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Background: Most filler procedures in the United States are performed with hyaluronic acid (HA) derivatives. Artefill (Suneva Medical, Inc, San Diego, California), the only polymethylmethacrylate (PMMA)-enhanced dermal filler approved by the US Food and Drug Administration (FDA), has been well tolerated by patients for treatment of nasolabial folds and has a safety profile similar to other approved fillers., Objectives: The authors investigate the safety and efficacy of Artefill for malar augmentation., Methods: This prospective, multisite, open-label study included a total of 24 patients with age-related lipoatrophy. Only patients with mild to moderate lipoatrophy were considered candidates for treatment. Artefill was injected in the supraperiosteal layer of the malar region, at a maximum volume of 6 mL (3 mL/side). Touch-up injections were performed at weeks 4 and 6, up to a maximum total volume of 8.8 mL. Standardized assessments of results were made at 2, 6, and 12 months. Outcome measures included the Global Aesthetic Improvement Scale (GAIS), change in malar lipoatrophy grade, and patient satisfaction. Standardized photographs of each patient were collected., Results: Average patient age was 48 ± 5 years. Average volume of injections was 5.55 ± 1.87 mL. Based on both the patient- and physician-rated GAIS, 95.8% of study participants were reported as being "improved" or "very much improved." The change in malar lipoatrophy grade was significantly improved from baseline to 1 year by 0.96 ± 0.98 (P < .0003). Patients also reported high levels of satisfaction, with 87.5% being "satisfied" or "very satisfied." There were no reported adverse safety events in the study., Conclusions: Artefill demonstrated improvement in malar atrophy with a high level of patient satisfaction and an excellent safety profile. The absence of any adverse events in our study patients was notable, and we believe this is a result of the uniform nature of the PMMA particles in the Artefill and the strict and sterile manner in which this PMMA dermal filler is produced.

Current measures for assessing the results of body contouring surgery are limited. The goal of our study was to analyze objectively and quantitatively the results of ultrasound-assisted lipoplasty by use of dual-energy x-ray absorptiometry (DEXA). A prospective study of nine patients who underwent ultrasound-assisted lipoplasty (Lysonics 2000 ( generator) was performed. Each patient underwent preoperative and postoperative DEXA scanning (Lunar). All patients were women, and the average age was 42 years (range 26 to 57 years). The amount of emulsion was recorded, and analysis of the emulsion demonstrated that approximately 40% was infiltration solution, serum, and blood. The average patient follow-up period was 14 weeks (range 8 to 22 weeks). The amount of fat that was measured after aspiration (adjusted for infiltration solution, serum, and blood) was consistently less than the fat reduction demonstrated by DEXA. Fat reduction by DEXA was shown to be 45% and 46% greater than the measured aspirated fat from the right and left thighs, respectively. For both the right and left hips, the difference was 48%, and for the abdomen, DEXA recorded a 30% greater fat reduction than was aspirated. DEXA can be used to assess objectively and quantitatively the results of ultrasound-assisted lipoplasty. Furthermore, DEXA more accurately reflects total fat reduction, including aspirated fat and resorbed emulsion, as well as any prolonged lipolytic effect that may be caused by thermal injury or any regional toxic effect of the emulsion.

The most common complication of lower blepharoplasty is malposition of the lower eyelid. This deformity may present as scleral show, ectropion, entropion, or canthal dystopia, with dry eye or epiphora. These problems occurred frequently in our initial series of patients undergoing blepharoplasty with subperiosteal face lift. The key to prevention lay in avoiding the potential causes of these problems: overresection of eyelid skin, retraction of the orbital septum, orbicularis oculi dysfunction, postoperative swelling, and downward pull from the facial suspension. This article reviews the cases of 14 consecutive patients who underwent a modified subperiosteal face lift with blepharoplasty. Eleven of the patients had a concomitant endoscopically assisted brow lift. This group is compared with a prior series of 16 patients who underwent 12 endoscope-assisted brow lifts without special modifications. The modifications in the second series consisted of the following: (1) Improved patient selection; (2) minimal tissue trauma; (3) intact orbital septum; (4) lengthening of the septum; (5) secure midfacial suspension; (6) three-step lateral canthoplasty; (7) limited resection of skin; and (8) specific postoperative care. Results regarding the incidence of eyelid malposition and reoperations were subjected to Fisher's exact test. In the 14 consecutive patients who underwent the modified procedure, two temporary episodes of lower eyelid malposition occurred (follow-up of 12 to 20 months). In the 16 patients who underwent a nonmodified procedure, five temporary and three permanent episodes of eyelid malposition occurred (follow-up of 20 to 30 months). Fisher's exact test demonstrated a significant difference with a p value of 0.038. Modifications of the subperiosteal face lift and lower blepharoplasty reduced significantly but did not eliminate the incidence of lower eyelid malposition.

Two new beta-lactoglobulin (BLG)/human serum albumin (HSA) hybrid gene vectors were constructed and tested for expression in COS-7 cells and in transgenic mice. The HSA sequences were inserted between the second and sixth BLG exons. Transient transfection experiments with these vectors as well as a series of additional vectors with either the BLG 5'- or 3'- intragenic sequences revealed that sequences within BLG exon 1/intron 1/exon 2 abrogated BLG- directed HSA expression in vitro, regardless of the presence of HSA introns or the origin of the 3' polyadenylation signal. In contrast, the same BLG expression cassette enabled the efficient expression of HSA cDNA or minigene in the mammary gland of transgenic mice with subsequent secretion of the corresponding protein into the milk of 56 and 82%, respectively of the mouse strains at levels up to 0.3 mg/ml. Previous attempts to express HSA cDNA inserted into exon 1 of the BLG gene had failed [Shani,M., Barash,I., Nathan,M., Ricca,G., Searfoss,G.H., Dekel,I., Faerman,A., Givol,D. and Hurwitz,D.R. (1992) Transgenic Res. 1, 195- 208]. The new BLG expression cassette conferred more stringent tissue specific expression than previously described BLG/HSA constructs [Barash,I, Faerman,A., Ratovitsky,T, Puzis,R., Nathan,M., Hurwitz,D.R. and Shani, M. (1994) Transgenic Res. 3, 141-151]. However, it was not able to insulate the transgenes from the surrounding host DNA sequences and did not result in copy number dependent expression in transgenics. Together, the in vitro and in vivo results suggest both positive and negative regulatory elements within the BLG intragenic sequences evaluated. The new BLG construct represents an extremely valuable vector for the efficient expression of cDNAs in the mammary gland of transgenic animals.

Serum cryoglobulins were found in nineteen out of twenty patients with infectious endocarditis. The cryoglobulins were of the 'mixed type' consisting of IgG, IgM and IgA. C3 and fibrinogen were present in some specimens. The concentration of the cryoglobulins tended to fall with therapy and clinical improvement of the patients. Serum antibodies to the offending bacterial organism were not preferentially concentrated in the cryoglobulins. In contrast, IgM rheumatoid factor was present in the cryoglobulins, though undetectable in the corresponding serum. These findings are consistent with the view that cryoglobulins represent circulating immune complexes which may be important in the pathogenesis of immunological sequelae sometimes found in patients with infectious endocarditis.

We have compared several combinations of enhancers and promoters in expressing the chloramphenicol acetyl transferase gene in transient assays, in mouse C127, the most widely used host cell for the bovine papilloma virus (BPV) expression vector. Of the various combinations tested, the unit comprised of the SV40 enhancer and adenovirus type 2 major late promoter (MLP) was the most active in BPV transformed C127 cells. We further demonstrate that untransformed and BPV transformed C127 cells respond differently to the various enhancer/promoter combinations tested. Moving the SV40 enhancer closer to the cap site of a complete MLP (from -414 to -107) reduced potentiation to less than half in BPV transformed cells. The level of potentiation with enhancer at either site was similar in human HeLa cells. In BPV transformed C127 cells, the SV40 enhancer and the MLP (at the -414 site) supports 4-5 fold greater levels of expression than the murine sarcoma virus (MSV) enhancer/mouse metallothionein (MT) promoter which has previously been extremely effective in BPV vectors. Our findings provide a basis for the improvement of the BPV vector system in supporting increased levels of expression of proteins of important therapeutic application.