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Phenotypic plasticity of fine root growth increases plant productivity in pine seedlings.

BACKGROUND: The plastic response of fine roots to a changing environment is suggested to affect the growth and form of a plant. Here we show that the plasticity of fine root growth may increase plant productivity based on an experiment using young seedlings (14-week old) of loblolly pine. We use two contrasting pine ecotypes, "mesic" and "xeric", to investigate the adaptive significance of such a plastic response. RESULTS: The partitioning of biomass to fine roots is observed to reduce with increased nutrient availability. For the "mesic" ecotype, increased stem biomass as a consequence of more nutrients may be primarily due to reduced fine-root biomass partitioning. For the "xeric" ecotype, the favorable influence of the plasticity of fine root growth on stem growth results from increased allocation of biomass to foliage and decreased allocation to fine roots. An evolutionary genetic analysis indicates that the plasticity of fine root growth is inducible, whereas the plasticity of foliage is constitutive. CONCLUSIONS: Results promise to enhance a fundamental understanding of evolutionary changes of tree architecture under domestication and to design sound silvicultural and breeding measures for improving plant productivity.

Adaptation, Physiological↗

On experimental design and discourse in plasticity research.

Communication in the stem cell field requires a common understanding of terminology and that "plasticity" phenomena are model- and, perhaps, species-dependent. Plasticity has generally been applied to unexpected differentiative events; will the term cease being useful when these unexpected pathways become recognized as normative? Four pathways of cell plasticity have now been recognized: (1) facultative, intraorgan self-renewing stem cells; (2) reversion of differentiated cells to blastema-like appearances, common in amphibians, perhaps restricted to neoplasia in mammals; (3) cells of one lineage directly changing to differentiation of another lineage cued by microenvironemental signals; (4) cell-cell fusion leading to changes in differentiation of the "incoming" cell in response to cytoplasmic and perhaps nuclear cues. In all of these, "differentiation" must be understood as a reflection of gene expression that is a highly intricate system of parallel, i.e., nonlinear molecular interactions. Present controversies regarding the plasticity of adult stem cells may be explained both by differences in experimental variables and techniques as well as by differing nonscientific, political, and/or polemical needs of investigators and commentators. Some of the variables in transplantation experiments, which are likely to be important in experimental outcome, but rarely addressed in interpretation of data, are the age of the cell donor and of the strain of mice or species used, the isolation technique used to obtain the putative stem cells, and the inherent effects of transgenic markers used to identify the donor or host cells. Also of great importance, but rarely controlled for in experimental design and interpretation, are the reproducibility and sensitivity of methods used to detect the markers of donor origin, the capacity of differentiated tissue to silence transgenes or alter marker expression, and--finally and most importantly--the different signals that influence plasticity phenomena in very different types of injury and regeneration. In different models of injury there are likely to be significant differences in promoting cell localization, proliferation, and predominance of "plasticity pathway," if any are involved, in determining outcome.

Adult↗

The evolution of plastic recombination.

Empirical data suggest that recombination rates may change in response to stress. To study the evolution of plastic recombination, we develop a modifier model using the same theoretical framework used to study conventional (nonplastic) modifiers, thus allowing direct comparison. We examine the evolution of plastic recombination in both haploid and diploid systems. In haploids, a plastic modifier spreads by forming associations with selectively favored alleles. Relative to nonplastic effects, selection on the plastic effects of a modifier is both much stronger and less sensitive to the specifics of the selection regime (e.g., epistasis). In contrast, the evolution of plastic recombination in diploids is much more restricted. Selection on plasticity requires the ability to detect DNA damage or cis-trans effects as may occur through maternal effects on fitness.

Evolution, Molecular↗

Phenotypic plasticity early in life constrains developmental responses later.

Plastic stem-elongation responses to the ratio of red:far-red (R:FR) wavelengths enable plants to match their phenotype to local competitive conditions. However, elongation responses early in the life history may occur at the cost of reduced plasticity later in the life history, because elongation influences both allocation patterns and structural integrity. A common-garden experiment was performed to test whether seedling responses to R:FR affect biomass allocation. biomass accumulation, and subsequent plasticity to the cue. Seedlings of Abutilon theophrasti were stimulated to elongate by low R:FR treatments, and subsequent growth and plasticity was compared with nonelongated individuals. Elongated seedlings were less responsive than nonelongated ones to a second bout of low R:FR. Thus, seedling plasticity to R:FR reduces subsequent responsiveness to this cue. This negative association across life-history stages suggests an important constraint on the evolution of plastic stem responses, because selection in A. theophrasti has previously been shown to favor increases in early elongation in combination with increased later elongation. The reduced responsiveness of elongated seedlings to R:FR appeared to result from a structural feedback mechanism, indicating that the opportunity cost of early responses may be lower in environments providing structural support.

Biological Evolution↗

[Plastic bronchitis in a child with thalassemia alpha].

OBJECTIVE: Plastic bronchitis is an unusual condition in children, associated with formation of mucofibrinous casts and mucous plugging of the tracheobronchial tree. Given that this illness is part of the differential diagnosis of acute respiratory failure, early treatment is important for improved prognosis. The aim of this report is to describe a case of plastic bronchitis in a child with alpha-thalassemia that was treated successfully with endoscopy. DESCRIPTION: A three year old, black, male child, previously healthy, presented with acute respiratory failure and a chest x-ray showing pulmonary atelectasis. There was no evidence of respiratory symptoms or previous allergy state. The diagnosis of plastic bronchitis was made using flexible and rigid bronchoscopy, and confirmed by histopathologic findings. The child progressed well, treatment was based on supportive care and antibiotics were not used. Ten days after discharge, radiographic appearance was normal. Alpha thalassemia was diagnosed through hemoglobin electrophoresis. COMMENTS: Plastic bronchitis is clinically important because has similar presentation to other prevalent diseases, such as foreign body aspiration and asthma. When plastic bronchitis is suspected, endoscopy is indicated in order to confirm diagnosis and define treatment. Plastic bronchitis has been previously described in patients with cystic fibrosis, cardiac surgery and sickle cell disease. In this case, an association with alpha-thalassemia was observed.

Bronchitis↗

[Response of stomatal characteristics and its plasticity to different light intensities in leaves of seven tropical woody seedlings].

Stomatal characteristics and its plasticity in leaves of four canopy species, Shorea chinensis, Pometia tomentosa, Anthocephalus chinensis, Calophyllun polyanthum and three middle-layer species, Barringtonia pendula, Garcinia hanburyi, Horsfieldia tetratepala acclimated to different light conditions (8%, 25%, 50% and 100% of full sunlight) for more than one year were surveyed. All plant's stomata were distributed on the abaxial of leaves. Pometia tomentosa and Barringtonia pendula had higher stomatal density, and the guard cell length of Anthocephalus chinensis and Calophyllun polyanthum were much greater than others'. Stomatal density and stomatal index (ratio of stomatal numbers to epidermal cell number) were increased with growth irradiance increased, while numbers of stomata per leaf were higher in the low than the high relative PFD, and stomatal conductance of leaves was the highest in the 50% of sunlight except for Anthocephalus chinensis. The relative PFD had little effects on the guard cell length of all seven plants. There was a significant negative correlation between stomatal density and leaf area, but the stomatal conductance was not significantly positive with the stomatal conductance in some degree. The analysis of phenotypic plasticity of stomatal characteristics showed that plasticity index for stomatal index and numbers of stomatal per leaf were similar for canopy and middle-layer species, while the plasticity index of stomatal density and stomatal conductance were significantly greater for canopy species than middle-layer species. The high plasticity of canopy species was consistent with the hypothesis that specialization in a more favorable environment increases plasticity.

Light↗

[Present view on the stem cell plasticity and cell therapy].

The most controversial problem in the present biology and medicine is the existence of stem cell plasticity. Experimental biology and medicine have been working with stem cells and stem cell therapy more than twenty years. The term plasticity, as it is understood, is the potential of stem cell phenotypes that is much broader that phenotypes of differentiated cells of their original tissues. Many laboratories have documented the existence of stem cell plasticity; however, many objections to the reported results still exist. Here, we present some of these objections questioning the data on stem cell plasticity. We wish to point out some problems associated with plasticity of stem cells, transdifferentiation and cell fusion. Recent experimental results indicate that stem cells may have a key role in stem cell therapy. This review is an introductory discussion on the stem cell plasticity and stem cell therapy.

Animals↗

[Preparation of plastic nano-hydroxyapatite/poly (3-hydroxybutyrate-hydroxyvalerate)-polymethyl lene glycol gentamicin drug delivery system].

OBJECTIVE: To develop the plastic nano-hydroxyapatite (nano-HA)/poly (3-hydroxybutyrate-hydroxyvalerate)-polyethylene glycol (PHBV-PEG) gentamicin (GM) drug delivery system (DDS) (nano-HA/PHBV-PEG-GM-DDS) for treating osteomyelitis and find its releasing character in vivo. METHODS: The plastic nano-HA/PHBV-PEG-GM-DDS was prepared using nano-HA as the core carrier of GM, nano-HA with PHBV and PEG as coating and plastic fibrin glue(FG) as microsphere scaffold. The morphological features of nano-HA, drug loaded nano-HA and drug loaded nano-HA/PHBV-PEG microsphere were examined by electron microscope. The GM concentration it blood, cortex bone and cancellous bone was detected at 12 different time points by the method of K-B after the plastic nano-HA/PHBV-PEG-GM-DDS was implanted into the femora of 36 rabbits. Its GM releasing character was assayed in vivo. RESULTS: Nano-HA was similar to a blackjack, and its length was less than 60 nm. Drug loaded nano-HA appeared natural crystal condensate, of which surface adsorbed massive GM. The average grain diameter was 200.5 nm. Drug loaded nano-HA/PHBV-PEG microsphere had a shrinkable porous structure, of which surface configuration was consistent. The average grain diameter was 34.5 microm. The GM concentration and the antibacterial annulus was in the linear correlation. The correlation coefficient was 0.998. In cortex and cancellous bone tissue, the GM concentration was about 95.50 +/- 16.50 microg/ml and 80.20 +/- 13.80 microg/ml from the plastic nano-HA/PHBV-PEG-GM-DDS on the 1st day, then decreased gradually. After 56 days of operation, the GM concentration still exceeded the minimum inhibitory concentration for the staphylococcus aureus, but the peak level of serum GM concentration was under the nephrotoxicity concentration. CONCLUSION: Plastic nano-HA/PHBV-PEG-GM-DDS was a good drug delivery system with sustained antibiotic effect in vivo. It was an effective method for the treatment of osteomyelitis.

Animals↗

Doses of 6-hydroxydopamine sufficient to deplete norepinephrine are not sufficient to decrease plasticity in the visual cortex.

These experiments were designed to test Kasamatsu and Pettigrew's (1979, 1983, and see below) hypothesis that plasticity in the visual cortex requires cortical norepinephrine (NE). Kittens were treated with various doses of intraventricular 6-hydroxydopamine (6-OHDA) or vehicle solution. Cortical NE content was measured with high-performance liquid chromatography with electrochemical detection. We sutured the right eyes of some kittens approximately 6 weeks of age for 1 week and recorded from the left visual cortex of these kittens at the end of the week of suture. We measured the ability of the deprived eye to drive cortical cells in animals that received either 0.2 or 4.8 mg of 6-OHDA, and also in control animals that received only vehicle solution. We concluded that a particular dose of 6-OHDA decreased plasticity if it increased (relative to controls) the ability of the deprived eye to drive cortical cells. Doses of 6-OHDA as small as 0.2 mg were sufficient to produce approximately maximal depletion of NE but did not decrease cortical plasticity. Doses of 4.8 mg or more did decrease cortical plasticity, although not as much as was reported by Kasamatsu and Pettigrew. We conclude that 6-OHDA can alter cortical plasticity but the decrease in plasticity does not result from NE depletion.

Animals↗

The ecological significance of plasticity.

Plastic responses of plants to environmental factors may be placed in an ecological context by regarding them as components of sets of traits which are predictably related to habitat stability and productivity. In ephemeral plants of temporary habitats plasticity is a major component of the mechanisms which tend to sustain reproduction when these plants are exposed to stress. When perennials of more stable habitats are subjected to stress the most frequently observed effect of plastic changes in allocation is to defer reproduction, a mechanism which appears to safeguard survival of the parent plant. It is suggested that plasticity is of vital importance in resource acquisition by plants. This hypothesis is supported by the results of experiments in which the roots and shoots of plants of contrasted ecology have been subjected to controlled patchiness in resource supply. We conclude that in plants of productive habitats high morphological plasticity is part of the foraging mechanisms which project new leaves and roots into the resource-rich zones of the constantly changing environmental mosaic created by the activity of competing plants. In long-lived plants of chronically unproductive habitats plasticity is expressed primarily through reversible physiological changes. These appear to maintain the viability and functional efficiency of leaves and roots over their long life spans and facilitate exploitation of the pulses of temporary and unpredictable resource supply which are characteristic of unproductive habitats.

Ecology↗

[The role of plastic and reconstructive surgery within an interdisciplinary treatment concept for diabetic ulcers of the foot].

BACKGROUND AND OBJECTIVE: Diabetes mellitus and its sequelae such as the "diabetic foot" are increasing in incidence and pose a challenging medical and financial problem. Interdisciplinary teams have been formed to prevent and treat these problems, consisting of diabetic nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general, orthopaedic and vascular surgeons. However, hardly mentioned in the literature are the surgical options offered by plastic and reconstructive surgeons. The aim of this study was to analyse the outcome of plastic surgical treatment for soft tissue defect coverage of the diabetic foot ulcer and to define the role of plastic and reconstructive surgery within an interdisciplinary treatment concept. PATIENTS AND METHODS: In a retrospective cohort study the charts of 38 diabetic patients (female n = 14/male n = 24) with an average age of 68.6 years and with 45 defects on the foot or ankle were analysed regarding the patient profile, defect etiology and size, operative procedures, complications and outcome results. RESULTS: Defect coverage was performed using 20 split skin grafts, 19 local flaps and 6 free flaps as well as 27 amputations. At the time of discharge 25 of 45 defects were closed (56 %), 15 patients had an amputation and in 3 cases a small defect remained. The success rate of defect coverage decreased with increasing comorbidity. Whereas 71 % of the defects were covered in ASA stage 2 patients, only 50 % of the defects could be covered in ASA stage 3 patients and only 33 % in ASA stage 4 patients. CONCLUSIONS: Despite a high complication rate, plastic surgical techniques in many cases prevented an amputation in this negatively preselected patient group. These results provide justification for plastic and reconstructive surgery being in any case part of an interdisciplinary treatment approach of the diabetic ulcer.

Aged↗

Migration testing of plastics and microwave-active materials for high-temperature food-use applications.

Temperatures have been measured using a fluoro-optic probe at the food/container or food/packaging interfaces as appropriate, for a range of foods heated in either a microwave or a conventional oven. Reheating ready-prepared foods packaged in plastics pouches, trays or dishes in the microwave oven, according to the manufacturers' instructions, resulted in temperatures in the range 61-121 degrees C. Microwave-active materials (susceptors) in contact with ready-prepared foods frequently reached local spot temperatures above 200 degrees C. For foods cooked in a microwave oven according to published recipes, temperatures from 91 degrees C to 200 degrees C were recorded, whilst similar temperatures (92-194 degrees C) were attained in a conventional oven, but over longer periods of time. These measurements form the basis for examining compliance with specific and overall migration limits for plastics materials. The testing conditions proposed depend on the intended use of the plastic - for microwave oven use for aqueous foods, for all lidding materials, and for reheating of foods, testing would only be required with aqueous simulants for 1 h at 100 degrees C; for unspecified microwave oven use, testing with olive oil would be required for 30 min at 150 degrees C; and for unspecified use in a conventional oven testing with olive oil would be required for 2 h at 175 degrees C. For microwave-active materials, it is proposed that testing is carried out in the microwave oven using a novel semi-solid simulant comprising olive oil and water absorbed onto an inert support of diatomaceous earth. The testing in this instance is carried out with the simulant instead of food in a package and heating in the microwave oven at 600 W for 4 min for every 100 g of simulant employed. There is an option in every case to test for migration using real foods rather than simulants if it can be demonstrated that results using simulants are unrepresentative of those for foods. The proposed testing conditions were validated as being realistic by measurement of the specific migration of various components from different plastics into foods under actual conditions of use and comparing with migration into simulants. Migration of plasticizers from PVC and VC/VDC copolymer films was monitored for both microwave reheating and cooking of foods. Total oligomer concentrations were measured from poly(ethylene terephthalate) (PET) trays, and volatile aromatics from thermoset polyester trays, using both types of container in microwave and conventional ovens.(ABSTRACT TRUNCATED AT 400 WORDS)

Adipates↗

An earthquake disaster in Turkey: assessment of the need for plastic surgery services in a crisis intervention field hospital.

On August 17, 1999, an earthquake of 7.4 magnitude struck Turkey, resulting in the destruction of the cities Golcuk, Izmit, Adapazari, and Yalova. Three days later, the Israel Defense Force Field Hospital arrived at Adapazari, serving as a reinforcement hospital until the rehabilitation of the local medical facilities. Surgical services in the field hospital were supplied by general, orthopedic, and plastic surgeons. The authors evaluated all soft-tissue injuries managed at the hospital and assessed the need for plastic surgery services in a crisis intervention field hospital. Information was gathered regarding soft-tissue injuries throughout the activity of the hospital. In addition, patients' charts, operations' reports, and entry and evacuation logs were reviewed for all patients accepted and treated in the field hospital. Interviews of patients, local physicians, and citizens of Adapazari were performed to evaluate the medical situation in the first 3 days after the earthquake. A total of 1205 patients were treated by the field hospital in Adapazari; 138 (11.45 percent) of these patients sought aid for isolated soft-tissue injuries, 105 of which (76.09 percent) were earthquake-related. Twenty (51.28 percent) of the operations performed in the hospital were to treat soft-tissue injuries; 1.49 percent of all patients underwent minor surgical manipulations by the plastic surgeon on staff. Plastic surgery patients occupied 13.6 percent of the hospital beds. In conclusion, the authors find it beneficial to supply plastic surgery services at a field hospital in an earthquake situation.

Disasters↗

The integral role of the plastic surgeon at a level I trauma center.

The role of plastic surgery in urban level I trauma centers in the United States has been largely undefined, despite the undeniable historical involvement of plastic surgery in reconstruction of posttraumatic defects. To explore and define this role, case data were prospectively collected during a 29-month period following initiation of a full-time plastic surgery position at an established urban level I trauma center. Referring and/or interacting surgical service, anatomical area of interest, and procedure data were tabulated. A total of 1009 operative reports comprising 1104 procedures were recorded. The most common interacting surgical services were orthopedics and general/trauma surgery; however, interaction occurred with a total of 10 surgical specialties. The upper extremity was the most common anatomical area operated on followed by head and neck, lower extremity, trunk, urogenital, and breast. A wide variety of procedures were performed in each anatomical area, demonstrating the broad scope of reconstructive surgery practiced in a trauma setting. Three hundred and twenty-four procedures involved expertise in microsurgery, flaps, and burn or frostbite care. Additional procedures commonly performed demonstrated considerable overlap with other fields of surgical specialization. This overlap in skills proved advantageous in distribution of facial trauma call and hand surgery coverage. Data presented in this study reinforce the idea that plastic surgery is a specialty defined by concept rather than anatomical area, and also demonstrate a significant role for plastic surgeons in a level I trauma center.

Colorado↗

Storage of platelets in earth orbit. Effect of gravity and the formulation of plastic storage containers on platelet IgG and C3.

We investigated the effects of gravitational force and three different plastic formulations of the storage bags on the quality of stored platelets by measuring the changes in platelet-associated immunoglobulin G (IgG) and two antigenic markers of the third component of human complement (C3), C3d and C3c. Pooled platelets were stored in parallel at microgravity (MG) and on the ground (1 g) using three different plastic polymers: (1) polyvinylchloride (PVC) plasticized with di-2-ethylhexyl phthalate (DEHP); (2) PVC plasticized with trioctyl trimellitate (TOTM), and (3) unplasticized polyolefin (PO). The IgG and C3 were quantified by an automated antiglobulin consumption test in freeze/thaw disrupted platelets (total IgG or C3). The baseline values for platelet associated IgG and C3, measured after 2.5 days of storage at 1 g just prior to the launch, fell within the normal range. Following an additional 6.5 day storage, platelets stored at MG had accumulated significantly less C3d than those stored at 1 g, suggesting that MG storage was beneficial. Specific plastic formulations also exerted a significant effect on the accumulation of these immunoproteins, the effect being particularly pronounced at MG. The smallest increases of IgG and C3 were seen in platelets stored in TOTM and the largest in those stored in DEHP. It is possible that further studies at MG would permit a clear characterization of the effects of other independent storage variables.

Benzoates↗

Knowledge of the scope of plastic and reconstructive surgery by surgical specialists at Ibadan and Ilorin, Nigeria.

BACKGROUND: Defects created by all surgical specialties require closure. Plastic and reconstructive surgery is a subspecialty that reconstructs large defects. Many people including the medical and dental practitioners are still unaware of its scope. This study was conducted to assess the level of awareness of surgical specialists in the practice of plastic and reconstructive surgery. METHODS: Questionnaires were sent to all surgical specialists working at the University College Hospital, Ibadan located in the South-West zone of Nigeria and to surgical specialists at the University of Ilorin Teaching Hospital, located in the North Central zone of Nigeria. Scores of respondents were compared and analysed using student t-test. RESULTS: The mean knowledge of specialists at the University College Hospital, Ibadan was 62.61% (SD 14.63) while that of University of Ilorin Teaching Hospital was 47.86% (SD 20.26). The difference was statistically significant (p < 0.05). CONCLUSION: The study demonstrated the general limitation of knowledge among surgical specialists on the scope of plastic surgery. It also showed a variation in the knowledge of the practitioners at Ibadan and Ilorin on the scope of plastic surgery. Greater progress must be made in the education of our colleagues as well as the general public, if the specialty of plastic and reconstructive surgery is to be practiced in its full scope.

Educational Status↗

Bipolar scissors in facial plastic surgery.

BACKGROUND: Many methods are available to the facial plastic surgeon for elevating and separating tissue, from cold steel to monopolar cautery to various laser-cutting technologies. Bipolar cautery has replaced monopolar cautery as the optimal hemostatic technique because of its decreased tissue damage and improved capabilities. Bipolar scissors concurrently offer a dissecting technique with hemostatic capability. Little exists in the otolaryngology literature on the use of bipolar scissors for soft tissue dissection. OBJECTIVE: To describe our experience using bipolar scissors in a variety of facial plastic and reconstructive procedures. SETTING: Tertiary care referral academic center. DESIGN: We retrospectively reviewed 78 procedures performed using bipolar scissors between June 1997 and August 1999. In facial plastic cosmetic surgery, bipolar scissors were used 31 times for deep plane face-lifts and 16 times for endoscopic browlifts. In facial plastic reconstructive surgery, bipolar scissors were used in 15 radial forearm free flaps, 10 fibula osteocutaneous flaps, 3 rectus abdominis free flaps, and 3 latissimus dorsi myocutaneous free flaps. RESULTS: In all procedures, bipolar scissors facilitated the dissection. By allowing for a drier field, less time was required to elevate the flap and obtain hemostasis. Complications were not increased compared with historical controls. In the harvesting of fibula osteocutaneous free flaps, use of bipolar scissors allowed harvesting without use of a tourniquet. CONCLUSION: Bipolar scissors, a new technology in facial plastic surgery, allow the same control as sharp dissection and provide simultaneous hemostasis.

Dissection↗

Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery.

OBJECTIVES: To evaluate the relationship between cosmetic facial plastic surgery procedure price and demand, and to test the hypothesis that these procedures function as luxury goods in the marketplace, with an upward-sloping demand curve. METHODS: Data were derived from a survey that was sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery, assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (face-lift, brow-lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. An economic analysis was performed to assess the relationship of price and demand for these procedures. RESULTS: A significant association was found between increasing surgeons' fees and total charges for cosmetic facial plastic surgery procedures and increasing demand for these procedures, as measured by their annual frequency (P</=.003). After a multiple regression analysis correcting for confounding variables, this association of increased price with increased demand holds for each of the 4 procedures studied, across all US regions, and for both periods surveyed. CONCLUSIONS: Cosmetic facial plastic surgery procedures do appear to function as luxury goods in the marketplace, with an upward-sloping demand curve. This stands in contrast to other, traditional, goods for which demand typically declines as price increases. It appears that economic methods can be used to evaluate cosmetic procedure trends; however, these methods must be founded on the appropriate economic theory.

Attitude to Health↗