Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image.We aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM.MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren's Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121.Effects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods.A total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I2:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I2:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I2:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I2:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I2:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I2:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I2:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I2:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported.Vaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them.The strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies.The data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is "very low" or "low".Filippini M, Porcari I, Ruffolo AF, et al., CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:452–470.

La chirurgie esthétique des paupières est de plus en plus demandée. Elle permet de rajeunir le regard au prix d'effets secondaires relativement minimes. Son rapport bénéfices escomptés/risques encourus est l'un des plus favorables de la chirurgie esthétique du visage. Cependant, la disgrâce palpébrale présentée par le patient n'est pas toujours correctement évaluée par ce dernier. C'est dire l'importance de l'examen clinique qui permet de cerner la demande du patient, puis de porter un diagnostic précis afin de poser une indication opératoire adaptée. On oppose globalement à l'heure actuelle les techniques de réductions tissulaires, consistant en une résection cutanéo-orbiculaire et/ou graisseuse aux techniques de remodelage palpébral consistant à "redistribuer" de la graisse par transposition des logettes adipeuses et à la lipostructure permettant d'apporter au sein d'une paupière creuse de la graisse autologue prélevée par lipo-aspiration. Par ailleurs, la place des traitements adjuvants à la blépharoplastie qui sont représentés essentiellement par les traitements de surface (peelings et lasers), les traitements volumateurs (produit de comblement), ainsi que le traitement des rides par contractions musculaires péri-orbitaires à l'aide de la toxine botulique, augmente régulièrement dans la prise en charge de l'esthétique palpébrale. Ils sont d'ailleurs de plus en plus utilisés de manière isolée dans les formes débutantes. Dans tous les cas, une bonne connaissance de l'anatomie, ainsi qu'une maîtrise parfaite des techniques restent nécessaires.Cosmetic eyelid surgery is becoming increasingly popular. It can rejuvenate the patient's appearance with relatively minor side effects. Its risk/benefit ratio is one of the best in facial cosmetic surgery. However, the patient does not always accurately assess the aesthetic appearance of his or her eyelids. This underscores the importance of clinical examination in order to determine the patient's wishes, and then make an accurate diagnosis and potential surgical plan. We currently oppose, in general, surgical techniques involving tissue removal (skin-muscle and/or fat) in favor of those involving tissue repositioning and grafting (autologous fat pearl transposition, obtained by liposuction, and lipostructure). Furthermore, the place of adjuvant therapies to blepharoplasty is steadily increasing. They mainly include surface treatments (peels and lasers), dermal fillers and anti-wrinkle botulinum toxin injections. They are also increasingly used in isolation in novel ways. In all cases, a perfect knowledge of anatomy and relevant skills and experience remain necessary.

La viscosupplémentation du liquide synovial par injection intra-articulaire d'acide hyaluronique est un traitement symptomatique de l'arthrose, largement utilisé dans la gonarthrose (arthrose du genou). À côté des produits conçus pour être administrés par injections multiples (typiquement 3 à 5 injections à intervalles de 1 semaine), un intérêt particulier se porte sur produits en injection unique (mono-injection) qui offrent des avantages spécifiques tels que la réduction du nombre de visites au médecin et du nombre d'interventions invasives avec leurs risques associés. Il subsiste toutefois une question concernant l'efficacité de ces mono-injections, par rapport aux protocoles à injections multiples.Une étude post-commercialisation, prospective, multicentrique, ouverte (ART-ONE 75), a été réalisée avec le produit pour injection unique Arthrum 2,5 % (3 mL, 75 mg d'acide hyaluronique) (LCA Pharmaceutical, Chartres, France), sur 214 patients atteints de gonarthrose. Les patients ont été suivis à 30, 60, 120 et 180 jours. Le profil moyen des patients à l'inclusion était un âge de 62,9 ans, 56 % de femmes, un stade radiologique Kellgren-Lawrence de I à III (46 % KL III), un indice de masse corporelle de 27,2 kg/m2 et une antériorité de 4 ans pour la gonarthrose. Une comparaison post hoc a été réalisée par rapport à une injection intra-articulaire unique de placebo (326 patients regroupés à partir de 3 essais randomisés contrôlés), et présentant un profil similaire de patients.Le critère principal était la variation par rapport à la baseline, de l'indice Western Ontario and McMaster Universities, sous-échelle de la douleur (WOMAC A) dont le score (base 0–100), était réduit à 60 jours, de 28,9 (17,4) pour la population en intention de traiter (199 patients), de 28,0 (17,8) pour la population per protocole à l'inclusion (175 patients), et de 27,7 (16.8) pour la population per protocole ayant terminé l'étude (143 patients). Les critères secondaires et accessoires comprenaient le score WOMAC A aux autres dates, le score WOMAC B (raideur), le score WOMAC C (fonction), la qualité de vie et le handicap à chaque date de suivi. Tous les indices étaient significativement améliorés et continuaient à s'améliorer à la fin de l'étude. L'évaluation thérapeutique à 180 jours a montré que plus de 75 % des patients étaient satisfaits de la réduction de la douleur, de l'amélioration de la mobilité et de la réduction de la consommation d'analgésiques et d'anti-inflammatoires non stéroïdiens. Le pourcentage de patients définis comme répondeurs selon les critères de l'OMERACT–OARSI Initiative était > 86 %, à partir de 60 jours. La tolérance globale était bonne, sans aucun évènement indésirable grave. Les résultats de la comparaison post hoc pour le score WOMAC A ont montré une taille d'effet variant de 0,33 (IC 95 % 0,15–0,51), à 60 jours à 0,65 (IC 95 % 0,45–0,85) à 180 jours (p < 0.001), versus placebo injecté (solution saline), qui est cliniquement significative en faveur d'Arthrum 2,5 %.La présente étude suggère l'efficacité clinique d'une mono-injection IA de 3 mL de solution viscoélastique contenant 75 mg d'AH natif de haut poids moléculaire (> 2 MDa).

L'acide hyaluronique (AH) est le produit de comblement le plus utilisé pour traiter les pertes de volume facial et les rides en particulier pour le rajeunissement facial. Selon la région du visage dans laquelle il est implanté, il sera soumis à deux types de forces (cisaillement latéral et compression/étirement) résultant de contraintes mécaniques intrinsèques et extrinsèques. L'objectif de cette note technique était d'expliquer comment la rhéologie, qui est l'étude de la déformation et de l'écoulement de la matière sous contrainte, peut nous aider dans notre pratique clinique d'injections et de comblement. En effet, la compréhension des propriétés rhéologiques des AH est indispensable au choix du produit idéal à utiliser selon la zone anatomique à corriger. Viscosité, élasticité et cohésivité du gel sont les trois composantes d'intérêt à prendre en compte lors de ce choix. Les médecins et chirurgiens esthétiques doivent se familiariser avec ces notions fondamentales afin de pouvoir choisir eux-mêmes le produit qui leur assurera un résultat naturel et durable.Hyaluronic acid (HA) is the most widely used dermal filler to treat facial volume deficits and winkles specially for facial rejuvenation. Depending on various areas of the face, filler is exposed to two different forces (shear deformation and compression/stretching forces) resulting from intrinsec and external mechanical stress. The purpose of this technical note is to explain how rheology, which is the study of the flow and deformation of matter under strains, can be used in our clinical practice of facial volumization with fillers. Indeed, comprehension of the rheological properties of HA has become essential in selection of dermal filler targeted to the area of the face. Viscosity, elasticity and cohesivity are the main three properties to be taken into consideration in this selection. Aesthetic physicians and surgeons have to familiarize with those basics in order to select the HA with the right rheological properties to achieve a natural-looking and long-lasting outcome.

We have analyzed the pronase-derived glycopeptides of the hemagglutinin glycoproteins expressed from SV40 vectors carrying cloned cDNA copies of the HA gene and of HA isolated from influenza virions (A/Jap/305/57). The glycopeptides derived from the HA glycoprotein obtained from cloned genes were heterogeneous, ranging in size from 3800 to 2800 dallons. Upon treatment with neuraminidase, sialic acid was released from the glycopeptides and their size was reduced to 2900–2400 daltons. However, under the same conditions, no sialic acid was detected in the virion HA. The presence of sialic acid was confirmed by monosaccharide analysis of the HA glycoprotein derived from products of cloned genes. These results support the idea that during replication of influenza virus, the viral neuraminidase cleaves sialic acid from the HA glycoprotein in infected cells.

L'hyperhidrose nous paraît encore insuffisamment prise en charge médicalement, alors qu'elle peut considérablement altérer la qualité de vie. Nous décomposerons l'approche thérapeutique du patient atteint d'hyperhidrose en plusieurs étapes : (a) connaître les bases physiologiques de la sécrétion sudorale ; (b) préciser le type d'hyperhidrose et rechercher les causes d'hyperhidrose secondaire avant d'affirmer le caractère primitif de l'hyperhidrose ; (c) évaluer le degré de sévérité de l'hyperhidrose, par une échelle validée (score HDSS), un test de Minor, voire des tests gravimétriques ; (d) choisir parmi les moyens thérapeutiques médicaux et chirurgicaux disponibles actuellement, à savoir les traitements locaux (antiperspirants, ionophorèse, injections de toxique botulique), généraux (oxybutynine) et chirurgicaux (sympathectomie thoracique).Hyperhidrosis continues to be undertreated in our view, despite its propensity to considerably impair quality of life. We shall break down therapeutic approaches to hyperhidrosis into several steps: (a) determine the physiological causes of excess sweating; (b) establish the type of hyperhidrosis involved and screen for causes of secondary hyperhidrosis before diagnosing essential hyperhidrosis; (c) evaluate the severity of the hyperhidrosis by means of a validated scale (HDSS score), Minor's starch-iodine test or gravimetric analysis; (d) select one of the medical therapies currently available, i.e. topical therapy (antiperspirants, iontophoresis or botulinum toxin injection), systemic therapy (oxybutynin) or surgery (thoracic sympathectomy).

Scar tissues were collected from patients with keloids, hypertrophic scars and mature scars. Normal skin was obtained from healthy individuals. Clinical attributes were used to select which tissue to obtain but the distribution of the specific hyaluronan (HA) staining was then used for the definite classification of the various scar types. Light microscopic and ultrastructural analyses were performed with an HA-binding probe, antibodies for collagen I and III and staining for mast cells.Ultrastructural studies of keloids revealed an altered collagen structure in the dermal layers, with an abundance of collagen fibres of similar diameter in both the reticular dermis (RD) and the papillary dermis (PD) compared to normal skin. Furthermore, the keloids displayed epidermal changes, which involved the basement membrane (BM), with fewer hemidesmosomes and an altered shape of desmosomes in the entire enlarged spinous layer. The frequency of mast cells found in keloids was lower than in other scar tissues and normal skin.These alterations in epidermis could influence the hydrodynamic and cell regulatory properties of the wounded skin with impaired function and insufficient regulative capacity to hinder the ever-growing collagen tissue that is characteristic for keloids.

In this study, torrefaction and organic-acid leaching pretreatment of rice husk samples was performed and their effects on the pyrolysis behavior were evaluated by TGA and laboratory scale pyrolysis reactor. The fuel characteristics of rice husk samples after pretreatment were improved. The results of ICP-OES analysis indicated that torrefaction process increased most inorganic species concentrations except Cl in the torrefied rice husk sample. Meanwhile, torrefaction decreased the removal efficiencies of inorganic species during leaching process. As the results of TGA shown, torrefaction and leaching pretreatment significantly changed the pyrolysis behavior. For laboratory scale pyrolysis experiment, the results indicated that torrefaction process reduced the bio-oil yield with the increase of the yield of char, but leaching process followed by torrefaction alleviated the adverse effects of torrefaction process. For the rice husk sample after combined torrefaction and leaching process the chemical compounds of phenols and sugars in bio-oil were enriched. Furthermore, the chemical compounds distribution in bio-oil after combined torrefaction and leaching pretreatment process was concentrated in the range between C6 and C9, which was conducive to refining gasoline by upgrading. Combined torrefaction and leaching process has the promoting role on the quality of bio-oil according to the physical properties of bio-oil.

Les cosmétiques contribuent au succès des traitements anti-acnéiques, en assurant une hygiène optimale, en compensant l’irritation et la sécheresse induites par les médicaments et en permettant un maquillage et une photoprotection adaptés. Les produits les plus modernes peuvent directement contribuer à l’obtention d’un bénéfice thérapeutique, seuls ou en accompagnement des médicaments.Le conseil prodigué par le dermatologue est essentiel. Ses choix sont guidés par l’information des laboratoires et l’efficacité et la tolérance relevées à l’usage. La cosmétologie est globalement considérée par le dermatologue comme une partie de la prise en charge de l’acné dénuée de tout effet secondaire notable.Au quotidien, l’attitude du dermatologue est la prescription concomitante de médicaments et de dermo-cosmétiques, approche que l’on retrouvera également dans la prise en charge d’autres affections, comme la dermatite atopique. Ce fonctionnement s’inscrit dans la cadre d’un véritable protocole de soins où chaque élément a et prend sa place, de l’hygiène quotidienne à l’isotrétinoïne, pour assurer une prise en charge complète et personnalisée.Cosmetics contribute to the success of antiacne treatments, by providing optimal hygiene, compensating the irritation and dryness induced by medications, and allowing use of adapted cosmetics and sun protection. The most contemporary products can contribute directly to obtaining a therapeutic benefit, either alone or with medications.The dermatologist's advice is essential. The choices are guided by information from laboratories and the efficacy and tolerance tested by use. Overall, cosmetology is considered by the dermatologist as part of the management of acne devoid of notable side effects.In day-to-day medical practice, the dermatologist prescribes medications and dermocosmetics together, an approach that is also found in managing other disorders such as atopic dermatitis. This mode of operation is part of a true healthcare protocol in which each part has its importance, from daily hygiene to isotretinoin, to ensure complete and individualized management.

This chapter discusses the neotectonics of the Alps. The distribution of earthquakes on both sides of the Mediterranean defines the diffuse boundary between the Eurasian and African plates with other microplates. The technique of direct measurement of active deformation of rocks is based on different methods of varying accuracy such as the contraction of tunnel diameters and the ellipticity of circular boreholes. In regions of strong relief, the interpretation of the results is beset by the difficulty of determining the role of gravity slides on mountain flanks. Present-day relative uplift and lowering of ground level have been measured directly over historical time with respect to the fixed reference of sea level. For periods of geological time, the vertical movement of rocks—that is, their burial or exhumation—is estimated with respect to ground level, which is variable with time. The spatial variation in horizontal movements can be derived from a comparison of repeated geodetic triangulation networks over several decades. The chapter describes the late faults in the field. Measurements of vertical and horizontal movements and a better knowledge of active deep structures are required for an integrated and explanatory model of the neotectonism, which is the subject of the research presented in the chapter.

Objective To compare the efficacy of combined tacrolimus and 308-nm excimer laser therapy vs 308-nm excimer laser monotherapy in treating vitiligo. Design Comparative, prospective, randomized, intraindividual study. Patients Fourteen patients, aged 12 to 63 years, with Fitzpatrick skin types II to IV. Intervention For each patient, 4 to 10 target lesions were chosen. The treatment applied to each target lesion was randomized by drawing lots. Each lesion was treated twice a week by the 308-nm excimer laser, for a total of 24 sessions. Initial fluences were 12 mcal/cm2(50 mJ/cm2) less than the minimal erythemal dose in vitiliginous skin. Then, fluences were increased by 12 mcal/cm2every second session. Moreover, topical 0.1% tacrolimus ointment was applied twice daily on target lesions receiving the combined tacrolimus and excimer laser treatment (group A). Group B target lesions received only excimer laser monotherapy. For each treated lesion, the untreated lesion on the opposite side served as the control. Tolerance was evaluated by a visual analog scale, and secondary events were recorded at each session. Main Outcome Measure Treatment efficacy, which was blindly evaluated by 2 independent physicians by direct and polarized light photographs taken before and after treatment. Results Forty-three lesions were treated (23 in group A and 20 in group B). All patients completed the study. Repigmentation was observed in all group A lesions (100%) and in 17 (85%) of the 20 group B lesions. Repigmentation was not observed in the untreated lesions (control group). A repigmentation rate of 75% or more was obtained in 16 (70%) of the 23 group A lesions and in 4 (20%) of the 20 group B lesions. In UV-sensitive areas (the face, neck, trunk, and limbs, with the exception of bony prominences and extremities), 10 (77%) of 13 group A lesions had a repigmentation rate of 75% or more vs 4 (57%) of 7 group B lesions. In classically UV-resistant areas, 6 (60%) of 10 group A lesions had a repigmentation rate of 75% or more vs 0 of the 13 group B lesions. The mean number of sessions necessary for an improvement of repigmentation was 10 in group A and 12 in group B. Adverse effects have been limited, and tolerance was excellent. Conclusions The combination treatment of 0.1% tacrolimus ointment plus the 308-nm excimer laser is superior to 308-nm excimer laser monotherapy for the treatment of UV-resistant vitiliginous lesions (P<.002). The efficacy and the good tolerance of the 308-nm excimer laser in monotherapy for treating localized vitiligo were also confirmed, but this treatment regimen should be proposed only for UV-sensitive areas.

Two patients with typical lesions of erythema gyratum repens, peripheral ichthyosis, palmoplantar hyperkeratosis and nail changes are described. A non-specific erythrodermic eruption of several weeks' duration had preceded the typical lesions. No signs of internal malignancy were found and the typical gyrate lesions disappeared within some weeks with full restitution of all skin lesions within 6-8 months.

A case of Erythema Gyratum Repens in a 76 year old man with bronchiolar carcinoma is reported. The onset of the dermatosis preceded the discovery of the neoplasm. Oral corticosteroids induced the disappearance of the skin lesions. No recurrence was observed after discontinuation of the treatment. The patient died 7 months after the onset of the dermatosis.