Analysis of modified ilib therapy in patients submitted to plastic surgery.

The sample comprised 44 volunteers who had undergone some surgical procedure and were equally divided into four groups. G1 started the therapy 24 h after the surgical procedure with the device off. G2 followed the same time pattern, 24 h, but with the device turned on. G3 and G4 started therapy three days after the surgical procedure; in G3, the device was turned off, and in G4, the device remained on during therapy; each session lasted 30 min, using 660 nm (red), energy 180 J. For all groups, the therapy started with daily use for seven days and followed the interval use of three times a week until completed 21 days. The revaluation was performed after 7 and 21 days. The results found show changes in HR at rest, systolic and diastolic BP, and in peripheral oxygen saturation, which showed a significant difference in the groups that used on-therapy (p < 0.05). In the MCGILL Scale evaluation, the mean total score showed a more accentuated drop in the groups that used ILIB, (p < 0.05). ILIB may have prevented a more significant evolution of firosis levels; however, no changes were observed in the evaluation of sleep and anxiety. The application of the ILIB in patients undergoing plastic surgery was supported in terms of hemodynamics and pain; in addition, starting the ILIB application 24 h after the procedure proved to be more advantageous.

Effects at cellular level of epilation with various laser wavelengths applied simultaneously on different skins: two case reports.

This study evaluated the effects of laser application of diverse wavelengths applied simultaneously and on different skins. The sample included two participants, a woman with light skin with abdominal hair and a woman with dark skin and hair on the inner part of the lower limbs, who received a laser therapy session. After 45 days from laser application, abdominoplasty and thigh dermolipectomy surgery were performed. In the control sample, the hair follicles were in the anagen phase, showing the presence of Bcl-2 expression. In the treated areas, follicles were observed in an advanced phase (telogen), with the presence of CK-18 and negativity of Bcl-2, highlighting the phase of hair loss at that moment and the complete apoptosis of the investigated follicle. Significant difference was observed in the comparison of the anagen phase (p = .00) and it similarly occurred in the comparison of the telogen phase (p = .00). The presence of a greater amount of follicles in the anagen phase in the control area and follicles in the telogen phase in the treated area demonstrates the efficiency of the laser at different wavelengths when reaching different skin phototypes and hair thickness, being reinforced by apoptosis and cell proliferation markers. Therefore, the hair-removal process has been optimized with various laser wavelengths.

Analysis of immediate use of sunscreen after microneedling.

INTRODUCTION: Microneedling promotes skin microlesions that lead to an inflammatory process, increasing cell proliferation, cell metabolism, and synthesis of collagen and elastin, therefore restoring skin integrity. OBJECTIVE: This study aims to investigate the differences between the physical and the physical-chemical sunscreen application after microneedling, assessed through histological analysis. METHOD: This was a two-phase study. The first phase investigated the physical and physical-chemical sunscreen penetration mixed with India ink through histological analysis. The sunscreens were applied after the microleakage in vivo on the skin of a volunteer who underwent abdominoplasty 24 hours after the procedure. Histological analyses were carried out using optical and electron microscopy. The second phase analysed the skin reactions with the use of physical sunscreen after different microneedling treatments. The sample consisted of 30 volunteers distributed into three groups: G1 received the "Roller" microneedling, G2 received pen micropuncture treatment, and G3 received the fractional radiofrequency treatment. RESULTS: The histological analyses of the first phase indicated that the physical-chemical protection sunscreen penetrated more deeply, and pigment was found among the collagen fibres and the dermal fibroblast cytoplasm in comparison to the physical protection sunscreen, which had the pigment confined exclusively in the superficial epidermis layer. The second phase results demonstrated that the use of the physical protection sunscreen after the different microneedling techniques showed no adverse reactions such as itching, pain or soreness, and the hyperaemia. CONCLUSION: The proposed intervention showed that the use of physical protection sunscreen after different microneedling procedures is safe.

Effects of subcutaneous injection of ozone during wound healing in rats.

Fibroblast growth factor 2 (FGF2) regulates the wound repair process and it is secreted by inflammatory and endothelial cells, and by myofibroblasts. This study aimed to establish the expression patterns of FGF2 and myofibroblastic differentiation during wound healing in rats treated with subcutaneous ozone injection. We created full-thickness excisional wounds in rats, and the healing process was analyzed through morphometric analyses and digital quantification of immunoreactivity of smooth muscle actin and FGF2. Ozone therapy-treated wounds presented granulation tissue with a reduced number of inflammatory cells and greater dermal cellularity, and intense collagen deposition. FGF2 immunoreactivity, microvessel density, and amount of myofibroblasts were significantly higher in treated wounds compared to controls. In conclusion, it was demonstrated that subcutaneous injections of ozone accelerate and ameliorate wound repairing process. Moreover, injectable ozone therapy's action mechanism may be associated with FGF2 overexpression.

Effects of the extracorporeal shock wave therapy on the skin: an experimental study.

Extracorporeal shock wave therapy (ESWT) has been extensively studied for its multiple biological properties, and although it is widely applied in esthetical procedures, little is known about its effects on the epidermis and dermis. In this study, a histological and immunohistochemical study of the effects of ESWT was performed on rat skin. Forty-five female rats were treated with one or two sessions of ESWT and sacrificed on days 1, 7, 14, and 21 after treatment. The samples were histologically processed and then morphometric analyses were performed to assess the epidermis, dermis, and subcutaneous fat tissue thickness. Immunohistochemical reactions were also performed against the antibodies: basic fibroblastic growth factor (FGF2), its receptor (FGFR1), and α-smooth muscle actin. Slides were scanned and digitally assessed, to determine the microvessel density (MVD) and digital scoring of the immunohistochemical staining. The results showed that ESWT produced a significantly higher collagen content, MVD, and epidermis and dermis thickness than the control, non-treated group. Both in epidermis and dermis, FGF2 was overexpressed in the ESWT-treated groups, whereas FGFR1 was increased only in the group treated with two ESWT sessions at 21-days post-treatment. The ESWT-treated groups have also shown diminished thickness of subcutaneous fat tissue. In conclusion, ESWT induces neocollagenesis and neoangiogenesis, and upregulates the FGF2 expression, particularly in the groups treated with two sessions. Furthermore, it was demonstrated that overexpression of FGF2 on skins treated with ESWT seems to be a key role on its mechanism of action.

Radiofrequency treatment induces fibroblast growth factor 2 expression and subsequently promotes neocollagenesis and neoangiogenesis in the skin tissue.

Radiofrequency (RF) treatment appears to be involved in production of new collagen fibrils and the improvement of existing collagen structures; however, the molecular bases of the effect of non-invasive RF on the skin tissue have not been fully elucidated. This study reports the effects of RF associated or not with hydrolyzed collagen (HC) in the skin tissue. Wistar rats were randomly divided into four groups, according to the treatment received: control group (G1, n = 5), no treatment; subjects in group G2 (n = 5) were treated with HC; and capacitive RF was applied to the back of each subject in G3 (n = 5) and RF associated with HC in G4 (n = 5). Biopsies were taken 30 days after treatment and then were histologically processed and studied for inflammatory cell counting, collagen content, and morphometry. In addition, FGF2, CD105, and COX-2 expression was assessed by immunohistochemical staining. The most relevant changes were the increase in cellularity and accumulation of intercellular substance in RF-treated animals (G3 and G4). The greatest dermis thickness rate was observed in G4, followed by G3 and G2 (p < 0.05). RF-treated skins (G3 and G4) exhibited a significant overexpression of FGF2 (p < 0.0001) and increased microvessel density (p < 0.0001) in comparison with G1 and G2. Moreover, the amount of COX-2 was significantly higher (p < 0.0001) in dermis of RF-treated areas compared to G1 and G2, and demonstrated differences in G3 (RF) compared to G4 (RF + HC) (p < 0.0001). Our results suggests that RF treatment associated or not with HC induces FGF2 overexpression, promotes neoangiogenesis and modulates the COX-2 expression, subsequently promotes neocollagenesis, and increased thickness rate of dermis.

Innovation of the protocol for the application of cryolipolysis: Effects and mechanisms of action.

BACKGROUND: In recent years, aesthetic procedures aiming at body remodeling and have grown exponentially. Cryolipolysis (CLL) has stood out as a noninvasive resource that acts directly on the subcutaneous adipose tissue promoting a significant reduction of adipose tissue through of cooling that could lead to the crystallization cytoplasmic lipids, loss of cellular integrity, apoptosis/necrosis of adipocytes, and local inflammation, producing selective loss of adipose tissue. Thus, the objective of the present study was to evaluate the effects of a specific technique of CLL application on the inflammatory reactions of the target tissue in different post-application times. METHODS: This is a randomized, blind clinical study that evaluated the tissue sample of six patients after 45, 60, and 90 days of an innovative protocol for the application of CLL, with samples collected through abdominoplasty surgeries. The samples were evaluated by immunohistochemical analyses of several markers. RESULTS: A significantly greater increase in fibroblasts was observed at 45 days and greater phagocytic action at 60 days. Regarding the apoptosis process, the expression of caspase 3 and cleaved caspase 3 markers varied at different times, with cleaved caspase 3 being higher at 45 and 90 days after CLL application. CONCLUSION: The protocol of the CLL presented in this study was able to induce inflammatory responses in addition to confirming the selective apoptotic action at the different times studied.

Plasma Jet versus Electrocarbonization in the Treatment of Wrinkles of the Upper Palpebral Region.

Background: The plasma jet is a non-surgical and minimally invasive procedure that acts by heating the superficial region of the skin, providing rejuvenation of the region. Objective: We sought to compare the clinical and histological effects of direct plasma jet versus electrocarbonization without plasma in the treatment of wrinkles in the upper palpebral region. Methods: This is a clinical trial in which 20 volunteers participated and divided into two groups: electrocarbonization (EG) and plasma jet (JPG), which were clinically evaluated before and after treatment through evaluation protocols, photographs, and questionnaires. Three treatment sessions were performed in the upper eyelid region with an interval of 30 days. After the treatment, a surgical procedure of upper blepharoplasty was performed on two volunteers to remove a skin fragment and later histological analysis. Results: The JPG showed better clinical responses in rejuvenation. The EG promoted an increase in the number of fibroblasts, the number of blood vessels and the amount of inflammation. The JPG showed an increase in the number of fibroblasts and blood vessels. It was observed that the JPG generated activation of T lymphocytes (CD3), macrophages (CD68), and plasmocytes (CD138); in addition to reducing the number of positive cells for CD57 (NK cells). The satisfaction analysis shows that 100 percent in the JPG considered themselves satisfied with the treatment. Conclusion: We verified that in comparison with electrocarbonization, the use of a direct plasma jet promoted tissue improvement at the histological level, in addition to fewer adverse reactions.

Use of Stationary Ultrasound Device In Subcutaneous Abdominal Fat Tissue: Analysis of Clinical Effects.

Background: High-intensity stationary therapeutic ultrasound (HITU) technology is gaining popularity as an attractive modality for treating different conditions, but little is known about its application in aesthetics. Objective: To analyze the effects of stationary unfocused ultrasound (HITU technology) in treating localized fat in women's abdominal region. Methods: The sample consisted of 43 women with localized abdominal adiposity, assessed pre and post-treatment by assessment protocols, adversity analysis questionnaires, ultrasound exams, and serum level exams. The volunteers were randomly divided into three subgroups: G-1, who used the device off, G-2 received therapy with the device once a week for two months (Parameters: Pulsed - 100Hz - 50% - 4.0 W/cm2 - 20 minutes) and the G-3 who used the device on twice a week for a month (Parameters: Pulsed - 100Hz - 50% - 3.2W/cm2 - 30 minutes). All groups received eight sessions in total. Results: There was a significant reduction for G-3 in the plicometry of the lower right region (p=0.01) in the comparison between the final and initial moments. In the comparison among the three research groups, there was a significant reduction in plicometry in the lower right (p=0.03) and left (p=0.02) regions in G3. Via ultrasound, a reduction in the fat layers average was observed in all groups. In G-3, there were significant differences in the left infraumbilical region (p=0.02) and right (p=0.04). In the group comparison, the right infraumbilical region showed significant differences (p=0.04) for the G-3. No differences were found for weight, BMI, body fat percentage and supra, infra and umbilical perimetry (p>0.05). The adverse reactions reported were: Mild hyperaemia (75%) and sensation of shock (21%), there were also reports of improvement in fluid retention in 93.7 percent of the volunteers, and most were satisfied with the result. Conclusion: Both treatment protocols for the reduction of localized adiposity were effective compared to the placebo group, with a significant reduction in the use of ultrasound and plicometry in the concentration of fat in the lower abdominal region.

Effectiveness of Light-Emitting Diode Epilation on Different Skin Types: A Pilot Study.

Objective: This study analyzed the histological and immunohistochemical changes in hair follicles submitted to epilation with light-emitting diode (LED). Background: The use of specific wavelengths of LED leads to the absorption of photons by chromophore tissues, enabling different photophysical and photochemical events, bringing therapeutic benefits such as removing body hair. Methods: The sample included five participants, with phototypes II-V, divided into two groups. The volunteers received a session of epilation with the Holonyak® device on the pubic region and right groin, whereas the contralateral side was kept as a control. An energy of 10 J and a cooling temperature of -5°C were used, after which the pain provoked by the equipment was questioned using the analogue pain scale. After 45 days, the punching procedure was performed in the region where skin samples were taken for histological and immunohistochemical analysis. Results: For all phototypes, in the treated area, the follicles and sebaceous glands were in a stage of involution, showing perifollicular inflammatory infiltrate with changes suggestive of apoptosis. The apoptosis process was confirmed by the increase in markers cytokeratin-18 and cleaved caspase 3, in addition to the reduced expression of Blc-2, and the lower cell proliferation (Ki67), reinforcing the action of LED based on the definite involution and resorption of the follicle, through macrophages (CD68) triggered by the inflammatory process. Conclusions: The preliminary results of this study found relevant histological changes and immunohistochemical markers in the epilation process, which may indicate the efficacy of LED in permanent hair removal.

Effects of Ultracavitation and Radiofrequency on Abdominal Adiposity.

Background: The mechanism of fat reduction from radiofrequency occurs via the thermal stimulation of adipocyte metabolism, causing a lipase-mediated triglyceride enzyme degradation, apoptosis, and adipocyte rupture. Ultracavitation promotes fat reduction using adipose cell destruction through mechanical stimulus. The literature on the combination of these two physical agents, named ultrafrequency, is still scarce and requires consistent analysis of the effects of this therapy combination. Objective: The objective of this study was to investigate the effects of radiofrequency associated with ultracavitation in the treatment of abdominal subcutaneous tissue of women. Methods: This was a prospective, randomized clinical trial in which 45 participants were divided into three distinct groups: the control group (no treatment); ultracavitation group; and ultracavitation and radiofrequency (UCV+RF) group, each with 15 volunteers. The following variables were evaluated: weight, perimetry, plicometry, ultrasonography, treatment reactions, and patient satisfaction. Results: The participants in the UCV+RF group presented a more significant decrease in adipose tissue, which was verified through all the evaluation methods. Conclusion: Based on our results, the simultaneous application of ultracavitation and radiofrequency generated a reduction in localized adiposity superior to the isolated use of ultracavitation.

Comparative effects of fractional radiofrequency and microneedling on the genitalia of postmenopausal women: Histological and clinical changes.

OBJECTIVES: The authors aimed to evaluate clinical and histological changes induced by Fractional Radiofrequency (FRF) and microneedling in vulvar tissue. METHODS: Thirty postmenopausal women were randomly divided into G1 (FRF) and G2 (microneedling) groups. Sub-ablative FRF was executed using disposable fractionated electrodes with an intensity of 8 mJ. Microneedling was performed using a derma roller system. The authors evaluated before and after treatment using the Vaginal Laxity Questionnaire (VLQ), EuroQol Five-Dimensional (EQ-5D) questionnaire, and the Blatt and Kupperman Menopausal Index (BKMI). Additionally, the authors performed biopsies of the labia majora for histological analysis pre- and post-treatment. Data were expressed as mean (± standard deviation). A paired t-test was used for intra-group comparison (pre- and post-treatment), with an independent t-test used to compare intergroup data (both pre- and post-treatment). RESULTS: In the G1 group, the VLQ values showed differences compared to the pre-treatment values with the data obtained 60 days after the beginning of the sessions (p = 0.01). Similarly, the data changes of the G2 group proved to be significant (p = 0.001) across the same time interval. In comparing the groups, VLQ values were not different (p > 0.05). Regarding histological analysis, FRF demonstrated improvement concerning the number of fibroblasts, blood vessels, and fatty degeneration (p < 0.05) compared to the control. Additionally, FRF and microneedling samples showed higher type III collagen and vimentin expression in the immunohistochemical analysis (p < 0.05). CONCLUSIONS: The therapies were found to be effective in treating the flaccidity of the female external genitalia. Additionally, histological changes were observed after interventions suggesting collagen remodeling.

CNS Antigen-Specific Neuroinflammation Attenuates Ischemic Stroke With Involvement of Polarized Myeloid Cells.

BACKGROUND AND OBJECTIVES: Experimental studies indicate shared molecular pathomechanisms in cerebral hypoxia-ischemia and autoimmune neuroinflammation. This has led to clinical studies investigating the effects of immunomodulatory therapies approved in multiple sclerosis on inflammatory damage in stroke. So far, mutual and combined interactions of autoimmune, CNS antigen-specific inflammatory reactions and cerebral ischemia have not been investigated so far. METHODS: Active MOG35-55 experimental autoimmune encephalomyelitis (EAE) was induced in male C57Bl/6J mice. During different phases of EAE, transient middle cerebral artery occlusion (tMCAO, 60 minutes) was induced. Brain tissue was analyzed for infarct size and immune cell infiltration. Multiplex gene expression analysis was performed for 186 genes associated with neuroinflammation and hypoxic-ischemic damage. RESULTS: Mice with severe EAE disease showed a substantial reduction in infarct size after tMCAO. Histopathologic analysis showed less infiltration of CD45+ hematopoietic cells in the infarct core of severely diseased acute EAE mice; this was accompanied by an accumulation of Arginase1-positive/Iba1-positive cells. Gene expression analysis indicated an involvement of myeloid cell-driven anti-inflammatory mechanisms in the attenuation of ischemic injury in severely diseased mice exposed to tMCAO in the acute EAE phase. DISCUSSION: CNS autoantigen-specific autoimmunity has a protective influence on primary tissue damage after experimental stroke, indicating a very early involvement of CNS antigen-specific, myeloid cell-associated anti-inflammatory immune mechanisms that mitigate ischemic injury in the acute EAE phase.

Does COVID-19 infection increase the risk of pressure injury in critically ill patients?: A narrative review.

ABSTRACT: Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.

A Standardized Evaluation Method for Assessing Patients With Genital Dyschromia.

Objective The population's ever-growing concern with genital aesthetic dysfunctions reflects an increasing demand in the field of intimate aesthetics. For this reason, as well as the lack of a standardized evaluation, this paper aims to develop a form that facilitates the initial investigation of aesthetic genital dysfunctions.  Methods An evaluation form for female and male genital dyschromia was developed between July and November 2018. Following initial development, the form was evaluated for quality and was updated by a panel of specialists (a psychologist, two pelvic dysfunction physiotherapists, and two dermato-functional physiotherapists) via email and through a content validity questionnaire. The face validity of the form was assessed by five physiotherapy and medical students who were randomly selected. The students answered a questionnaire evaluating the proposed form. The reliability of the form was established through the test-retest procedure by evaluating its reproducibility over time. Results The "Genital Dyschromia Evaluation Form'' (composed of identification, anamnesis, and physical examination sections) was approved by the specialist panel. They suggested questions to be added in the anamnesis (dermatological lesions or fungal and bacterial infections) and physical examination (hyperemia, edema in the perianal and internal thigh region) sections. As for the image analysis, an increase in quality, resolution, and sharpness was suggested. Lastly, for the cutaneous phototype evaluation, the DoctorSkinFototipo® digital analyzer device was chosen since it is small, portable, easily positioned on the genital area, and can be readily cleaned between patients.  Conclusion The "Genital Dyschromia Evaluation Form" is a questionnaire approved by specialists and could represent a suitable option for health professionals.

Grafted Neural Progenitor Cells Persist in the Injured Site and Differentiate Neuronally in a Rodent Model of Cardiac Arrest-Induced Global Brain Ischemia.

Hypoxic-ischemic brain injury is the leading cause of disability and death after successful resuscitation from cardiac arrest, and, to date, no specific treatment option is available to prevent subsequent neurofunctional impairments. The hippocampal cornu ammonis segment 1 (CA1) is one of the brain areas most affected by hypoxia, and its degeneration is correlated with memory deficits in patients and corresponding animal models. The aim of this work was to evaluate the feasibility of neural progenitor cell (NPC) transplantation into the hippocampus in a refined rodent cardiac arrest model. Adult rats were subjected to 12 min of potassium-induced cardiac arrest and followed up to 6 weeks. Histological analysis showed extensive neuronal cell death specifically in the hippocampal CA1 segment, without any spontaneous regeneration. Neurofunctional assessment revealed transient memory deficits in ischemic animals compared to controls, detectable after 4 weeks, but not after 6 weeks. Using stereotactic surgery, embryonic NPCs were transplanted in a subset of animals 1 week after cardiac arrest and their survival, migration, and differentiation were assessed histologically. Transplanted cells showed a higher persistence in the CA1 segment of animals after ischemia. Glia in the damaged CA1 segment expressed the chemotactic factor stromal cell-derived factor 1 (SDF-1), while transplanted NPCs expressed its receptor CXC chemokine receptor 4 (CXCR4), suggesting that the SDF-1/CXCR4 pathway, known to be involved in the migration of neural stem cells toward injured brain regions, directs the observed retention of cells in the damaged area. Using immunostaining, we could demonstrate that transplanted cells differentiated into mature neurons. In conclusion, our data document the survival, persistence in the injured area, and neuronal differentiation of transplanted NPCs, and thus their potential to support brain regeneration after hypoxic-ischemic injury. This may represent an option worth further investigation to improve the outcome of patients after cardiac arrest.

Analysis of the Effects of Cryofrequency on Localized Fat.

BACKGROUND: Cryofrequency combines cryotherapy with radiofrequency, reaching the tissue in different layers, providing various biological effects, and reducing localized adiposity. OBJECTIVE: We sought to evaluate the efficacy of cryofrequency in reducing localized adiposity. METHODS: The study population consisted of 63 women with infra-abdominal adiposity, evaluated before and after treatment using evaluation protocols, questionnaires, and ultrasound imaging. The volunteers were randomly distributed into three subgroups; of these, Group 1 (G01) received the cryofrequency treatment (temperature of -10°C, 85% power); Group 2 (G02) underwent cryofrequency associated with ultracavitation (frequency of 60 Hz, 70% power, shooting at 25%, duty cycle of 60% on and 40% off); and the control group (CG) received cryotherapy alone (temperature of -10°C). All groups were submitted to four treatment sessions, one session per week. RESULTS: The reduction in the fat layer analyzed by ultrasonography showed that the right side of G01 presented a significant difference in comparison with CG (p=0.01); a significant difference was also observed in the comparison between the G01 and G02 groups (p=0.001). Considering the left side, significant differences were observed in G01 when compared with CG (p=0.01) and between G01 and G02 (p=0.001). The variables of plicometry and perimetry presented a significant difference relative to in CG; however, no differences were observed with regard to weight or body mass index (p>0.05). The majority of participants reported positive feelings about the treatment. CONCLUSIONS: The cryofrequency protocol alone led to a significant reduction in the fat layer but its association with ultracavitation led to superior results.

Hepathic, biochemical, hematological, and histological effects of the ultracavitation in rabbits livers.

PURPOSE: To collect data capable of pointing out the effects of the ultracavitation treatment on the liver of rabbits after adipose tissue application, by means of histological analyses of the liver and hematological and biochemical exams. METHODS: This is an experimental study with 12 albino rabbits as sample, which were divided into 3 groups and submitted to a hypercaloric diet for one month. Subsequently, subjects underwent UCV treatment: 3 minutes, 30 W, continuous mode at 100%, every 2 ERAS = 441.02 J/cm2, intensity of 10w/cm2. They were then euthanized and underwent biopsy after 24 hours. RESULTS: After 48 hours from the ultracavitation treatment, the animals' livers presented greater amount of fat infiltration if compared to the amount presented 96 hours after the treatment. However, laboratory tests showed no alterations. Values were maintained within normal parameters of cholesterol, triglycerides, liver enzymes, hemoglobin and hematocrit levels. CONCLUSIONS: This study has identified that infiltrates may appear on livers after the treatment, despite high hematological and biochemical tests results. The fat infiltrates reduction 96 h after treatment suggests lower risks to animal health, if the period between applications is respected.

Fractures of the distal radius treated with cross-pin fixation and a nonbridging external fixator, the CPX system: a preliminary report.

PURPOSE: To present the preliminary findings of distal radius fractures (DRF) treated with percutaneous cross-pin fixation and a nonbridging external fixator, the Cross-Pin Fixation (CPX) system. METHODS: Thirty-five consecutive patients with 37 DRFs were selected from a series of 51 DRFs for closed reduction, percutaneous pinning, and external fixation with the CPX system. Outcome was determined by studying (1) radiological measurements of radial height, palmar tilt, radial inclination and ulnar variance (UV); (2) grip and pinch strength; (3) wrist active range of motion; and (4) patient outcome instruments-the Patient-Rated Wrist Hand Evaluation and the Disabilities of the Arm, Shoulder, and Hand. RESULTS: We are reporting on 21 patients, 13 females and 8 males, mean age 54 years (range, 27 to 87 y) with AO type fractures A2, B2, B3, C1, C2, and C3. Follow-up was a minimum of 1 year (range, 12 to 36 months). Wrist rehabilitation began at a mean of 10 days (range, 4 to 16 d) after surgery. There was no loss of reduction. Final mean grip and lateral pinch strength recovered 86% and 94%, respectively, and active range of motion increased to a minimum of 89% of the noninjured side. Disabilities of the Arm, Shoulder, and Hand showed change in functional status (minimal detectable change at 95% confidence level) at 4 and 12 weeks. The Patient-Rated Wrist Hand Evaluation results reported resumption of usual activities in the early postoperative period. One patient developed type I complex regional pain syndrome, which resolved, and one patient had residual transient mild superficial radial nerve sensitivity. There were no pin track infections, nonunions, or tendon injuries. All patients returned to their prior employment and activities. CONCLUSIONS: The CPX system is a minimally invasive technique of closed reduction and internal fixation for displaced, reducible extra-articular and nondisplaced and displaced reducible intra-articular fractures of the distal radius, allowing rehabilitation of the wrist and resumption of usual activities while maintaining fracture reduction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Study protocol for a Community Health Worker (CHW)-led comprehensive neighborhood-focused program for medicaid enrollees in detroit.

Residents of low income neighborhoods disproportionately experience poor health, and many have unmet social needs. Clinical trials have shown the efficacy of Community Health Worker (CHW) programs in improving outcomes for a variety of health conditions. An important next step is developing and evaluating financially sustainable CHW program models in real-life settings. This program evaluation examines health care utilization among participants in a geographically targeted program led by salaried CHWs from three Medicaid health plans. Beneficiaries who reside in the Cody Rouge neighborhood of Detroit and had more than 3 Emergency Department (ED) visits or at least 1 ambulatory care-sensitive hospitalization in the prior 12 months are eligible for the program. Health plan CHWs assigned to the program reach out to eligible beneficiaries to provide an assessment; link them to resources; and provide follow-up. At 12-month follow up, claims data on ED visits, ambulatory care-sensitive hospitalizations, primary care visits, and related costs will be compared between beneficiaries who participated and eligible beneficiaries randomized to receive usual outreach. We hypothesize that patients enrolled in the CHW intervention will experience a reduction in acute care usage resulting in cost savings compared to those receiving usual health plan outreach. This study is among the first to evaluate the impact on health care utilization of augmented services delivered by health plan CHWs for high-utilizing health plan members as part of a health plan-community-academic partnership. This study will provide important information on CHW program sustainability and provide insights into effective implementation of such programs. TRIAL REGISTRATION: NCT03924713.