El reposicionamiento malar. Presentación de una técnica original: punto MM / Malar repositioning. Presentation of an original technique: point MM

El envejecimiento facial es una sinergia compleja de cambios texturales de la piel, hiper- o hipoactividad muscular, reabsorción del tejido graso y resorción ósea. El déficit de volumen resultante, la deflación y la posterior caída del tercio medio facial produce una cara menos atractiva y juvenil. Los procedimientos inyectables en región malar son cada vez más populares y solicitados por los pacientes. El conocimiento de la anatomía de la cara media es fundamental para el inyector. La comprensión de la irrigación facial puede ayudar a disminuir la exposición a la aparición de hematomas y complicaciones vasculares severas. Existen múltiples técnicas de inyección propuestas para el tercio medio, en este artículo presentamos una técnica original, simple, segura y eficaz con resultados satisfactorios y riesgo reducido

Facial aging is a complex synergy of textural skin changes, muscle hyperactivity, fat dysmorphism, bone resorption. The resulting volume deficit and deflation of the mid face produces a less attractive and youthful face. Injectable midface procedures are becoming increasingly popular and requested by patients. Knowledge of the anatomy of the midface is critical for the injector. Understanding the irrigation of the face can help decrease the risk of hematoma and severe vascular complications. There are multiple injection techniques proposed for the middle third, in this article we present a simple, safe and effective technique with satisfactory results and lower risk

Rejuvenecimiento periorbitario fisiológico / Physiological periorbital rejuvenation

Pivoting Brow Lift es una nueva opción terapéutica cuyas ventajas son tres mínimas incisiones, prácticamente imperceptibles, bien aceptadas por pacientes de todas las edades, sexo y incluso pacientes calvos. Una incisión se realiza en la región temporal y otra dentro del cuero cabelludo en la región medio frontal o en una arruga en pacientes calvos. La disección en región frontal es sub-perióstica, muchas veces llega a la punta nasal para reposicionarla. La disección en la región temporal se realiza entre las hojas superficiales y profundas extendiéndose hasta el tarso y canto externo del ojo; en la región palpebral la disección se realiza entre la piel y el musculo. La fijación son dos puntos externos en el cuero cabelludo y unos papeles adherentes. Los puntos del cuero cabelludo se retiran a los 14 días. Evita las complejas fijaciones que se realizan actualmente con tornillos, puntos internos o Endotime. La sencillez del procedimiento hace que este se pueda realizar entre 30 y 45 minutos, con anestesia local y sedación; esto permite lograr una mayor seguridad operatoria. Se han documentado pacientes tratados hace 9 años donde se demuestra la duración en el tiempo. El bajo índice de complicaciones y la alta satisfacción de los pacientes documentadas en encuestas hace que este procedimiento pueda ser considerado como una nueva opción terapéutica.

Myomodulation with Facial Fillers: A Comprehensive Technical Guide and Retrospective Case Series.

BACKGROUND: Placement of fillers in close proximity to the mimetic or sphincter muscles of the face appears to enhance or suppress muscle action in a relatively predictable way. METHODS: From June 2016 to June 2021, patients who underwent the first author's technique of myomodulation with dermal fillers to address aesthetic concerns or to manage facial spasms or synkinesis were evaluated in a retrospective case series. Additionally, the authors provide a technical guide for a whole-face approach to treatment with fillers and a conceptual map for treatment of each facial subunit with a focus on myomodulation. RESULTS: A total of 1352 patients (1108 women, 244 men; mean age, 51 years) underwent at least 1 treatment session during the 5-year study period. The treatment patterns of the study population and details of 2 representative cases are presented. CONCLUSIONS: Although not well understood mechanistically, myomodulation with injectable fillers shows promise for significant and reliable results of facial rejuvenation. 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 .

Experiência do Serviço de Cirurgia Plástica do Hospital do Servidor Público Municipal de São Paulo em Ritidoplastia nos últimos cincos anos / Experience of the Plastic Surgery Service of the Hospital do Servidor Público Municipal de São Paulo in Rhytidectomy in the last five years

A busca por procedimentos cirúrgicos estéticos de rejuvenescimento facial tem crescido ao longo dos últimos anos e, por conseguinte, as cirurgias da face tem sido cada vez mais procuradas. Em vista disso, o presente estudo tem como escopo analisar a experiência do Serviço de Cirurgia Plástica do Hospital do Servidor Público Municipal de São Paulo (HSPM-SP) na cirurgia de ritidoplastia ao longo dos últimos cinco anos. Foram avaliados, durante o período de janeiro 2018 a janeiro de 2023, todos os pacientes submetidos a este procedimento. Palavras-chaves: Ritidoplastia. Cirurgia Plástica. Face. Procedimentos de Cirurgia Plástica.

Rejuvenecimiento facial con plasma rico en plaquetas autólogo / Facial rejuvenation with autologous platelet rich plasma

Introducción: La creciente necesidad de una piel de aspecto juvenil impulsa innovaciones continuas con procedimientos mínimamente invasivos. El plasma rico en plaquetas autólogo representa una terapéutica regenerativa incluida en el novedoso arsenal de intervenciones que buscan este efecto. Objetivo: Evaluar los resultados de la terapéutica con plasma rico en plaquetas autólogo en pacientes con envejecimiento facial. Métodos: La muestra estuvo constituida por 68 pacientes valorados con la escala para valoración clínica de fotoenvejecimiento cutáneo al inicio del tratamiento. Se sometieron a cuatro sesiones de plasma rico en plaquetas cada 15 días y una sesión adicional a los 3 meses de concluir el tratamiento inicial. Los pacientes fueron seguidos durante 6 meses al cabo de los cuales se volvieron a evaluar con el mismo instrumento. Resultados: Las edades estuvieron comprendidas entre 21 y 73 años con una media de 46,80 años, predominó el sexo femenino (89,9 %). Los resultados significativos en el tratamiento de las arrugas, los surcos, la textura de la piel y las lesiones cutáneas estuvieron relacionados con la mesoterapia con plasma rico en plaquetas. El procedimiento produjo una mejoría valorada a través de la escala para valoración clínica de fotoenvejecimiento cutáneo. Conclusiones: La terapia con plasma rico en plaquetas tiene buenos resultados en el tratamiento de pacientes con envejecimiento facial.

Introduction: The growing need for youthful looking skin drives continued innovations with minimally invasive procedures. Autologous platelet-rich plasma represents a regenerative therapeutic included in the new arsenal of interventions that seek this effect. Objective: Assess the results of platelet-rich plasma therapy in patients with facial aging. Methods: The sample consisted of 68 patients assessed with the scale for the clinical assessment of cutaneous photoaging (SCACPH). They underwent four PRP sessions every 15 days and an additional session 3 months after completing the initial treatment. The patients were followed up for 6 months, after which they were reevaluated which the same instrument. Results: The ages of the patients were between 21 and 73 years with a mean of 46.80 years, the female sex predominated (89.9%). Significant results in the treatment of wrinkles, furrows, and skin texture and skin lesions were related to PRP mesotherapy. The procedure produced an improvement assessed with the SCACPH. Conclusions: Autologous PRP therapy has good results in the treatment of patients with facial aging.

Aging and rejuvenation - a modular epigenome model.

The view of aging has evolved in parallel with the advances in biomedical sciences. Long considered as an irreversible process where interventions were only aimed at slowing down its progression, breakthrough discoveries like animal cloning and cell reprogramming have deeply changed our understanding of postnatal development, giving rise to the emerging view that the epigenome is the driver of aging. The idea was significantly strengthened by the converging discovery that DNA methylation (DNAm) at specific CpG sites could be used as a highly accurate biomarker of age defined by an algorithm known as the Horvath clock. It was at this point where epigenetic rejuvenation came into play as a strategy to reveal to what extent biological age can be set back by making the clock tick backwards. Initial evidence suggests that when the clock is forced to tick backwards in vivo, it is only able to drag the phenotype to a partially rejuvenated condition. In order to explain the results, a bimodular epigenome is proposed, where module A represents the DNAm clock component and module B the remainder of the epigenome. Epigenetic rejuvenation seems to hold the key to arresting or even reversing organismal aging.

Partial Reprogramming As An Emerging Strategy for Safe Induced Cell Generation and Rejuvenation.

BACKGROUND: Conventional cell reprogramming involves converting a somatic cell line into induced pluripotent stem cells (iPSC), which subsequently can be re-differentiated to specific somatic cell types. Alternatively, partial cell reprogramming converts somatic cells into other somatic cell types by transient expression of pluripotency genes thus generating intermediates that retain their original cell identity, but are responsive to appropriate cocktails of specific differentiation factors. Additionally, biological rejuvenation by partial cell reprogramming is an emerging avenue of research. OBJECTIVE: Here, we will briefly review the emerging information pointing to partial reprogramming as a suitable strategy to achieve cell reprogramming and rejuvenation, bypassing cell dedifferentiation. METHODS: In this context, regulatable pluripotency gene expression systems are the most widely used at present to implement partial cell reprogramming. For instance, we have constructed a regulatable bidirectional adenovector expressing Green Fluorescent Protein and oct4, sox2, klf4 and c-myc genes (known as the Yamanaka genes or OSKM). RESULTS: Partial cell reprogramming has been used to reprogram fibroblasts to cardiomyocytes, neural progenitors and neural stem cells. Rejuvenation by cyclic partial reprogramming has been achieved both in vivo and in cell culture using transgenic mice and cells expressing the OSKM genes, respectively, controlled by a regulatable promoter. CONCLUSION: Partial reprogramming emerges as a powerful tool for the genesis of iPSC-free induced somatic cells of therapeutic value and for the implementation of in vitro and in vivo rejuvenation keeping cell type identity unchanged.

Treating Excess Lower Eyelid Skin Without Incisions.

INTRODUCTION: Periocular rhytids and dermatochalasis are common and striking signs of facial aging. The CO2 laser technique described herein addresses Hester classification type I, aging at the level of the lower eyelid, focus on the treatment of the dermatochalasis. MATERIALS AND METHODS: In this retrospective study of patients undergoing treatment at our clinic between 2000 and 2018, 263 were classified as Hester I and CO2 laser therapy was the treatment to improve the local rhytids. RESULTS: Improvement in dermatochalasis was found in all patients, resulting in better rejuvenation of the target area while eliminating visible scarring from a suture through the skin. DISCUSSION: In our experience, CO2 laser functions as a substitute for transcutaneous lower blepharoplasty, due to the fact that the contracture of the skin renders resection of that skin unnecessarily, thus avoiding the tell-tale scalpel incisions under the lashes. CONCLUSION: The quality of the results of this retrospective study allows us to offer this laser therapy to treat lower eyelids classified as Hester I. 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 .

Injeção de agregados plaquetários no rejuvenescimento facial: uma revisão sistemática / Injection of platelet aggregates in facial rejuvenation: a systematic review

Introdução: Essa revisão sistemática foi conduzida para avaliar se a associação da aplicação da injeção de agregados plaquetários quando comparada a outras terapias faciais favorece no rejuvenescimento facial em pacientes adultos. Métodos: A pesquisa buscou ensaios clínicos randomizados que compararam uso de técnicas de rejuvenescimento facial isoladas com as mesmas técnicas aliadas à injeção de agregados plaquetários. A busca foi realizada em bases de dados indexadas e literatura cinzenta. A ferramenta de risco de viés da "Cochrane Collaboration" foi aplicada para a avaliação da qualidade dos estudos. Resultados: Foram identificados 7137 artigos. Apenas quatro estudos permaneceram na síntese qualitativa, e os demais foram considerados com risco indefinido de viés nos domínios chaves. Conclusão: Existem poucos estudos na literatura que comparam o uso de agregados plaquetários em rejuvenescimento facial e os que estão disponíveis têm risco de viés "indefinido" ou "alto". Há necessidade de realizar mais estudos clínicos bem delineados que comparem o uso de injeção de agregados plaquetários associados ou não às técnicas de rejuvenescimento facial.

Introduction: This systematic review was conducted to assess whether the use of a platelet aggregate injection with or without associated facial rejuvenation techniques favors facial rejuvenation in adult patients. Methods: Randomized clinical trials that compared the use of techniques for facial rejuvenation alone with the same techniques coupled with the injection of platelet aggregates were searched. The search was performed in indexed databases and in the gray literature. The Cochrane Collaboration bias risk tool was applied to assess the quality of the studies. Results: In total, 7137 articles were identified. Only four studies remained in the qualitative synthesis, and the others were considered as having undefined bias risk in the key domains. Conclusion: There are few studies in the literature that compare the use of platelet aggregates in facial rejuvenation and those that are available have a risk of "undefined" or "high" bias. There is a need for more well-designed clinical studies comparing the use of platelet aggregate injection with or without associated facial rejuvenation techniques.

Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics.

BACKGROUND: Considering that aesthetic benefits can be obtained with the use of permanent filling materials, this work focuses on the development of a consensus regarding the facial and corporal use of polymethylmethacrylate (PMMA) filler in Brazil. METHODS: A questionnaire regarding PMMA treatment, which included items on the main indication, application site, volume of product applied, criteria for selection of the material, complications, contraindications, and individual professional experience, was distributed to the Expert Group members. In addition, the responses were summarized, constituting the starting point for the debate regarding the use of PMMA-based fillers on The First Brazilian PMMA Symposium to create a guideline to be followed in PMMA facial and corporal treatments. RESULTS: This survey involved 87,371 cases. PMMA treatment is recommended for restorative and aesthetic purposes in facial and corporal cases, particularly for facial balance. PMMA 30% filler is recommended in specific facial sites (nose, mentum, mandible angle, zygomatic arc, and malar). PMMA filler is contraindicated in other sites (lips) regardless of concentration. With regard to facial treatment, the juxtaperiostal is the application plane most recommended. For PMMA corporal application, intramuscular is the application plane most indicated, while intradermal and justadermal planes are contraindicated. The submuscular plane application is relative to PMMA filler concentration. The experts also inquired regarding the amount of PMMA recommended in each corporal site (50 mL in the calf, 100-150 mL in the gluteal region). CONCLUSION: These recommendations provide a guideline for physicians, supporting them to perform safe and efficacious treatment with PMMA fillers. LEVEL OF EVIDENCE V: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement.

Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance. LEVEL OF EVIDENCE V: 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 .

Management of the Heavy Brows: Long-Term Surgical Options.

One of the first signs of aging belongs to the upper third of the face. With the aging process, mestizo facial features become more prominent. The thicker skin-soft tissue envelope (S-STE) has a tendency to sag more, hooding of the eyelids tends to be more pronounced, and there is a tendency for eyebrows to droop, specifically the tail of the brows, because of the loss of support. A "tired" or "sad" look implies that the complex eyebrow-upper eyelid is showing one or more of these signs. Different surgical as well as non-surgical techniques have been described to treat this area, every one of them aiming at making the patient look rested and natural. The objective of this study is to describe a technique for endoscopic brow lifting, consisting on minimal incisions, a biplanar dissection, and a different fixation technique designed for helping reshape the brow. This particular surgical technique has shown the advantage of being minimally invasive and effective. Careful analysis of the patient should be made to decide both the technique and the changes desired by the patient and the surgeon. The authors believe the technique described is another option for approaching and fixating the heavy eyebrows in mestizo patients.

Evaluation of cutaneous rejuvenation associated with the use of ortho-silicic acid stabilized by hydrolyzed marine collagen.

BACKGROUND: Organic silicon plays an important role in dermal structure by promoting neocollagenesis. Thus, the supplementation of silicon in a highly bioavailable form can be used for skin rejuvenation. AIMS: This study aimed to evaluate skin changes associated with the use of ortho-silicic acid stabilized by hydrolyzed collagen. PATIENTS/METHODS: Patients were randomized to receive 600 mg of ortho-silicic acid stabilized by hydrolyzed collagen (group 1, n = 11) or placebo (group 2, n = 11) to be taken 15 minutes before breakfast for 90 days. Clinical, photographical, and patients' subjective evaluations were conducted. RESULTS: A total of 22 patients were included. Clinical evaluations demonstrated changes in skin texture, firmness, and hydration statistically superior in group 1. Brightness, firmness, and overall appearance showed trends for a difference favoring group 1 according to patients' subjective evaluations. Objective images showed no statistical differences. No side effects, hypersensitivity, or systemic symptoms were observed in group 1. Treatment satisfaction in group 1 reached 80%. CONCLUSIONS: Ortho-silicic acid stabilized by hydrolyzed collagen in a daily dose of 600 mg showed positive results in skin rejuvenation according to clinical evaluation in firmness, hydration, and skin texture. Further studies with larger and representative samples should be conducted to confirm our results.

Microfocused ultrasound in combination with diluted calcium hydroxylapatite for improving skin laxity and the appearance of lines in the neck and décolletage.

BACKGROUND: Skin laxity and wrinkling on the neck and décolletage reveal age as reliably as the face. OBJECTIVE: To evaluate the combined use of microfocused ultrasound with visualization (MFU-V; Ultherapy® ) and diluted calcium hydroxylapatite (CaHA; Radiesse® ) for treating the neck and décolletage. METHODS: Subjects with moderate-to-severe lines on the neck and/or décolletage were retrospectively enrolled. MFU-V was applied using 7 and 10 MHz transducers followed by subdermal injection of CaHA diluted 1:1 with lidocaine solution. Photographs at baseline and 90 days were assessed by two independent, blinded evaluators using three scales: Merz Aesthetics décolleté wrinkles, Fabi-Bolton chest wrinkle, and Allergan transverse neck lines scales. RESULTS: A total of 47 subjects were treated as follows: 29 (neck only), five (décolletage only), and 13 (both areas). Mean neckline score improved from 2.6 (moderate-to-severe lines) at baseline to 1.3 (mild lines) 90 days after treatment (P < .001). Mean décolletage scores improved from 2.6 and 3.3 (moderate-to-severe wrinkles) on the Merz Aesthetics and Fabi-Bolton scales, respectively, to 1.1 and 1.8 (mild wrinkles), respectively, after treatment (both P < .001). Both procedures were well tolerated with high subject satisfaction. CONCLUSIONS: Combining MFU-V with 1:1 diluted CaHA is effective for improving the appearance of neck and décolletage lines and wrinkles.

Aplicación de la ingeniería de tejidos y nuevas tecnologías a los implantes faciales / Application of tissue engineering and new technologies for implants facials

El presente artículo analiza los biomateriales destinados a la estética facial, sus aplicaciones terapéuticas, y expone los sintetizados por los autores. En los últimos años, el manejo del envejecimiento facial ha sufrido una verdadera revolución, gracias a la introducción de nuevas técnicas de rejuvenecimiento, y el desarrollo de biomateriales seguros y efi caces. El envejecimiento es un proceso cronológico, con una alteración intrínseca en todos los planos faciales determinada por factores genéticos e infl uenciada por factores ambientales. Esto provoca el inicio de arrugas fi nas, que dan lugar a fi suras o surcos en diferentes zonas del rostro. Su tratamiento requiere sustancias de relleno, que se utilizan para ocupar o expandir el espacio disminuido y otorgan aumento de volumen. Los implantes representan alternativas, que cuentan con diferentes formas, clasifi cadas de acuerdo con su duración en el organismo. En la actualidad, la posibilidad de la aplicación de la ingeniería de tejidos y los biomateriales a la estética permite la creación de prótesis o implantes personalizados para cada paciente. Esta sinergia tecnológica tiene la capacidad de estimular los procesos reparativos, integrar el implante al huésped, o incluso sembrarlo con células madre autólogas. Todo esto es completamente viable en la Argentina actual.

The present article analyzes the biomaterials destined to facial aesthetics, their therapeutic applications, and exposes the synthetized by authors. In recent years, the management of facial rejuvenation has undergone a real revolution, with the introduction of new techniques for rejuvenation, and the development of safe and eff ective biomaterials. Aging is a chronological process, which is identifi ed as intrinsic alteration in all the facial planes, determined by genetic factors, and infl uenced by environmental factors, causing the start of fi ne of lines, that result in fi ssures or furrows in forehead, eyebrows, mouth and naso-genian furrow. The grafts or implants represent alternatives, which account with diff erent forms, classifi ed by their lasting in organism. To this respect, the possibility of the application of tissue and biomaterial engineering to aesthetics, allow the creation of costume made prostheses and implants. This technological synergy have the capability of stimulate the repairing processes and integrate the implant to host, and inclusive, seeding it with stem cells. All these aspects are completely viable in the actual Argentina.

Cell reprogramming: Therapeutic potential and the promise of rejuvenation for the aging brain.

Aging is associated with a progressive increase in the incidence of neurodegenerative diseases, with Alzheimer's (AD) and Parkinson's (PD) disease being the most conspicuous examples. Within this context, the absence of efficacious therapies for most age-related brain pathologies has increased the interest in regenerative medicine. In particular, cell reprogramming technologies have ushered in the era of personalized therapies that not only show a significant potential for the treatment of neurodegenerative diseases but also promise to make biological rejuvenation feasible. We will first review recent evidence supporting the emerging view that aging is a reversible epigenetic phenomenon. Next, we will describe novel reprogramming approaches that overcome some of the intrinsic limitations of conventional induced-pluripotent-stem-cell technology. One of the alternative approaches, lineage reprogramming, consists of the direct conversion of one adult cell type into another by transgenic expression of multiple lineage-specific transcription factors (TF). Another strategy, termed pluripotency factor-mediated direct reprogramming, uses universal TF to generate epigenetically unstable intermediates able to differentiate into somatic cell types in response to specific differentiation factors. In the third part we will review studies showing the potential relevance of the above approaches for the treatment of AD and PD.

The Emerging View of Aging as a Reversible Epigenetic Process.

The achievement of animal cloning and subsequent development of cell reprogramming technology are having a profound impact on our view of the mechanisms of aging in complex organisms. The experimental evidence showing that an adult somatic nucleus implanted into an enucleated oocyte can give rise to a whole new individual strongly suggests that the integrity of the genome of an adult nucleus is fully preserved. Here, we will review recent experimental evidence showing that pluripotency gene-based cell reprogramming can erase the epigenetic marks of aging and rejuvenate cells from old individuals reversing most signs of aging and that when induced pluripotent stem cells are differentiated back to the cell type of origin, the rejuvenated cells share many of the features of wild-type counterparts from young donors. This evidence supports the idea that progressive epigenetic dysregulation may be the key driver of organismal aging and challenges the conventional view of aging as an irreversible process. The model of aging as an epigenetic process provides an elegant explanation of a number of age-related processes difficult to explain by conventional theories of aging.

[The <> and beginnings of Chilean endocrinology in the 1920s]. / El <> y los inicios de la endocrinología chilena en la década de 1920.

Rejuvenation was a chapter of critical importance for the worldwide development of endocrinology in the 1920s. This work explores the acceptance of these techniques in Chile. Starting in the late 19th century, the Chilean Medical Journal (Revista Médica de Chile) incorporated references to experiments with endocrine gland preparations that were being conducted in Europe at the time. An appropriation of the experiments by the Austrian Eugen Steinach began in 1920, with prominent figures such as the Italian professor Juan Noe Crevani and the young Chilean student Ottmar Wilhelm. Between 1922 and 1924, Wilhelm developed a series of experiments on dogs, bulls, pigs, rats and Welfare Board patients through the so-called Steinach operation, which consisted of the sectioning of the efferent channel in one of the testicles. Professor Noe's scientific patronage policy and Wilhelm's strategy of succession in the field led the latter to hold a chair in the new School of Medicine of Universidad de Concepci6n at the age of 25. From this position, the. figure of Wilhelm was fundamental for the development of a line of endocrinological research that was able to position Universidad de Concepci6n as a scientific development centre, which was strengthened by the arrival of another disciple of Steinach in Chile, the Latvian professor Alejandro Lipschütz.

Functional lung rejuvenation in obese patients after bariatric surgery.

OBJECTIVE: To determine the lung age (LA) in obese people before and after bariatric surgery, compare the LA with the chronological age (CA) before and after the peration, and verify whether there was a functional pulmonary rejuvenation after it. METHODS: A prospective longitudinal study including 43 morbidly obese patients who underwent bariatric surgery. The patients underwent clinical and spirometric evaluation in two stages, before and after the surgery. In both stages, LA, CA and spirometric variables were measured. RESULTS: A significant improvement in the spirometric variables (FVC; FEV1; and FEV1/FVC ratio) was found after the operation (p≤ 0.0001). Comparing the LA before (50.93±13.36 years) and after the surgery (39.02±12.95 years), there was an important reduction of 11.90±9.12 years (95CI:9.10-14.71; p≤0.0001) in LA after surgery. The difference between LA and CA before surgery was 12.20± 11.71 years (95CI:8.60-15.81) with significant difference (p≤0.0001), and the difference between LA and CA after surgery was -1.95±11.83 years (95CI: -5.59-1.69) with no significant difference (p≤0.28). Regarding LA, we observed a pulmonary aging of 12.20±11.71 years before the surgery and a pulmonary rejuvenation of 11.90±9.12 years after it. CONCLUSION: Morbid obesity is responsible for early damage and functional accelerated pulmonary aging. After the correction of the body weight by surgery, there is a functional pulmonary rejuvenation demonstrated by the normalization of LA in relation to CA.

Functional lung rejuvenation in obese patients after bariatric surgery / Rejuvenescimento pulmonar funcional em pacientes obesos após cirurgia bariátrica

Summary Objective: To determine the lung age (LA) in obese people before and after bariatric surgery, compare the LA with the chronological age (CA) before and after the peration, and verify whether there was a functional pulmonary rejuvenation after it. Methods: A prospective longitudinal study including 43 morbidly obese patients who underwent bariatric surgery. The patients underwent clinical and spirometric evaluation in two stages, before and after the surgery. In both stages, LA, CA and spirometric variables were measured. Results: A significant improvement in the spirometric variables (FVC; FEV1; and FEV1/FVC ratio) was found after the operation (p≤ 0.0001). Comparing the LA before (50.93±13.36 years) and after the surgery (39.02±12.95 years), there was an important reduction of 11.90±9.12 years (95CI:9.10-14.71; p≤0.0001) in LA after surgery. The difference between LA and CA before surgery was 12.20± 11.71 years (95CI:8.60-15.81) with significant difference (p≤0.0001), and the difference between LA and CA after surgery was -1.95±11.83 years (95CI: -5.59-1.69) with no significant difference (p≤0.28). Regarding LA, we observed a pulmonary aging of 12.20±11.71 years before the surgery and a pulmonary rejuvenation of 11.90±9.12 years after it. Conclusion: Morbid obesity is responsible for early damage and functional accelerated pulmonary aging. After the correction of the body weight by surgery, there is a functional pulmonary rejuvenation demonstrated by the normalization of LA in relation to CA.

Resumo Objetivo: determinar a idade pulmonar (IP) em obesos no pré e pós-operatório de cirurgia bariátrica, comparar a IP com a idade cronológica (IC) antes e após a cirurgia, e verificar se houve rejuvenescimento pulmonar funcional após a cirurgia. Métodos: estudo longitudinal, prospectivo, envolvendo 43 pacientes obesos mórbidos submetidos à cirurgia bariátrica. Os pacientes foram submetidos à avaliação clínica e espirométrica antes e após a cirurgia, sendo determinadas IP, IC e variáveis espirométricas. Resultados: observou-se melhora significativa nas variáveis espirométricas (VEF1, CVF e razão VEF1/CVF) após a cirurgia (p≤0,0001). Comparando a IP antes (50,93±13,36 anos) e após a cirurgia (39,02±12,95 anos), observou-se redução significativa da IP no pós-operatório de 11,90±9,12 anos (IC 95% 9,10-14,71; p≤0,0001). A diferença entre IP e IC no pré-operatório foi de 12,20±11,71 anos (IC 95% 8,60-15,81) com diferença significativa (p≤0,0001). A diferença entre IP e IC no pós-operatório foi de -1,95±11,83 anos (IC 95% -5,59-1,69), sem apresentar diferença significativa (p≤0,28). Quando comparamos a IP antes e após a cirurgia, observamos um envelhecimento pulmonar de 12,20±11,71 anos antes e um rejuvenescimento pulmonar de 11,90±9,12 anos após a cirurgia. Conclusão: a obesidade mórbida causa dano precoce e envelhecimento pulmonar funcional acelerado. Após a correção do peso corpóreo pela cirurgia, há um rejuvenescimento pulmonar funcional, mostrado pela normalização da IP em relação à IC.