Clustering of Cardiovascular Risk Factors and Heart Failure in Older Adults from the Brazilian Far North.

Given the aging global population, identifying heart failure (HF) phenotypes has become crucial, as distinct disease characteristics can influence treatment and prognosis in older adults. This study aimed to analyze the association between clustering of cardiovascular risk factors and HF in older adults. A cross-sectional epidemiological study was conducted with 1322 older adults (55% women, mean age 70.4) seen in primary health care. Diagnosis of HF was performed by a cardiologist based on diagnostic tests and medical history. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, and smoking. Using logistic regression, potential associations were tested. Individual risk factor analysis showed that older adults with hypertension, diabetes, or hypercholesterolemia had up to 7.6 times higher odds to have HF. The cluster where older adults had only one risk factor instead of none increased the odds of HF by 53.0%. Additionally, the odds of older patients having HF ranged from 3.59 times for the two-risk factor cluster to 20.61 times for the simultaneous presence of all four factors. The analysis of clusters substantially increasing HF risk in older adults revealed the importance of individualizing subgroups with distinct HF pathophysiologies. The clinical significance of these clusters can be beneficial in guiding a more personalized therapeutic approach.

Effects of gallic acid and physical training on liver damage, force, and anxiety in obese mice: Hepatic modulation of Sestrin 2 (SESN2) and PGC-α expression.

Obesity and overweight are multifactorial diseases affecting more than one-third of the world's population. Physical inactivity contributes to a positive energy balance and the onset of obesity. Exercise combined with a balanced diet is an effective non-pharmacological strategy to improve obesity-related disorders. Gallic acid (GA), is a natural endogenous polyphenol found in a variety of fruits, vegetables, and wines, and has beneficial effects on energetic homeostasis. The present study aims to investigate the effects of exercise training on obese mice supplemented with GA. Animal experimentation was performed with male Swiss mice divided into five groups: ST (standard control), HFD (obese control), HFD + GA (GA supplement), HFD + Trained (training), and HFD + GA + Trained (GA and training). The groups are treated for eight weeks with 200 mg/kg/body weight of the feed compound and, if applicable, physical training. The main findings of the present study show that GA supplementation improves liver fat, body weight, adiposity, and plasma insulin levels. In addition, animals treated with the GA and a physical training program demonstrate reduced levels of anxiety. Gene expression analyses show that Sesn2 is activated via PGC-1α independent of the GATOR2 protein, which is activated by GA in the context of physical activity. These data are corroborated by molecular docking analysis, demonstrating the interaction of GA with GATOR2. The present study contributes to understanding the metabolic effects of GA and physical training and demonstrates a new hepatic mechanism of action via Sestrin 2 and PGC-1α.

The Brazilian national prospective active surveillance (AS) cohort of patients with low-risk prostate cancer in the public health system: vigiaSUS study protocol.

BACKGROUND: Prostate cancer exhibits a very diverse behaviour, with some patients dying from the disease and others never needing treatment. Active surveillance (AS) consists of periodic PSA assessment (prostate-specific antigen), DRE (digital rectal examination) and periodic prostate biopsies. According to the main guidelines, AS is the preferred strategy for low-risk patients, to avoid or delay definitive treatment. However, concerns remain regarding its applicability in certain patient subgroups, such as African American men, who were underrepresented in the main cohorts. Brazil has a very racially diverse population, with 56.1% self-reporting as brown or black. The aim of this study is to evaluate and validate the AS strategy in low-risk prostate cancer patients following an AS protocol in the Brazilian public health system. METHODS: This is a multicentre AS prospective cohort study that will include 200 patients from all regions of Brazil in the public health system. Patients with prostate adenocarcinoma and low-risk criteria, defined as clinical staging T1-T2a, Gleason score ≤ 6, and PSA < 10 ng/ml, will be enrolled. Archival prostate cancer tissue will be centrally reviewed. Patients enrolled in the study will follow the AS strategy, which involves PSA and physical examination every 6 months as well as multiparametric MRI (mpMRI) every two years and prostate biopsy at month 12 and then every two years. The primary objective is to evaluate the reclassification rate at 12 months, and secondary objectives include determining the treatment-free survival rate, metastasis-free survival, and specific and overall survival. Exploratory objectives include the evaluation of quality of life and anxiety, the impact of PTEN loss and the economic impact of AS on the Brazilian public health system. DISCUSSION: This is the first Brazilian prospective study of patients with low-risk prostate cancer under AS. To our knowledge, this is one of the largest AS study cohort with a majority of nonwhite patients. We believe that this study is an opportunity to better understand the outcomes of AS in populations underrepresented in studies. Based on these data, an AS national clinical guideline will be developed, which may have a beneficial impact on the quality of life of patients and on public health. TRIAL REGISTRATION: Clinicaltrials registration is NCT05343936.

Lychnophora ericoides Mart. (Brazilian arnica) ethanol extract accelerates the skin wound healing process: Evidence for its mechanism of action.

BACKGROUND: Lychnophora ericoides Mart, also known as the Brazilian arnica or fake arnica, belongs to the Asteraceae family. Leaves and roots are used in alcoholic and hydroalcoholic preparations for the treatment of wounds, inflammation, and pain. PURPOSE: The present study aimed to investigate the effects of L. ericoides ethanolic extract (EELE) on cutaneous wound healing and the mechanisms of action involved. METHODS: A total of 72 C57BL/6 mice were randomly divided into four groups of six animals each. An excisional wound was made in the dorsal region of each mouse. The test groups were topically treated with the vehicle, a positive control commercial reference drug, EELE ointment (5%), and EELE ointment (10%). The treatments were applied over 14 days. The wound area was measured every two days to verify the wound closure kinetics. On days 3, 7, and 14 the wound tissue samples were processed for Hematoxylin and Eosin, Masson-Trichrome, and Toluidine blue staining. The expression of renin-angiotensin system (RAS) components, the vascular growth factor-A (VEGF-A), the basic fibroblast growth factor (FGF-2), and type I collagen genes were evaluated. Phytochemical analyses were performed using HPLC-DAD and HPLC-MS/MS. RESULTS: The EELE (10%) significantly reduced the wound area compared to the treatments used for the other groups. Histological analysis demonstrated that wounds treated with L. ericoides for 14 days developed improved anatomical skin features, healed with hair follicles and sebaceous glands, increased collagen production and angiogenesis, and decreased the number of mast cells at the injury site. Real-time PCR data demonstrated that groups treated with EELE (10%) showed increased Type I collagen, VEGF-A, FGF-2, and AT1R and decreased ACE II and receptor MAS. The healing action of L. ericoides may be related to the presence of phenolic compounds, such as phenolic acids, chlorogenic acid derivatives, and C-glycoside flavonoids. CONCLUSION: Topical treatment with EELE increases important factors for wound healing: FGF, VEGF, collagen formation, and the expression of the proliferative axis of the renin-angiotensin system. For the first time, the present study shows the healing action of L. ericoides at the molecular level in an animal model. This process can be used as an alternative therapy for wound healing and the development of herbal therapy.

Successful outcome of combined surgical and negative pressure therapy in complex enterocutaneous fistulas: a case report.

An enterocutaneous fistula (ECF) is a complex medical issue that occurs when abnormal communication between the small intestine and the skin occurs. This can lead to the leakage of digestive contents, such as feces and food, onto the skin's surface. The case of an 86-year-old woman is presented, who developed high-output ECF after undergoing Hartmann surgery, intestinal transit reconstruction for perforated diverticulitis and incisional hernia treatment involving hernioplasty and polypropylene mesh. The patient had suffered from a serous-purulent discharge from a low-volume surgical wound for several years. Despite optimizing the patient's nutritional status, a laparotomy and small bowel resection were performed successfully. However, using vacuum dressing as a cover for the fistula in the lower gastrointestinal tract remains a subject of debate and limited research. No officially recognized international guidelines recommend its use for small bowel ECF.

Initial Characterization of Focal Bone Lesions with Conventional Radiographs or Computed Tomography: Diagnostic Performance and Interobserver Agreement Assessment.

Objectives: To ascertain the role of CT and conventional radiographs for the initial characterization of focal bone lesions.Methods: Images from 184 patients with confirmed bone tumors included in an ethics committee-approved study were retrospectively evaluated. The reference for benign-malignant distribution was based on histological analysis and long-term follow-up. Radiographs and CT features were analyzed by 2 independent musculoskeletal radiologists blinded to the final diagnosis. Lesion margins, periosteal reaction, cortical lysis, endosteal scalloping, presence of pathologic fracture, and lesion mineralization were evaluated. Results: The benign-malignant distribution in the study population was 68.5-31.5% (126 benign and 58 malignant). In the lesions that could be seen in both radiographs and CT, the performance of these methods for the benign-malignant differentiation was similar (accuracy varying from 72.8% to 76.5%). The interobserver agreement for the overall evaluation of lesion aggressiveness was considerably increased on CT compared to radiographs (Kappa of .63 vs .22). With conventional radiographs, 18 (9.7%) and 20 (10.8%) of the lesions evaluated were not seen respectively by readers 1 and 2. Among these unseen lesions, 50%-61.1% were located in the axial skeleton. Compared to radiographs, the number of lesions with cortical lysis and endosteal scalloping was 26-34% higher with CT. Conclusion: Although radiographs remain the primary imaging tool for lesions in the peripheral skeleton, CT should be performed for axial lesions. CT imaging can assess the extent of perilesional bone lysis more precisely than radiographs with a better evaluation of lesion fracture risk.

The importance of the clinical classification of adult T-cell leukemia/lymphoma (ATLL) in the prognosis.

BACKGROUND: Adult T-cell leukemia/lymphoma (ATLL), a peripheral T-cell leukemia/lymphoma associated with the human T-cell lymphotropic virus type-1 (HTLV-1), has been classified following the clinical forms defined by Shimoyama in 1991. A suggestion to modify Shimoyama's classification was proposed in 2007 to differentiate within the smoldering patients those who presented nodules or tumors in the skin without lung involvement, which was named the primary cutaneous tumoral (PCT) form of ATLL. In the present study, according to their clinicopathological characteristics, we estimated the mortality rates of 143 ATLL patients from Bahia, Brazil. We also evaluated the importance of classifying PCT/ATLL separately from the smoldering type on disease prognosis. METHODOLOGY/PRINCIPAL FINDINGS: Diagnosis of ATLL was established based on a positive serology for HTLV-1, histopathological and/or cytological diagnosis of peripheral T-cell leukemia/lymphoma. Patients were clinically grouped according to Shimoyama's classification, considering PCT variants separately from the smoldering cases. Bivariate and multivariable survival analyses were applied to identify factors associated with disease prognosis. Significant differences in the median survival time were observed between the clinical types, with the smoldering type presenting the longest median survival (109 months) compared to the other forms (<50 months); the median survival for PCT/ATLL was 20 months. Multivariable analysis confirmed that ATLL clinical types were associated with survival, with a better prognosis for patients with the smoldering and chronic types. Furthermore, skin involvement was related to a worse outcome in the multivariable analysis, regardless of the clinical form and presence of lymphadenopathy. CONCLUSIONS/SIGNIFICANCE: Our results reinforce the importance of considering the PCT/ATLL separately from the smoldering type when classifying ATLL to better define prognosis and treatment, given the significant difference in the survival of patients between the smoldering form and PCT/ATLL. Skin involvement should also be considered an independent prognostic factor in patients with ATLL.

Serum biomarkers associated with SARS-CoV-2 severity.

Immunity with SARS-CoV-2 infection during the acute phase is not sufficiently well understood to differentiate mild from severe cases and identify prognostic markers. We evaluated the immune response profile using a total of 71 biomarkers in sera from patients with SARS-CoV-2 infection, confirmed by RT-PCR and controls. We correlated biological marker levels with negative control (C) asymptomatic (A), nonhospitalized (mild cases-M), and hospitalized (severe cases-S) groups. Among angiogenesis markers, we identified biomarkers that were more frequently elevated in severe cases when compared to the other groups (C, A, and M). Among cardiovascular diseases, there were biomarkers with differences between the groups, with D-dimer, GDF-15, and sICAM-1 higher in the S group. The levels of the biomarkers Myoglobin and P-Selectin were lower among patients in group M compared to those in groups S and A. Important differences in cytokines and chemokines according to the clinical course were identified. Severe cases presented altered levels when compared to group C. This study helps to characterize biological markers related to angiogenesis, growth factors, heart disease, and cytokine/chemokine production in individuals infected with SARS-CoV-2, offering prognostic signatures and a basis for understanding the biological factors in disease severity.

Household clustering supports a novel chemoprophylaxis trial design for a mosquito-borne viral disease.

Infections because of chikungunya and other mosquito-borne viruses, such as dengue and Zika, represent an area of significant unmet medical need. There are currently no approved medicines for prophylaxis or treatment of these diseases, and the development and implementation of vaccines against these viruses have proved problematic. Although antiviral molecules with treatment and prophylactic potential against the chikungunya virus have been identified, no successful field trials have been reported. Chemoprophylaxis may be attractive for unvaccinated at-risk populations; however, performing a successful chemoprophylaxis trial during a chikungunya outbreak will require a clearly identifiable at-risk population. We propose the application of a household transmission model as used in testing drugs against respiratory viruses. Current evidence on household clustering of chikungunya and other Aedes mosquito-borne viral infections is supportive. We suggest that this model may improve prophylaxis trial feasibility and focus research and future treatment on a population likely to benefit.

Leptin Signaling Suppression in Macrophages Improves Immunometabolic Outcomes in Obesity.

Obesity is a major concern for global health care systems. Systemic low-grade inflammation in obesity is a major risk factor for insulin resistance. Leptin is an adipokine secreted by the adipose tissue that functions by controlling food intake, leading to satiety. Leptin levels are increased in obesity. Here, we show that leptin enhances the effects of LPS in macrophages, intensifying the production of cytokines, glycolytic rates, and morphological and functional changes in the mitochondria through an mTORC2-dependent, mTORC1-independent mechanism. Leptin also boosts the effects of IL-4 in macrophages, leading to increased oxygen consumption, expression of macrophage markers associated with a tissue repair phenotype, and wound healing. In vivo, hyperleptinemia caused by diet-induced obesity increases the inflammatory response by macrophages. Deletion of leptin receptor and subsequently of leptin signaling in myeloid cells (ObR-/-) is sufficient to improve insulin resistance in obese mice and decrease systemic inflammation. Our results indicate that leptin acts as a systemic nutritional checkpoint to regulate macrophage fitness and contributes to obesity-induced inflammation and insulin resistance. Thus, specific interventions aimed at downstream modulators of leptin signaling may represent new therapeutic targets to treat obesity-induced systemic inflammation.

Lift temporal com reposicionamento do músculo orbicular e da cauda da sobrancelha / Temporal lift with repositioning of the orbicular muscle and eyebrow tail

Introdução: O sistema musculoaponeurótico superficial (SMAS) é a melhor estrutura que temos à nossa disposição para elevar e reposicionar a face e o pescoço no face lift. No entanto, na região têmporo-orbitária, esta estrutura é frequentemente negligenciada. Na busca por uma solução de execução simples, eficiente e segura para tratar a queda têmporo-orbitária, o autor descreve uma tática de lift temporal com reposicionamento da cauda das sobrancelhas para tratamento do envelhecimento e flacidez da região têmporo-orbitária. Métodos: Foi realizado o tratamento em 358 pacientes entre 2017 e 2020, em lifts completos ou apenas temporais. Destes, apenas 30 foram incluídos no artigo por terem sido submetidos exclusivamente a lifts temporais, acompanhados ou não de blefaroplastias. Através de incisão intracapilar marginal quebrada em região temporal e com descolamento supraSMAS, foi realizado tratamento musculoaponeurótico da região órbito-temporal, além de ressecção da pele em excesso. Resultados: A tática apresentada foi eficiente na elevação e na abertura da cauda das sobrancelhas em todos os casos tratados, além do efeito de perda da função contrátil da porção lateral do músculo orbicular, com melhora significativa das rugas periorbitais e da flacidez órbito-temporal. Conclusão: A eficácia e os ótimos resultados alcançados com a tática operatória descrita, associada à escassez de opções de tratamento isolado ou específico da região órbito-temporal, tornam o lift têmporo-orbitário proposto uma excelente alternativa para o rejuvenescimento desta região.

Introduction: The superficial musculoaponeurotic system (SMAS) is the best structure that we have at our disposal to raise and reposition the face and neck in face lifts. However, in the temporal-orbital region, this structure is often overlooked. In search of a simple, efficient and safe solution to treat temporal-orbital fall, the author describes a technique of temporal lift with repositioning of the eyebrow tail to treat aging and flaccidity of the temporal-orbital region. Methods: The treatment was performed on 358 patients between 2017 and 2020, in face lifts or temporal lifts. Of these, only 30 were included in the article because they underwent temporal lifts exclusively, with or without blepharoplasty. Through a marginal, "W" type, intra-capillary incision in the temporal region and with supra-SMAS detachment, we performed muscle-aponeurotic treatment of the orbital-temporal region and excessive skin resection. Results: The technique presented was efficient in raising and opening the tail of the eyebrows in all treated cases, in addition to the effect of loss of contractile function of the lateral portion of the orbicularis muscle, with significant improvement of peri-orbital wrinkles and temporal-orbital flaccidity. Conclusion: The efficacy and the excellent results achieved with the described operative technique, associated with the scarcity of isolated or specific treatment options for the orbital-temporal region, make the proposed temporo-orbital lift an excellent alternative for the rejuvenation of this region.

Extinct Neuropterida of Brazil (Insecta: Neuroptera, Megaloptera, Raphidioptera)

ABSTRACT The currently-known extinct Neuropterida fauna of Brazil comprises 18 families, 55 genera and 99 species (Neuroptera: 15 families, 49 genera, 89 species; Raphidioptera: 1 family, 2 genera, 5 species, + 1 genus incertae sedis with 2 species; Megaloptera: 1 family, 2 genera, 2 species; Order incertae sedis: 1 family, 1 genus, 1 species). All of these species have been described since 1980 and they collectively constitute the overwhelming majority of extinct Neuropterida presently known from South America. Other than one species of Permithonidae (Neuropterida incertae sedis) described from the Late Permian Irati Formation (Paraná Basin) of Rio Grande do Sul state, all extinct Brazilian Neuropterida taxa are known only from the Early Cretaceous Crato Formation (Araripe Basin) in Ceará and Pernambuco states. Of the 35 authors who have contributed to the descriptive literature of this fauna over the past 42 years, the work of Brazilian paleontologists Rafael Gioia Martins-Neto [1954-2010] and Maria Aparecida Vulcano-d'Andretta [1921-2018] - who together contributed to the description of 67 species - is especially notable. However, since their deaths, extinct Neuropterida have received little attention from Brazilian scientists and most later work on this fauna has been undertaken by workers outside Brazil. We provide this updated synthesis of the extinct Neuropterida of Brazil in order to centralize baseline knowledge for this fauna, to support efforts to document and conserve Brazilian fossil sites, and to encourage future work on the fauna, particularly by the next generation of Brazilian paleoentomologists.

COVID-19 outbreaks among crew members in non-cruise vessels anchoring in Salvador, Brazil, 2021

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected the maritime sector due to virus transmission onboard and traffic restrictions. However, reports of SARS-CoV-2 transmission on board have been mostly restricted to those occurring on cruise ships. OBJECTIVES To report COVID-19 outbreaks in eight non-cruise vessels and discuss measures to prevent and control the onboard transmission of SARS-CoV-2. METHODS We investigated outbreaks of COVID-19 on vessels anchoring in Baía de Todos-os-Santos, Salvador, Brazil, between February and November 2021. FINDINGS Most vessels were cargo ships that had docked several times before anchoring in Salvador (five had docked in ≥ 9 ports). The crew ranged from 22 to 63 members. The infection attack rate on each vessel ranged from 9.7 to 88.9%. The risk of symptomatic infection largely varied among the crew of each vessel (0 to 91.6%). Overall, the risk of developing COVID-19 signs and symptoms was lower among crew members vaccinated (age-adjusted risk ratio: 0.19; 95% confidence interval 0.06-0.65). SARS-CoV-2 variants not previously identified in Salvador were detected (C.14, B.1.617.2 and B.1.351). MAIN CONCLUSIONS Despite maritime guidelines to avert COVID-19 on board, outbreaks have happened. The multiple stopovers of non-cruise vessels during their routes may contribute to the spread of SARS-CoV-2 variants worldwide. Reducing the onboard transmission of SARS-CoV-2 depends on joint efforts by the crew and local health authorities and, equally important, achieving high vaccination coverage to prevent infections and illness.

Reproduction of the Cancer Genome Atlas (TCGA) and Asian Cancer Research Group (ACRG) Gastric Cancer Molecular Classifications and Their Association with Clinicopathological Characteristics and Overall Survival in Moroccan Patients.

INTRODUCTION: The Cancer Genome Atlas (TCGA) project and Asian Cancer Research Group (ACRG) recently categorized gastric cancer into molecular subtypes. Nevertheless, these classification systems require high cost and sophisticated molecular technologies, preventing their widespread use in the clinic. This study is aimed to generating molecular subtypes of gastric cancer using techniques available in routine diagnostic practice in a series of Moroccan gastric cancer patients. In addition, we assessed the associations between molecular subtypes, clinicopathological features, and prognosis. METHODS: Ninety-seven gastric cancer cases were classified according to TCGA, ACRG, and integrated classifications using a panel of four molecular markers (EBV, MSI, E-cadherin, and p53). HER2 status and PD-L1 expression were also evaluated. These markers were analyzed using immunohistochemistry (E-cadherin, p53, HER2, and PD-L1), in situ hybridization (EBV and HER2 equivocal cases), and multiplex PCR (MSI). RESULTS: Our results showed that the subtypes presented distinct clinicopathological features and prognosis. EBV-positive gastric cancers were found exclusively in male patients. The GS (TCGA classification), MSS/EMT (ACRG classification), and E-cadherin aberrant subtype (integrated classification) presented the Lauren diffuse histology enrichment and tended to be diagnosed at a younger age. The MSI subtype was associated with a better overall survival across all classifications (TCGA, ACRG, and integrated classification). The worst prognosis was observed in the EBV subtype (TCGA and integrated classification) and MSS/EMT subtype (ACRG classification). Discussion/Conclusion. We reported a reproducible and affordable gastric cancer subtyping algorithms that can reproduce the recently recognized TCGA, ACRG, and integrated gastric cancer classifications, using techniques available in routine diagnosis. These simplified classifications can be employed not only for molecular classification but also in predicting the prognosis of gastric cancer patients.

Solitary bone tumor imaging reporting and data system (BTI-RADS): initial assessment of a systematic imaging evaluation and comprehensive reporting method.

OBJECTIVES: Identify the most pertinent imaging features for solitary bone tumor characterization using a multimodality approach and propose a systematic evaluation system. METHODS: Data from a prospective trial, including 230 participants with histologically confirmed bone tumors, typical "do not touch" lesions, and stable chondral lesions, were retrospectively evaluated. Clinical data, CT, and MR imaging features were analyzed by a musculoskeletal radiologist blinded to the diagnosis using a structured report. The benign-malignant distribution of lesions bearing each image feature evaluated was compared to the benign-malignant distribution in the study sample. Benign and malignant indicators were identified. Two additional readers with different expertise levels independently evaluated the study sample. RESULTS: The sample included 140 men and 90 women (mean age 40.7 ± 18.3 years). The global benign-malignant distribution was 67-33%. Seven imaging features reached the criteria for benign indicators with a mean frequency of benignancy of 94%. Six minor malignant indicators were identified with a mean frequency of malignancy of 60.5%. Finally, three major malignant indicators were identified (Lodwick-Madewell grade III, aggressive periosteal reaction, and suspected metastatic disease) with a mean frequency of malignancy of 82.4%. A bone tumor imaging reporting and data system (BTI-RADS) was proposed. The reproducibility of the BTI-RADS was considered fair (kappa = 0.67) with a mean frequency of malignancy in classes I, II, III, and IV of 0%, 2.2%, 20.1%, and 71%, respectively. CONCLUSION: BTI-RADS is an evidence-based systematic approach to solitary bone tumor characterization with a fair reproducibility, allowing lesion stratification in classes of increasing malignancy frequency. TRIAL REGISTRATION: Clinical trial number NCT02895633 . KEY POINTS: • The most pertinent CT and MRI criteria allowing bone tumor characterization were defined and presented. • Lodwick-Madewell grade III, aggressive periosteal reaction, and suspected metastatic disease should be considered major malignant indicators associated with a frequency of malignancy over 75%. • The proposed evidence-based multimodality reporting system stratifies solitary bone tumors in classes with increasing frequencies of malignancy.

Um novo conceito em envelhecimento de pescoço: "cintura cervicofacial" / A new concept in neck aging: "cervicofacial waist"

Introdução: O envelhecimento do terço inferior da face promove o apagamento da definição da borda mandibular e do ângulo cervicofacial, além do surgimento das bandas platismais na região anterior do pescoço. Os pacientes têm grande expectativa de que o facelift resolva de maneira significativa tais efeitos. Para alcançar estes resultados, desenvolvemos uma abordagem cuja finalidade é a definição marcante do que chamamos de cintura cervicofacial. Métodos: O autor propõe uma nova abordagem cirúrgica de facelift já realizada em 444 pacientes consecutivos, desde 2015, que envolve uma plicatura agressiva do SMAS-platisma somada a uma tração lateral, também por plicatura, das bandas mediais do platisma. Resultados: Apesar da dificuldade em comparar resultados com diferentes técnicas, percebemos claramente uma melhora significativa nos nossos resultados com a nova técnica cirúrgica, sem aumento dos índices de complicações. Discussão: Buscamos novas técnicas pelo fato de que os tratamentos clássicos da região cervical nos parecem falhos e baseados em conceitos mal fundamentados. Estes envolvem a plicatura medial das bandas platismais por abordagem submentoniana, aproximando-as e prejudicando a elevação cranial do SMAS-platisma. Assim, passamos a realizar plicaturas laterais diretamente sobre as bandas através do acesso lateral do descolamento da face, com confecção de uma cintura cervicofacial. Conclusão: A soma dos efeitos da plicatura do SMAS com a plicatura lateral da banda medial do platisma torna a definição cervicofacial mais nítida com otimização importante dos efeitos estéticos desejados.

Introduction: The aging of the lower third of the face stimulates the definition deletion of the mandibular border and the cervicofacial angle, besides the appearance of platysmal bands in the anterior neck region. Patients have high expectations that the facelift will significantly resolve such effects. To achieve these results, we have developed an approach to defining what we call the cervicofacial waist. Methods: The author proposes a new surgical facelift approach that has been performed on 444 consecutive patients since 2015, which involves an aggressive plication of the SMAS-platysma plus lateral traction, also by plication, of the platysma medial bands. Results: Despite the difficulty in comparing results with different techniques, we perceive a significant improvement in our results with the new surgical technique, without increasing the complication rates. Discussion: We are looking for new techniques because the cervical region's traditional treatments seem flawed and based on ill-founded concepts. These involve the medial plication of the platysma bands by a submental approach, bringing them closer together and impairing the cranial elevation of the SMAS-platysma. Thus, we started to directly perform lateral plications on the bands through the lateral access of the face detachment, making a cervicofacial waist. Conclusion: The sum of the effects of the plication of the SMAS with the lateral plication of the platysma medial band makes the cervicofacial definition clearer with important optimization of the desired aesthetic effects.