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Dermal filler injectability is a critical factor for commercial product adoption by medical aesthetic professionals and for successful clinical administration. We have previously reported (in vitro and ex vivo) cross-linked hyaluronic acid (HA)-based dermal filler benchmarking in terms of manual and automated injectability requirements. To further enhance the function-oriented product characterization workflows and the clinical relevance of dermal filler injectability assessments, the aim of this study was to perform in vivo evaluations. Therefore, several variants of the MaiLi® product range (OxiFree™ technology) were characterized in vitro and in vivo in terms of injectability attributes, with a focus on hydrogel system homogeneity and ease of injection. Firstly, standardized in vitro assays were performed in SimSkin® cutaneous equivalents, with variations of the clinical injector, injection site, and injection technique. Then, automated injections in SimSkin® cutaneous equivalents were comparatively performed in a texture analysis setup to obtain fine-granulometry injection force profile results. Finally, five female participants were recruited for the in vivo arm of the study (case reports), with variations of the clinical injector, injection site, and injection technique. Generally, the obtained quantitative force values and injection force profiles were critically appraised from a translational viewpoint, based on discussions around the OxiFree™ manufacturing technology and on in-use specialized clinician feedback. Overall, the present study outlined a notable level of homogeneity across the MaiLi® product range in terms of injectability attributes, as well as consistently high ease of administration by medical aesthetic clinicians.

The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM®, Restylane®, BELOTERO®, TEOSYAL RHA®, and STYLAGE® brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin® cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results.

Most marketed HA-based dermal fillers use chemical cross-linking to improve mechanical properties and extend their lifetime in vivo; however, stiffer products with higher elasticity require an increased extrusion force for injection in clinical practice. To balance longevity and injectability, we propose a thermosensitive dermal filler, injectable as a low viscosity fluid that undergoes gelation in situ upon injection. To this end, HA was conjugated via a linker to poly(N-isopropylacrylamide) (pNIPAM), a thermosensitive polymer using “green chemistry”, with water as the solvent. HA-L-pNIPAM hydrogels showed a comparatively low viscosity (G′ was 105.1 and 233 for Candidate1 and Belotero Volume®, respectively) at room temperature and spontaneously formed a stiffer gel with submicron structure at body temperature. Hydrogel formulations exhibited superior resistance against enzymatic and oxidative degradation and could be administered using a comparatively lower injection force (49 N and >100 N for Candidate 1 and Belotero Volume®, respectively) with a 32G needle. Formulations were biocompatible (viability of L929 mouse fibroblasts was >100% and ~85% for HA-L-pNIPAM hydrogel aqueous extract and their degradation product, respectively), and offered an extended residence time (up to 72 h) at the injection site. This property could potentially be exploited to develop sustained release drug delivery systems for the management of dermatologic and systemic disorders.

Dermal filler injectability is a critical factor for commercial product adoption by medical aesthetic professionals and for successful clinical administration. We have previously reported (in vitro and ex vivo) cross-linked hyaluronic acid (HA)-based dermal filler benchmarking in terms of manual and automated injectability requirements. To further enhance the function-oriented product characterization workflows and the clinical relevance of dermal filler injectability assessments, the aim of this study was to perform in vivo evaluations. Therefore, several variants of the MaiLi® product range (OxiFree™ technology) were characterized in vitro and in vivo in terms of injectability attributes, with a focus on hydrogel system homogeneity and ease of injection. Firstly, standardized in vitro assays were performed in SimSkin® cutaneous equivalents, with variations of the clinical injector, injection site, and injection technique. Then, automated injections in SimSkin® cutaneous equivalents were comparatively performed in a texture analysis setup to obtain fine-granulometry injection force profile results. Finally, five female participants were recruited for the in vivo arm of the study (case reports), with variations of the clinical injector, injection site, and injection technique. Generally, the obtained quantitative force values and injection force profiles were critically appraised from a translational viewpoint, based on discussions around the OxiFree™ manufacturing technology and on in-use specialized clinician feedback. Overall, the present study outlined a notable level of homogeneity across the MaiLi® product range in terms of injectability attributes, as well as consistently high ease of administration by medical aesthetic clinicians. [ABSTRACT FROM AUTHOR]

The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM®, Restylane®, BELOTERO®, TEOSYAL RHA®, and STYLAGE® brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin® cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results. [ABSTRACT FROM AUTHOR]

P Micheels,1 S Besse,2 J Vandeputte3 1Private Practice, Geneva, Switzerland; 2Medimage, Geneva, Switzerland; 3Plastic Surgery Unit, AZ Oudenaarde, Oudenaarde, Belgium Background: Concentrated hyaluronic acid (HA) gels with a high degree of cross-linking such as Cohesive Polydensified Matrix® (CPM) HA have been designed for long-term facial volume restoration. Objective: To determine the behavior and longevity of CPM HA gel, a case series of subjects underwent magnetic resonance imaging (MRI) or computed tomography (CT) scans several years after their initial treatment. Methods: Six subjects, three from the initial CPM HA Conformité Européenne registration study and three from private practice who had received prior injection of CPM HA for facial volumizing indications agreed to undergo an MRI or CT scan at intervals ranging from 1 to 4 years after the initial treatment. The amount of HA gel originally injected was compared with the amount estimated from volumetric analysis of the MRI and CT scans. The scans were also examined for the signs of any abscess or granuloma formation and to determine the behavior of the HA gel over time. Results: CT and MRI imaging of the six study subjects indicated CPM HA gel persisted for 2–4 years after only a single treatment. In some patients, product was evident in deeper facial fat compartments than originally injected suggesting some diffusion of product had occurred. There was no MRI or CT evidence of abscess or granuloma formation. Conclusion: Our findings indicate that CPM HA volumizing gel has substantial longevity when injected subcutaneously or in deep soft tissues. Keywords: MRI, CT scan, CPM HA volumizing gel, long-lasting results

Abstract This paper examines the importance of two resources, namely a market orientation and an entrepreneurial orientation, in new product development and satisfaction with firm performance among direct and alternative marketers. Using a partial least squares structural equation model and data from a 2013 survey, this paper models the effect of a market orientation and entrepreneurial orientation on satisfaction with current performance and expected future performance for agricultural firms in Ontario, Canada. Our results show that a market orientation and entrepreneurial orientation are important factors in determining rates of product and marketing innovations among farm-based agribusinesses. These findings further demonstrate that a market orientation is a powerful resource as it enables firms to become aware of opportunities to provide superior value for consumers, especially when operating in non-traditional markets.

Saskatchewan has a history of restricting farmland ownership, often for political reasons and having uncertain economic impacts. We build a model that includes fundamental and nonfundamental components of land valuation as well as indicator variables to capture the effects of ownership restrictions. Using Saskatchewan farmland value data from 1950Ð2014, we estimate the effect of SaskatchewanÕs farmland ownership restrictions on land values. The results suggest that ownership restrictions on residents of other Canadian provinces caused a 4.45% decline in the growth rate of land prices for years in which they were in effect.

Most marketed HA-based dermal fillers use chemical cross-linking to improve mechanical properties and extend their lifetime in vivo; however, stiffer products with higher elasticity require an increased extrusion force for injection in clinical practice. To balance longevity and injectability, we propose a thermosensitive dermal filler, injectable as a low viscosity fluid that undergoes gelation in situ upon injection. To this end, HA was conjugated via a linker to poly(N-isopropylacrylamide) (pNIPAM), a thermosensitive polymer using "green chemistry", with water as the solvent. HA-L-pNIPAM hydrogels showed a comparatively low viscosity (G′ was 105.1 and 233 for Candidate1 and Belotero Volume®, respectively) at room temperature and spontaneously formed a stiffer gel with submicron structure at body temperature. Hydrogel formulations exhibited superior resistance against enzymatic and oxidative degradation and could be administered using a comparatively lower injection force (49 N and >100 N for Candidate 1 and Belotero Volume®, respectively) with a 32G needle. Formulations were biocompatible (viability of L929 mouse fibroblasts was >100% and ~85% for HA-L-pNIPAM hydrogel aqueous extract and their degradation product, respectively), and offered an extended residence time (up to 72 h) at the injection site. This property could potentially be exploited to develop sustained release drug delivery systems for the management of dermatologic and systemic disorders. [ABSTRACT FROM AUTHOR]

The Late Miocene (11.6–5.3 Ma) is a crucial period in the history of the Asian monsoon. Significant changes in the Asian climate regime have been documented for this period, which saw the formation of the modern Asian monsoon system. However, the spatiotemporal structure of these changes is still ambiguous, and the associated mechanisms are debated. Here, we present a simulation of the average state of the Asian monsoon climate for the Tortonian (11–7 Ma) using the regional climate model CCLM3.2. We employ relatively high spatial resolution (1° × 1°) and adapt the physical boundary conditions such as topography, land-sea distribution and vegetation in the regional model to represent the Late Miocene. As climatological forcing, the output of a Tortonian run with a fully-coupled atmosphere-ocean general circulation model is used. Our regional Tortonian run shows a stronger-than-present East Asian winter monsoon wind as a result of the enhanced mid-latitude westerly wind of our global forcing and the lowered present-day northern Tibetan Plateau in the regional model. The summer monsoon circulation is generally weakened in our regional Tortonian run compared to today. However, the changes of summer monsoon precipitation exhibit major regional differences. Precipitation decreases in northern China and northern India, but increases in southern China, the western coast and the southern tip of India. This can be attributed to the changes in both the regional topography (e.g. the lower northern Tibetan Plateau) and the global climate conditions (e.g. the higher sea surface temperature). The spread of dry summer conditions over northern China and northern Pakistan in our Tortonian run further implies that the monsoonal climate may not have been fully established in these regions in the Tortonian. Compared with the global model, the high resolution regional model highlights the spatial differences of the Asian monsoon climate in the Tortonian, and better characterizes the convective activity and its response to regional topographical changes. It therefore provides a useful and compared to global models, a complementary tool to improve our understanding of the Asian monsoon evolution in the Late Miocene.