Eyebrow Lift: Open-Book ROOF Transposition and Orbicularis-Frontalis Sliding Maneuver.

This article delves into innovative surgical techniques, the open-book ROOF (retro-orbicularis oculi fat) transposition technique (OBRoof) and the orbicularis-frontalis sliding maneuver (OFS), designed for eyebrow and upper eyelid rejuvenation in the aging process. Emphasis is placed on understanding the dynamic changes occurring within the forehead and eyebrow envelope's five layers and their intrinsic relationships as well as the impact of the ROOF ptosis causing upper eyelid hooding. The OBRoof technique is highlighted for its effectiveness in addressing ptotic volume, offering a rejuvenated appearance by relocating volume to the supraciliary region.In the OFS, we explore the concept of extensive dissection above the upper border of the eyebrow to allow for free repositioning of the eyebrow. The stabilization is based on deep-plane facelift concepts, as the orbicularis oculi muscle corresponds to the superficial muscular aponeurotic system, and it is anchored to the deep layers (periosteum) by passing through the frontal muscle.In summary, this article provides a comprehensive exploration of innovative and minimally invasive techniques for eyebrow and upper eyelid rejuvenation, shedding light on their anatomical foundations, procedural intricacies, and the potential for achieving natural and lasting outcomes.

Biological Activity and Chemical Composition of Propolis Extracts with Potential Use in Vulvovaginal Candidiasis Management.

Environmental sustainability is an increasing challenge in the pharmaceutical field, leading to the search for eco-friendly active ingredients. Among natural ingredients, propolis arises as an excellent alternative, being a complex substance with pharmacological properties. This work aims to explore the potential of propolis as a new pharmaceutical ingredient for the replacement of conventional vulvovaginal antifungals. Propolis extracts were obtained by Ultrasound-Assisted Extraction using different solvents (water, water/ethanol (50:50, v/v), and ethanol). Afterwards, the extracts were characterized regarding total phenolic content (TPC), antioxidant/antiradical activities, radical scavenging capacity, antifungal activity against strains of Candida species, and viability effect on two female genital cell lines. The aqueous extract achieved the best TPC result as well as the highest antioxidant/antiradical activities and ability to capture reactive oxygen species. A total of 38 phenolic compounds were identified and quantified by HPLC, among which ferulic acid, phloridzin and myricetin predominated. Regarding the anti-Candida spp. activity, the aqueous and the hydroalcoholic extracts achieved the best outcomes (with MIC values ranging between 128 and 512 µg/mL). The cell viability assays confirmed that the aqueous extract presented mild selectivity, while the hydroalcoholic and alcoholic extracts showed higher toxicities. These results attest that propolis has a deep potential for vulvovaginal candidiasis management, supporting its economic valorization.

Osteotomy Techniques in Preservation Rhinoplasty with an Analysis of a Radix-Skull Base Computed Tomography Series.

This study aims to explain our experience with dorsal preservation osteotomies, focusing on transverse, lateral, and dorsal aesthetic lines (DAL) osteotomies. We describe the utilization of a variety of surgical instruments, including osteotomes, saws, burrs, and piezo. This paper describes our concept of transcutaneous ultrasonic osteotomy, microedged-specific osteotomy, applying drills for lateral wall reshaping, and integrating piezo technology to establish new DAL. Furthermore, we present a radix-skull base computed tomography series analysis to evaluate the safety of transverse and radix osteotomies.

Cardiac magnetic resonance patterns of left ventricular remodeling in patients with severe aortic stenosis referred to surgical aortic valve replacement.

Left ventricular (LV) hypertrophy is a common finding in patients with severe aortic stenosis (AS). Cardiac magnetic resonance (CMR) is the gold-standard technique to evaluate LV remodeling. Our aim was to assess the prevalence and describe the patterns of LV adaptation in AS patients before and after surgical aortic valve replacement (AVR). Prospective study of 130 consecutive patients (71y [IQR 68-77y], 48% men) with severe AS, referred for surgical AVR. Patterns of LV remodeling were assessed by CMR. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling. At baseline CMR study: mean LV indexed mass: 81.8 ± 26.7 g/m2; mean end-diastolic LV indexed volume: 85.7 ± 23.1 mL/m2 and median geometric remodeling ratio: 0.96 g/mL [IQR 0.82-1.08 g/mL]. LV hypertrophy occurred in 49% of subjects (concentric 44%; eccentric 5%). Both normal LV structure and concentric remodeling had a prevalence of 25% among the cohort; one patient had an adverse remodeling pattern. Asymmetric LV wall thickening was present in 55% of the patients, with predominant septal involvement. AVR was performed in 119 patients. At 3-6 months after AVR, LV remodeling changed to: normal ventricular geometry in 60%, concentric remodeling in 27%, concentric hypertrophy in 10%, eccentric hypertrophy in 3% and adverse remodeling (one patient). Indexes of AS severity, LV systolic and diastolic function and NT-proBNP were significantly different among the distinct patterns of remodeling. Several distinct patterns of LV remodelling beyond concentric hypertrophy occur in patients with classical severe AS. Asymmetric hypertrophy is a common finding and LV response after AVR is diverse.

Shedding light on ai in radiology: A systematic review and taxonomy of eye gaze-driven interpretability in deep learning.

X-ray imaging plays a crucial role in diagnostic medicine. Yet, a significant portion of the global population lacks access to this essential technology due to a shortage of trained radiologists. Eye-tracking data and deep learning models can enhance X-ray analysis by mapping expert focus areas, guiding automated anomaly detection, optimizing workflow efficiency, and bolstering training methods for novice radiologists. However, the literature shows contradictory results regarding the usefulness of eye-tracking data in deep-learning architectures for abnormality detection. We argue that these discrepancies between studies in the literature are due to (a) the way eye-tracking data is (or is not) processed, (b) the types of deep learning architectures chosen, and (c) the type of application that these architectures will have. We conducted a systematic literature review using PRISMA to address these contradicting results. We analyzed 60 studies that incorporated eye-tracking data in a deep-learning approach for different application goals in radiology. We performed a comparative analysis to understand if eye gaze data contains feature maps that can be useful under a deep learning approach and whether they can promote more interpretable predictions. To the best of our knowledge, this is the first survey in the area that performs a thorough investigation of eye gaze data processing techniques and their impacts in different deep learning architectures for applications such as error detection, classification, object detection, expertise level analysis, fatigue estimation and human attention prediction in medical imaging data. Our analysis resulted in two main contributions: (1) taxonomy that first divides the literature by task, enabling us to analyze the value eye movement can bring for each case and build guidelines regarding architectures and gaze processing techniques adequate for each application, and (2) an overall analysis of how eye gaze data can promote explainability in radiology.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

Trends in 3D models of inflammatory bowel disease.

Inflammatory bowel disease (IBD) encompasses a set of chronic inflammatory conditions, namely Crohn's disease and ulcerative colitis. Despite all advances in the management of IBD, a definitive cure is not available, largely due to a lack of a holistic understanding of its etiology and pathophysiology. Several in vitro, in vivo, and ex vivo models have been developed over the past few decades in order to abbreviate remaining gaps. The establishment of reliable and predictable in vitro intestinal inflammation models may indeed provide valuable tools to expedite and validate the development of therapies for IBD. Three-dimensional (3D) models provide a more accurate representation of the different layers of the intestine, contributing to a stronger impact on drug screening and research on intestinal inflammation, and bridging the gap between in vitro and in vivo research. This work provides a critical overview on the state-of-the-art on existing 3D models of intestinal inflammation and discusses the remaining challenges, providing insights on possible pathways towards achieving IBD mimetic models. We also address some of the main challenges faced by implementing cell culture models in IBD research while bearing in mind clinical translational aspects.

Procedural success in transaxillary transcatheter aortic valve implantation according to type of transcatheter heart valve: results from the multicenter TAXI registry.

BACKGROUND: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. AIMS: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). METHODS: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. RESULTS: From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. CONCLUSIONS: Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.

Glycerol as substrate and NADP+-dependent glyceraldehyde-3-phosphate dehydrogenase enable higher production of 3-hydroxypropionic acid through the ß-alanine pathway in E. coli.

Microbial engineering is a promising way to produce3-HP using biorenewable substrates such as glycerol. However, theglycerol pathway to obtain 3-HPrequires vitamin B-12, which hinders its economic viability. The present work showed that 3-HP can be efficiently produced from glycerol through the ß-alanine pathway. To develop a cell factory for this purpose, glycerol was evaluated as a substrate and showed more than two-fold improved 3-HP production compared to glucose. Next, the reducing power was modulated by overexpression of an NADP+ -dependent glyceraldehyde-3-phosphate dehydrogenase coupled with CRISPR-based repression of the endogenous gapA gene, resulting in a 91 % increase in 3-HP titer. Finally, the toxicity of 3-HP accumulation was addressed by overexpressing a putative exporter (YohJK). Fed-batch cultivation of the final strain yielded 72.2 g/L of 3-HP and a productivity of 1.64 g/L/h, which are the best results for the ß-alanine pathway and are similar to those found for other pathways.

Evaluation of mechanical properties and morphology of miniscrews Ti6Al4V cold worked versus annealed in artificial bones.

PURPOSE: This study aimed to evaluate the influence of different manufacturing procedures (Eli annealed - hot work versus cold worked - cold work) of the raw material under mechanical properties and morphological characteristics of orthodontic miniscrews (MS). MATERIAL AND METHODS: Thirty MS were randomly separated into 3 types (n=10) according to manufacturer and manufacturing process of the raw material: type A - SIN® annealed (control group); type B - Dentfix® annealed; and, type C - Dentfix® cold worked. MI were inserted in artificial bone blocks, through the manufacturer's specific manual key attached to the digital torquemeter stabilized via custom device. Data of fracture's occurrence was performed using Fisher's exact test. Comparisons between the other two types regarding insertion torque and removal torque were performed using the Mann-Whitney test. Data of fracture torque, shear stress, normal stress and torque ratio was submitted to Kruskal Wallis and Dunn tests (α=0.05). Representative images of surface morphology and fractures were selected. RESULTS: Type C showed statistically the lowest fracture torque (N.cm) (26.11±0.41) (P=0.0012) and highest torque ratio (%) (98.74±0.85) (P=0.0007). Type C showed statistically higher calculated shear (MPa) (2,432.73±508.41) and normal stress (MPa) (1,403.86±293.39) than type B and type A, showing that they differed in relation to the mechanical strength of the material with which they were made (P=0.0007). CONCLUSION: Type A fractured completely inside the most apical bone. Type B and type C fractured closer to the transmucosal profile. Cold worked process should be more prone to fractures than those annealed raw manufactured.

Demographic and Clinical Characteristics of Mpox Patients Attending an STD Clinic in Lisbon.

Mpox is a viral disease caused by the monkeypox virus, which marked the year of 2022 with a global outbreak. While previously considered to be a zoonosis of almost exclusive animal-to-human transmission, the current outbreak has been attributed to human-to-human transmission, particularly sexual transmission. As a new sexually transmissible disease, we studied the epidemiological and clinical features, as well as the concomitant occurrence of other sexually transmissible diseases, treatment approach, and outcome of our 291 patients, in the current outbreak. We found a total of 169 concomitant sexually transmissible infections of bacterial and viral origins, corresponding to 107 patients. Neisseria gonorrhoeae was the most common agent, particularly in the anal location. With this work, we emphasize the need for a thorough epidemiological and medical history, as well as a concomitant complete laboratorial screening for other STIs in patients with confirmed or suspected mpox.

Chitosan-based sponges containing clotrimazole for the topical management of vulvovaginal candidiasis.

Vulvovaginal candidiasis (VVC) persists as a worrying women's healthcare issue, often relying on suboptimal therapeutics. Novel intravaginal dosage forms focusing on improving patient acceptability and featuring improved biopharmaceutical properties could be interesting alternatives to available antifungal products. Different formulations of sponges based on chitosan (Ch), with or without crosslinking and co-formulated with poly(N-vinylcaprolactam) (PNVCL), were produced for the topical administration of clotrimazole (CTZ) and further tested for physicochemical properties, drug release, cytotoxicity and antifungal activity. Results showed that high amounts of CTZ (roughly 30-50 %) could be incorporated into sponges obtained by using a simple freeze-drying methodology. Cross-linking of Ch with ammonia affected the morphology and mechanical features of sponges and shifted the release profile from sustained (around 20 % and 60 % drug released after 4 h and 24 h, respectively) to fast-releasing (over 90 % at 4 h). The combination of PNVCL with non-crosslinked Ch also allowed tuning drug release, namely by increasing the initial amount of CTZ released in simulated vaginal fluid (roughly 40 % after 4 h), as compared to sponges featuring only non-crosslinked Ch. All formulations displayed low toxicity to cell lines derived from the female genital tract, with viability values kept above 70 % after 24 h incubation with sponge extracts. These also allowed maintaining the rapid onset of the antifungal effects of CTZ at minimum inhibitory concentrations ranging from 0.5 to 16 µg/mL for a panel of six different Candida spp. strains. Overall, proposed sponge formulations appear to be promising alternatives for the safe and effective management of VVC.

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

Outdoor Finishing of Intact Male Portuguese Alentejano Pigs on a Sustainable High-Fiber Diet: Impacts on Blood, Growth, Carcass, Meat Quality and Boar Taint Compounds.

This trial evaluated the effect of sex on the blood, growth, carcass, meat quality, and boar taint compounds in male Alentejano (AL) pigs (n = 30). From ~40 to 130 kg LW, castrated (C) and intact pigs (I and IExp groups) were fed commercial diets ad libitum. Between ~130 and 160 kg (slaughter), C and I pigs continued on commercial diets, while IExp were fed an experimental diet containing locally produced pulses and by-products aimed at reducing boar taint. At ~160 kg, blood urea levels were higher in IExp than C pigs, triacylglycerols were lower in both intact groups, and cortisol was lower in IExp. IExp pigs exhibited faster growth, improved feed conversion ratio, carcass higher commercial yield and leaner meat than C pigs. The loin intramuscular fat in intact pigs was lower, less saturated and more polyunsaturated, while total collagen was higher. Fat androstenone content was higher in intact pigs and skatole content was similar across treatments, although they were below threshold values for consumer detection. Finally, although boar taint compounds were low in intact AL pigs raised outdoors, adding pulses and by-products to the experimental diet did not result in a reduction in fat skatole content compared to pigs fed the commercial diet.

Deflection of tandem archwire in a specific self-ligating metal bracket system: an in vitro study.

The aim of this study was to quantify the force exerted by tandem archwires in a specific system of passive self-ligating bracket. Forty-eight thermo-activated nickel-titanium orthodontic archwires were separated into four groups (n = 12): G1 - two .014" + .014" round archwires; G2 - two .014" + .016" round archwires; G3 - .014" x .025" rectangular archwire; and. G4 - .016" x .022" rectangular archwire. Brackets were fixed onto teeth 1.5 to 2.5 using a device that represented the upper teeth, maintaining an interbracket distance of 6.0 mm. The deflection tests were performed using the structure representative of tooth 1.1 as support on the Instron testing machine at a speed of 2.0 mm/min. The archwires were evaluated at deflections of 0.5 mm, 1.0 mm, and 1.5 mm. The data were analyzed by a generalized linear model, considering values at different deflections as repeated measurements in the same experimental unit (α = 0.5%). At 0.5 mm, higher forces were observed in G2 and G3, which did not differ significantly (p > 0.05). The lowest force was observed in G4 (p < 0.05). At 1.0 mm and 1.5 mm, the highest force was observed in G3, followed by G4 and G2 (p < 0.05). The lowest force was observed in G1 (p < 0.05). In general, tandem archwires (same or different calibers) in a specific passive self-ligating bracket exerted lower force when compared with rectangular archwires.

Porphyrin-associated fluorescence spectroscopy (Photogen®) for the optical diagnosis of dental biofilm in orthodontic treatment: An observational clinical trial.

OBJECTIVE: This study assessed the presence of dental biofilm with fluorescence spectroscopy associated with porphyrin (Photogen®) in users of orthodontic appliances. METHODS: This cross-sectional observational clinical trial included 21 patients with metallic orthodontic fixed appliances. The presence of biofilm was evaluated by fluorescence spectroscopy (Evince-MMÓptics. São Carlos-SP, Brazil) with a porphyrin photo-evidence device (Photogen®). Digital images of the buccal surface of the upper anterior teeth (central and lateral incisors and canines) without and with porphyrin were analyzed using the histogram R (red) function in ImageJ software. The results were analyzed using the maximum and mode values of the red pixels from the histograms. The statistical analysis considered the significance level of 5%. RESULTS: The maximum values and modes of the red pixels were significantly higher in biofilms analyzed by porphyrin-associated optical spectroscopy compared to optical spectroscopy alone. CONCLUSIONS: Porphyrin-associated fluorescence spectroscopy was able to detect dental biofilm in the oral environment of patients with orthodontic treatment. This method better evidenced the presence of biofilm on the buccal surfaces of the upper teeth compared to that observed with fluorescence spectroscopy without porphyrin.

Repair of a gigantic ascending aortic pseudoaneurysm - A challenging approach.

Aortic pseudoaneurysms can be a potentially fatal, yet rare, complication of heart surgery. Surgery is indicated but is high risk during sternotomy. Therefore, careful planning is required. We report the case of a 57-year-old patient who underwent heart surgery twice in the past and who presented with an ascending aortic pseudoaneurysm. A successful repair of the pseudoaneurysm was performed under deep hypothermia, left ventricular apical venting, periods of circulatory arrest and endoaortic balloon occlusion.