An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique.

BACKGROUND: The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse PlusTM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse DuoTM. Herein, we present cases that illustrate the use of this approach. METHODS: This pilot study enrolled 36 participants (33 women and three men; ages 37-68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment. RESULTS: Treatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume. CONCLUSIONS: The V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse PlusTM for restructuring and retaining ligaments and Radiesse DuoTM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of tauroursodeoxycholic acid in liver cells' cultures by MEKC: Initial hints to comprehend its role in diabetes mellitus of obese individuals.

Genetic factors, diet, lifestyle, and other factors lead to various complications in the body, such as obesity and other chronic diseases. The inflammatory state caused by excessive accumulation of body fat affects the pathways related to the control of glycemic homeostasis, leading to a high demand for insulin, to subsequent failure of stressed ß cells, and development of type 2 diabetes mellitus (T2DM). The study of new endocrine signalers, such as bile acids (BAs), becomes necessary as it allows the development of alternatives for T2DM treatment. In this work, a methodology was developed to quantify tauroursodeoxycholic BA (TUDCA) in liver cells of the HepG2 strain treated in hyperlipidic medium. This BA helps to improve insulin clearance by increasing the expression of the insulin-degrading enzyme, restoring sensitivity to this hormone, and making it viable for treating T2DM. Herein, a targeted metabolomic method for TUDCA determination in extracellular medium of hepatocyte matrices by micellar electrokinetic chromatography-UV was optimized, validated, and applied. The optimized background electrolyte was composed of 40 mmol/L sodium cholate and 30 mmol/L sodium tetraborate at pH 9.0. The following figures of merit were evaluated: linearity, limit of quantification, limit of detection, accuracy, and precision. Data obtained with the validated electrophoretic method showed a self-stimulation of TUDCA production in media supplemented only with BA. On the other hand, TUDCA concentration was reduced in the hyperlipidic medium. This suggests that, in these media, the effect of TUDCA is reduced, such as self-stimulated production and consequent regulation of glycemic homeostasis. Therefore, the results reinforce the need for investigating TUDCA as a potential T2DM biomarker as well as its use to treat several comorbidities, such as obesity and diabetes mellitus.

Efficacy and Tolerability of Hyperdiluted Calcium Hydroxylapatite (Radiesse) for Neck Rejuvenation: Clinical and Ultrasonographic Assessment.

Background: The subdermal injection of calcium hydroxylapatite (CaHA) can improve the mechanical properties of the skin, providing immediate correction and stimulating the endogenous production of collagen, elastin, angiogenesis, and dermal cell proliferation; however, few studies have examined the neck region. Purpose: This study assessed the clinical and ultrasonographic improvement induced by two sessions of subdermal injection of hyperdiluted (1:4) CaHA for neck rejuvenation in 22 women. Patients and Methods: A quasi-experimental longitudinal trial (before and after) was performed by enrolling 22 adult women with mild and moderate neck aging (grades 1 and 2) on Merz Neck Volume Scale at rest (laxity) and Neck Horizontal Lines. They were submitted to two sessions of subdermal hyperdiluted CaHA (D0 and D45) treatments and assessed clinically and ultrasonographically at D0, D45, and D120. The main outcomes were the blinded photographic assessment (Merz scales of neck laxity and horizontal lines), dermal thickness (at three points), and the GAIS (Global Aesthetic Improvement Scale) score. Results: The mean (SD) age was 43.5 (5.6) years. At the inclusion, the Merz scores for neck laxity were mild for 27% and moderate for 73% of participants, and the Merz scores for necklines were mild for 32% and moderate for 68%. At D120, scores decreased in 86% (95% CI 68-99%) of the participants by at least one degree on the necklines scale and in 82% (95% CI 73-90%) for neck laxity. According to the GAIS, 91% (95% CI 77-99%) of the participants evidenced improvement at D120. The mean dermal thickness increased by 15% (95% CI 8-21%) at D120. No severe adverse effects were recorded, and high satisfaction was reported by 82% of the participants. Conclusion: Two sessions of subdermal hyperdiluted CaHA were well-tolerated and improved necklines, neck laxity, and dermal thickness in adult women with mild and moderate cervical aging.

Contouring Plus: A Comprehensive Approach of the Lower Third of the Face with Calcium Hydroxylapatite and Hyaluronic Acid.

A well-defined jawline is aesthetically pleasing, so that rejuvenation of the jawline is becoming part of routine aesthetic practice. Restoring balance to the lower face without surgical intervention requires a multiple treatment approach, among which the minimally invasive injectables play a central role. Nevertheless, amidst the plethora of different injectable products available, choosing the option that best suits the patient's need can be a challenge. A panel of experts sought to describe herein 4 clinical cases, illustrating the Contouring Plus technique, which provides a practical guidance for lower third assessment, choice of products, and treatment execution, especially among hyaluronic acid and calcium hydroxylapatite, aiming for immediate, as well as mid-to-long-term results.

Tauroursodeoxycholic acid improves glucose tolerance and reduces adiposity in normal protein and malnourished mice fed a high-fat diet.

Early childhood malnutrition may facilitate the onset of obesity and diabetes mellitus in adulthood which, when established, makes it more resistant to therapeutic interventions. The beneficial effects of tauroursodeoxycholic acid (TUDCA) in glucose homeostasis and body fat accumulation were analyzed in protein-restricted mice fed a high-fat diet (HFD). C57BL/6 mice were fed a control (14% protein [C]) or a protein-restricted (6% protein [R]) diet for 6 weeks. Afterward, mice received an HFD or not for 12 weeks (C mice fed an HFD [CH] and R mice fed an HFD [RH]). In the last 15 days of this period, half of the mice fed a HFD received i.p. PBS (groups CH and RH) or 300 mg/kg TUDCA (groups CHT and RHT). RH mice developed obesity, as demonstrated by the increase in fat accumulation, liver steatosis, and metabolic inflexibility. Additionally, showed glucose intolerance and insulin hypersecretion. TUDCA reduced adiposity and improve metabolic flexibility through increased HSL phosphorylation and CPT1 expression in eWAT and BAT, and reduced ectopic fat deposition by activating the AMPK/HSL pathway in the liver. Also, improved glucose tolerance and insulin sensitivity, normalizing insulin secretion by reducing GDH expression and increasing insulin peripheral sensitivity by greater expression of the IRß in muscle and adipose tissue and reducing PEPCK liver expression. Our data indicate that TUDCA reduces global adiposity and improves glucose tolerance and insulin sensitivity in protein malnourished mice fed a HFD. Therefore, this is a possible strategy to reverse metabolic disorders in individuals with the double burden of malnutrition.

After the Temporal Lifting Technique-What comes next?

BACKGROUND: The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA)-based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique. OBJECTIVES: To identify the safety and esthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, and increase jawline contouring when included into a full-face injection algorithm. METHODS: The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4) kg/m2 were retrospectively analyzed after a full-face injection algorithm was performed using HA-based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region, and the pyriform fossa using both needles and cannula. RESULTS: No adverse events were observed during the 6-month retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p < 0.001. CONCLUSION: Despite each individual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and esthetically effective. Future studies will need to confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective esthetic outcomes.

Calculating the Thickness of the Superficial Fatty Layer of the Body Using Age, Gender, and Body Mass Index

BACKGROUND: Injections of biostimulator agents are increasing in popularity as an alternative to surgical or energy-based skin tightening procedures. The present study was designed to develop a formula that helps to guide health care providers injecting biostimulators into the correct plane to enhance effectiveness and longevity by targeting precisely the superficial fascial system. METHODS: 150 Caucasian individuals (75 males and 75 females) were investigated with a balanced distribution of age (n=30 per decade: 20­29, 30­39, 40­49, 50­59, and 60­69 years) and body mass index (n=50 per group: BMI≤24.9kg/m2, BMI between 25.0 and 29.9kg/m2 BMI≥30kg/m2). The distance between skin surface and the superficial fascia was measured via ultrasound in the buccal region, premasseteric region, the lateral neck, posterior arm, abdomen, buttocks, anterior thigh, medial thigh, and posterior thigh. RESULTS: Mean thickness of the superficial fatty layer is variable between the different locations investigated with smallest values for the lateral neck of 3.71mm ± 0.55 [range, 2.00­5.00mm] and greatest values for the gluteal region with 20.52mm±10.07 [range, 6.10­38.40mm]. A formula was developed to estimate the thickness of the superficial fatty layer based on the targeted region, age, gender, and body mass index of the patient: Thickness of superficial fatty layer (mm): Region constant + (XX* BMI) - (YY*Age). CONCLUSIONS: Injections of biostimulators deeper than the calculated values might result in reduced efficacy as the superficial fascial system is not targeted and the effected collagen neogenesis does not affect the skin surface. J Drugs Dermatol. 2020;19(1):36-44. doi:10.36849/JDD.2020.4619

La evaluación en educación física: más allá del control social / The Evaluation in Physical Education: Beyond Social Control / A avaliação em educação física: além do controle social

A la luz de las transformaciones históricas de la evaluación en Educación Física en Uruguay, problematizamos los conceptos de Evaluación para Aprender (EpA) y Evaluación Formativa y Compartida (EFyC) en torno a la formación inicial del profesorado. Ellos serán tensionados por otro, el de Evaluación para la Praxis (EpP), concepto que, a modo de ensayo, se pone a discusión de la comunidad académica. Se parte de conceptualizar evaluación, aprendizaje y praxis. En segundo lugar, y a partir de las nociones EpA y EFyC, se presenta a la EpP que, revisando las anteriores, realiza una apuesta por enfatizar el potencial transformador (y estratégico) de la evaluación en el sistema de la formación inicial del profesorado de Educación Física. Finalmente, aportamos criterios orientadores para la construcción de dispositivos de EpP ­en ese ámbito de la universidad­, enfatizando las mutaciones imprescindibles que han de vigilarse para que las formas (y los sentidos) de la evaluación, apuesten a trazar posibilidades emancipatorias.

In light of the historical transformations suffered by the evaluation in Physical Education in Uruguay, we problematize the concepts of Evaluation for Learning (EpA) and Formative and Shared Evaluation (EFyC) around the initial teacher training. These concepts will be stressed by another one, Evaluation for Practice (EpP), a concept that, as an essay, will be discussed by the academic community. The starting point is to conceptualize evaluation, learning, and praxis. Secondly, and based on the notions EpA and EFyC, it is presented the EpP which, revising the previous ones, makes a commitment to emphasize the transforming (and strategic) potential of evaluation in the system of initial training of Physical Education teachers. Finally, we provide guiding criteria for the construction of EpP devices ­in this area of the university­, emphasizing the essential mutations that must be monitored so that the forms (and the senses) of evaluation attempt to trace emancipatory possibilities.

De acordo com as transformações históricas da avaliação em Educação Física no Uruguai, problematizamos os conceitos da Avaliação para Aprender (sigla em espanhol EpA) e da Avaliação Formativa e Compartilhada (sigla em espanhol EFyC) em torno da formação inicial de professores. Eles serão contrastados com outro conceito: Avaliação para a Práxis (sigla em espanhol EpP). Conceito que, como ensaio, é colocado na discussão da comunidade acadêmica. Para isso, em primeiro lugar, oferece-se uma conceitualização de avaliação, aprendizagem e prática. Em segundo lugar, com base nas noções EpA e EFyC, apresenta-se a EpP que revisa às anteriores, além disso enfatiza o potencial transformador (e estratégico) da avaliação no sistema de treinamento inicial do corpo docente de Educação Física. Finalmente, fornecemos critérios norteadores para a construção de dispositivos de EpP ­ nessa área da universidade ­, enfatizando as mutações essenciais que devem ser monitoradas para que as formas (e os sentidos) da avaliação visem traçar possibilidades emancipatórias.

Fontes de estresse, bem-estar psicológico e saúde entre estudantes de Odontologia: uma comparação entre fases pré-clínica e clínica e entre os sexos / Sources of stress, psychological well-being and health among dental students: a comparison between preclinical and clinical phases and between sexes

O objetivo do estudo foi avaliar bem-estar psicológico, saúde geral e fontes de estresse de estudantes de Odontologia de quatro cursos, comparando as fases pré-clínica e clínica e os sexos. Três instrumentos foram aplicados: Dental Environment Stress (DES), Psychological General Well-Being Index (PGWB) e Health Survey (SF-36), respondidos por 203 estudantes, sendo 75 (37%) em fase pré-clínica e 128 (63%) em clínica. Desses, 59 (29%) eram homens e 144 (71%) mulheres. As comparações foram realizadas pelo teste de Mann-Whitney, adotando um nível de significância de 5%. Nos domínios analisados pelo DES (performance acadêmica; dificuldades e inseguranças sobre o futuro profissional; responsabilidade com pacientes; fatores pessoais e institucionais; relações interpessoais), estudantes em fase pré-clínica demonstraram escores significativamente menores quando comparados a estudantes em fase clínica. No escore total de PGWB e em dois domínios (ansiedade e saúde geral), observou-se também escores menores em estudantes em fase pré-clínica. Quatro domínios do SF-36 (dor corporal, funcionamento físico, funcionamento social e papel físico), apresentaram significativa melhor saúde geral dos estudantes em fase pré-clínica. Entre os sexos, dois domínios do DES (performance acadêmica, dificuldade e insegurança sobre o futuro profissional) mostraram menores fatores estressores para o sexo masculino. O PGWB demonstrou diferença significativa em quatro domínios (estado deprimido; autocontrole; saúde geral; vitalidade), com melhor bem-estar psicológico para homens. O sexo masculino apresentou melhor vitalidade no domínio do SF-36. Concluiu-se que estudantes em fase pré-clínica e do sexo masculino demonstraram menores fontes de estresse, melhor bem-estar psicológico e percepção de saúde geral (AU).

The aim of this study was to evaluate psychological well-being, overall health, and sources of stress among dental students from four Doctor of Dental Surgery (DDS) programs, comparing the preclinical and clinical phases and sexes. Three instruments were applied: Dental Environment Stress (DES), Psychological General Well-Being Index (PGWB) and Health Survey (SF-36), answered by 203 students, with 75 (37%) in the preclinical phase and 128 (63%) in the clinical one. Among them, 59 were male (29%) and 144 were female (71%). Comparisons were performed using the Mann-Whitney test, adopting a significance level of 5%. In the domains analyzed using DES (academic performance, difficulties and insecurities about their professional future, responsibilities with patients, personal and institutional factors, interpersonal relationships), preclinical students showed significantly lower scores than students enrolled in the clinical phases. For PGWB total score and in two domains (anxiety and general health), lower scores were also observed in preclinical students. Four domains of SF-36 (bodily pain, physical functioning, social functioning and role-physical) showed significantly better overall health for preclinical students. Among the sexes, two DES domains (academic performance and difficulties and insecurities about their professional future) showed lower stressors for males. PGWB showed a significant difference in four domains (depressed mood, self-control, general health and vitality), with better psychological well-being for males. Males showed better vitality in the SF-36 domain. Concluding, preclinical and male students showed lower sources of stress, better psychological well-being and better perception of their overall health (AU).

Clinical and Vitamin Response to a Short-Term Multi-Micronutrient Intervention in Brazilian Children and Teens: From Population Data to Interindividual Responses.

SCOPE: Micronutrients are in small amounts in foods, act in concert, and require variable amounts of time to see changes in health and risk for disease. These first principles are incorporated into an intervention study designed to develop new experimental strategies for setting target recommendations for food bioactives for populations and individuals. METHODS AND RESULTS: A 6-week multivitamin/mineral intervention is conducted in 9-13 year olds. Participants (136) are (i) their own control (n-of-1); (ii) monitored for compliance; (iii) measured for 36 circulating vitamin forms, 30 clinical, anthropometric, and food intake parameters at baseline, post intervention, and following a 6-week washout; and (iv) had their ancestry accounted for as modifier of vitamin baseline or response. The same intervention is repeated the following year (135 participants). Most vitamins respond positively and many clinical parameters change in directions consistent with improved metabolic health to the intervention. Baseline levels of any metabolite predict its own response to the intervention. Elastic net penalized regression models are identified, and significantly predict response to intervention on the basis of multiple vitamin/clinical baseline measures. CONCLUSIONS: The study design, computational methods, and results are a step toward developing recommendations for optimizing vitamin levels and health parameters for individuals.

SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS.

BACKGROUND: In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%. AIM: To evaluate the surgical results of severe obesity in adolescents. METHODS: Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members. RESULTS: Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30. CONCLUSIONS: Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results.

SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS / TRATAMENTO CIRÚRGICO DA OBESIDADE SEVERA EM ADOLESCENTES: RESULTADOS TARDIOS

Background: In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%.Aim: To evaluate the surgical results of severe obesity in adolescents.Methods: Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members.Results: Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30.Conclusions: Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results.

Racional: Em crianças estima-se que a prevalência de sobrepeso e obesidade aumentou até cinco vezes nos países desenvolvidos e até quatro naqueles em desenvolvimento. No Brasil, a proporção de crianças e adolescentes com excesso de peso também cresceu de aproximadamente 4,1% para 13,9%.Objetivo: Avaliar os resultados cirúrgicos da obesidade severa em pacientes adolescentes.Métodos: Estudo retrospectivo e descritivo de 2737 pacientes portadores de obesidade severa e submetidos à derivação gástrica em Y-de-Roux selecionando deles 44 com idade média de 18,1 anos. Houve seguimento ambulatorial de 20 pacientes (45,45%). Todos foram acompanhados pré-operatoriamente por equipe multidisciplinar e tiveram sua indicação cirúrgica confirmada após a aprovação unânime de todos os membros da equipe.Resultados: Entre os 20 pacientes adolescentes 14 eram mulheres. Cinco do adolescentes em uso de anti-hipertensivos ou hipoglicemiantes antes da operação, quatro (80%) tiveram a suspensão da medicação e um (20%) reduziu a dose em 50% no pós-operatório. A média de perda ponderal foi de 45,4 kg após seguimento médio de 60 meses. Não houve mortalidade no grupo estudado nem complicações operatórias graves. Entre os que realizaram o acompanhamento pós-operatório com equipe multidisciplinar, 18 ficaram com IMC<30.Conclusões: Adolescentes submetidos à derivação gástrica em Y-de-Roux tiveram boa resposta em relação à perda de peso e melhora das comorbidades. Apresentaram baixa taxa de complicações e nenhum óbito. Todos ficaram satisfeitos com os resultados.

Revision surgery for treatment of weight regain after Roux-en-Y gastric bypass.

BACKGROUND: This study aims to evaluate results on revision surgery for weight regain after gastric bypass, based on surgical technique and follow-up. METHODS: This study is a retrospective analysis of 29 patients who presented weight regain on follow-up after more than 5 years, divided into four groups according to revision surgery type: group 1 (n = 9) includes patients who underwent an increase in the length of the alimentary limb to 200 cm; group 2 (n = 13) are patients who underwent an increase in the length of the alimentary limb and placing of a silicon ring; group 3 (n = 2) are patients who underwent an increase in the length of the alimentary limb and gastric plication, and group 4 (n = 5) are patients who underwent gastric plication and placing of a silicon ring. RESULTS: The average preoperative weight before revision surgery was 117.8 kg, and the average postoperative follow-up for revision surgery was 13.7 months. Weight loss after revision surgery was observed in all groups but was greater in patients with longer revisional postoperative follow-up. Patients who underwent placing of a silicon ring presented greater weight loss than those who had had such a band since the original gastric bypass operation. CONCLUSIONS: Data suggest that revision surgery may be a useful tool in achieving weight loss in patients presenting weight regain following gastric bypass, obesity, bariatric surgery, gastric bypass, weight regain, and revision surgery.

A unique dermoscopy pattern of solitary cutaneous reticulohistiocytosis.

Histiocytosis represents a group of rare disorders characterized by nonneoplastic proliferation of histiocytes and solitary cutaneous reticulohistiocytosis (SCR) is a form of non-Langerhans histiocytosis. SCR consists of small papule, usually single, varying in color from yellow to brownish-red, more frequent in young adults, and uncommon in childhood. We report a case of SCR in an 11-year-old child and emphasize a unique dermoscopy pattern of this lesion and its correlation with clinical and histopathological aspects in the diagnosis.