The last resort requirement under REACH: From principle to practice.

REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) is a European Union regulation that aims to protect human health and the environment from the risks posed by chemicals. Article 25 clearly states that: "[i]n order to avoid animal testing, testing on vertebrate animals for the purposes of this Regulation shall be undertaken only as a last resort." In practice, however, the standard information requirements under REACH are still primarily filled using animal studies. This paper presents examples illustrating that animal testing is not always undertaken only as a last resort. Six over-arching issues have been identified which contribute to this: (1) non-acceptance of existing animal or non-animal data, (2) non-acceptance of read-across, (3) inflexible administrative processes, (4) redundancy of testing, (5) testing despite animal welfare concerns and (6) testing for cosmetic-only ingredients. We, members of the Animal-Free Safety Assessment (AFSA) Collaboration, who work together to accelerate the global adoption of non-animal approaches for chemical safety assessment, herein propose several recommendations intended to aid the European Commission, the European Chemicals Agency and registrants to protect human health and the environment while avoiding unnecessary animal tests - truly upholding the last resort requirement in REACH.

ECHA ARN documents: chemical grouping without a toxicological rationale.

The EU chemical strategy for sustainability (CSS) plans to use chemical grouping to "prioritise (…) substances for restrictions for all uses through grouping, instead of regulating them one by one". Thus, toxicological grouping will become a key tool used by regulatory authorities in Europe. Over the last 2 years, ECHA has published a high number of documents labelled "Assessment of Regulatory Needs (ARN)" which are based on groups of chemicals based on structural considerations. The ARN documents are legally non-binding, yet they present the public impression of a conclusion about restrictions for groups or sub-groups of chemicals and hence may set a precedent for further binding actions. ECHA has set out definitions on what is considered a group in REACH Annex XI. However, as shown in this commentary based on five examples, the ARN do not follow these principles and propose toxicological groupings without taking into consideration mode of action and the toxicological information on the chemicals. Given the emphasis on grouping projected by the CSS, the groupings in the ARN set an unfortunate precedent on what a toxicological group means and they do not follow clear scientific standards or established toxicological principles. They also lead to a public image of guilt by association for chemicals, without any recourse for registrants to establish the scientific basis for their safe use, as presented within REACH registrations.

Spawning, egg and larval description of the brazilian basslet Gramma brasiliensis Sazima, Gasparini & Moura, 1998 in captivity.

Brazilian basslet Gramma brasiliensis is a fish highly appreciated by the marine ornamental industry. There is an increasing interest in the development of a breeding protocol for this species. However, descriptions of the reproductive biology, eggs and larval development are scarce. This study was the first to describe the spawning, eggs and larvae of G. brasiliensis in captivity, including mouth size information. Six spawning events produced egg masses with 27, 127, 600, 750, 850, and 950 eggs. Larger egg masses showed embryos with at least two different developmental stages. Eggs are spherical (∼1.0 mm diameter), held together by filaments entangling chorionic projections. Larvae with fewer than 12 hph (hours post-hatch) presented 3.55 mm standard-length, well developed eyes, fully absorbed yolk sac, an inflated swim bladder and mouth opened. Exogenous feeding on rotifers began within 12 hph. The average mouth width at first feeding was 0.38 mm. The first settled larva was noted by day 21. This information should help to determine appropriate diets and prey-shift time during the larviculture of the species.

New insight into the role of oxygen supply for surfactin production in bench-scale bioreactors using induced surface aeration.

Surfactin biosurfactant produced by Bacillus sp. has been studied, because it has enormous potential in several applications in the oil and cosmetics industry. The cultivation conditions for obtaining this bioproduct, however, still require attention, as, for example, parameters related to oxygen supply and consumption. In this study, different volumetric oxygen transfer coefficient (KLa) levels (0-11.56 h-1) were tested in bench-scale bioreactor for surfactin biosurfactant production by Bacillus velezensis H2O-1, using induced surface aeration. While conditions close to anaerobiosis showed insignificant production of surfactin, an intermediated KLa condition (4.24 h-1) generated the best surfactin concentration (579.6 mg L-1), with a volumetric productivity of 11.9 mg L-1 h-1. These results showed that the oxygen demand to produce surfactin is not high, being possible to use induced surface aeration strategy in bioreactors, minimizing foam formation. In addition, in all KLa conditions tested, surfactin homologues C14 and C15 had higher relative abundance. Nevertheless, the KLa parameter seems to have had minimal influence on affecting the relative abundances of surfactin homologues produced. Particularly noteworthy in this study is the possibility of producing surfactin using a low-cost and scale-up feasible aeration strategy, unlike the foam collection strategies developed in other studies to obtain this bioproduct.

Improving propionic acid production from a hemicellulosic hydrolysate of sorghum bagasse by means of cell immobilization and sequential batch operation.

Propionic acid (PA) is an important organic compound with extensive application in different industrial sectors and is currently produced by petrochemical processes. The production of PA by large-scale fermentation processes presents a bottleneck, particularly due to low volumetric productivity. In this context, the present work aimed to produce PA by a biochemical route from a hemicellulosic hydrolysate of sorghum bagasse using the strain Propionibacterium acidipropionici CIP 53164. Conditions were optimized to increase volumetric productivity and process efficiency. Initially, in simple batch fermentation, a final concentration of PA of 17.5 g⋅L-1 was obtained. Next, fed batch operation with free cells was adopted to minimize substrate inhibition. Although a higher concentration of PA was achieved (38.0 g⋅L-1 ), the response variables (YP/S = 0.409 g⋅g-1 and QP = 0.198 g⋅L-1 ⋅H-1 ) were close to those of the simple batch experiment. Finally, the fermentability of the hemicellulosic hydrolysate was investigated in a sequential batch with immobilized cells. The PA concentration achieved a maximum of 35.3 g⋅L-1 in the third cycle; moreover, the volumetric productivity was almost sixfold higher (1.17 g⋅L-1 ⋅H-1 ) in sequential batch than in simple batch fermentation. The results are highly promising, providing preliminary data for studies on scaling up the production of this organic acid.

Upper airways after mandibular advancement orthognathic surgery: A 4-year follow-up.

INTRODUCTION: The purpose of this study was to assess the stability of changes in the upper airways 4 years after orthognathic surgery in patients with skeletal Class II malocclusion. METHODS: A retrospective clinical study was conducted including 33 cone-beam computed tomography images from 11 patients (average age of 35.91 years) followed up longitudinally for 4 years. The airways were measured with the help of the Dolphin Imaging software (Dolphin Imaging and Management Systems, Chatsworth, Calif) at 3 points: T1 (preoperative), T2 (6 months after surgery), and T3 (4 years after surgery). The parameters assessed were surface area (SA), minimum axial area, and volume (VOL) of the pharyngeal airway space. The times were compared using analysis of variance and Tukey's test. Pearson's analysis was performed to assess the correlation with surgical changes and age (P <0.05). RESULTS: Four years after operating on the airway spaces, the means of SA and VOL were significantly higher than those observed before the surgery (P <0.05). The means at 6 months were intermediate, with no significant difference before the surgery and 4 years after it (P >0.05). There was no significant correlation of the changes in SA, VOL, and minimum axial area with the amount of mandibular advancement, counterclockwise rotation of the occlusal plane, and age of the patient (P >0.05). CONCLUSIONS: Four years after mandibular advancement surgery in patients with skeletal Class II malocclusion, the increases in the airways remained stable.

Oxybutynin in primary hyperhidrosis: A long-term real-life study.

Hyperhidrosis is a condition of excessive sweating beyond physiological parameters that can seriously impair quality of life. This study aims to evaluate the oral oxybutynin effectiveness in hyperhidrosis, besides its tolerance and safety. In a real-life long-term study, 30 patients with primary hyperhidrosis and Hyperhidrosis Disease Severity Scale (HDSS) with score of at least two were submitted to a questionnaire to assess demographic data, HDSS and side effects of oxybutynin. Most patients were women (n = 23, 76.7%), median age was 40 years (range 12-70, SD 17.5) and 17(56.7%) had family history of hyperhidrosis. The most common hyperhidrosis form was axillary (n = 15, 50.0%), followed by palmoplantar (n = 8, 26.7%), cranio-facial (n = 11, 36.7%) and trunk (n = 5, 16.7%). Median duration of treatment was 2.4 years (range 1-6 years, SD 1.3). Thus, all patients used oxybutynin for at least 1 year, 30% for 2 years, 20% 3 years, 17% 4 years, and 3% 6 years. There was a significant improvement in HDSS score of patients (P < .001). This real life study suggests that oxybutynin is effective and safe for treatment of hyperhidrosis, both in children and adults, with mild and tolerable side effects, with significant improvement in HDSS.

Evaluation of the Post Orthognathic Surgery Satisfaction: a Comparative Cross-Sectional Study of Patients Class II and III.

The aim of this study was to analyze the degree of postoperative satisfaction regarding facial and dental esthetics, masticatory and respiratory function, and psychosocial factors in patients with dentofacial deformity Class II compared with Class III. The patients were divided into 2 groups with 50 patients in Group 1 (Class II) and 30 patients in Group 2 (Class III). Assessing the degree of postoperative satisfaction, the authors did not observe a significant difference between the groups in terms of improvements in the aesthetic and functional aspects and the psychological impact of the treatment. It can be concluded that regardless of the type of dentofacial changes, the treatment well indicated and conducted, results in significant positive effects on patients lives, both aesthetically and in the function, and psychosocial great benefit.

The influence of habitat structure on fish assemblages in Amazonian streams of Machado river basin.

Igarapés are Amazonian streams that are extremely susceptible to environmental changes. Due to the rapidly occurring riparian land use changes, and the several impacts these may have on fish assemblages, it is highly valuable to describe and understand the current relationships between these assemblages and the local environmental conditions, especially in barely know areas. In this research, we studied the taxonomic composition and fish assemblage attributes variation in three streams with different riparian conservation conditions: forest, intermediate and pasture. Samplings were performed every two months from October 2011 to September 2012, in three 1st order streams in the Machado River Basin, Rondônia. Fish were collected using trawls (seine net with a mesh size of 2 mm) and dip nets (2 mm mesh) along the entire stretch; the obtained samples were preserved and identified per site type. A total of 2 141 fish specimens belonging to 59 species, 17 families and five orders were recorded. Unlike the intermediate and pasture streams, the forest stream showed a high richness and low abundance. The forested stream exhibited the highest diversity and evenness value, and had low dominance, unlike the other streams. The variance partitioning and partial Redundancy Analysis (pRDA) indicated that assemblage composition was significantly explained by the environmental variables such as: depth, water velocity, pteridophytes and grasses, but not by spatial predictors. The non-metric multidimensional scaling (NMDS) analysis showed that intermediate and pasture streams separated from the forested stream. We concluded that both, the stream environmental variables and fish assemblage attributes were influenced by the different conservation status and land cover. Given the influence of regional processes, which have a pervasive role in local fish assemblages, land use at the watershed scale is important, especially to explain the higher richness and diversity found in forested streams.

Probabilistic hazard assessment for skin sensitization potency by dose-response modeling using feature elimination instead of quantitative structure-activity relationships.

Supervised learning methods promise to improve integrated testing strategies (ITS), but must be adjusted to handle high dimensionality and dose-response data. ITS approaches are currently fueled by the increasing mechanistic understanding of adverse outcome pathways (AOP) and the development of tests reflecting these mechanisms. Simple approaches to combine skin sensitization data sets, such as weight of evidence, fail due to problems in information redundancy and high dimensionality. The problem is further amplified when potency information (dose/response) of hazards would be estimated. Skin sensitization currently serves as the foster child for AOP and ITS development, as legislative pressures combined with a very good mechanistic understanding of contact dermatitis have led to test development and relatively large high-quality data sets. We curated such a data set and combined a recursive variable selection algorithm to evaluate the information available through in silico, in chemico and in vitro assays. Chemical similarity alone could not cluster chemicals' potency, and in vitro models consistently ranked high in recursive feature elimination. This allows reducing the number of tests included in an ITS. Next, we analyzed with a hidden Markov model that takes advantage of an intrinsic inter-relationship among the local lymph node assay classes, i.e. the monotonous connection between local lymph node assay and dose. The dose-informed random forest/hidden Markov model was superior to the dose-naive random forest model on all data sets. Although balanced accuracy improvement may seem small, this obscures the actual improvement in misclassifications as the dose-informed hidden Markov model strongly reduced " false-negatives" (i.e. extreme sensitizers as non-sensitizer) on all data sets.

Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study.

OBJECTIVE: The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support. METHODS: A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization. RESULTS: A total of 261 patients were evaluated, with a median age of 61.0 (49.0-69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass. CONCLUSION: There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.

Bivariate and multivariate analyses of the influence of blood variables of patients submitted to Roux-en-Y gastric bypass on the stability of erythrocyte membrane against the chaotropic action of ethanol.

The stability of the erythrocyte membrane, which is essential for the maintenance of cell functions, occurs in a critical region of fluidity, which depends largely on its composition and the composition and characteristics of the medium. As the composition of the erythrocyte membrane is influenced by several blood variables, the stability of the erythrocyte membrane must have relations with them. The present study aimed to evaluate, by bivariate and multivariate statistical analyses, the correlations and causal relationships between hematologic and biochemical variables and the stability of the erythrocyte membrane against the chaotropic action of ethanol. The validity of this type of analysis depends on the homogeneity of the population and on the variability of the studied parameters, conditions that can be filled by patients who undergo bariatric surgery by the technique of Roux-en-Y gastric bypass since they will suffer feeding restrictions that have great impact on their blood composition. Pathway analysis revealed that an increase in hemoglobin leads to decreased stability of the cell, probably through a process mediated by an increase in mean corpuscular volume. Furthermore, an increase in the mean corpuscular hemoglobin (MCH) leads to an increase in erythrocyte membrane stability, probably because higher values of MCH are associated with smaller quantities of red blood cells and a larger contact area between the cell membrane and ethanol present in the medium.

Cervical uterine lesions: an epidemiological and molecular investigation in midwestern Minas Gerais, Brazil.

Cervical uterine cancer is the second most frequent form of cancer in the female population and the fourth cause of cancer deaths among Brazilian women. In Divinópolis county, Minas Gerais state, cervical cancer accounted for 6.6% of deaths in 2007. The purpose of this study was to conduct an epidemiological and molecular investigation of samples of pre-neoplastic and neoplastic cervical uterine lesions from patients assisted at public healthcare services in the county. The study was based on clinical-epidemiological descriptions retrieved from cytological examination request forms from 2006 to 2010. For molecular analysis, samples from 95 patients were collected and DNA was extracted using the Chelex 100 method. PCR was performed for detection and typing of HPV 6/11, 16, 18, 31, and 33. Of the 52 168 patients who underwent cytological examination, 625 had pre-neoplastic or neoplastic lesions during the study period. Age distribution was consistent with the literature, with a predominance of patients aged 20-49 years. The microorganism found most frequently was Lactobacillus sp. (65%). Prominent among cellular alterations were cervical intraepithelial neoplasia I (39.7%) and atypical squamous cells of undetermined significance (32%). Molecular analysis revealed 72.6% of positive samples for HPV. HPV 16 (26.3%) was the most frequent type, followed by types 6/11 (7.4%), 18 (5.3%), 33 (2.1%), and 31 (1%). The results provided improved understanding of the association between HPV and cancer in Divinópolis, in addition to providing data that can contribute to the design of measures to prevent and control HPV infection in the county investigated.

Neomycin: sources of contact and sensitization evaluation in 1162 patients treated at a tertiary service.

BACKGROUND: Neomycin is used in several over-the-counter pharmaceutical formulations in Brazil. In Europe and Canada, where it is not freely available, its sensitization frequency is lower than in the United States, where this does not occur. OBJECTIVE: To present the frequency of sensitization to neomycin observed in a tertiary hospital and the pharmaceutical formulations sold in Brazil containing neomycin. METHOD: Retrospective analysis of positive results to neomycin, obtained through patch tests performed in a tertiary hospital, from 2009 to 2018 and investigation of topical drugs and vaccines containing neomycin in Brazilian databases available on the internet. RESULTS: Among 1,162 patients, 71 (6%) had positive reactions to neomycin, 65% female and 35% male individuals, 46% were over 50 years old, and 24% had a personal history of atopy. The dermatitis lasted from four months to 20 years. Lesions were located in 69% of the patients on the upper limbs, in 55% they were on the lower limbs, and in 42% they were disseminated in more than 4 sites. Polysensitization was detected in 55% of cases. Of these, 28% were linked to sensitization to rubber allergens and 27% to potassium bichromate. A total of 158 topical presentations of neomycin were found: 79 ointments, 58 creams, 10 ophthalmic solutions, seven otological solutions, one oral solution, two nasal solutions, and one antiseptic powder, in addition to 11 types of vaccines. STUDY LIMITATIONS: Retrospective study. CONCLUSION: Sensitization to neomycin occurred in 6% of the studied population, affecting more females aged over 50 years, with skin lesions located mainly on the upper and lower limbs, in the context of chronic contact dermatitis. Neomycin was found in 135 formulations, most of them available over the counter, as well as in 11 miscellaneous vaccines.

Normal Trichoscopic Findings after Hair Transplantation in Androgenetic Alopecia: A Prospective Case Series.

Background: Trichoscopy can be very useful for evaluation for hair transplantation (HT), helping rule out simulators of androgenetic alopecia (AGA). There are only a few reports about normal trichoscopic findings after HT. Objective: The aim of this study was to evaluate donor and recipient area trichoscopy after FUE in HT without complications in AGA patients. Method: A prospective study was carried out with 10 patients, for 24 weeks, with photographic follow-up, using FotoFinder®. Patients were evaluated from week 1 (w1) to week 8 weekly, then, at week 12 and week 24 post-HT. Results: Main results were perifollicular crusts, donor area erythema, recipient area erythema, perifollicular erythema, white circles, perifollicular whitish halos, repilation black dots, dystrophic hairs, folliculitis, yellow dots. We discussed the meaning of each of these findings in the period in which they occurred. Conclusion: Normal trichoscopic findings in post-transplant patients have not been well established yet. Our findings are an attempt to define a normal pattern. Future studies with a longer follow-up may be necessary to corroborate these results.

Validation and reliability analysis of the Questionnaire on the Emotional Impact of Vertigo-CIEV version translated to the Brazilian Portuguese language. / Análise de validação e confiabilidade do Questionário Emocional da Vertigem-CIEV em versão traduzida para o Português-Brasileiro.

PURPOSE: To determine the internal consistency and reliability of the "Questionário de Impacto Emocional da Vertigem (CIEV)" and to validate the instrument with respect to the Dizziness Handicap Inventory (DHI) in a sample of individuals with balance disorders. METHODS: 38 subjects participated in the study, males and females, aged from 23 to 85 years, who presented dizziness, vertigo, and/or falls complaints and attended to the Vestibular Disorders clinic at the University Hospital. Individuals with hearing complaints and/or tinnitus unrelated to dizziness, previous psychiatric comorbidities, and/or cognitive impairments were excluded. We performed an anamnesis and collected complementary data from the medical records. After that, the self-perception questionnaires, DHI, and CIEV, were applied. Statistical analysis was performed in which the Cronbach's alpha verified the internal consistency of the CIEV. Reliability and validity of the CIEV related to the DHI were calculated using Intraclass Correlation Index (ICC) and Pearson's correlation test, respectively. RESULTS: There was a statistically significant correlation between the scores obtained, for both reliability and validation analysis (p<0.001). The mean ICC showed a moderate correlation between the total scores (0.695) and a strong correlation with the physical, emotional, and functional DHI domains (0.706 to 0.869), being the emotional aspect the highest degree (0.869). Pearson's correlation showed strong correlation between the total scores (r=0.820) and varied from moderate to strong, with strongest correlations to the DHI emotional domain (r=0.788). CONCLUSION: The outcomes illustrate important contribution to validation parameters to consider clinical use of the CIEV in the Brazilian population, aiming to identify emotional aspects in patients with balance disorders.

OBJETIVO: Determinar a consistência interna e confiabilidade do "Questionário de Impacto Emocional da Vertigem-CIEV" e validar o instrumento em relação ao Dizziness Handicap Inventory (DHI), em uma amostra de pacientes com distúrbio do equilíbrio corporal. MÉTODO: Participaram 38 sujeitos, idades entre 23 e 85 anos, ambos os sexos, com queixas relacionadas à tontura, desequilíbrios e/ou quedas, atendidos em um ambulatório de Otoneurologia do Hospital Universitário. Foram excluídos sujeitos com queixas auditivas e/ou zumbido sem tontura associada, comorbidades psiquiátricas prévias e/ou comprometimento cognitivo que impedisse a compreensão dos questionários. Foi realizada anamnese, levantamento de prontuário para caracterização da amostra e aplicados os questionários de autopercepção, DHI e CIEV. O alfa de Cronbach verificou a consistência interna do CIEV e a confiabilidade e validade do CIEV em relação ao DHI foram calculadas pelo Índice de Correlação intraclasse (ICC) e teste de Correlação de Pearson, respectivamente. RESULTADOS: Houve correlação estatisticamente significante entre os escores obtidos, tanto à análise de confiabilidade quanto de validação (p<0,001). O ICC médio demonstrou moderada correlação para o escore total (0,695) e forte correlação com os domínios físico, emocional e funcional do DHI (0,706 a 0,869) sendo o maior grau para o domínio emocional (0,869). A Correlação de Pearson demonstrou grau forte para o escore total (r=0,820) e variação de moderado a forte para os domínios, com melhor resultado também para o domínio emocional do DHI (r=0,788). CONCLUSÃO: Os achados representam parâmetros importantes de contribuição para a validação do CIEV para uso clínico na população brasileira, direcionado para a identificação de aspectos emocionais em pacientes com distúrbios do equilíbrio corporal.

Regulatory assessment of in vitro skin corrosion and irritation data within the European framework: Workshop recommendations.

Validated in vitro methods for skin corrosion and irritation were adopted by the OECD and by the European Union during the last decade. In the EU, Switzerland and countries adopting the EU legislation, these assays may allow the full replacement of animal testing for identifying and classifying compounds as skin corrosives, skin irritants, and non irritants. In order to develop harmonised recommendations on the use of in vitro data for regulatory assessment purposes within the European framework, a workshop was organized by the Swiss Federal Office of Public Health together with ECVAM and the BfR. It comprised stakeholders from various European countries involved in the process from in vitro testing to the regulatory assessment of in vitro data. Discussions addressed the following questions: (1) the information requirements considered useful for regulatory assessment; (2) the applicability of in vitro skin corrosion data to assign the corrosive subcategories as implemented by the EU Classification, Labelling and Packaging Regulation; (3) the applicability of testing strategies for determining skin corrosion and irritation hazards; and (4) the applicability of the adopted in vitro assays to test mixtures, preparations and dilutions. Overall, a number of agreements and recommendations were achieved in order to clarify and facilitate the assessment and use of in vitro data from regulatory accepted methods, and ultimately help regulators and scientists facing with the new in vitro approaches to evaluate skin irritation and corrosion hazards and risks without animal data.

Reconstruction of Scalp Anterior Hairline with Tissue Expansion and Skin Flap.

Introduction: Cutaneous defects involving the frontal region and anterior hairline of the scalp can result from congenital or acquired conditions. The negative esthetic impact can cause disturbances in the psychic and social sphere of the patient, causing problems in interpersonal relationships and in the body image itself. The use of skin expanders is usually effective in this region due to the bone base providing support and stability for its use. Case Report: We describe the case of a 64-year-old woman submitted to reconstruction of the anterior hairline of the scalp due to scar sequelae after coronal rhytidoplasty followed by pustular erosive dermatosis. We used tissue expansion (50 mL of saline per week until it reached 300 mL) and advancement flap. Discussion/Conclusion: Scalp reconstruction also includes vascularized soft tissue coverage, acceptable cosmetic appearance, and minimal morbidity for the donor area. The correction of scalp scars must obey 2 basic principles: tissue similarity and natural capillary pattern (direction, angle, capillary growth, and proper capillary line design). Tissue expansion and skin flap techniques can successfully correct defects in extensive scarring alopecia such as in the presented case.

Prevalence and factors associated with gynoid lipodystrophy in Brazilian adolescent girls: a cross-sectional study.

BACKGROUND: Gynoid lipodystrophy (GLD), or female cellulitis, is a chronic multifactorial disorder characterized by the irregular appearance of the skin surface on the thighs and gluteal regions, which affects 80-90% of women after puberty. No curative treatments are available, and there is a paucity of epidemiological studies related to its prevalence, quality of life impact, and risk factors. We aimed to identify the prevalence and factors associated with the development of GLD in Brazilian adolescent girls. METHODS: A cross-sectional study examined adolescent girls from São Paulo, Brazil. The explored factors were grouped: familial history, gynecological and hormonal characteristics, exercise practice, nutrition and diet, anthropometric measures, body mass index, and body composition, according to GLD severity assessed through multivariate hierarchic statistics. RESULTS: In total, 184 girls, aged from 12 to 18 years, were included in the study. The overall prevalence of GLD was 77.7% (CI 95% 71.7-82.1%); moderate and severe categories of GLD occurred in 56.5% (CI 95% 48.9-62.5%) of the sample. An impact on the quality of life was identified in 39.7% of the girls. GLD was independently associated with higher body mass index, early menarche, higher carbohydrate intake, lower water consumption, menstrual irregularity, familial report of GLD, and less exercise practice. CONCLUSION: Gynoid lipodystrophy is a multifactorial disorder; its onset in adolescent girls is associated with familial occurrence, body composition, diet habits, exercise, and hormonal factors. These results support further interventions for GLD prevention and treatment.