Background:The majority of aesthetic treatments today are nonsurgical or minimally invasive aesthetic procedures. Soft-tissue augmentation with hyaluronic acid (HA) is one of them. Lip fullness and definition are key aesthetic factors associated with attractiveness, which is the reason that lip augmentation with HA fillers has become so popular.Objective: To provide a systematic review of published medical literature on the effectiveness and safety of different HA fillers used to enhance overall lip fullness. Methods and materials:The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-two studies were included in the qualitative synthesis, 9 of them with level of evidence (LOE) 1b (randomized controlled trials), 1 with LOE 2b (individual cohort study), and 12 with LOE 4 (case series, poor-quality cohort, and case-control studies). A total number of subjects included in all studies were 3965. Results:Hyaluronic acid fillers turned out to be an effective and safe treatment. The assessment methods (especially for efficacy) varied greatly from one study to another. Observed responses to the treatment in studies using different lip fullness scales varied between 71% and 93.2%. The most common adverse events were local reactions at the injection sites (swelling, contusion, bruising, pain, redness, and itching). Conclusion:Based on the results of the studies included in this systematic review, HA fillers are effective and safe to use. The majority of included subjects were satisfied with the result and their looks. K E Y W O R D S efficacy, filler, hyaluronic acid, lips, safety
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection often causes pneumonia and respiratory failure that may lead to postintensive care syndrome, including critical illness neuropathy (CIN) and critical illness myopathy (CIM). The data on the rehabilitation outcomes of post-novel coronavirus disease (COVID) patients with CIN and CIM following respiratory failure and mechanical ventilation are still limited. To address this, we enrolled in our prospective observational study a sample of 50 consecutive COVID-19 patients admitted to our facility between 2 November 2020 and 3 May 2021 with electrophysiologically confirmed or clinically suspected diagnosis of CIN/CIM. The functional abilities were assessed at admission and discharge with the Functional Independence Measure (FIM), The Canadian Occupational Performance Measure, 10-metre walk test, 6-min walk test and the de Morton Mobility Index. The gain in motor FIM and the length of stay were used as an index of rehabilitation efficiency. Nutritional status was also assessed using anthropometric measurements and bioelectrical Impedance analysis. Psychologic evaluation was performed at admission only. At admission, functional limitations and severe malnutrition were present in all patients with psychologic problems in about one third. At discharge (42 ± 16 days later), clinically important and statistically significant improvements were found in all outcome measures, which was also noted by the patients. The gain in motor FIM was larger with the longer length of stay up to 2 months and plateaued thereafter. We conclude that post-COVID-19 patients who develop CIN/ CIM following respiratory failure can improve functional and nutritional status during inpatient rehabilitation.
Rehabilitation programs after amputation often include fitting a prosthesis, but prescriptions vary under similar circumstances. The US Medicare Functional Classification Level (K-level) is a scale for describing functional abilities of persons after lower-limb amputation (from 0 = no ability or potential to ambulate, to 4 = prosthetic demands of a child/active adult/athlete). Different outcome measures are used to assess K-level, including six-minute walk test (6MWT). We attempted to predict the assigned K-level of unilateral transtibial prosthesis users from their results of 6MWT and one-leg standing test on prosthesis (OLSTP). Outpatients who had been rehabilitated and fitted with transtibial prosthesis at the University Rehabilitation Institute in Ljubljana in 2014 were included in a retrospective audit. The data were analysed using receiver-operating-characteristics curves, linear discriminant analysis, classification trees and ordinal logistic regression. Among the 120 patients (aged 39–90, mean 67 years; 79% men), eight belonged to K1 level, 94 to K2, and 18 to K3 or K4; 61 could not stand on the prosthesis, eight stood on it for 1 s, and 51 stood on it for 2 s or more. With a simple classification rule based only on 6MWT (130 m threshold for K2/K3/K4 vs. K1, 340 m for K3/K4 vs. K1/K2), we observed sensitivity and specificity close to 90%. The more sophisticated statistical approaches yielded substantially similar and comparably accurate results. 6MWT and OLST could therefore be used as predictors for transtibial prosthesis prescription in clinical practice.
Patients with Guillain–Barré syndrome (GBS) are at high risk for inadequate nutrition throughout their illness, yet the wider impact of malnutrition in this population remains unknown. Thus, the purpose of our study was to investigate the associations between nutritional status and functional status at admission to inpatient rehabilitation for GBS and to determine whether the admission phase angle, a biological marker of cellular health, is a prognostic indicator of functional improvement at the end of rehabilitation. The study included 27 participants recovering from GBS who screened positive for nutritional risk upon admission to rehabilitation. According to the Global Leadership Initiative on Malnutrition criteria, the majority of participants were classified as malnourished. A decreased phase angle was found in 93% (mean 3.7°, SD 1.3°). Lower phase angle was moderately associated with lower motor Functional Independence Measure (mFIM) at admission (r = 0.53, P = 0.005), suggesting that phase angle may be an indicator of functional status. By the end of rehabilitation, all participants improved functional independence and muscle strength, and the majority improved walking abilities. However, the correlation between admission phase angle and mFIM efficiency was not statistically significant (P = 0.3867). We conclude that malnutrition is significantly associated with low functional independence and muscle strength at admission. The inability of admission phase angle to predict functional improvement is probably due to the complex interactions between recovery from GBS and interventions provided during a comprehensive multidisciplinary rehabilitation for GBS, and also relatively small sample size.
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