Analysis of the use of isotretinoin as an adjuvant in rhinoplasty.

BACKGROUND: Isotretinoin has been used in the treatment of acne for decades through the reduction of sebaceous secretion. There are reports in the literature that isotretinoin may be associated with decreased skin thickness, especially in patients with thick nasal skin for whom rhinoplasty can be more challenging. The objective of this study was to quantify, through ultrasonography, the effect of the use of oral isotretinoin in patients undergoing rhinoplasty, pre- and postoperatively. METHODS: Twenty-four patients participated in this randomized, single-blind controlled pilot clinical trial. The intervention group used oral isotretinoin (20 mg/day) for 2 months before rhinoplasty and for 4 months after. Both groups underwent rhinoplasty in the same plastic surgery department and were submitted to high-frequency (22 MHz) ultrasound evaluation of the epidermis and dermis on the nasal dorsum, nasal tip, and left nose wing at the beginning of the study and 6 months after rhinoplasty, with the aim of assessing changes in skin thickness. RESULTS: Six months after rhinoplasty, a statistically significant reduction was observed in the thickness of the epidermis and dermis of the nasal dorsum and left nose wing, as well as of the epidermis of the nasal tip, but only in the intervention group. The results of the satisfaction questionnaire were better after rhinoplasty in both groups, with no statistical difference between them regarding the specific questions; however, the intervention group had significantly higher satisfaction scores than the control group. CONCLUSIONS: Isotretinoin was effective in reducing the thickness of the skin covering the nose of the evaluated sites.

Flint corn silage management: influence of maturity stage, inoculation with Lentilactobacillus buchneri, and storage time on fermentation pattern, aerobic stability, and nutritional characteristics.

Introduction: High quality corn silage depends on factors such as corn type, stage of crop development at harvest time, fermentation time, in addition to use or not of inoculants. This study aimed to investigate the impact of maturity stage, bacterial inoculation, and storage time on fermentation, aerobic stability, and nutritional characteristics of flint corn silage and their implications for corn silage management. Methods: A flint corn hybrid was harvested very early, early, and medium (at 250, 300 and 350 g dry matter (DM)/kg as fed, respectively) and ensiled in mini-silos without (control) or with Lentilactobacillus buchneri CNCM I-4323 at 1 × 105 cfu/g for 120, 240 and 360 d to investigate how these factors interact with each other. Results and discussion: There was only a small increase (7 g/kg starch; p = 0.003) in starch digestibility (starch-D) in the silages stored for 360 d when compared to that stored for 240 d, but with no difference for 120 d. Despite the reduced starch-D (526 vs. 694 g/kg starch; p < 0.001), silages produced from medium harvest had higher (p < 0.001) starch content (317 vs. 137 g/kg DM) and higher amount of digestible starch (169 vs. 98.5 g/kg DM; p < 0.001) compared to very early harvest. The 2-way interactions (inoculation × storage time and maturity × storage time) showed that inoculation of corn silage with L. buchneri increased (p < 0.001) the aerobic stability, and that more mature crop silage had higher aerobic stability (140 h; p = 0.036) than the others (118 and 48.5 h for those silages from very early and early harvest). Conclusion: The storage for a longer time (>120 d) with the goal of increasing silage digestibility did not occur. Harvesting whole-crop flint corn with 300 to 350 g/kg DM is desirable to have higher DM yield and starch accumulation. Inoculation with L. buchneri is recommended to preserve the silage against aerobic deterioration. This study has shown the importance of harvesting flint corn at the right time, and the need for inoculation with L. buchneri to ensure greater yield, starch accumulation, and silage preservation, if 120 days of storage are not exceeded.