Most of the research on bacterial pathogenesis has focused on acute infections, but much less is known about the pathogenesis of infections caused by bacteria that grow as aggregates in biofilms. These infections tend to be chronic as they resist innate and adaptive immune defence mechanisms as well as antibiotics, and the treatment of biofilm infections presents a considerable unmet clinical need. To date, there are no drugs that specifically target bacteria in biofilms; however, several approaches are in early-stage development. Here, we review current insights into biofilm physiology and pathology, and discuss how a deep insight into the physical and biological characteristics of biofilms can inform therapeutic strategies and molecular targets for the development of anti-biofilm drugs.

Applying insights from biofilm biology to drug development — can a new approach be developed?

Prevention of catheter-related infections: the potential of a new nano-silver impregnated catheter

Biofilms and catheter-associated urinary tract infections.

Introduction
Skin aging occurs through both intrinsic and extrinsic processes. Fractional radiofrequency (RF) with a microneedling array is the newest form of fractional therapy to be useful in treating aging skin. The current study utilized a noninsulated fractional RF microneedling system.

Methods
This multicenter clinical trial saw 49 patients complete 3 monthly treatments with the new fractional RF microneedling treatments and be followed for 3 months following their last treatment. Pain during treatment was recorded as well as overall improvement using a GAIS scale. Adverse events were also noted.

Results
Forty-nine patients completed all of the treatments and follow-ups. Mild to moderate erythema were reported immediately after treatment which lasted up to 12 hours after the treatment. Pain, as measured on a 1–10 VAS, was noted to 4, on average. The average Fitzpatrick's wrinkle scale score at baseline was 5.04 ± 1.22, 1 month after 3 treatments 3.829 ± 1.69 and 3 months after 3 treatments 3.5 ± 1.66. These results are statistically highly significant (correlated T-test, P < 0.001). Improvement was shown in 100% of patients while 65% of patients had significant improvement (GAIS levels 3–5). Significant skin tightening and skin lifting were also observed. No unusual adverse events were noted throughout the course of the study.

Conclusion
This multicenter study showed significant wrinkle reduction, skin tightening, and lifting of the mid and lower face with the noninsulated fractional RF microneedling system. Lasers Surg. Med. 48:727–733, 2016. © 2016 Wiley Periodicals, Inc.

Non-insulated smooth motion, micro-needles RF fractional treatment for wrinkle reduction and lifting of the lower face: International study.

Background Noninvasive technologies for treating acne scars use radiofrequency (RF)-emitting microneedles for both mechanical disruption of fibrotic strands and heat-mediated collagen remodeling. Objective Efficacy and safety evaluation of electronically controlled noninsulated RF microneedling system on acne scars in patients with dark skin. Methods Nineteen patients, 24 to 51 years old, skin types III to V, with acne scars were enrolled in the study. Each patient had 3 treatment sessions at monthly intervals using a multisource RF treatment platform with a microneedle RF applicator. Efficacy was evaluated by the Goodman and Barron's Global Qualitative Acne Scarring System. Results No bleeding points occurred during treatments. Post-treatment erythema was observed immediately after the treatment and lasted up to 10 hours after the treatment. Improvement of at least 1 acne scar grade was noted in 11 of 19 patients (57.9%) after 1 month and in 9 of 9 patients (100%) after 3 months. Conclusion The tested noninsulated electronically controlled RF microneedles were found to be safe and efficient in the treatment of atrophic acne scars in skin types III to V with minimal pain or downtime.

Treatment of Acne Scars on Darker Skin Types Using a Noninsulated Smooth Motion, Electronically Controlled Radiofrequency Microneedles Treatment System.

SummaryBackground
Microneedle fractional radiofrequency has been reported to be effective for improving wrinkles, enlarged pores and various scars. Sublative fractional radiofrequency has been shown to induce both fractional ablation of epidermis and upper dermal remodelling, which had rejuvenation effects in photoaged skin. Both modalities may have the potential synergy to improve acne scars.

Objective
To evaluate the efficacy and safety of combined microneedle and sublative fractional radiofrequency for acne scars in Asian skin.

Methods
Twenty subjects comprised 11 males and 9 females (mean age 23.65 ± 2.94, skin phototype III–IV) with moderate to severe acne scars. The subjects received three consecutive combined microneedle and sublative fractional radiofrequency at 4-week intervals over 12 weeks. Both blinded dermatologists and subjects assessed the clinical improvement based on the standardized photography and questionnaires, respectively. The quartile grading scale was utilized and defined as follows: grade 1, 0–25% improvement; grade 2, 26–50% improvement; grade 3, 51–75% improvement and grade 4, 76–100% improvement.

Results
All 20 subjects were assessed to have grade 2 or more clinical improvement by physicians; four (20%) had grade 4, 10 (50%) had grade 3, and six (30%) had grade 2 improvement. The subjects' grading also showed a good concordance as indicated by Kappa index of 0.695. The mean duration of post-therapy crusting was 5.2 days and post-therapy erythema lasted 2.5 days.

Conclusion
Combined microneedle and sublative fractional radiofrequency can have a positive therapeutic effect with no serious complications and may provide a new therapeutic approach on acne scars in Asians.

The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin

Background and objectives: For skin rejuvenation, microneedle fractional radiofrequency (RF) is a recently developed minimally invasive method for delivering RF energy directly into the skin using microneedle. Additionally, the use of growth factors in skin rejuvenation is emerging as a novel anti-aging treatment. We evaluated efficacy and safety of microneedle fractional RF for skin rejuvenation, and furthermore the synergistic effect of stem cell conditioned medium, composed of a large number of growth factors and cytokines. Materials and methods: Fifteen females were included for a split-face comparative study with a blinded response evaluation. One side of each subject's face was treated with fractional RF alone, and the other side was treated with fractional RF plus stem cell conditioned medium. Patients received 3 sessions of treatment at 4-week intervals. Results: All patients showed clinical improvement on physician's global assessment and patient satisfaction scores on both sides of their...

Skin rejuvenation by microneedle fractional radiofrequency and a human stem cell conditioned medium in Asian skin: a randomized controlled investigator blinded split-face study

Importance Recent studies suggest that dipeptidyl peptidase 4 (DPP-4) inhibitors are associated with an increased risk of developing bullous pemphigoid (BP). Population-based studies on the association between DPP-4 inhibitors and BP are limited. 
Objective To characterize the potential association between the use of DPP-4 inhibitors and an increased risk of developing BP. 
Design, Setting, and Participants This retrospective, nationwide, population-based, case-control study using Korean insurance claims data from January 1, 2012, to December 31, 2016, included patients with newly diagnosed BP and diabetes. Control patients with diabetes (and without BP) were randomly obtained after matching for age, sex, and year of diagnosis within the same period. 
Main Outcomes and Measures The number of patients with newly diagnosed BP and diabetes per year and annual changes in the proportion of patients with diabetes among all patients with BP were measured. The association between use of DPP-4 inhibitors and risk of developing BP was analyzed using univariate and multivariate logistic regression analyses. 
Results The study included 670 case patients (with diabetes and BP) and 670 control patients (with only diabetes) (mean [SD] age, 75.3 [10.0] years in each group; 342 [51.0%] male in each group). The number of patients with diabetes and BP more than doubled during the study period (from 77 in 2012 to 206 in 2016). The proportion of patients with diabetes among all patients with BP also increased (from 0.18 in 2012 to 0.33 in 2016). The use of DPP-4 inhibitors was associated with a significant increase in the risk of developing BP (adjusted odds ratio [aOR], 1.58; 95% CI, 1.25-2.00; P < .001); among all DPP-4 inhibitors used in Korea, the highest aOR was associated with the use of vildagliptin (aOR, 1.81; 95% CI, 1.31-2.50; P < .001). Subgroup analyses revealed a significant association in male patients (aOR, 1.91; 95% CI, 1.39-2.63; P < .001) and that vildagliptin was the most high-risk DPP-4 inhibitor (aOR, 2.70; 95% CI, 1.73-4.34; P < .001). 
Conclusions and Relevance The findings suggest that DPP-4 inhibitors are associated with a significantly increased risk of the development of BP in patients with diabetes. Of the DPP-4 inhibitors available in Korea, vildagliptin was associated with the highest risk, particularly in male patients. Practitioners should consider that DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of BP in patients with diabetes. These nationwide, population-based results may serve as a foundation for further studies seeking to understand how DPP-4 inhibitors contribute to the development of BP.

/pdf/association-of-dipeptidyl-peptidase-4-inhibitor-use-with-3b2ef98mce.pdf

Association of Dipeptidyl Peptidase 4 Inhibitor Use With Risk of Bullous Pemphigoid in Patients With Diabetes

Background
For skin rejuvenation, microneedle fractional radiofrequency (RF) is a recently developed minimally invasive method for delivering RF energy directly into the skin using microneedle.

Objective
We evaluated efficacy and safety of microneedle fractional RF for skin rejuvenation in Asian skin and also conducted immunohistochemical analysis before and after treatment.

Patients and Methods
Twenty-five females (mean age 54.2, Fitzpatrick skin phototypes III–IV) received three consecutive fractional RF treatment at 4-week intervals. Outcome assessments included standardized photography, physician's global assessment, patient's satisfaction scores, objective biophysical measurements, and histologic analysis including immunohistochemical staining.

Results
All patients showed clinical improvement on physician's global assessment and patient's satisfaction scores. Among objective biophysical measurements, improvement in hydration and skin roughness was noticed. Histologic examination revealed marked increase in dermal thickness, dermal collagen content and dermal fibrillin content. Side effects were minimal.

Limitations
The limitations are the small number of patients and lack of long-term follow-up.

Conclusion
Microneedle fractional RF is a safe and effective skin rejuvenation method in Asians. Lasers Surg. Med. 44: 631–636, 2012. © 2012 Wiley Periodicals, Inc.

Skin rejuvenation by microneedle fractional radiofrequency treatment in Asian skin; Clinical and histological analysis

Background: Intense focused ultrasound (IFUS) has been used successfully for skin tightening.Objective: To investigate the efficacy of IFUS in treating enlarged pores and to evaluate changes in skin elasticity and sebum production following IFUS.Materials and methods: Twenty-two subjects with enlarged pores were randomized to receive a single treatment with IFUS using 1.5-mm transducer on one side of the face, and 3.0-mm transducer on the other. Objective clinical assessments were made by blinded photographic evaluation. Subjective satisfaction and adverse effects were evaluated. Measurements of elasticity and sebum were performed at baseline, 3 and 6 weeks post-treatment.Results: Physicians’ evaluation showed clinical pore improvements in 86% and 91% of the IFUS-treated sites using 1.5-mm and 3.0-mm transducer, respectively. The mean improvement scores were 1.7 and 1.9 for 1.5-mm and 3.0-mm transducer, respectively, with no statistical differences. Cutometer measurement demonstrated a significant...

Moon Soo Yoon

Papers

The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin

Skin rejuvenation by microneedle fractional radiofrequency and a human stem cell conditioned medium in Asian skin: a randomized controlled investigator blinded split-face study

Association of Dipeptidyl Peptidase 4 Inhibitor Use With Risk of Bullous Pemphigoid in Patients With Diabetes

Skin rejuvenation by microneedle fractional radiofrequency treatment in Asian skin; Clinical and histological analysis

The efficacy and safety of intense focused ultrasound in the treatment of enlarged facial pores in Asian skin