Cardiac Troponins for the Clinical Management of Patients with Claudication and without Cardiac Symptoms

Many patients with peripheral arterial disease (PAD) exhibit undiagnosed obstructive coronary artery disease. We aim to identify the patients with lifestyle limiting claudication due to PAD and without cardiac symptoms, requiring coronary revascularization based on high-sensitive troponin T (hsTnT) values. We assessed hsTnT in consecutive patients referred for elective endovascular treatment due to claudication [Rutherford categories (RC) 2 & 3] between January 2018 and December 2021. Diagnostic work-up by non-invasive imaging and, if required, cardiac catheterization was performed according to clinical data, ECG findings and baseline hsTnT. The occurrence of cardiac death, myocardial infarction or urgent revascularization during follow-up was the primary endpoint. Of 346 patients, 14 (4.0%) exhibited elevated hsTnT ≥ 14 ng/L, including 7 (2.0%) with acute myocardial injury by serial hsTnT sampling. Coronary revascularization by percutaneous coronary intervention was necessary in 6 of 332 (1.5%) patients with normal versus nine of 14 (64.3%) patients with elevated hsTnT (p < 0.001). During 2.4 ± 1.4 years of follow-up, 20 of 286 (7.0%) patients with normal versus four of 13 (30.8%) with elevated hsTnT at baseline reached the composite primary endpoint (p = 0.03 by log-rank test). In conclusion, elevated troponins in cardiac asymptomatic patients with claudication modify subsequent cardiac management and may increase the need for closer surveillance and more aggressive conservative management in polyvascular disease.

Phoenix atherectomy for patients with peripheral artery disease

BACKGROUND

Endovascular atherectomy enables minimally invasive plaque removal in peripheral artery disease (PAD).

AIMS

We aimed to evaluate the safety and the long-term effectiveness of the Phoenix atherectomy for the treatment of complex and calcified lesions in PAD patients.

METHODS

Consecutive all-comer patients with PAD underwent the Phoenix atherectomy. Device safety in terms of perforation and distal embolisation were evaluated. Lesion calcifications were categorised by the Peripheral Arterial Calcium Scoring System (PACSS) and lesion complexity was assessed by the Transatlantic Inter-Society Consensus (TASC). Clinically driven target lesion revascularisation (TLR) was assessed.

RESULTS

A total of 558 lesions were treated in 402 consecutive patients. Clinical follow-up was available at 15.7±10.2 months for 365 (91%) patients. Of 402 patients, 135 (33.6%) had claudication, 37 (9.2%) had ischaemic rest pain and 230 (57%) exhibited ischaemic ulcerations. Lesions were mostly identified in the femoropopliteal segments (55%), followed by below-the-knee (BTK) segments (32%). Complex TASC C/D lesions and moderate to severe calcifications (PACSS score ≥2) were present in 331 (82%) and 323 (80%) patients, respectively. The mean lesion length was 20.6±14.3 cm. Five (1%) perforations and 10 (2%) asymptomatic embolisations occurred. Bail-out stenting was performed in 4%, 16% and 3% of patients with common femoral artery, femoropopliteal and BTK lesions, respectively. During follow-up, 5 (3.9%) patients with claudication and 52 (21.9%) patients with critical limb-threatening ischaemia (CLTI) died (hazard ratio [HR] 3.7; p<0.001). Freedom from TLR was 87.5% (112 of 128) in patients with claudication and 82.3% (195 of 237) in patients with CLTI, respectively (HR 1.8; p=0.03).

CONCLUSIONS

The Phoenix atherectomy can be safely performed in patients with complex lesions with a relatively low rate of bail-out stenting and clinically acceptable TLR rates.

GERMAN CLINICAL TRIALS REGISTER

DRKS00016708.

Safety and effectiveness of Phoenix atherectomy for endovascular treatment in calcified common femoral artery lesions

Background: Traditionally endarterectomy has been considered as the gold standard technique for the treatment of common femoral artery (CFA) lesions. The aim of this study is to investigate the procedural safety and mid-term outcomes of minimal invasive Phoenix atherectomy for the treatment of CFA lesions. Patients and methods: Phoenix atherectomy was used for treatment of 61 consecutive, moderately to heavily calcified CFA lesions in 56 patients. Lesions were classified based on the CFA occlusive disease classification (Type I, II&III lesions). Primary endpoints were technical, procedural, and clinical success rate. Safety endpoints (vessel perforation, peripheral embolization) and clinically driven target lesion revascularization (TLR) were also assessed. Results: Of 61 CFA lesions, 58 (95%) exhibited at least moderate/severe calcification (PACSS3 in 38 (62%) and PACSS4 in 20 (33%) cases). Type III lesions were present in 30 (49%), type I/II lesions in 31 (51%) cases. Technical and procedural success was achieved in 30 (49%) and all 61 (100%) lesions, respectively with low complication rates (0% perforation, 2% embolization). Adjunctive treatment after atherectomy was performed using drug-coated balloon (DCB) in 35 (57%) and bail-out stenting in 6 (10%) cases. Target lesion revascularization (TLR) occurred in 4 (7%) cases during a mean follow-up duration of 11±7months. All patients exhibited clinical improvement at follow-up, showing mean Rutherford category reduction from 3.7±1.1 to 1.5±1.1 (p<0.001). Conclusions: The Phoenix device can be used for the effective endovascular treatment of CFA lesions, due to its reasonable safety profile and mid-term results.

Exercises and Skin Physiology During International Space Station Expeditions

BACKGROUND: The first skin physiological pilot experiment (SkinA) on a single astronaut showed a deterioration of the skin. In a follow-up experiment (SkinB) we showed that skin physiological parameters improved on average. However, it is well known that sports have positive effects on the skin, that astronauts prefer special sports devices, and do sports with different intensity. The aim of this study was to analyze the different sports activities of SkinB astronauts and to find out whether they have an influence on the skin physiological parameters.METHODS: The cumulative distance covered on the treadmill and on the cycle ergometer as well as the repetition of arm-related exercises have been calculated and possible correlation between sports activities and skin physiological parameters have been analyzed.RESULTS: The average distance covered for all six astronauts per day is 1364 AU on the treadmill T2, and 11,077 AU on the cycle ergometer CEVIS. In addition, the astronauts performed an average of about 73 repetitions of all arm-related exercises daily. Here, we were able to show very well how differently the astronauts on the ISS train. In addition, a decreasing trend in skin volume can be observed in astronauts with increasing activity on the bicycle and more repetitions on arm-related exercises.CONCLUSION: Increased activity on the cycle ergometer and increased arm-related exercises have a medium negative impact on the parameter skin volume and thus reflects more fluid content in the skin. No correlations between sports activities and skin moisture/skin barrier function could be found.Braun N, Hunsdieck B, Theek C, Ickstadt K, Heinrich U. Exercises and skin physiology during International Space Station expeditions. Aerosp Med Hum Perform. 2021; 92(3):160166.

Safety, effectiveness and mid-term follow-up in 136 consecutive patients with moderate to severely calcified lesions undergoing phoenix atherectomy

To investigate the safety and effectiveness of the Phoenix atherectomy device for the treatment of complex and calcified lesions in patients with peripheral artery disease (PAD). 136 consecutive all-comer patients with chronic PAD underwent Phoenix atherectomy. Safety in terms of vessel injury and embolism, efficacy and clinical success in terms of ≥ 1Rutherford class (RF) improvement during follow-up were systematically analyzed. Lesion calcification was categorized by the Peripheral Arterial Calcium Scoring System (PACSS), whereas lesion complexity was classified by the Transatlantic Inter-Society Consensus (TASC). 151 lesions were treated in 136 consecutive patients. Clinical follow-up was available at 10.3 ± 4.2 months in 132 (97%) patients. 55 patients (40%) had intermittent claudication, 16 (12%) rest pain and 65 (48%) had ischemic ulcerations (mean RF class = 4.2 ± 1.1). 15 (11%) patients had TASC B lesions, whereas the majority 72 (53%) and 49 (36%) exhibited TASC C and D lesions, respectively. Mean PACSS score was 3.3 ± 0.9. Mean lesion length was 106 ± 92 mm. Atherectomy was combined with drug-coated balloon (DCB) in 129 (95%) patients. Nine (6.6%) patients with infra-inguinal lesions received stents. Technical and procedural success were recorded in 102 (75%) and 135 (99%), respectively. Perforation was noticed in 2 (1%), whereas asymptomatic embolism occurred in 6 (4%) patients. Clinical success was present in 54 (100%) patients with claudication and in 65 of 78 (83%) patients with critical limb ischemia (CLI). Atherectomy in combination with DCB angioplasty can be safely performed in patients with complex, calcified peripheral lesions with a relatively low rate of bail-out stenting and promising clinical mid-term results.German Clinical Trials Register: DRKS00016708.

The Influence of Short-Wave and Long-Wave Radiation Spectrum on the Photostability of Sunscreens

BACKGROUND

Sunscreen products aim to help protect the skin against UV radiation and consequently reduce the risk of early skin ageing and skin cancer. However, it is well known that some sunscreen ingredients are not photostable, but this usually refers to irradiation with UV light. Moreover, it has to be mentioned that a relative cumulative erythema effectiveness compliant light source is used for the in vivo sun protection factor (SPF) testing. Here, UV simulators equipped with a xenon arc lamp use filters such as WG320 and UG11 (thickness 1 mm) to minimize infrared (IR) radiation and wavelength below 300 nm. However, under practical conditions, the sunscreen product is not only exposed to UVA/B light, but also to visible light (VIS) and IR light. In fact, the spectrum of solar radiation is composed of approximately 7% UV, 39% VIS and 54% IR.

AIMS

To investigate the influence of short-wave and long-wave radiation on the photostability of sunscreens.

METHODS

Irradiation was performed with the Suntest CPS+ that is considered to closely imitate solar radiation. The filter UG11 (thickness 1 mm), which absorbs much of the VIS and IR light, and the glass filter WG320 (thickness 2 mm), which effectively absorbs radiation of wavelengths less than 300 nm, were used in the Suntest CPS+ both individually and in combination and were inserted between the light source and the samples. The following transmission measurements were carried out with Labsphere's UV-2000s device. Here, the effectiveness (percentage change of SPF before irradiation to SPF after irradiation) as a measure of the photostability was calculated.

RESULTS

As expected after total solar spectrum irradiation, the effectiveness in all tested sunscreens is lower compared to relative cumulative erythema effectiveness light used for in vitro testing of SPF. In the reference sunscreen formula S2 as well as in the two different sunscreen products, especially long-wave radiation (>400 nm) had an effect on photostability, whereas short-wave radiation had only a minor impact. In contrast, in the BASF sun care gel line only short-wave radiation below 300 nm had an effect on photostability, and blocking VIS and IR light had no effect at all.

CONCLUSION

Based on these data, we can conclude that short waves and/or VIS + IR light have an influence on the photostability of sunscreens.

3049Equally high detection rates of atrial fibrillation in patients after a TIA and stroke by systematic ECG monitoring with an implanted device: SPIDER-AF study

Introduction

The risk of neurovascular and cardiovascular morbidity is substantially increased by undetected atrial fibrillation (AF). Therefore, early detection of AF is crucial to initiate appropriate therapy in persons at risk and may improve outcome. An implantable loop recorder (ILR) can monitor the heart rhythm for up to three years, modern devices provide dedicated algorithms to detect AF.

Hypothesis

We aimed to investigate the AF detection rate by the use of an ILR in patients after a recent cerebrovascular event (TIA n=137 or stroke n=363) presenting in sinus rhythm and no history of AF in the ambulatory setting by office based cardiologists.

Purpose

Observational study in patients with no prior diagnosis of AF, who had (presumably thromboembolic) transient ischemic attack (TIA) or stroke within 12 months and were implanted an ILR in the last 6 months. Follow-up visits every 3 months for 1 year overall.

Results

In 34 outpatient cardiology centers in Germany, a total of 500 patients were documented (mean age 63.1±12.7 years, 35.4% >70 years; 60.8% males). The qualifying event - diagnosed by neurologists - was a TIA in 137 (27.4%) and a stroke in 363 (72.6%) with typical thromboembolic pattern in NMR imaging (29.2% TIA/45.2% stroke, p<0.001), in CT imaging (7.3% TIA/7.7% stroke, n.s.), in both (6.6% TIA/19.6% stroke, p<0.001).

During follow-up, AF was newly detected by the device in TIA patients in 29.9% and in stroke patients in 25.6% (n.s.). The mean screening period until detection of AF with the Reveal LinQ device was 170±134 days in TIA, 145±128 in stroke respectively (n.s.). 95.7% had paroxysmal and 4.3% persistent AF in stroke, TIA patients had 100% paroxysmal AF (n.s.), median duration was 5.0 min in TIA and 5.2 min in stroke, respectively (n.s.). Most AF patients were asymptomatic (68.3% TIA/ 83.9% stroke, p<0.03).

The mean CHA2DS2Vasc score in patients with AF was 4.0 and 4.1 in those with TIA and stroke (n.s.), for patients in sinus rhythm 3.7 and 3.9, respectively (n.s.). Arterial hypertension was present in 71.5% with TIA/76.0% with stroke (n.s.), diabetes mellitus in 15.3% with TIA/25.1% with stroke (p<0.05), coronary artery disease in 12.4% with TIA/14.6% with stroke (n.s.), vascular disease in 3.6% with TIA/5.0% with stroke (n.s.).

Conclusions

In patients in sinus rhythm and no history of AF after a TIA or stroke, during 1-year follow-up AF could be newly detected in a quarter of patients by means of systematic continuous screening with an implantable ECG device. As AF diagnosis usually leads to immediate secondary prevention with long-term anticoagulation, such screening is useful not only in stroke but also in TIA patients and may substantially reduce the risk of recurrent stroke and cardiovascular morbidity.

Acknowledgement/Funding

SPIDER-AF registry was performed by BNK Service GmbH, Munich (Germany) and supported by Bayer Vital GmbH and Medtronic GmbH in equal parts

Surface Evaluation of Living Skin (SELS) parameter correlation analysis using data taken from astronauts working under extreme conditions of microgravity

BACKGROUND

In space, due to fluid shift a 45% decrease in the skin topography parameter volume (mm³ ) was seen using the VisioScan^® camera. Simultaneously, the parameters roughness, scaling and wrinkles changed dramatically as well. Thus, the present study has the objective to understand the relationship between the SELS parameters under extreme conditions and their application by addressing scientific-dermatological questions.

MATERIAL AND METHODS

SELS measurements were performed on the volar forearms of six astronauts. The Pearson correlation coefficient was used to determine the association between the variables.

RESULTS

A significant correlation was found between the skin topography parameter volume and the skin parameters roughness, scaling and wrinkles. A closer look at each astronaut revealed a significant correlation for all astronauts for the parameters volume and roughness and for more than 65% of the astronauts for the parameters volume and scaling and volume and wrinkles. However, no correlation could be found between the parameters skin hydration and roughness and scaling, respectively.

CONCLUSION

Only the parameter skin volume leads to meaningful data under microgravity. Physiological changes observed by fluid shift are comparable to the skin condition edema on earth. Based on the obtained data, we can conclude that the formulas for the SELS parameters roughness, scaling and wrinkles for this special skin condition need to be reviewed.

Application of an Easy-to-Perform High-Energy and Low-End Visible Light Transmittance Method and the Influence of Tinted Sunscreens on High-Energy/Low-End Visible Light Transmittance and Infrared Protection

BACKGROUND

About 50% of the sun's radiation arriving on earth is visible light (VIS). For a long time, its effects on human health have not been fully investigated. But recently, the influence of VIS has gained more attention, especially regarding skin physiology. Studies showed various effects, many of them harmful, comparable to UV radiation. As a result, there are now a few sunscreens commercially available which claim protection against VIS. The question of whether protection is necessary is still much discussed.

AIMS

The objective of this study was to develop an easy-to-perform high-energy visible (HEV) and low-end visible (LEV) light transmittance method to determine the direct VIS protection of sunscreens and other cosmetic samples. Furthermore, the influence of the brightness of the tested products on the HEV, LEV, and infrared A protection was investigated.

METHODS

An experimental setup consisting of a light source, a VIS-transmissible filter system, and a sensor unit was built to measure the direct VIS protection of sunscreens and other daily skin care products in two ranges of the VIS area. For a closer look, the brightness of the samples was evaluated by photometric assessment.

RESULTS/CONCLUSION

The experimental setup could be validated. It could be demonstrated for the first time that there is a strong positive linear correlation between transmittance and brightness of tinted sunscreen and daily skin care products with sunscreen properties in the HEV, LEV, and infrared A range. However, tinted samples worked best in the blue light region, and the higher the wavelength range, the lower the protection.

Current Data on Effects of Long-Term Missions on the International Space Station on Skin Physiological Parameters

BACKGROUND

Skin reaction to spaceflight has not really been studied yet, although the skin has a very important barrier function to protect the body and can contribute to a more general understanding of physiology. It is proposed here to make a more thorough investigation of the skin during long-term spaceflight, using noninvasive techniques.

AIMS

The aim of the present Skin-B study is to investigate the kinetics and range of possible skin modifications during long-duration spaceflights and their recovery.

METHODS

In order to investigate the effect on skin physiological parameters during spaceflight, measurements were carried out on 6 astronauts with respect to skin hydration, transepidermal water loss/barrier function, and surface evaluation of the living skin in orbit. Additional measured parameters on the ground were skin elasticity, skin density and thickness, as well as microcirculation.

RESULTS

Data from the Skin-B subjects (n = 6) contradict the results obtained in the previous pilot study SkinCare (n = 1 subject). In the present study, no deterioration of the skin was found but rather an improvement in skin hydration and skin barrier function, and no changes or improvement in the appearance of the skin surface. Furthermore, the skin density and skin thickness as well as skin elasticity values were unchanged from pre-flight values.

CONCLUSION

In conclusion, we found that spaceflight under present conditions has no negative impact on skin physiological parameters.

Self-Reported Skin Changes by a Selected Number of Astronauts after Long-Duration Mission on ISS as Part of the Skin B Project

BACKGROUND

One of the most challenging and important factors of manned space missions is to keep astronauts healthy on orbit. In a study on 46 ISS crew members who were on 6-month (average) missions, skin rashes were the most self-reported event. Furthermore, among notable events, 40% were classified as skin rashes/hypersensitivities. Thus, especially skin conditions during space travel are of major clinical interest and require further research.

AIMS

The aim of the study was to determine skin conditions in space flight among US and European astronauts, especially taking into account the terrestrial skin conditions as well as on-orbit skin care habits.

METHODS

A preflight questionnaire was given to the astronauts asking about their terrestrial skin care habits and skin conditions/atopy before launch. In addition, they were asked to fill out a postflight questionnaire asking about their on-orbit skin care routine and whether any special observations regarding the skin were made during flight.

RESULTS

A total of 23 skin symptoms were recorded by 8 nonatopic astronauts (mean age: 41 years) during the mission. The symptoms were peeling (21.74%), rash (17.39%), dryness (13.04%), severe dryness (8.70%), reddening (8.70%), itchiness (8.70%), bruising (4.35%), skin sensitivity (4.34%), bumps (4.35%), acne (4.35%) and slow healing of contusions and lacerations (4.35%). Especially the hands and feet were affected by skin problems. As a result of this examination, it was shown that the skin symptoms correlate with poor hygiene on orbit, whereas the factor "environment" on the ISS plays a minor role. Surprisingly, 2 astronauts even experienced positive effects on their skin.

CONCLUSION

Based on these preliminary data, it is important to pay more attention to skin hygiene and maintenance in space.

Multicenter methodology comparison of the FDA and ISO standard for measurement of in vitro UVA protection of sunscreen products

In vitro standard methods are available and accepted worldwide to assess UVA protection of sunscreen products. Though, harmonisation of methods has made progress in the last decade, still two differing methods - one by FDA the other by ISO - are in use. In a multicentre study including 9 centres in Germany, 4 different commercial sunscreen products were assessed using both methods to discover their similarities and differences. UVA protection factor and Critical Wavelength were detected at various substrate type (sandblasted versus moulded PMMA plates), at different surface roughness of the plates as well as at different product application dose using two different irradiation spectra. Results: The strongest influence on UVA protection factor results from the surface roughness of the plates. Depending on the roughness (accepted range of 2 to 7 μm in the FDA method) a variability in the UVA protection factor of up to 25% was observed, while the much narrower definition of plate roughness by ISO (4.5 to 5.2 μm) had no relevant influence on the test results. Sandblasted plates in our assessment led to higher UVA protection factors and produced less scattered results compared to moulded plates. These differences were not pronounced. Application dose and spectra of the irradiation source were of negligible influence on UVA protection factor results for the investigated UV-filter combinations. The UVA protection factor which is the endpoint of the ISO method was found to be a parameter with a high potential to differentiate among different test products. The endpoint of the FDA method - the Critical Wavelength - was found to be an unambitious endpoint. Insensitivity to all described modifications of the method was observed. All investigated products performed similar and passed the Critical Wavelength criteria independent of method and parameters.

Wirksamkeit und Verträglichkeit einer Fußcreme bei Typ-2-Diabetikern

In der vorliegenden Studie wurde eine Fußcreme hinsichtlich ihrer Eignung zur Fußpflege von Typ-2-Diabetikern untersucht. An der Wirksamkeitsstudie nahmen 23 Probanden über einen Zeitraum von 6 Wochen teil, welche die Fußcreme 2-mal täglich applizierten. Die Fußcreme zeichnete sich durch gute feuchtigkeitsspendende Eigenschaften aus und trug zu einer signifikanten Verbesserung der Hautbarriere bei. Gleichzeitig konnte die Durchblutung der Haut und damit die Versorgung der Haut mit Feuchtigkeit deutlich verbessert werden. Messungen der Hauttemperatur zeigten keine Temperaturerhöhung. Es wurde über ein angenehmes Hautgefühl berichtet. Die Keimbesiedlung wurde konstant gehalten. Zusätzlich wurden subjektive Bewertungen in Bezug auf Hautbild, Wirksamkeit und Verträglichkeit mittels Fragebogen erfasst. Hier spiegelte sich die gute Wirksamkeit und Verträglichkeit der Fußcreme durch hohe Akzeptanz bei den Probanden wider.

Nutritives Anti-Aging

Für die Substanzklasse der Carotinoide konnte gezeigt werden, dass diese in lipophilen Systemen als Antioxidantien wirksam sind. In zahlreichen Studien wurde nachgewiesen, dass Carotinoide nicht nur Algen und Pflanzen vor intensiver Sonneneinstrahlung schützen, sondern auch beim Menschen von einer fotoprotektiven Wirkung ausgegangen werden kann. Um die Gesundheit von Haut und Haar zu erhalten, werden vermehrt sogenannte „Nutricosmetics“ angeboten. Hier stellt sich die Frage, ob unsere Ernährung tatsächlich alle notwendigen Mikronährstoffe enthält.

Zahlreiche Studien zeigten, dass „Nutricosmetics“ zur Verbesserung einzelner Hautparameter wie Oberflächenstruktur, Hautdichte und -Elastizität führten. Weiterhin wurden Hydratation und Barrierefunktion der Haut positiv beeinflusst. Anti-Aging-Konzepte wurden bestätigt. Natürliche Carotinoide, häufig in Kombination mit Vitaminen und Mineralstoffen, führten zu einer Steigerung der Wirksamkeit, hier spielen synergistische Effekte offenbar eine Rolle. Auch andere Wirkstoffe wie Polyphenole, aus Kakao oder grünem Tee gewonnen, hatten positive Wirkungen auf die Hautparameter bei täglicher Einnahme als Drink.

In den hier gezeigten Untersuchungen konnten nach 12-wöchiger Einnahme nachhaltige Wirkungen von „Nutricosmetics“ nachgewiesen werden. Somit kann eine, zumindest temporäre, Supplementierung von Nahrungsergänzungsmitteln zur Erhöhung des körpereigenen Lichtschutzes oder zur Verbesserung der Hautqualitäten empfohlen werden. Allerdings sollten Nahrungsergänzungsmittel nicht als Ausgleich einer ungesunden Ernährung verstanden werden.

Determination of the Influence of the Antiphlogistic Ingredients Panthenol and Bisabolol on the SPF Value in vivo

BACKGROUND

Today, the sun protection factor (SPF) value of sunscreen products is determined in vivo with a standardized protocol (EN ISO 24444:2010), and the measured SPF biological end point is the visible skin erythema. However, many of the sunscreen products currently available on the market have antiphlogistic ingredients, which may potentially result in an overestimated SPF of the sunscreen.

AIMS

To investigate the potential influence of the antiphlogistic ingredients panthenol and bisabolol in sunscreens on the determined SPF value in vivo.

METHODS

Formulations with different concentrations of the antiphlogistic ingredients bisabolol or panthenol were tested. As a reference, a base formulation (vehicle) without antiphlogistic ingredients was used. First, the SPF of the sunscreen formulas with and without antiphlogistic ingredients was analyzed in vitro. To investigate whether the antiphlogistic ingredient may suppress the inflammatory response to ultraviolet (UV) irradiation, the SPF was determined in vivo. Finally, selected formulations were also analyzed in an erythema model for testing formulations on UV-induced inflammation.

RESULTS

It could be confirmed that no differences between the formula with and that without the active antiphlogistic ingredients bisabolol or panthenol exist when measured in vitro. However, there was also no statistically significant difference in the erythemal response between the vehicle (without an antiphlogistic active ingredient) and the test formulations with different concentrations of the antiphlogistic active ingredients in the in vivo determination of the SPF. Evidence of anti-inflammatory activity of the sunscreen antiphlogistics bisabolol and panthenol was also not apparent in the UV model over a time course of 48 h. Conlusion: The antiphlogistic ingredients panthenol and bisabolol incorporated in the tested sunscreen formula do not interfere with erythema reddening and thus do not affect the SPF value in vivo.

Development of an in vitro Test Procedure to Determine the Direct Infrared A Protection of Sunscreens and Non-Cosmetic Samples

BACKGROUND

Every day human skin is exposed to infrared A (IRA) radiation as part of the natural sun rays. As IRA radiation accounts for around one third of the solar radiation, it has gained great attention concerning its effects on the human body and skin. In the past few years it has been discussed controversially whether IRA radiation (of solar origin) is harmful or not. Nonetheless, there are several sunscreens on the German market that claim IRA protection for themselves.

AIMS

The present study seeks to find an experimental set-up and a test procedure for the determination and quantification of direct IRA protection (realized via reflection or absorption of the IRA radiation), since to our knowledge these do not yet exist.

METHODS

In this study we proved the usability of a set-up consisting of a light source, an IRA-transmissible filter system and a sensor unit, for the determination and quantification of the IRA protection of cosmetic and non-cosmetic samples.

RESULTS/CONCLUSION

The applicability of the IRA emission of the light source, the spectral detector, transmissivity of the filter systems and the sample carriers could be validated. This experimental set-up can be used as an in vitro test procedure for the determination of direct IRA protection.

Effect of the multifunctional cosmetic ingredient sphinganine on hair loss in males and females with diffuse hair reduction

Sphingolipids are well known to promote keratinocyte differentiation and to induce ceramide production. In addition, they show anti-inflammatory and antimicrobial activities. Thus, the aim of this study is to investigate the potential effect of sphinganine on prolonging the hair anagen rate and improving the overall hair quality and scalp health. The inhibitory potential of sphinganine toward 5-α-reductase was studied using an in vitro assay. The stimulation of the antimicrobial peptide HBD2 by sphinganine was measured by real-time polymerase chain reaction and immunostaining. Sphinganine bioavailability was studied ex vivo using a pig skin model. A placebo-controlled, double-blind study was designed to evaluate the efficacy of sphinganine on hair loss and hair/scalp quality in vivo. In vitro results showed that sphinganine is a potent inhibitor of 5-α-reductase type I that prevents the conversion of testosterone to dihydrotestosterone, a key factor of androgenetic male baldness. In vivo results demonstrated efficacy in reducing non-illness-related hair loss among males. In terms of expert rating, all hair quality and scalp parameters improved after application of sphinganine. Improved scalp health might be linked to the observed increase of the antimicrobial peptide HBD2. Thus, sphinganine is well suited as a topical alternative for the improvement of scalp health and hair quality and anti-hair loss application.

[Mesembryanthemum crystallinum L. as dermatologically effective medicinal plant - first results from 3 pilot studies]

BACKGROUND

Apart from well-known medical plants of rational phytotherapy there is a variety of plants, such as Mesembryanthemum crystallinum L., whose potential effects are not examined sufficiently to date. Therefore, in 3 pilot studies we investigated the dermatological effect of an extract of M. crystallinum (Mesem Cream).

MATERIALS AND METHODS

In a retrospective user survey and a pre-post study with 6 persons in a wheelchair the efficacy profile of Mesem Cream was investigated. In a third placebo-controlled pilot study changes in skin hydration was measured using corneometer measurement in 6 healthy volunteers with dry skin.

RESULTS

Compared to untreated skin, corneometer measurement revealed a significant increase of skin hydration with Mesem Cream (25.8 ± 5.8 pre to 46.6 ± 9.2 post treatment vs. 26.3 ± 6.0 pre to 33.8 ± 6.0 post treatment) as well as a statistical trend (p=0.11; t-Test) compared to basic cream (25.1 ± 4.7 pre to 41.9 ± 7.3 post treatment). Improvement in skin hydration was also found in 17 of 29 survey participants. Further, the volunteers in the wheelchair showed significant improvements in their subjectively rated skin softness and hydration level.

CONCLUSION

These pilot studies investigated skin hydrating effects of the traditional medical plant M. crystallinum. Although the results were promising, they have to be interpreted with caution in particular due to low sample size. Further, study design should be more clear-cut and focus skin hydration as a main outcome parameter in more detail.

Influence of different cosmetic formulations on the human skin barrier

The human skin barrier is an important part of the skin's intactness and its functionality is a precondition for healthy skin. Ingredients in cosmetic formulations, especially penetration enhancers, can influence this barrier function as they transport active agents into deeper skin layers. In this study different cosmetic formulations were tested by 60 healthy female volunteers over a period of 4 weeks. The skin hydration and barrier function before and during the application were measured. Significant changes in both parameters were determined. A negative influence on the barrier function by penetration enhancers could be observed, but it was also found that lamellar lipid structures (DermaMembranSysteme®, DMS®) are able to enhance the skin barrier. Both penetration enhancers as well as DMS can increase skin hydration.

In vitro testing to assess the UVA protection performance of sun care products

The UVA protection delivered by sunscreens is an issue of increasing importance due to the increasing knowledge about UVA-induced skin damage. In Europe there is no officially accepted method available to determine the degree of UVA protection. Therefore, the objective of the present study was to design a protocol combining the merits of an in vitro model, which are simple and reproducible, with aspects known to be relevant from in vivo studies. The principle is: an UV-transparent support to which the test product is applied, a (pre)irradiation and a transmission measurement. Transpore(R) tape (standard support for SPF determinations) was found to be incompatible with many preparations on prolonged contact times. Roughened quartz was adopted as a suitable alternative. Transmission measurements on this support are not reliable with a layer of 2 mg cm(-2) (standard for SPF) due to detection limitations of spectrophotometers, hence a reduced layer of 0.75 mg cm(-2) was adopted. Overall, it is very difficult to apply products in a reproducible thin layer on appropriate substrates. As a consequence, absolute parameters derived from the transmission profile show relatively large dispersion, whereas relative parameters, such as critical wavelength lambda(c)[1] or UVA/UVB ratio are much less sensitive to unavoidable variations in layer thickness. An increase in deviations was observed when the samples were irradiated before measurement. It is crucial to control the output carefully (spectral distribution and even more importantly, irradiance and dose delivered) of the light source. By doing so and also taking into account the previous learning steps, a protocol was drafted and tested in a ringtest (four samples in six laboratories). The results are encouraging and show that if relative parameters (e.g. lambda(c), UVA/UVB ratio) are considered, the intra- as well as interlaboratory reproducibility is clearly better than can be obtained in vivo. In general, we describe a suitable method, which can be considered in any future official discussions about the methodology to determine UVA protection.

Sebusuppressive efficacy of the antioxidant bis-ethylhexyl hydroxydimethoxy benzylmalonate in the treatment of oily and blemished skin

The aim of this study was to assess the effect of 2% bis-ethylhexyl hydroxydimethoxy benzylmalonate (HDBM; RonaCare(®) AP) as an active ingredient in the treatment of oily and blemished skin. This study was carried out as a randomized, placebo-controlled, single-blind study on 44 test subjects with blemished skin over a period of 8 weeks. Sebum measurement, skin inflammation/redness scoring by an expert, photographic documentation and a self-assessment with regard to skin improvement, and tests of skin compatibility and galenic characteristics were performed. Treatment with 2% HDBM resulted in a significant reduction of sebum excretion and showed efficacy against inflamed/red lesions also shown by photographic documentation. Efficacy and galenic performance of 2% HDBM were judged to be superior to the placebo emulsion. Additionally, 2% HDBM was well tolerated; approximately 80% of the test subjects rated the compatibility as good to very good.

An encapsulated fruit and vegetable juice concentrate increases skin microcirculation in healthy women

BACKGROUND/AIM

Microcirculation in the dermis of the skin is important for nutrient delivery to this tissue. In this study, the effects of a micronutrient concentrate (Juice Plus+®; 'active group'), composed primarily of fruit and vegetable juice powder, on skin microcirculation and structure were compared to placebo.

STUDY DESIGN/METHODS

This 12-week study had a monocentric, double-blind placebo and randomized controlled design with two treatment groups consisting of 26 healthy middle-aged women each. The 'oxygen to see' device was used to evaluate microcirculation. Skin density and thickness were measured using ultrasound. Measurements for skin hydration (Corneometer®), transepidermal water loss and serum analysis for carotenoids and α-tocopherol were also performed.

RESULTS

By 12 weeks, microcirculation of the superficial plexus increased by 39%. Furthermore, skin hydration increased by 9% while skin thickness increased by 6% and skin density by 16% in the active group. In the placebo group, microcirculation decreased, and a slight increase in skin density was observed.

CONCLUSION

Ingestion of a fruit- and vegetable-based concentrate increases microcirculation of the skin at 12 weeks of intervention and positively affects skin hydration, density and thickness.

Green tea polyphenols provide photoprotection, increase microcirculation, and modulate skin properties of women

Dietary constituents including polyphenols and carotenoids contribute to endogenous photoprotection and modulate skin characteristics related to structure and function of the tissue. Animal and in-vitro studies indicate that green tea polyphenols affect skin properties. In a 12-wk, double-blind, placebo-controlled study, 60 female volunteers were randomized to an intervention or control group. Participants consumed either a beverage with green tea polyphenols providing 1402 mg total catechins/d or a control beverage. Skin photoprotection, structure, and function were measured at baseline (wk 0), wk 6, and wk 12. Following exposure of the skin areas to 1.25 minimal erythemal dose of radiation from a solar simulator, UV-induced erythema decreased significantly in the intervention group by 16 and 25% after 6 and 12 wk, respectively. Skin structural characteristics that were positively affected included elasticity, roughness, scaling, density, and water homeostasis. Intake of the green tea polyphenol beverage for 12 wk increased blood flow and oxygen delivery to the skin. Likewise, in a separate, randomized, double-blind, single-dose (0.5, 1.0, and 2.0 g) study of green tea polyphenols, blood flow was maximized at 30 min after ingestion. In summary, green tea polyphenols delivered in a beverage were shown to protect skin against harmful UV radiation and helped to improve overall skin quality of women.

Supplementation of flaxseed oil diminishes skin sensitivity and improves skin barrier function and condition

BACKGROUND

Skin sensitivity is a common problem in the Western population correlated with changes of skin properties like skin barrier function, hydration and skin physiology. Skin properties can be modulated by dietary fatty acids (FA), especially poly-unsaturated FA. The present study was performed to evaluate the effect of daily supplementation with flaxseed oil and safflowerseed oil on healthy volunteers with sensitive skin.

METHODS

The study was designed as a randomized, double-blind 12-week intervention with 2 female treatment groups (n = 13). Plasma FA profile, skin sensitivity, skin hydration, transepidermal water loss (TEWL) and skin surface were evaluated on day 0, week 6 and week 12.

RESULTS

Supplementation with flaxseed oil led to significant decreases in sensitivity (after nicotinate irritation), TEWL, skin roughness and scaling, while smoothness and hydration were increased. Concomitantly, the ratio of n-6/n-3 FA in plasma decreased. Upon supplementation with safflowerseed oil, only a significant improvement in skin roughness and hydration was observed; however, the effects were less pronounced and determined at a later point in time than with flaxseed oil. The plasma n-6/n-3 FA ratio increased.

CONCLUSION

The data provide evidence that daily intake of flaxseed oil modulates skin condition.

Comparison of sun protection factors determined by an in vivo and different in vitro methodologies: a study with 58 different commercially available sunscreen products

An extensive study on the sun protection factors (SPF) of sun care products was carried out using the COLIPA (The European Cosmetic Toiletry and Perfumery Association) method, which relates to in vivo experiments. Furthermore, in vitro methods were tested with sunscreen formulations that were prepared as films on surface-roughened plates of polymethyl methacrylate (PMMA). One of the in vitro methods, i.e. using the sunscreen tester, has been recently developed, whereas the second has been defined by a pure spectroscopic approach, which is based on spectral transmission measurements of sunscreen films. Altogether 58 different sunscreen formulations, with manufacturer declared SPF values ranging from 4 to 60 and currently available on the European market, were investigated. The quality of correlations with results from the individual products based on the different in vitro methods versus the COLIPA values that were considered as generally accepted standard values was assessed. In this context, also variations because of sample preparation and spectral measurement were discussed. For sunscreen products with in vivo SPF values larger 25, the spectral transmittance within the UVA/UVB range is rapidly decreasing, which is experienced even for products with reduced amounts reaching 0.5 mg cm(-2) and still leading to unsatisfactory correlation of the spectroscopically derived SPF values versus the results from the alternative assays. Opposite to these small amounts, a sunscreen product spread of 2 mg cm(-2) is standard for the in vivo COLIPA method, whereas an area-normalized amount of 1 mg cm(-2) is currently routinely used for the sunscreen tester method. Furthermore, an overview of the individual product characteristics, such as their specific critical wavelengths and their UVA/UVB ratios is provided; both parameters can also be calculated from the spectral absorbances of the standardized sunscreen films.

Effects of dehydroepiandrosterone therapy on pubic hair growth and psychological well-being in adolescent girls and young women with central adrenal insufficiency: a double-blind, randomized, placebo-controlled phase III trial

CONTEXT AND OBJECTIVE

The efficacy of oral dehydroepiandrosterone (DHEA) in the treatment of atrichia pubis and psychological distress in young females with central adrenal insufficiency is unknown. Our study aimed to evaluate this therapy.

DESIGN AND PATIENTS

A total of 23 young females (mean age 18 yr, range 13-25) was enrolled in a double-blind randomized placebo-controlled trial. Inclusion criteria were ACTH deficiency plus two or more additional pituitary deficiencies, serum DHEA less than 400 ng/ml, and pubertal stage more than B2. Exclusion criteria were cerebral radiation with more than 30 Gy, tumor remission less than 1 yr, amaurosis, hypothalamic obesity, psychiatric disorders, and unstable hormone medication.

INTERVENTION

Patients were randomized to placebo (n = 12) or 25 mg HPLC-purified DHEA/d (n = 11) orally for 12 months after stratification into a nontumor (n = 7) and a tumor group (n = 16).

MAIN OUTCOME MEASURES

Clinical scoring of pubic hair stage was performed at 0, 6, and 12 months (primary endpoint), and psychometrical evaluation (Symptom Check-List-90-R and the Centre for Epidemiological Studies-Depression Scale) at 0 and 12 months (secondary endpoint). Androgen levels and safety parameters were measured at 0, 6, and 12 months; 24-h androgen urinary excretion rates were calculated at 0 and 12 months.

RESULTS

In the placebo group, four patients dropped out because of recurrence of craniopharyngioma, manifestation of type 1 diabetes, and change of residence (n = 2); in the DHEA group, one patient dropped out because of recurrent anxiety attacks. DHEA substitution resulted in normalization of DHEA sulfate and androstanediol glucuronide morning serum levels 2 h after drug intake (P < 0.006), and of its 24 h urinary metabolite levels (P < 0.0001), placebo had no effect. Morning serum levels of androstenedione increased in the DHEA group (P < 0.02) but did not normalize. The DHEA group exhibited significant progress in pubic hair growth from Tanner stage I-III to II-V (mean: +1.5 stages), whereas the placebo group did not (relative risk 0.138; 95% confidence interval 0.021-0.914; P = 0.0046). Importantly, eight of the 10 Symptom Check-List-90-R scores, including those for depression, anxiety, and interpersonal sensitivity, and the global severity index improved in the DHEA group in comparison to the placebo group (P < 0.048). DHEA was well tolerated.

CONCLUSIONS

In adolescent girls with central adrenal insufficiency, daily replacement with 25 mg DHEA orally is beneficial: atrichia pubis vanishes, and psychological well-being improves significantly.

Change in skin physiological parameters in space--report on and results of the first study on man

Astronauts often show skin reactions in space. Systematic tests, e.g. with noninvasive skin physiological test methods, have not yet been done. In an interdisciplinary cooperation, a test series with skin physiological measurements was carried out before, during and after a long-term mission in the International Space Station. The hydration of the stratum corneum (Corneometer), transepidermal water loss (Tewameter), and the surface structure of the skin (SkinVisiometer) were measured. In order to record cutaneous states, the suction elasticity was measured (Cutometer), and an ultrasound measurement with 20 MHz (DermaScan) was also made. In addition, one measuring field of the two inner forearms was treated with a skin care emulsion. There were indications of a delayed epidermal proliferation of the cells, which would correspond to the clinical symptoms. Hydration and TEWL values are improved by respective skin care. On the cutaneous level, the elasticity measurements and the ultrasound picture showed results which correspond to a significant loss of elasticity of the skin. Further examinations are necessary to validate these preliminary results.

Absorption spectra of human skin in vivo in the ultraviolet wavelength range measured by optoacoustics

Knowledge of the optical properties of human skin in the ultraviolet range is fundamental for photobiologic research. However, optical properties of human skin in the ultraviolet spectral range have so far mainly been measured ex vivo. We have determined the absorption spectra of human skin in vivo in the wavelength range from 290 to 341 nm in 3 nm steps using laser optoacoustics. In this technique, optical properties are derived from the pressure profile generated by absorbed light energy in the sample. In a study on 20 subjects belonging to phototypes I-IV, we studied the optical properties at the volar and dorsal aspect of the forearm as well as on the thenar. Analysis of the measured absorption spectra shows that comparable skin areas-like different sides of the forearm-have qualitatively similar optical characteristics. Still, the optical properties may vary substantially within the same area, probably due to the skin structure and inhomogeneities. Comparison of the spectra from different skin sites indicates that the spectral characteristics of the stratum corneum and its chromophores play an important role for the optical properties of human skin in vivo in the ultraviolet B range.

Wavelength-dependent penetration depths of ultraviolet radiation in human skin

The wavelength-dependent penetration depth of ultraviolet radiation in human skin is a fundamental parameter for the estimation of the possible photobiological impact of ultraviolet (UV) radiation. We have determined the absorption spectra of human skin in vivo in the wavelength range from 290 to 341 nm in 3-nm steps using laser optoacoustics and calculated the respective penetration depths. Data were analyzed with respect to different skin regions and skin phototype of the 20 subjects in the study (phototype I: n=3; II: n=7; III: n=5; IV: n=5), revealing large variability between individuals. The penetration depth of UV radiation in human skin is highly dependent on wavelength and skin area, but no significant dependence on skin phototype could be found.

Effect of ultraviolet adaptation on the ultraviolet absorption spectra of human skin in vivo

BACKGROUND

The absorption spectrum of human skin provides a basis for the estimation of the possible photobiological impact of ultraviolet (UV) radiation. The optical properties of human skin in the UV spectral range have so far mainly been measured ex vivo due to a lack of an appropriate in vivo technique and the change of optical properties during the course of adaptation to higher UV doses has hardly been addressed.

METHODS

We have determined the absorption spectra of human skin in vivo in the wavelength range from 290 to 341 nm in 3 nm steps using laser optoacoustics. In this technique, optical properties are derived from the pressure profile generated by absorbed light energy in the sample. Spectra from the volar and dorsal aspects of the forearm of 20 subjects were compared, i.e. sites with native and various facultative pigmentation.

RESULTS

UV adaptation shows as an increase in absorption coefficients over the entire measured UV range and especially in short-range UVB. Subject groups with high vs. low UV exposure can be discriminated by analyzing the difference absorption spectra between dorsal and volar aspects of the forearm. No dependence on the subject's phototype was seen in the degree of adaptation.

CONCLUSION

The difference between native and facultative pigmentation may be explained by the absorption properties of the two prime chromophores responsible for adaptation to higher UV exposure: melanin and keratin. Stronger pigmentation, i.e. a higher melanin concentration, is found as an increase of absorption coefficients over the entire UVA-II/UVB range. The thickening of the horny layer and accordingly, a higher influence of keratin on the absorption spectra is prominent especially in the UVB region.

In vivo assessment of Ectoin: a randomized, vehicle-controlled clinical trial

The aim of the study was to assess an Ectoin formulation with regard to the antiageing properties. The study was designed as a monocentric, randomized, double-blind application test, in order to ensure the compatibility and the efficacy of Ectoin in comparison to a vehicle emulsion. A total of 104 voluntary healthy female test subjects were included in the study. Moisturizing properties as well as other parameters of skin ageing, like skin surface structure and skin elasticity, were determined for treatment A (vehicle) and treatment B (with 2% Ectoin) versus an untreated control. Statistical evaluations according to the Wilcoxon rank-sum test indicate a general preference for the Ectoin treatment by the test subjects in both the application and the efficacy tests. None of the participating test subjects had any side effects throughout the study. In terms of antiageing properties, previous in vitro studies could be confirmed by this clinical trial, clarifying that the natural cell protection concept of Ectoin is transferable to skin care with manifold benefits.