Use of the microdialysis technique to assess lipolytic responsiveness of femoral adipose tissue after 12 sessions of mechanical massage technique

Micromassage Compression Leggings Associated with Physical Exercise: Pilot Study and Example of Evaluation of the Clinical and Instrumental Effectiveness of Conservative Treatment in Lipedema

We evaluated the effect of compression leggings with micromassage in association with physical activity on women with lipedema, not previously treated and without recent changes in body weight. The treatment resulted in an improvement in all subjective parameters, in spontaneous and evoked pain, in the volume of the limbs, in the absence of significant changes in body weight, and regardless of the duration of use, age, years of illness, the clinical stage, and body mass index (BMI). Evoked pain did not improve in areas affected by untreated lipedema; foot circumferences did not increase. We found a significant reduction in the thickness of subcutaneous adipose tissue (SAT) and skin evaluated in multiple points of the lower limb. Micromassage compression leggings are proposed as an integral part of conservative treatment. A method is proposed for the clinical evaluation of evoked pain, called the Progressive Pain Check (PPC), which allows for the calculation of a numerical score called the Ricolfi-Patton Score (RPS) and for the ultrasound evaluation of tissues. The method is simple and repeatable and allows for completion of the clinical evaluation of the patient at diagnosis and for an evaluation of the effects of various treatments, even applied to just one side of the body.

Comparison of selected body composition parameters in women using DXA and anthropometric method

Background

An excessive accumulation of the adipose tissue in women's organism is a frequent and important medical problem which should be monitored. The aim of this study was to explore correlations between the selected parameters of body composition assessed using DXA and anthropometric methods.

Materials and Methods

The study group consisted of 50 women aged 51-85. Both adipose mass and fat-free mass were assessed with the DXA method, and the nutritional status of the participants was evaluated with the anthropometric methods.

Results

The mean body mass index (BMI) value assessed with the DXA method amounted to 28.4 (±5.12). The Spearman's Rho correlation indicated the presence of a moderate association (0.27-0.50) between: (1) right arm lean and the circumference of the arm (P = 0.020), forearm (P = 0.011), and transverse cross-section of the arm (P = 0.020), (2) right leg fat and circumference of the thigh (P = 0.003), shin (P = 0.009), and also the musculature index of the lower extremity (P = 0.034), (3) visceral adipose tissue (VAT) mass and BMI (P = 0.050), Waist to HeightRatio (WtHR) (P = 0.031), (4) Android fat and WHtR (P = 0.044), and (5) gynoid fat and Škerlj index (P = 0.025).

Conclusion

The selected parameters assessed with DXA were significantly correlated with the selected parameters assessed with anthropometric methods. WHtR anthropometric parameter is significantly correlated with DXA parameters: VAT mass, gynoid region % fat and android region % fat.

Subcutaneous adipose tissue therapy reduces fat by dual X-ray absorptiometry scan and improves tissue structure by ultrasound in women with lipoedema and Dercum disease

Lipoedema is painful nodular subcutaneous adipose tissue (SAT) on legs and arms of women sparing the trunk. People with Dercum disease (DD) have painful SAT masses. Lipoedema and DD fat resists loss by diet and exercise. Treatments other than surgery are needed. Six women with lipoedema and one with DD underwent twelve 90-min sessions over 4 weeks. Body composition by dual X-ray absorptiometry scan, leg volume, weight, pain, bioimpedance, tissue size by caliper and ultrasound were analysed before and after SAT therapy by paired t-tests. There was a significant decrease from baseline to end of treatment in weight, 87.6 ± 21 to 86.1 ± 20.5 kg (P = 0.03), leg fat mass 17.8 ± 7.7 to 17.4 ± 7.6 kg (P = 0.008), total leg volume 12.9 ± 4 to 12 ± 3.5 L (P = 0.007), six of 20 calliper sites and tissue oedema. Pain scores did not change significantly. By ultrasound, six women had 22 hyperechoic masses in leg fat that resolved after treatment; five women developed seven new masses. Fascia improved by ultrasound after treatment. SAT therapy reduced amount and structure of fat in women with lipoedema and Dercum disease; studies are needed to compare SAT therapy to other therapies.

The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature

Vacuum massage is a non-invasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction, creates a skin fold and mobilises that skin fold. In the late 1970s, this therapy was introduced to treat traumatic or burn scars. Although vacuum massage was invented to treat burns and scars, one can find very little literature on the effects of this intervention. Therefore, the aim of this review is to present an overview of the available literature on the physical and physiological effects of vacuum massage on epidermal and dermal skin structures in order to find the underlying working mechanisms that could benefit the healing of burns and scars. The discussion contains translational analysis of the results and provides recommendations for future research on the topic. An extended search for publications was performed using PubMed, Web of Science and Google Scholar. Two authors independently identified and checked each study against the inclusion criteria. Nineteen articles were included in the qualitative synthesis. The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin. Besides physical effects, a variety of physiological effects are reported in literature, for example, an increased number of fibroblasts and collagen fibres accompanied by an alteration of fibroblast phenotype and collagen orientation. Little information was found on the decrease of pain and itch due to vacuum massage. Although vacuum massage initially had been developed for the treatment of burn scars, this literature review found little evidence for the efficacy of this treatment. Variations in duration, amplitude or frequency of the treatment have a substantial influence on collagen restructuring and reorientation, thus implying possible beneficial influences on the healing potential by mechanotransduction pathways. Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts. Suggestions for future research include upscaling the study design, investigating the molecular pathways and dose dependency, comparing effects in different stages of repair, including evolutive parameters and the use of more objective assessment tools.

Microenvironmental Control of Adipocyte Fate and Function

The properties of tissue-specific microenvironments vary widely in the human body and demonstrably influence the structure and function of many cell types. Adipocytes are no exception, responding to cues in specialized niches to perform vital metabolic and endocrine functions. The adipose microenvironment is remodeled during tissue expansion to maintain the structural and functional integrity of the tissue and disrupted remodeling in obesity contributes to the progression of metabolic syndrome, breast cancer, and other malignancies. The increasing incidence of these obesity-related diseases and the recent focus on improved in vitro models of human tissue biology underscore growing interest in the regulatory role of adipocyte microenvironments in health and disease.

Benefit of endermology on indurations and panniculitis/lipoatrophy during relapsing-remitting multiple sclerosis long-term treatment with glatiramer acetate

INTRODUCTION

Use of endermology (Endermologie®), which consists of a deep mechanical massage, in patients with multiple sclerosis receiving glatiramer acetate suggested improvements in injection-site indurations and panniculitis/lipoatrophy in our previous pilot experience. We aimed to assess the effect of endermology in a larger population of patients with multiple sclerosis receiving glatiramer acetate in clinical practice.

METHODS

This was the extension phase of our pilot experience, carried out in patients with relapsing-remitting multiple sclerosis (RRMS) and indurations and/or panniculitis/lipoatrophy associated with long-term glatiramer acetate administration. Patients underwent endermology sessions twice per week, for 6 weeks, according to clinical practice.

RESULTS

Seventy evaluable patients were included (mean age, 42.7±9.3 years; female, 95.7%; mean multiple sclerosis duration, 9.2±8.6 years; mean glatiramer acetate duration, 46.7±29.9 months). Fifty (71.4%) patients showed indurations and 58 (82.9%) panniculitis/lipoatrophy. After 12 endermology sessions, the number of patients with indurations significantly decreased (71.4% vs. 28.6%; p<0.001), as did the number of their indurations (4.2±3.6 vs. 3.7±3.4; p<0.001). Although the number of patients with panniculitis/lipoatrophy did not significantly decrease, there was a significant reduction in the number of areas of panniculitis/lipoatrophy (4.3±2.6 vs. 3.9±2.2; p<0.05). Forty-nine (98.0%) patients with indurations and 57 (98.3%) patients with panniculitis/lipoatrophy felt satisfied/very satisfied with treatment and considered endermology useful/very useful. Endermology was well tolerated, as some pain was reported in eight (11.4%) patients, discomfort in three (4.3%) patients, and local blotch/swelling and transient bruise in one (1.4%) patient each. Endermology enabled glatiramer acetate tolerance to be enhanced in 42 (60.0%) patients.

CONCLUSION

This project represents the largest experience available supporting the benefit of endermology in the reduction/disappearance of indurations and improvement in panniculitis/lipoatrophy in patients with RRMS receiving long-term glatiramer acetate treatment. Moreover, these benefits also contributed to enhancing glatiramer acetate tolerance.

Intensive treatment of cellulite based on physiopathological principles

Aim. The aim of this paper is to report a novel intensive therapy of gynoid lipodystrophy (cellulite) based on a new hypothesis. Methods. Were evaluated in 10 patients with ages ranging between 25 and 59 years (mean 35.6 years) grade IV cellulite identified by clinical evaluation. Before initiating treatment, perimetry was performed at 5 cm intervals along both thighs, at the gluteal fold, 5, 10, and 15 cm above the gluteal fold, at the navel, and 5 cm above the navel. The patients were submitted to a 4-hour daily treatment session that consisted of manual and mechanical lymph drainage and cervical stimulation by the Godoy & Godoy technique adapted for the treatment of cellulite. After 10 sessions over two weeks, the patients were again evaluated. The paired t-test was utilized for statistical analysis with an alpha error of 5% (P value < 0.05). A reduction was identified at all of the measurement points (paired t-test; P value < 0.0001). Results. The mean reductions varied between 4.0 and 5.7 cm at the measurement points but reductions of more than 10 cm in perimeter were achieved in some patients. Conclusion. This technique involving lymphatic system stimulation is efficacious in the treatment of cellulite.

Exploring channeling optimized radiofrequency energy: a review of radiofrequency history and applications in esthetic fields

INTRODUCTION

Because of its high efficiency and safety, radiofrequency (RF) energy is widely used in the dermatological field for heating biological tissue in various esthetic applications, including skin tightening, skin lifting, body contouring, and cellulite reduction. This paper reviews the literature on the use of nonablative RF energy in the esthetic field and its scientific background. The purpose of this article is to describe in detail the extensive use of medical devices based on RF technology, the development of these medical devices over the years, and recent developments and trends in RF technology.

METHODS

The authors conducted a systematic search of publications that address safety and efficacy issues, technical system specifications, and clinical techniques. Finally, the authors focused on their own clinical experiences with the use of patented Channeling Optimized RF Energy technique and mechanical massage. An in-vivo study was conducted in domestic pigs, with a thermal video camera. Twenty-seven female patients participated in a cellulite and body shaping study. The treatments were conducted according to a three-phase protocol. An additional 16 females participated in a skin tightening case study. All of the patients underwent three treatment sessions at 3-week intervals, each according to a protocol specific to the area being treated.

RESULTS

The review of the literature on RF-based systems revealed that these systems are safe, with low risks for potential side effects, and effective for cellulite, body contouring, and skin tightening procedures. The in-vivo measurements confirmed the theory that the penetration depth of RF is an inverse function of its frequency, and using a vacuum mechanism makes an additional contribution to the RF energy penetration. The heating effect of RF was also found to increase blood circulation and to induce collagen remodeling. The results from the cellulite and body shaping treatments showed an overall average improvement of 55% in the appearance of cellulite, with an average circumferential reduction of 3.31 cm in the buttocks, 2.94 cm in the thighs, and 2.14 cm in the abdomen. The results from the skin tightening procedure showed moderate improvement of skin appearance in 50% and significant improvement in 31%. At the follow-up visits the results were found to be sustained without any significant side effects.

CONCLUSION

Of all tissue heating techniques, RF-based technologies appear to be the most established and clinically proven. The design and specifications of the described vacuumassisted bipolar RF device fall within the range of the specifications currently prescribed for esthetic, nonablative RF systems.

Impact of a mechanical massage on gene expression profile and lipid mobilization in female gluteofemoral adipose tissue

BACKGROUND

Gluteofemoral adipose tissue areas are known to be poorly metabolically reactive. Mechanical massage has previously been reported to show morphological and functional impact on this tissue. The present study was carried out to delve more deeply into the mechanistic considerations regarding the incidence of a mechanical massage technique on gene expression profile and β-adrenergic-mediated lipid mobilization in female femoral adipose tissue.

METHODS

Twelve premenopausal healthy women were included and received 12 sessions of calibrated mechanical massage (Endermologie®). Total RNA was extracted from femoral adipose tissue biopsies for gene expression studies. Microdialysis was carried out in the femoral adipose tissue in order to assess lipolytic responsiveness (via glycerol determination) and changes in local blood flow following perfusion of a lipolytic agent, isoproterenol. Evaluations were performed before and after the 6-week experimental period.

RESULTS

Mechanical massage initiated important modifications in gene expression profile. The lipid-mobilizing effect of isoproterenol was enhanced after the experimental period. Basal local blood flow and isoproterenol-induced vasodilatation were also improved.

CONCLUSION

The protocol of mechanical massage used in the study promoted noticeable changes in the expression of genes involved in metabolic pathways. The lipolytic and local adipose tissue blood flow responses initiated by isoproterenol were significantly enhanced.

Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite

OBJECTIVE

To evaluate and compare the effectiveness of three different noninvasive treatment techniques on fat mass and regional fat thickness of the patients with cellulites.

METHODS

Sixty subjects were randomized into three groups. Group 1 (n = 20) treated with mechanical massage (MM), group 2 (n = 20) treated with manual lymphatic drainage (MLD) and group 3 (n = 20) treated with connective tissue manipulation (CTM) techniques. Subjects were evaluated by using standardized photographs, body composition analyzer (TBF 300) (body weight (BW), body mass index (BMI), fat %, fat mass (FM), fat free mass (FFM), total body water (TBW)), circumference measurement from thigh, waist-hip ratio (WHR), fat thickness measurements from abdomen, suprailium and thigh regions with skin fold caliper.

RESULTS

All groups had an improvement in thinning of the subcutaneous fat after the treatment (P < 0.05). Thigh circumference decreased by an average of 0.5 cm in all groups and thigh fat thickness decreased 1.66 mm in Group 1, 2.21 mm in Group 2 and 3.03 mm in Group 3. Abdomen and suprailium fat thicknesses decreased 2.4 and 2.58 mm in Group 1, 1.78 and 2 mm in Group 2 and 1.23 and 0.64 mm in Group 3, respectively. The mean difference in waist-hip ratio was 0.1 cm in all groups.

CONCLUSION

All the treatment techniques are effective in decreasing the regional fat values of the patients with cellulites.