Feasibility of paying people who use drugs cash to distribute naloxone within their networks

INTRODUCTION

Immediate access to naloxone is needed to prevent fatal opioid-related overdoses in the presence of fentanyl analogs saturating the opioid supply. Peer models engage impacted populations who are not accessing naloxone through standard venues, yet compensating peers who utilize syringe service programs with cash stipends to distribute naloxone within networks of people who use drugs is not well described.

METHODS

As part of the HEALing Communities Study, syringe service program-based interventions were developed in Holyoke and Gloucester, MA, which paid people who use drugs ("peers") cash to distribute naloxone. Early program outcomes were evaluated for the time each program was funded within the HCS study period.

RESULTS

During 22 study-months of observation, peers in two communities distributed 1104 naloxone kits. The total cost of peer compensation for program delivery was $10,510. The rate of peer-distributed naloxone per 100 K population reached 109 kits/mo and 222 kits/mo in the two communities. Participating peers addressed gaps in harm reduction outreach and distributed naloxone and other harm reduction equipment to individuals who were not syringe service program participants, expanding organizational reach. Being compensated with unrestricted cash stipends supported dignity and acknowledged peers' work in overdose prevention.

CONCLUSION

The underutilization of compensated peer models is often attributed to funding and organizational barriers. These programs demonstrate that providing cash stipends to peers is feasible and expanded naloxone distribution at two existing syringe service programs. Providing cash stipends for peers who engage in secondary naloxone distribution offers promise in delivering naloxone to people not accessing syringe services.

No Tradeoff between Coherence and Sub-Poissonianity for Heisenberg-Limited Lasers

The Heisenberg limit to laser coherence C-the number of photons in the maximally populated mode of the laser beam-is the fourth power of the number of excitations inside the laser. We generalize the previous proof of this upper bound scaling by dropping the requirement that the beam photon statistics be Poissonian (i.e., Mandel's Q=0). We then show that the relation between C and sub-Poissonianity (Q<0) is win-win, not a tradeoff. For both regular (non-Markovian) pumping with semiunitary gain (which allows Q→-1), and random (Markovian) pumping with optimized gain, C is maximized when Q is minimized.

Synthesis and anti-HIV activity of guanidinoglycosides

The new guanidinylation reagent N,N'-diBoc-N''-triflylguanidine was used to efficiently convert multiamine-containing glycosides including kanamycin A and B, tobramycin, paromomycin, and neomycin B to the corresponding fully guanidinylated analogues (guanidinoglycosides). This transformation occurs in the presence of H(2)O under mild conditions. Guanidinotobramycin and guanidinoneomycin B were found to inhibit the replication of the HIV virus with activities approximately 100 times greater than the parent aminoglycosides.

Total synthesis of Monatin

The naturally occurring sweetener Monatin, a diastereomer of Monatin, and a phenyl analogue of Monatin have been prepared and isolated in their enantiomerically pure forms.

Nonsurgical breast enlargement using an external soft-tissue expansion system

Less than 1 percent of the women interested in having larger breasts elect to have surgical augmentation mammaplasty with insertion of breast implants. The purpose of this report is to describe and test the efficacy of a nonsurgical method for breast enlargement that is based on the ability of tissues to grow when subjected to controlled distractive mechanical forces. Seventeen healthy women (aged 18 to 40 years) who were motivated to achieve breast enlargement were enrolled in a single-group study. The participants were asked to wear a brassiere-like system that applies a 20-mmHg vacuum distraction force to each breast for 10 to 12 hours/day over a 10-week period. Breast size was measured by three separate methods at regular intervals during and after treatment. Breast tissue water density and architecture were visualized before and after treatment by magnetic resonance imaging scans obtained in the same phase of the menstrual cycle. Twelve subjects completed the study; five withdrawals occurred due to protocol noncompliance. Breast size increased in all women over the 10-week treatment course and peaked at week 10 (final treatment); the average increase per woman was 98 +/- 67 percent over starting size. Partial recoil was seen in the first week after terminating treatment, with no significant further size reduction after up to 30 weeks of follow-up. The stable long-term increase in breast size was 55 percent (range, 15 to 115 percent). Magnetic resonance images showed no edema and confirmed the proportionate enlargement of both adipose and fibroglandular tissue components. A statistically significant decrease in body weight occurred during the course of the study, and scores on the self-esteem questionnaire improved significantly. All participants were very pleased with the outcome and reported that the device was comfortable to wear. No adverse events were recorded during the use of the device or after treatment. We conclude that true breast enlargement can be achieved with the daily use of an appropriately designed external expansion system. This nonsurgical and noninvasive alternative for breast enlargement is effective and well tolerated.

Preapplication of mitomycin C for enhanced patency of myringotomy

OBJECTIVES

Ventilation tubes are the mainstay of surgical treatment for eustachian tube dysfunction and have been used successfully for many years. Certain disadvantages of ventilation tubes, however, have prompted research into alternative techniques including laser myringotomy. We investigated the use of KTP laser myringotomy in conjunction with topical mitomycin C to delay healing and prolong the patency of the myringotomy.

METHODS

Twenty myringotomies were created in 10 Sprague-Dawley rats. A solution of mitomycin C was applied to the intact tympanic membrane for 15 minutes. The solution was then suctioned free, and a myringotomy was created with a KTP laser. Fifty-three rats with saline application serving as controls from a previous study were used to allow statistical assessment.

RESULTS

The myringotomies remained open for a median of 9.5 weeks. Control myringotomies, which received saline solution instead of mitomycin C, healed within a median of 1.5 weeks. The difference was statistically significant at P < 0.0001. No complications were noted.

CONCLUSION

Topically administered mitomycin C before laser myringotomy is effective in prolonging the patency of laser myringotomies in rats. The patency rate is similar to that achieved in experiments in which topical mitomycin C is placed into the myringotomy site created by the laser.

Refinements in face lifting: enhanced facial contour using vicryl mesh incorporated into SMAS fixation

As we have gained experience with the extended superficial musculoaponeurotic system (SMAS) technique in face lifting, refinements in our procedure have led to increased consistency in results. The important factors that have led to our technical modifications include the following: (1) the significance of the retaining ligaments of the midface, which determine the degree of surgical dissection required for both skin and SMAS in rhytidectomy; (2) the changes in facial shape that occur with aging, secondary to the descent of facial fat; (3) the possibility of modifying facial shape through the repositioning of facial fat in an extended SMAS face lift; (4) the improved longevity of result to be obtained by incorporating Vicryl mesh into SMAS fixation; (5) the artistic nuances of incision design that help to minimize scar perceptibility. Understanding these factors enables surgeons to use the extended SMAS technique successfully with more challenging cases, enhancing facial appearance while minimizing signs that the patient has undergone a surgical procedure.

Engineering novel cell surface receptors for virus-mediated gene transfer

The absence of viral receptors is a major barrier to efficient gene transfer in many cells. To overcome this barrier, we developed an artificial receptor based on expression of a novel sugar. We fed cells an unnatural monosaccharide, a modified mannosamine that replaced the acetyl group with a levulinate group (ManLev). ManLev was metabolized and incorporated into cell-surface glycoconjugates. The synthetic sugar decorated the cell surface with a unique ketone group that served as a foundation on which we built an adenovirus receptor by covalently binding biotin hydrazide to the ketone. The artificial receptor enhanced adenoviral vector binding and gene transfer to cells that are relatively resistant to adenovirus infection. These data are the first to suggest the feasibility of a strategy that improves the efficiency of gene transfer by using the biosynthetic machinery of the cell to engineer novel sugars on the cell surface.

Histologic effects of the high-energy pulsed CO2 laser on photoaged facial skin

To delineate the histologic effects of laser resurfacing at photoaged skin, a protocol was designed to biopsy laser test sites in conjunction with adjacent actinically damaged skin at the time of rhytidectomy. Five patients with photodamaged skin underwent resurfacing of the preauricular region to examine the effect of increasing pulse energy and increasing number of passes on depth of dermal penetration. Histologic examination of these specimens showed that the depth of laser injury was dose-dependent. Increasing pulse energy created a deeper wound, and increasing the number of passes similarly produced a larger band of necrosis. Ten patients with photodamaged skin underwent resurfacing of the preauricular region 15 days to 6 months prior to undergoing a rhytidectomy. A comparison of the laser-resurfaced test spot with the adjacent untreated photodamaged skin demonstrated consistent histologic changes to both epidermis and dermis in all specimens examined. Following laser resurfacing, epidermal atrophy and atypia were eliminated, and all specimens exhibited a regeneration of epithelium that was normal in its morphology. Melanocytic hypertrophy and hyperplasia were corrected following treatment, although density and function of epidermal melanocytes appeared normal. All specimens exhibited a substantial amount of neocollagen formation involving both the superficial and middermis following resurfacing. In association with new collagen development within the dermis, there was noted to be a similar degree of proliferation of elastic fibers, as well as a diminution of glycosaminoglycans, which are typically present in actinically damaged elastotic dermis. To determine the effect of laser resurfacing on-black skin, laser test spots were placed in the postauricular region of three black patients. Biopsy of these test sites showed that the histologic effects of laser resurfacing were similar to those observed in Caucasian patients, with complete repopulation of epidermal melanocytes in specimens biopsied 3 months following resurfacing. The histologic effects of laser resurfacing are microscopically similar to those of phenol peeling in terms of the amelioration of photodamage. The distinction between these two treatment methods lies in their apparent effect on epidermal melanocytes, which appear to function normally following laser resurfacing.

Inhibition of superantigen-induced proinflammatory cytokine production and inflammatory arthritis in MRL-lpr/lpr mice by a transcriptional inhibitor of TNF-alpha

We have used fas-defective MRL-lpr/lpr mice to study the effects of the staphylococcal enterotoxin superantigens on the development of autoimmune, inflammatory joint disease in animals that are susceptible to the development of rheumatoid arthritis-like disease. We show that systematic administration by a single i.p. injection of staphylococcal enterotoxin B (SEB; 10 micrograms/mouse) caused a mild, inflammatory arthritis +30 days postchallenge in the knee joints of young (< 2-mo-old) MRL-lpr/lpr mice, but not aged-matched MRL +/+ mice. In aged (> 8-mo-old) MRL-lpr/lpr mice, but not in aged MRL +/+ mice, SEB caused a severe, inflammatory arthritis, as assessed histologically, and systemic autoimmune disease, including glomerulonephritis and autoantibody production. Furthermore, in aged MRL-lpr/lpr mice, SEB but not heat-denatured SEB caused acute weight loss and elevated levels of serum proinflammatory cytokines. Compared with highly purified peritoneal macrophages obtained from either aged MRL +/+, young MRL-lpr/lpr, or young MRL +/+, peritoneal macrophages obtained from aged MRL-lpr/lpr mice constitutively expressed 2- to 10-fold greater levels of TNF-alpha, IL-1 beta, IL-6, and IL-10, and produced elevated amounts of these cytokines when treated in vitro with SEB. SEB-challenged aged MRL-lpr/lpr mice treated with anti-TNF mAb (100 micrograms/mouse; every other day), anti-V beta 8 TCR mAb (250 micrograms/mouse; every other day), or orally with the novel TNF-alpha inhibitor MDL 201,449A (9-[(1R, 3R)-trans-cyclopentan-3-ol] adenine; 25 mg/kg/day) exhibited reduced inflammatory arthritis, autoantibody formation, and serum TNF-alpha levels, but not IL-10 levels, after +30 days of treatment. These data suggest that SEB is an extremely potent macrophage-activating factor in vitro and in vivo, enhancing several aspects of autoimmune disease in MRL-lpr/lpr mice, and that anti-TNF therapies may have potential use in inflammatory arthritis.

Inhibition of superantigen-induced proinflammatory cytokine production and inflammatory arthritis in MRL-lpr/lpr mice by a transcriptional inhibitor of TNF-alpha

We have used fas-defective MRL-lpr/lpr mice to study the effects of the staphylococcal enterotoxin superantigens on the development of autoimmune, inflammatory joint disease in animals that are susceptible to the development of rheumatoid arthritis-like disease. We show that systematic administration by a single i.p. injection of staphylococcal enterotoxin B (SEB; 10 micrograms/mouse) caused a mild, inflammatory arthritis +30 days postchallenge in the knee joints of young (&lt; 2-mo-old) MRL-lpr/lpr mice, but not aged-matched MRL +/+ mice. In aged (&gt; 8-mo-old) MRL-lpr/lpr mice, but not in aged MRL +/+ mice, SEB caused a severe, inflammatory arthritis, as assessed histologically, and systemic autoimmune disease, including glomerulonephritis and autoantibody production. Furthermore, in aged MRL-lpr/lpr mice, SEB but not heat-denatured SEB caused acute weight loss and elevated levels of serum proinflammatory cytokines. Compared with highly purified peritoneal macrophages obtained from either aged MRL +/+, young MRL-lpr/lpr, or young MRL +/+, peritoneal macrophages obtained from aged MRL-lpr/lpr mice constitutively expressed 2- to 10-fold greater levels of TNF-alpha, IL-1 beta, IL-6, and IL-10, and produced elevated amounts of these cytokines when treated in vitro with SEB. SEB-challenged aged MRL-lpr/lpr mice treated with anti-TNF mAb (100 micrograms/mouse; every other day), anti-V beta 8 TCR mAb (250 micrograms/mouse; every other day), or orally with the novel TNF-alpha inhibitor MDL 201,449A (9-[(1R, 3R)-trans-cyclopentan-3-ol] adenine; 25 mg/kg/day) exhibited reduced inflammatory arthritis, autoantibody formation, and serum TNF-alpha levels, but not IL-10 levels, after +30 days of treatment. These data suggest that SEB is an extremely potent macrophage-activating factor in vitro and in vivo, enhancing several aspects of autoimmune disease in MRL-lpr/lpr mice, and that anti-TNF therapies may have potential use in inflammatory arthritis.

Factors related to the initiation of prenatal care in the adolescent nullipara

The purpose of this cross-sectional descriptive study was to explore factors that influence the timing of the first prenatal care visit of pregnant adolescents. Although researchers agree that barriers to prenatal care need to be identified and interventions formulated, barriers have not been well defined for any specific population. Increased availability and adequacy of health care resources, more family system support, and higher self-care agency scores are hypothesized to predict earlier prenatal care. A convenience sample of 51 pregnant adolescents from a university clinic was surveyed. The study found that the availability/adequacy of health care resources was the most significant predictor of the initiation of prenatal care (p = .03). Of the various health care resources assessed, only the ease in attaining a medical card was positively related to the onset of prenatal care. Practitioners can be instrumental in disseminating information about the availability of health care resources and in easing access to those resources through local and national political involvement.

What's new in aesthetic surgery

This article describes new trends, techniques, and instrumentation in aesthetic surgery. Advances in our understanding of anatomy and the changes that come about with intrinsic and extrinsic factors are discussed. Specifically, anatomic approaches to rhytidectomy, the preservation of lid shape in blepharoplasty, and CO2 facial resurfacing are highlighted. Body contouring surgical techniques, including minimal scar breast reductions, endoscopic-assisted augmentation mammoplasty, and superficial liposuction, are reviewed.

Increased susceptibility of fas mutant MRL-lpr/lpr mice to staphylococcal enterotoxin B-induced septic shock

MRL-lpr/lpr mice are defective in the fas Ag/APO-1 apoptosis gene (CD95). Using the hepatotoxin D-galactosamine (D-GalNH2), we demonstrate that MRL-lpr/lpr mice have an increased susceptibility to staphylococcal enterotoxin B (SEB)-induced lethal shock, which causes them to exhibit the septic shock-like behaviors of fur ruffling and listlessness, and death occurs within 8 to 18 h. SEB susceptibility is greater in V beta 8.2 TCR transgenic MRL-lpr/lpr mice than in nontransgenic mice. In studies designed to elucidate the molecular pathways of SEB-induced septic shock, we found that C57Bl/6.Ab0/Ab0, MHC class II-deficient "C2D" mice, but not C57Bl/6-(+/+) mice, are nonresponsive to challenge with SEB. C2D mice, backcrossed with the fas mutation resulting in double-knockout C2D;lpr/lpr mice, are more susceptible to challenge with SEB/D-GalNH2. The LD50s for C57Bl/6.C3H-gld/gld "fas ligand-mutant mice" challenged with SEB/D-GalNH2 were comparable to C57Bl/6.MRL-lpr/lpr and MRL-lpr/lpr mice, suggesting that reciprocal mutations in either fas or fas ligand increases susceptibility to bacterial superantigens (SAGs). SEB-induced lethal shock can be reversed by treatment with Abs to V beta 8 TCR, MHC class II Ia+, IL-2, and TNF-alpha, by the immunosuppressant cyclosporin A, or by treatment with carbocyclic nucleoside analogues. These data indicate that SAG-induced septic shock is dependent on interactions with the TCR and MHC class II Ags, and they also suggest a critical role for a functional fas and/or fas ligand in resistance to SAG-induced septic shock.

Increased susceptibility of fas mutant MRL-lpr/lpr mice to staphylococcal enterotoxin B-induced septic shock

MRL-lpr/lpr mice are defective in the fas Ag/APO-1 apoptosis gene (CD95). Using the hepatotoxin D-galactosamine (D-GalNH2), we demonstrate that MRL-lpr/lpr mice have an increased susceptibility to staphylococcal enterotoxin B (SEB)-induced lethal shock, which causes them to exhibit the septic shock-like behaviors of fur ruffling and listlessness, and death occurs within 8 to 18 h. SEB susceptibility is greater in V beta 8.2 TCR transgenic MRL-lpr/lpr mice than in nontransgenic mice. In studies designed to elucidate the molecular pathways of SEB-induced septic shock, we found that C57Bl/6.Ab0/Ab0, MHC class II-deficient "C2D" mice, but not C57Bl/6-(+/+) mice, are nonresponsive to challenge with SEB. C2D mice, backcrossed with the fas mutation resulting in double-knockout C2D;lpr/lpr mice, are more susceptible to challenge with SEB/D-GalNH2. The LD50s for C57Bl/6.C3H-gld/gld "fas ligand-mutant mice" challenged with SEB/D-GalNH2 were comparable to C57Bl/6.MRL-lpr/lpr and MRL-lpr/lpr mice, suggesting that reciprocal mutations in either fas or fas ligand increases susceptibility to bacterial superantigens (SAGs). SEB-induced lethal shock can be reversed by treatment with Abs to V beta 8 TCR, MHC class II Ia+, IL-2, and TNF-alpha, by the immunosuppressant cyclosporin A, or by treatment with carbocyclic nucleoside analogues. These data indicate that SAG-induced septic shock is dependent on interactions with the TCR and MHC class II Ags, and they also suggest a critical role for a functional fas and/or fas ligand in resistance to SAG-induced septic shock.

Extended SMAS dissection as an approach to midface rejuvenation

The objective in rhytidectomy is to rejuvenate and improve facial appearance. To obtain consistent results, facelifting should be approached not just as a tightening or lifting procedure but also as a reconstructive procedure, reversing the anatomic changes that occur in aging. The ability to bring aesthetic harmony back into the aging face requires the blending of surgical technique, anatomic knowledge, and artistic sensitivity to individualize the surgical approach for a given patient. To obtain surgical rejuvenation while minimizing signs of surgical distortion remains the ultimate goal of our facelifting procedures.

Image of nurse-midwifery: a barrier to practice

The image of nurse-midwifery forms a barrier to utilization that is just as, if not more, formidable as laws restricting practice. In this paper, the issue of image for its impact on the practice of nurse-midwifery is analyzed. Historical, technological, consumer-oriented, and nursing-oriented factors that have affected midwifery's image and the profession's current status are explored. Recommendations to clarify the role and image, including political involvement, networking strategies, and research, are discussed. Although nurse-midwives, who emphasize cost-effective, quality, primary care, should be in the forefront of health care delivery, they are still widely misperceived, underutilized, and unrecognized as mainstream health care providers. In this era of health care reform, it is essential that the role and image of the nurse-midwife be clearly defined to the general public, maternity care consumer, fellow health care providers, and legislators.

Treatment of photoaging. Facial chemical peeling (phenol and trichloroacetic acid) and dermabrasion

A complete armamentarium using phenol, trichloroacetic acid, and dermabrasion allows the physician to successfully treat a variety of difficult photoaged skin problems in a consistent fashion. These three techniques have their specific indications, and patient selection is the key to a successful outcome. Proper attention to technical detail will allow the physician to fine-tune technique to meet the individual's needs. It is important to realize that phenol, trichloroacetic acid, and dermabrasion are not exclusive of each other, but are additive in their value. As one becomes well versed in these differing treatment modalities, one can tailor these techniques to obtain consistent results according to the needs and desires of the patient.

The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging

Controversy persists regarding the relationship of the superficial facial fascia (SMAS) to the mimetic muscles, deep facial fascia, and underlying facial nerve branches. Using fresh cadaver dissection, and supplemented by several hundred intraoperative dissections, we studied facial soft-tissue anatomy. The facial soft-tissue architecture can be described as being arranged in a series of concentric layers: skin, subcutaneous fat, superficial fascia, mimetic muscle, deep facial fascia (parotidomasseteric fascia), and the plane containing the facial nerve, parotid duct, and buccal fat pad. The anatomic relationships existing within the facial soft-tissue layers are (1) the superficial facial fascia invests the superficially situated mimetic muscles (platysma, orbicularis oculi, and zygomaticus major and minor); (2) the deep facial fascia represents a continuation of the deep cervical fascia cephalad into the face, the importance of which lies in the fact that the facial nerve branches within the cheek lie deep to this deep fascial layer; and (3) two types of relationships exist between the superficial and deep facial fascias: In some regions of the face, these fascial planes are separated by an areolar plane, and in other regions of the face, the superficial and deep fascia are intimately adherent to one another through a series of dense fibrous attachments. The layers of the facial soft tissue are supported in normal anatomic position by a series of retaining ligaments that run from deep, fixed facial structures to the overlying dermis. Two types of retaining ligaments are noted as defined by their origin, either from bone or from other fixed structures within the face.(ABSTRACT TRUNCATED AT 250 WORDS)

Production, characterisation and use of monoclonal antibodies to human interleukin-5 in an enzyme-linked immunosorbent assay

Two mouse monoclonal antibodies (Mabs) against recombinant human interleukin-5(rhIL-5) have been produced, characterised and purified. Both are IgG1 antibodies and neutralised the activity of rhIL-5 in the B13 assay. Neither Mab cross-reacted with mouse IL-5. A two-site sandwich enzyme-linked immunosorbent assay (ELISA) was developed with different combinations of the mouse Mabs and also a rat anti-mouse IL-5 Mab, TRFK5, which also has activity against rhIL-5. The most sensitive assay, with a lower detection limit of 0.5 ng/ml IL-5, used TRFK5 as the capture antibody and the mouse anti-human IL-5 Mab as second antibody. The sensitivity of this assay was increased by an enhanced chemiluminescent reagent and resulted in a lower limit of detection around 40 pg/ml IL-5.

The anatomy and clinical applications of the buccal fat pad

The buccal fat pad is an anatomically complex structure that has great importance in facial contour. In properly selected individuals, judicious harvesting of buccal fat can produce dramatic changes in facial appearance by reducing the fullness of the cheek and highlighting the malar eminences. Using fresh cadaver dissection, the anatomy of the buccal fat pad is delineated and its relationship to the masticatory space, facial nerve, and parotid duct is defined. An intraoral approach for buccal fat harvesting is described based on these anatomic findings. Clinical experience manipulating the buccal fat pad for aesthetic modification of facial contour is illustrated.

Chemical peel: a change in the routine

The use of occlusive taping following phenol chemical peel has become a standard technique. Many studies have demonstrated the effectiveness of tape occlusion in producing a deeper, more profound chemical peel. For the last 18 months, we have abandoned tape occlusion following phenol peel and have substituted an occlusive dressing using a thick layer of petroleum jelly (Vaseline). The occlusiveness provided by the petroleum jelly has proved to be almost as effective as the standard tape mask, and the results using this technique parallel those with a tape mask. The advantages of Vaseline occlusive dressing include greater patient comfort, the ability to evaluate the wound beneath the petroleum jelly, and the prevention of streaking, which can occur from uneven tape application. Eschar formation and crust separation are avoided after the peel by the constant use of facial lubricants, our preference being A & D ointment.

New horizons in surgical rejuvenation of the aging face

The development of aesthetic surgery as a major segment of plastic and reconstructive surgery is accepted among physicians. From a procedure at one time limited to the few, aesthetic surgery of the aging face has become commonplace. The patient seeking aesthetic surgery is attempting to improve self-image. The three major factors necessary for successful results are proper patient selection, a careful preoperative psychological evaluation, and expertise in carrying out the surgical procedure including management of complications. A total preoperative evaluation is essential to individualize the appropriate procedure which is correct for the particular patient.

Midazolam (Versed) in ambulatory surgery

Midazolam is a very useful drug in outpatient aesthetic surgery. Its principal advantages are (1) short duration of action (a half-life of 2.3 hours), (2) painless injection, (3) no incidence of postoperative phlebitis (as compared with diazepam), and (4) a high degree of safety and effectiveness. Since one of the main objectives in outpatient surgery is to have the patient recover as quickly as possible and be discharged without any significant drug hangover, we recommend the incorporation of midazolam into the armamentarium of the aesthetic surgeon. Subsequent to the presentation of this paper (Twentieth Annual Meeting of the American Society for Aesthetic Plastic Surgery, in Los Angeles, California, March 23, 1987), we have administered midazolam to an additional 400 patients undergoing outpatient surgery and no apnea has occurred requiring an airway or supportive respiratory measures.

Facial mimics and the coronal brow lift

The classic rhytidectomy leaves the upper third of the face without improvement. Yet the eye-eyebrow region is the most influential in determining facial expressions. There is only a narrow range of positions of the eyebrows in which they are perceived as attractive. The influence of the coronal browlift on facial mimics is discussed as it seems to be a way to predictably reposition the eyebrows and improve crow's feet and forehead, and glabellar wrinkles at the same time. The results of 56 patients surveyed 1-3 years postoperatively are presented.

Interleukin 1 of the central nervous system is produced by ameboid microglia

By screening specific populations of rat brain cells, we found that ameboid microglia secrete an 18 kD peptide with IL-1 biological activity. The IL-1 activity released by microglia was found to be identical to rat macrophage IL-1 on fractionation by gel filtration and high pressure liquid anion-exchange chromatography, and it was neutralized by an antiserum specific for murine IL-1. When added to astroglia grown in culture, microglial IL-1 increased the cell number of five- to sevenfold, and increased astroglial incorporation of [3H]thymidine by three- to fivefold. We propose that the proliferation of astroglia in specific brain regions may be regulated by the signaled release of IL-1 from activated microglial cells.

Characterization of ameboid microglia isolated from developing mammalian brain

Ameboid microglia are isolated from the cerebral tissue of neonatal rat by selective cell adhesion to plastic. Histochemical markers show that the microglial preparations are homogeneous (95 +/- 3%) and represent a 10% yield from starting cultures. Isolated ameboid microglia contain nonspecific esterase activity, the macrophage surface antigens MAC-1 and MAC-3, and acetylated low-density lipoprotein receptors. Ameboid cells have functional properties similar to those of macrophages, including the ability to engulf 5 micron latex beads, to secrete Interleukin-1 (IL-1) and to release superoxide anion. Unlike monocytes and adherent spleen cells, ameboid microglia do not show peroxidase activity by histochemical stain. Unlike resident peritoneal macrophages, ameboid microglia proliferate in vitro. Scanning electron microscopy shows that ameboid cells have short, spinous processes that can be distinguished from the ruffled surfaces of body macrophages. Our observations suggest that ameboid microglia are a distinct class of mononuclear phagocytic cells. Retinoic acid and dimethyl sulfoxide, agents known to accelerate differentiation in vitro, stimulate ameboid cells to develop thin processes several hundred microns in length. These "process-bearing" microglia eventually lose the capacity to engulf latex beads and to proliferate. They also show reductions in nonspecific esterase activity and in the binding of acetylated low-density lipoprotein. We suggest that in vitro ameboid microglia differentiate into nonphagocytic cells similar to ramified microglia found in normal adult brain. The isolation techniques described here provide the opportunity to study the composition and function of different microglial subpopulations during the development of the CNS.

Brain peptides and glial growth. I. Glia-promoting factors as regulators of gliogenesis in the developing and injured central nervous system

Glia-promoting factors (GPFs) are peptides of the central nervous system which accelerate the growth of specific glial populations in vitro. Although these factors were first discovered in the goldfish visual system (Giulian, D., Y. Tomozawa, H. Hindman, and R. Allen, 1985, Proc. Natl. Acad. Sci. USA., 83:4287-4290), we now report similar peptides are found in mammalian brain. The cerebral cortex of rat contains oligodendroglia-stimulating peptides, GPF1 (15 kD) and GPF3 (6 kD), as well as astroglia-stimulating peptides, GPF2 (9 kD) and GPF4 (3 kD). The concentrations of specific GPFs increase in brain during periods of gliogenesis. For example, GPF1 and GPF3 are found in postnatal rat brain during a peak of oligondendroglial growth while GPF2 and GPF4 are first detected at a time of astroglial proliferation in the embryo. Stab wound injury to the cerebral cortices of rats stimulates astroglial proliferation and induces marked elevations in levels of GPF2 and GPF4. Our findings suggest that two distinct classes of GPFs, those acting upon oligodendroglia and those acting upon astroglia, help to regulate cell growth in the developing and injured central nervous system.

Peptides released by ameboid microglia regulate astroglial proliferation

Peptides that stimulate astroglial proliferation are produced in traumatized adult rat brain by 10 d after injury. These same peptides are released by ameboid microglia activated in vitro. Our findings suggest that astroglial scarring is regulated in part by the release of factors from ameboid microglia near the site of brain injury.

Long-term histologic follow-up of phenol face peels

Deep phenol peels were done on 11 middle-aged white women with severe actinic damage. Subsequently, face lifts were carried out after periods of 1.5 to 20 years. This made it possible to obtain a full-thickness specimen extending several centimeters on either side of the border between peeled and unpeeled skin. In contrast to the markedly abnormal elastotic appearance of unpeeled skin, a new band of connective tissue 2 to 3 mm in width was laid down in the subepidermal region. Fine elastic fibers formed a dense network in the band of regenerated collagen. The disarray and cytologic abnormalities of sun-damaged epidermis were also largely corrected. Melanocytes were not eliminated, but melanin synthesis was evidently impaired, accounting for the bleaching effects. The effects of a phenol peel are very long lasting and adequately account for the effacement of wrinkles and obliteration of actinic keratoses, mottling, and freckling.

Chemical peeling as a practical method for removing rhytides of the upper lip

Chemical peeling is a safe, effective method for removing upper lip lines, or rhytides, over a long period of time. While the predictable, undesirable sequela of loss of pigmentation occurs in a significant number of patients, the effectiveness and safety of the procedure seem to outweigh this problem. Chemical peeling has become an accepted and effective tool for eliminating upper lip lines due to aging, and should be considered by physicians undertaking treatment of the wrinkled upper lip.

Chemical peel

Chemical face peeling as described in this article produces gross and microscopic changes in the skin which are permanent. The most important aspect in assuring the success of this procedure is the proper selection of patients. The primary use of this procedure is for the purpose of eliminating wrinkles, whether as the primary or ancillary procedure, such as regional peeling. Chemical peeling of the face is a valuable adjunct in the treatment of the aging face and can produce some rather dramatic results with the careful selection of patients and meticulous attention to detail in carrying out the peel, as well as the exact adherence to the post peel instructions by the patient.

Upper lid blepharoplasty

We reviewed, retrospectively, our upper lid blepharoplasties to critically compare our own postoperative results after (1) conventional blepharoplasty, or (2) fixation of the levator aponeurosis to the lower margin of the orbicularis, or (3) fixation of the levator to the lower margins of the orbicularis and the skin. We found no demonstrable difference in our results with these 3 techniques. It is our opinion that the standard conventional blepharoplasty (including excision of a strip of orbicularis muscle) is preferable for use in most caucasian eyelids. The results are as good, it is simple, and it is less likely to cause problems.

Rhytidectomy: a statistical analysis

A statistical analysis of 1,500 consecutive rhytidectomies is presented. In rhytidectomy, complications occur in a significant percentage of the operations. The plastic surgeon must be aware of the incidence and significance of these complications, and also he must know how to avoid or manage them.