane S.A., Geneva, SwitzerlandCorrespondence: Pauline MaffertTeoxane S.A., Rue de Lyon 105, Geneva, 1203, SwitzerlandTel +41 22 344 96 36Email p.maffert@teoxane.comBackground: Monitoring the effectiveness, safety and emerging uses of hyaluronic acid (HA) fillers in their wide range of indications requires a holistic approach.Purpose: To propose an observational study design aiming to gather real-world evidence (RWE) and continuously evaluate the performance and safety of marketed devices in routine practice.Materials and Methods: A prospective, observational registry was initiated at six European sites. Investigators enrolled any subject receiving at least one injection with a target study device (TEOSYAL Deep Lines [HADL] and/or Global Action [HAGA]). They followed their routine practice regarding injection technique, volume, and subject follow-up. Effectiveness was evaluated at 3 months using the global aesthetic improvement scale (GAIS). Safety was assessed based on common treatment reactions (CTR) and adverse events (AE).Results: High quantity of RWE was collected following the initiation of this registry. In the first 158 subjects enrolled, 1220 injections were performed in more than 25 indications, including 679 with the target devices and 271 with devices of the same filler line. The primary objective was achieved, with 93.9% of treatments providing improvement at Month 3 according to the PI and subject. Post-injection CTR were mild to moderate and short-lived, and there was no clinically significant AE. More than 76% of treatments still provided some visible effect at month 12.Conclusion: Based on RWE, HADL and HAGL are effective and safe in their respective indications mostly distributed in the midface, perioral region, and lower face. Observational registries are a valuable asset in the context of post-market clinical follow-up.Keywords: aesthetic, facial rejuvenation, nonsurgical, real-world evidence, registry

BackgroundThe aim of this systematic review and meta-analysis was to estimate the efficacy and prognostic value of protective weight-bearing for ONFH.MethodsThe authors searched the PubMed, EMBASE and Cochrane Library databases, up to February 25, 2022. RCTs and observational studies on conservative treatment, including the use of crutches, for skeletally mature patients with ONFH and written in English were included. Outcomes were the total hip arthroplasty (THA) rate, collapse rate, Hip Harris score (HHS) and visual analog scale (VAS) score. Cochrane Review Manager Software 5.4 and Stata 15.1 were used to perform the statistical analyses.ResultsA total of 14 studies involving 813 patients (1,025 hips) were included in this meta-analysis. The results showed that the THA rate, collapse rate, HHS and VAS scores in the protective weight-bearing group were not significantly different from those in the surgical group. In the protective weight-bearing group, the results showed that the THA rate was 40%, 8% in ARCO stage II, 37% in ARCO stage III, and the collapse rate was 46%. The mean HHS and VAS score was 80.86 and 1.00, respectively. The HHS score at the 3-, 6-, 12-, and 24-month follow-up was 79.93, 83.94, 85.94, and 96.09 points, respectively, whereas the VAS score at the 6- and 12-month follow-up was 2.20 and 1.29, respectively.ConclusionProtective weight bearing could achieve satisfactory results in terms of THA rate, collapse rate, HHS and VAS scores. Protective weight-bearing allows most precollapse patients to preserve the hip but also allows postcollapse patients to delay THA or hip-preserving surgery. The effects and prognosis of protective weight-bearing in the short or mid-term are noninferior to surgical hip preservation and are a viable alternative option for osteonecrosis of the femoral head.

We aimed to quantify the need for additional surgery in patients with chronic subdural hematoma (CSDH) primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery. Data were retrospectively collected from 283 patients with CSDH, primarily treated with dexamethasone, in 3 hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR). In total, 283 patients with CSDH were included: 146 patients (51.6%) received 1 dexamethasone course (DXM group), 30 patients (10.6%) received 2 dexamethasone courses (DXM-DXM group), and 107 patients (37.8%) received additional surgery (DXM-SURG group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared with 1, aOR 2.05; 95% confidence interval [CI] 0.90–4.65), used statins (aOR 2.09; 95% CI 1.01–4.33), had a larger midline shift (aOR 1.10 per mm; 95% CI 1.01–1.21) and had larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09–1.23), had a bilateral hematoma (aOR 1.85; 95% CI 0.90–3.79), and had a separated hematoma (as compared with homogeneous, aOR 1.77; 95% CI 0.72–4.38). Antithrombotics (aOR 0.45; 95% CI 0.21–0.95) and trabecular hematoma (as compared with homogeneous, aOR 0.31; 95% CI 0.12–0.77) were associated with a lower likelihood of surgery. More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas. [ABSTRACT FROM AUTHOR]

Dachshunds are at significant risk of experiencing thoracolumbar intervertebral disk herniation (IVDH) during their lifetimes. Standard of care includes advanced imaging, surgical intervention, and postoperative rehabilitation. Conservative management is commonly recommended for cases where the standard of care is declined, and little is known about the prognosis of treatment with conservative management and rehabilitation (nonsurgical rehabilitation). This retrospective cohort study assessed 12-week functional outcome and recurrence of clinical signs in 40 dachshunds with T3-L3 myelopathy presumed to be due to Hansen's Type I disc herniation, treated with nonsurgical rehabilitation. The overall prognosis was good with 34 of 40 (85.0%, 95% CI 70.2–94.2) dachshunds achieving functional pet status by 12 weeks postinjury. Modified Frankel Score at presentation was significantly (p < 0.001) higher in dogs with a positive 12-week outcome compared to dogs that did not recover by 12 weeks. All 27 dogs with motor function at presentation had a positive outcome. Of the 9 dogs exhibiting paraplegia with intact deep nociception at presentation, 7 dogs (77.8%) had achieved a positive outcome by 12 weeks. None of the 4 dogs persistently lacking deep nociception had a positive outcome. Among 27 dogs with a positive outcome for whom follow-up records were available, the 1- and 2-year recurrence rates for T3-L3 myelopathy were 5 and 11%, respectively. Nonsurgical rehabilitation should be considered in dachshunds with mild to moderate T3-L3 myelopathy or in severe cases when advanced imaging and surgical intervention are not possible.

Introduction: Non-surgical aesthetic treatments of the lower face are increasingly in demand, particularly aimed to restore facial youth following the changes secondary to a progressive resorption of facial skeleton and atrophy of facial fat compartments, which give the perception of a descent face. Objective: The aim of this research is to describe non-surgical reshaping of aged lower jaw by means of hyaluronic acid fillers. Methods: A retrospective analysis of data from adult female patients undergoing treatment of the lower third of the face with hyaluronic acid injections was performed. Injection techniques, relevant anatomy of the anatomical area and rheological properties of the fillers to be used are highlighted. Results: Thirty-six consecutive patients were enrolled (100% female; mean age, 45.7 years). A minimum of 4 vials, up to 7, of hyaluronic acid filler, were injected in order to achieve the desired results. Visual analog scale (VAS) was used to assess patient satisfaction. Thirty-two patients (88.8%) rated their appearance post-treatment with a satisfaction score ranging between 85 and 100%. Total absence of ecchymosis and/or swelling in the early post-operative days has been highlighted. There were no cases of infection, paresthesia, hematoma or necrosis. Conclusions: Jaw line remodeling with hyaluronic acid fillers, in patients not willing to undergo surgery, seems to be a viable option for ameliorating the definition of the lower third of the face, although it is mandatory to perform multi-layer injections using fillers with different rheological properties.

Approximately 15% of married couples undergo a fertility examination. Approximately half of the infertility cases have a male factor. Numerous advances have been made in reproductive medicine in the last few years. Infertile couples who previously were considered untreatable now have a chance at genetic paternity. Although it is possible to solve the problem with assisted reproductive techniques in cases with severe male factor, applying these treatment methods to all infertile partners is extra treatment, the cost increases, and rare but serious risks such as ovarian hyperstimulation may occur in the female partner. Prior to any andrological treatment, a serious diagnostic work-up should be performed and treatment should be individualized, providing adequate treatment options in selected cases. Primarily, specific therapeutic therapy directed against the etiological cause of infertility should be attempted. Specific medical treatment of infertility is based on identifying the causes of reversible infertility and treating it with appropriate drugs. Infertility causes such as hormonal disorders, i.e. congenital hypogonadotropic hypogonadism, hyperprolactinemia, genital tract infections, and sexual dysfunctions can be easily diagnosed and successfully treated with medical methods that do not require surgery. In this review, reversible causes of male infertility and nonsurgical specific medical treatment methods are discussed in the light of the current literature. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effectiveness of a multi-modal physical rehabilitation protocol (MPRP) in reducing pain and disability and preventing surgery in patients with chronic lumbar radicular pain (LRP) at a minimum follow-up of 12 months. Pre and post-treatment NPRS score, ODI score, disability categories of 189 patients with chronic LRP treated with MPRP were analysed to determine the efficacy of the treatment. Patients were followed-up at a minimum duration of 12 months for pain, disability, surgery performed, and patient satisfaction with treatment. After a mean treatment of 59 days, there was significant reduction in mean NPRS (p < 0.0001) and mean ODI (p < 0.0001) scores. Of 89 patients (47%) who could be contacted at mean follow-up of 18 months, 9 patients (10%) had undergone lumbar surgery, 52 patients (58.5%) reported no pain or complaints related to their lower back and 66 patients (74%) were either very satisfied or satisfied with the outcome of their treatment. A MPRP is effective in significantly improving pain and disability in patients advised surgery for chronic LRP. At a minimum follow-up of 12 months, pain and disability continued to be significantly lower and only 10% (9/89) patients underwent lumbar surgery. [ABSTRACT FROM AUTHOR]

Lesser metatarsophalangeal (MTP) joint instability can cause pain in the MTP joints with ambulation. The goal of nonsurgical treatment is to offload the metatarsal heads and stabilize the MTP joints. Achilles stretching can be effective by decreasing pressure in the forefoot with ambulation. Metatarsal offloading does not stabilize the lesser MTP joints but can alleviate pain in the plantar surface of the metatarsal heads. Crossover taping and strapping can stabilize the MTP joint and resist MTP hyperdorsiflexion. Steroid injections can alleviate inflammation but is also associated with further attenuation of the ligamentous structures that stabilize the MTP joint., Competing Interests: Disclosures Paragon28-research grants and consultant., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction The facial beauty is not easy to define, yet it is paramount to assess the needs of each patient to propose an appropriate treatment plan that will provide beautification or rejuvenation in a natural-looking fashion. One of the beauty aspects easily recognized is the face shape, which can give a perception of age, gender, and attractiveness, and reflects the facial anatomical structure. Because addressing the structure of the face is the basis for the aesthetic approach with dermal fillers, we find the identification of the patient’s face shape to be a very good starting point in the facial assessment. Objective To discuss important aspects of facial beauty, the characteristics of the different facial shapes (oval, heart, round, and angular), and a method of planning the aesthetic treatment with injectable fillers based on the strengths and weaknesses of each morphology of the face, that is called the AB face technique. Methods In this study, we describe seven clinical cases: two cases each of oval, heart, and round, and one case of angular shape. Results The evaluation of the face shape can help us define the priorities of the aesthetic approach, determining the areas that need to be restored in the aging face, as well as which areas could be enhanced in the younger patient. Conclusion This approach can be helpful in proposing the aesthetic treatment plan with injectable fillers to provide beautification, rejuvenation, and enhancement of the facial structure, which may benefit facial contours through aging.

The lower third is very important for the pleasant appearance of the face. A well-contoured jawline is desirable in men and women, giving a perception of beauty and youth. It is also key to sexual dimorphism, defining masculine and feminine characteristics. The nonsurgical rejuvenation and beautification of the lower third of the face is becoming more frequent. Injectable fillers can reshape the jawline, lift soft tissues, and improve facial proportions, effectively improving the appearance of the area. It is paramount to understand the facial anatomy and perform a good facial assessment in order to propose a proper aesthetic treatment plan. The aesthetic goal of the rejuvenation approach is to redefine the mandibular angle and line. In young patients, beautification can be achieved through correction of constitutional deficit or enhancement of the contour of the face, improving the facial shape. It is very important to possess knowledge of facial anatomy and of the aging process in order to deliver effective and safe results. In this article, we discuss the anatomy of the lower third of the face, facial assessment, aging process, and treatments of the chin, prejowls and mandibular line and angle with injectable fillers. The authors’ experience in the approach of this area is discussed.

Abstract Background Cervical radiculopathy is usually caused by disc herniation or spondylosis. The prognosis is expected to be good in most patients, but there is limited scientific evidence on the indications for nonsurgical and surgical treatments. The aim of the present study is to evaluate and compare the effectiveness of surgical and nonsurgical treatment in two trials – including disc herniation and spondylosis, respectively, and to evaluate factors that contribute to better decision making. Methods/design Patients with disabling radicular arm pain and MRI-proven cervical disc herniation or spondylosis will be randomised to receive nonsurgical or surgical treatment. The follow-up period is one year and the sample size is estimated to be 50 for each arm in the two trials, giving a total of 200 patients. The primary outcomes are the Neck Disability Index and arm pain. Secondary outcomes include neck pain; EQ-5D and costs to evaluate cost-effectiveness; prognostic factors; CT and MRI scans, to estimate intervertebral foraminal area and nerve root compression; and the expected minimal improvement for willingness to undergo treatment. Discussion The outcomes of this study will contribute to better decision making in the treatment of cervical radiculopathy. Trial registration This study has been registered at ClinicalTrials.gov as NCT03674619 , on September 17, 2018.

Debulking followed by intralesional 5‐fluorouracil (deb‐IL5FU) is a nonsurgical modality which has been used to treat skin cancer anecdotally for many years. There are few in depth studies examining this technique and success rate of intralesional 5‐fluorouracil (IL5FU) for the treatment of cutaneous squamous cell carcinoma (cSCC). To evaluate the response rate of deb‐IL5FU for the treatment of cSCC and to determine which patient factors were associated with tumor clearance or treatment failure. A retrospective chart analysis of patients with the diagnosis of cSCC or keratoacanthoma (KA) and subsequent deb‐IL5FU treatment. Sixty‐one patients with a total of 315 tumors (cSCC and KA), were treated using deb‐IL5FU. The overall tumor clearance rate was 89%. This was highest for well‐differentiated SCC, SCC, KA‐type SCC, and KA. Tumors on the trunk and extremities showed high clearance rates while tumors on the scalp/face/neck/ears showed lower clearance rates. Immunocompetent patients cleared more tumors compared to immunocompromised patients. Limitations included the retrospective nature of this analysis as well as a small sample size. Treatment of cSCC and KA with deb‐IL5FU demonstrated high tumor clearance rates. Lower rates of clearance were seen in males, immunosuppressed patients, tumors located on the scalp and face/neck/ears. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective.Objective: The aim of this study was to investigate the effect of body mass index (BMI) on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation.Summary Of Background Data: Despite being a well-known risk factor for developing LBP, there is minimal data on the effect of BMI on pain and disability in patients with chronic mechanical low back pain (LBP) treated with multimodal rehabilitation.Methods: Data from patients with chronic mechanical LBP who underwent multimodal rehabilitation treatment at a chain of spine rehabilitation outpatient clinics in one of the three BMI groups-1564 patients in normal body weight (BMI ≥18.5-24.9), 1990 patients in overweight (BMI ≥25-29.9), and 891 patients in obese (BMI ≥ 30) groups-were retrospectively analyzed. Pre- and post-treatment Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores, and final treatment outcomes were compared between the three groups. Multivariate analysis was used to determine the association between pre-treatment covariates and post-treatment clinical outcomes.Results: Post-treatment, the mean NPRS (P = 0.005) and mean ODI (P < 0.001) scores were significantly higher with a significantly lower percentage of full success outcome (P = 0.009) in the obese group when compared to normal and overweight groups. However, multivariate analysis showed a significant correlation between age, the number of treatment sessions, pre-treatment NPRS and ODI scores, and post-treatment NPRS and ODI scores and treatment failure, and no correlation with patient BMI.Conclusion: Patient BMI may not affect pain and disability outcomes in patients undergoing a multimodal rehabilitation treatment for chronic LBP. In contrast to BMI, other covariates such as age, treatment sessions, and pre-treatment NPRS and ODI scores may be associated with increased risk for poor treatment outcome. Obese individuals can expect clinical outcomes similar to normal or overweight individuals with multimodal physical rehabilitation for chronic LBP.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]