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Mauricio de Maio,1 Elian Elisabeth Anne Brenninkmeijer,2 Iman Nurlin,3 Ligia Colucci,4 Tania Sanchez5 1MD Codes Institute, Sao Paulo, SP, Brazil; 2Brenninkmeijer Aesthetic Dermatology, Amsterdam, the Netherlands; 3Ribelle Clinic, Örebro, Sweden; 4Clinica Colucci, Belo Horizonte, MG, Brazil; 5Instituto Dermatológico de Jalisco, Zapopan, Jalisco, MexicoCorrespondence: Mauricio de Maio, MD Codes Institute, Avenida Brigadeiro Faria Lima, 4509 - cjs 121, Vila Olímpia, Sao Paulo, SP, Brazil, Tel +55 11 5535-9286, Fax +55 11 5531-4720, Email mauriciodemaio@uol.com.brBackground: Aesthetic treatment directed at improving facial emotional messages and social attributes may maximize patient satisfaction with treatment results. The MD Codes™ is an approach to facial aesthetic treatment that accounts for emotional messages and social attributes while minimizing variability in patient assessment, injection technique, injection sites, and treatment outcomes.Objective: To assess the impact of the MD Codes systematic treatment approach on emotional and social attributes and natural appearance after facial aesthetic treatment with hyaluronic acid (HA) fillers.Methods: A retrospective analysis was performed in patients treated with 12 mL of HA fillers (Juvéderm® Vycross™ products) per patient using the MD Codes. Study injectors, experienced clinician observers, clinical staff, laypeople, and patients evaluated impact of treatment on emotional and social attributes and natural appearance based on pre- and post-treatment photographs of patients.Results: Twelve patients and 49 external observers, from 12 countries, evaluated the images. More than 90% of patients named “eye bags” as the facial area most in need of aesthetic treatment; > 55% of external observers identified “cheeks.” The top 3 facial emotional attributes noted by all evaluators after treatment were, in order, “less tired”, “less saggy”, and “younger.” All patients reported a visible and positive change in emotional attributes except for “less sad.” After 9 months, most patients reported looking “less tired” (n=11/12), “less saggy” (n=8/12), and “less sad” (n=6/12). At months 6 and 9, all patients rated their appearance as natural looking. At least 90% of external observers considered the frontal view results natural for all but 1 patient. Patients reported improved positive social attributes (eg, “looking friendlier”) and improvements in well-being after treatment. No serious side effects were reported.Conclusion: Implementing the MD Codes for facial aesthetic treatment may improve facial emotional attributes as well as enhance social attributes and well-being, with natural-looking results.Keywords: aesthetics, dermal fillers, hyaluronic acid, rejuvenation, skin aging, skin wrinkling

O uso da toxina botulínica é cada vez mais freqüente em procedimentos estéticos não cirúrgicos. Muitos aspectos, no entanto, ainda necessitam ser esclarecidos. Através do agrupamento de pacientes em diferentes padrões musculares, a duração do efeito pode ser estabelecida e informada aos pacientes.Os grupos consistem em: padrões cinéticos, hipercinéticos e hipertônicos. O padrão cinético indica que pacientes apresentam uma concordância com a expressão facial e emoções. Eles provavelmente precisarão somente de um tratamento por ano. O padrão hipercinético refere-se a pacientes que não movem seus músculos de acordo com sua mímica. Os músculos faciais contraem rapidamente e a duração varia de 4 a 6 meses. O padrão hipertônico é encontrado naqueles pacientes que são incapazes de relaxar seus músculos faciais e a duração pode ser somente de 2 a 3 meses. O que torna o tratamento frustrante para pacientes e médicos. Através do entendimento do comportamento muscular, a abordagem do paciente e seu agrupamento de acordo com os específicos padrões musculares possibilita a previsão da duração e orienta sobre os futuros tratamentos. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate whether the type and degree of physical activity commitment (i.e., team sport athletes, highly active individuals, sedentary behavior) influence body image and exercise behavior. A total of 96 participants (46 women and 50 men; age: 22.7 ± 2.7 years; height: 170 ± 8.6 cm; weight: 67.6 ± 10.8 kg) were divided in six groups: female volleyball and male football players (student athletes classified as Tier 2), highly physically active women and men, with high sitting time completed the Body Image Dimensional Assessment and the 21-item Exercise Dependence Scale to evaluate body dissatisfaction and level of dependency on exercise. The Body Image Dimensional Assessment is a silhouette-based scale, where three direct indices are derived from the participants' responses: body dissatisfaction, sexual body dissatisfaction, and comparative body dissatisfaction. The Exercise Dependence Scale is a six-point Likert scale that evaluates seven dimensions of exercise dependence (tolerance, withdrawal, intention effects, lack of control, time, reductions in other activities, and continuance) and provides an overall score. A multivariate analysis of variance was used to examine the effects of different levels of physical activity, team sport participation (volleyball and football), and sedentary behavior (i.e., high sitting time) on participants' body image indices and dimensions of exercise dependence according to sex. Volleyball players showed significantly higher body dissatisfaction than football players ( d = 0.99) and the physically active men group ( d = 2.31), who had lower values than sedentary women group ( d = 1.68). Football players had lower comparative body dissatisfaction values than volleyball players ( d = 1.70) and sedentary women ( d = 1.69), who had higher values than sedentary men ( d = 1.04). Sedentary women had a significantly lower exercise dependence scale score than volleyball players ( d = 1.71), football players ( d = 1.12), and physically active men ( d = 1.21). The findings highlight the impact of regular physical activity on body dissatisfaction and the variance in body image perceptions between the sexes. Moreover, the high exercise dependence values found in volleyball and football players and physically active men suggest an effect of intense training and maladaptive exercise behaviors, underlining the need for comprehensive strategies to address exercise dependence.

Background: Brugada syndrome poses significant challenges in terms of risk stratification and management, particularly for asymptomatic patients who comprise the majority of individuals exhibiting Brugada ECG pattern (BrECG). The aim of this study was to evaluate the long-term prognosis of a large cohort of asymptomatic patients with BrECG., Methods: Asymptomatic patients with BrECG (1149) were consecutively collected from 2 Italian centers and followed-up at least annually for 2 to 22 years. For the 539 asymptomatic patients (men, 433 [80%]; mean age, 46±13 years) with spontaneous type 1 documented on baseline ECG (87%) or 12-lead 24-hour Holter monitoring (13%), an electrophysiologic study (EPS) was proposed; for the 610 patients with drug-induced-only type 1 (men, 420 [69%]; mean age, 44±14 years), multiple ECGs and 12-lead Holter were advised in order to detect the occurrence of a spontaneous type-1 BrECG. Arrhythmic events were defined as sudden death or documented ventricular fibrillation or tachycardia., Results: Median follow-up was 6 (4-9) years. Seventeen (1.5%) arrhythmic events occurred in the overall asymptomatic population (corresponding to an event-rate of 0.2% per year), including 16 of 539 (0.4% per year) in patients with spontaneous type-1 BrECG and 1 of 610 in those with drug-induced type-1 BrECG (0.03% per year; P <0.001). EPS was performed in 339 (63%) patients with spontaneous type-1 BrECG. Patients with spontaneous type-1 BrECG and positive EPS had significantly higher event rates than patients with negative EPS (7 of 103 [0.7% per year] versus 4 of 236 [0.2% per year]; P =0.025). Among 200 patients who declined EPS, 5 events (0.4% per year) occurred. There was 1 device-related death., Conclusions: The entire population of asymptomatic patients with BrECG exhibits a relatively low event rate per year, which is important in view of the long life expectancy of these young patients. The presence of spontaneous type-1 BrECG associated with positive EPS identifies a subgroup at higher risk. Asymptomatic patients with drug-induced-only BrECG have a minimal arrhythmic risk, but ongoing follow-up with 12-lead Holter monitoring is recommended to detect the appearance of spontaneous type-1 BrECG pattern., Competing Interests: Disclosures None.

Background: Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment)., Aims: To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade., Methods: This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20-60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns., Results: Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes., Conclusions: Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Parkinson's disease (PD) is a progressive and neurodegenerative disorder defined by physical symptoms such as hand disability and postural instability. To counteract the detrimental effects of PD, physical activity programs showed improvements in overall aspects of physical functioning. Therefore, this protocol will aim to evaluate the effect a of postural and fine motor skills training program in older adults with PD. PD individuals, with mild to moderate stage PD, aged between 65 to 80 years, will be voluntary selected from the Nursing Home Residences and Rehabilitation Centers. Subsequently, they will be randomly assigned to intervention group (PD) to receive a combined training program (postural control and fine motor skills exercises) or to the Control group (CON) to receive a stretching program. Before (PRE) and after (POST) a 12-week program both groups will perform wobble board (WB) and grooved pegboard (GPT) tests. Different performances between groups will be expected: (1) no significant differences between PD and CON group for WB and GPT test values before the beginning of the training intervention (PRE); (2) significantly better WB and GPT test values in PD subjects after the training intervention (POST) when compared to the base values (PRE); and (3) no significant differences in WB and GPT test values in CON subjects after the training intervention (POST) when compared to the base values (PRE). The findings of the present study protocol could be used for future studies investigating clinical populations, such as PD, and the effects of different rehabilitative interventions aiming to improve postural control and fine motor skills performances assessed by WB and GPT tests.

Background: Regardless of the treatment protocol, stability in Class III patients always represents a major concern. The aim of this study was to assess the short and long-term skeletal and dentoalveolar modifications in a group of class III patients treated with hybrid rapid maxillary expander (RME) and facemask (FM). Indeed, no long-term studies have been conducted yet with the objective of evaluating the effects of this kind of approach when applied to patients who have already gone thought their peak of growth., Material and Methods: 27 patients with skeletal Class III malocclusion were treated using hybrid RME according to alternating rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by 4 months of facemask therapy. After the orthopaedic phase, each patient underwent orthodontic treatment with fixed multibracket appliances. A mean follow-up of 7 years, 10 months was performed. Pre-treatment (TO), post-treatment (T1) and follow up (T2) cephalometric tracing were analysed, comparing dental and skeletal measurements., Results: Point A advanced by a mean of 3.5 mm with respect to VerT, then relapsed by 0.7 in the post-facemask period, thereby yielding of a mean advancement of 2.7 at T2. The sagittal relationship significantly changed after RME + facemask protraction (3.8° of ANB and 5.189 mm of Wits). Although both Wits and ANB values worsened over time, the improvement from T0 is still appreciable at T2., Conclusion: Despite the physiological relapse due to mandibular growth, the long-term cephalometric follow-up confirms the maintenance of all positive outcomes of the previous orthopaedic treatment with hybrid RME and facemask., (© 2022. The Author(s).)

The role of physical activity in improving overall aspects of health regardless of age is well documented. Due to the coronavirus disease 2019 outbreak, preventive measures to limit airborne infection have been introduced, with people, especially older adults, advised to stay at home, thus increasing sedentary lifestyle and the risk of chronic diseases. As one of the few possible ways to stay active is home-based training, this review aims to provide evidence on alternative and feasible home-based activity programs as a tool to improve the fitness level in older adults, especially when preventive measures are needed to ensure isolation and limit interpersonal contacts. During quarantine, older adults, especially those with chronic diseases, are recommended to regularly exercise. Combined balance and muscle-strengthening training has proven to be particularly useful in limiting falls and mobility limitations. In addition, the use of virtual reality systems seems to be a potential strategy in remaining physically active, reducing physical inactivity time and significantly increasing the compliance of the older adults with physical activity programs. In conclusion, home-based programs induce improvements in physical functions in general and quality of life in older people with or without co-morbidities, and it can be considered in the future as one of the feasible and economic ways to increase physical well-being. This may be of unique importance in the setting of coronavirus disease 2019 enforced limitations in out-of-home activity.

Computerized wobble boards (WB) are used to objectively assess balance in healthy and chronic ankle instability individuals. As in field setting health professionals might not own WB, objective evaluations are not always feasible. Therefore, the aim of this tudy was to investigate the contribution of sagittal plane joints angular-displacement and anthropometrics to predict equations to estimate WB performance by portable two-dimensional motion analysis (2D-MA) and cross-validate the developed equations in chronic ankle instability individuals. Thirty-nine healthy and twenty chronic ankle instability individuals stood on a WB in single stance position. The balance test consisted of three 30s trials per limb keeping the platform flat at 0°. Trials were video recorded, and three time-segments joints angular-displacement analyzed with 2D-MA: segment 1 (T1) including 30s data, segment 2 (T2) from second 0 to 10, segment 3 (T3) only the first 5s. Mixed regression for multilevel models was used to estimate WB performance for each time-segment and to examine limb differences for the predicted WB performance in chronic ankle instability sample. The accuracy of the equations to detect injured limbs was calculated via area under the curve for receiver operating characteristic. Ankle and knee angular-displacement parameters, body height and lower limb length were the major predictors of WB performance for the extrapolated models (p < 0.05; R 2 = 0.83-0.56). The measured WB performance and T1 model showed significant (p < 0.05) performance differences between the injured and uninjured limbs. Receiver operating characteristic analysis showed an asymptotic significance of 0.03 for T1 equation with area under the curve of 0.70. The proposed models provide different methods to quantify the performance and accurately detect the injured limb in individuals with unilateral chronic ankle instability, when measuring balance via WB might not be feasible. App-makers may use the equations to provide an automatic all-in-one system to monitor the performance status and progress., (© 2020 Published by Elsevier Ltd.)

Groundwater contamination by hexavalent chromium (Cr (VI)) is currently a very serious and challenging issue. Therefore, in the present study, 108 shallow groundwater samples were collected during the years 2012 to 2015 (n = 27 samples each year) from an industrial town (Aosta) to assess the contamination status of the area. To evaluate the Cr (VI) concentration level, sources of pollutants and groundwater geochemistry of the study area, a combined approach of the multi-statistical and hydrogeochemical techniques were used. Furthermore, a geographic information system (GIS) was applied for the spatial distribution of Cr (VI) so that the most contaminated sites can be identified for a quick decision by policymakers. Results show that the groundwater chemistry was dominated by HCO 3 - and SO 4 2- in the anionic chemistry and Ca 2+ and Na + in the cationic chemistry, while Ca-Mg-HCO 3 and Ca-Mg-Cl-SO 4 were the main water types during the years 2012-2015 in the study area. The central part and some north-eastern parts of the Aosta town groundwater was contaminated with Cr (VI) and are unsafe for drinking use. Concentration levels of Cr (VI) in the groundwater were 0.09 μg/L (lowest value) and 165 μg/L (highest value) in the years studied, and the spatial analysis shows the diffusion of Cr (VI) to north-east direction from the source. Contamination of Cr (VI) in the groundwater was due to the superficial slag deposits from a steel company within the study area. This study would be helpful for current and future water resource management in the area concerned., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Fifty-six groundwater samples were taken from the island of Favignana to evaluate the interaction between the groundwater and seawater, as well as the deterioration factors for the aquifers, using the combined hydrogeochemical and multivariate statistical approaches. Results show that the order of the groundwater chemistry in the study area was Na + > Ca 2+ >Mg 2+ >K + and Cl - >HCO 3 - >SO 4 2- >NO 3 - . The groundwater samples were in the moderate saline zone to highly saline zone and indicate that the groundwater of the island of Favignana was recharged with seawater. The spatial distribution maps of Cl - and NO 3 - show that most of the groundwater samples had high concentrations of Cl - and NO 3 - in the study area. The ionic ratio diagrams, such as Na + /Cl - versus Cl - , Mg 2+ /Ca 2+ versus Cl - and Ca 2+ /HCO 3 - versus Cl - , and other hydrogeochemical plots reveal that the groundwater chemistry of the study was primarily controlled by the seawater intrusion and reverse ion exchange process, with a small contribution from carbonate dissolution. Additionally, the NO 3 - /Cl - versus Cl - diagram and principal component analysis (PCA) show that the contamination of nitrate in the study area was due to human activities (i.e. agriculture and domestic sewage disposal). The outcome of the present research could be helpful for groundwater resource management in coastal environments., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: There is increasing interest among patients and plastic surgeons for alternatives to rhinoplasty, a common surgical procedure performed in Asia., Objectives: To evaluate the safety, efficacy, and longevity of a hyaluronic acid filler in the correction of aesthetically detracting or deficient features of the Asian nose., Methods: Twenty-nine carefully screened Asian patients had their noses corrected with the study filler (Juvéderm VOLUMA [Allergan plc, Dublin, Ireland] with lidocaine injectable gel), reflecting individualized treatment goals and utilizing a standardized injection procedure, and were followed for over 12 months., Results: A clinically meaningful correction (≥1 grade improvement on the Assessment of Aesthetic Improvement Scale) was achieved in 27 (93.1%) patients at the first follow-up visit. This was maintained in 28 (96.6%) patients at the final visit, based on the independent assessments of a central non-injecting physician and the patients. At this final visit, 23 (79.3%) patients were satisfied or very satisfied with the study filler and 25 (86.2%) would recommend it to others. In this small series of patients, there were no serious adverse events (AEs), with all treatment-related AEs being mild to moderate, transient injection site reactions, unrelated to the study filler., Conclusions: Using specific eligibility criteria, individualized treatment goals, and a standardized injection procedure, the study filler corrected aesthetically detracting or deficient features of the Asian nose, with the therapeutic effects lasting for over 12 months, consistent with a high degree of patient satisfaction. This study supports the safety and efficacy of this HA filler for specific nose augmentation procedures in selected Asian patients. LEVEL OF EVIDENCE 3: Therapeutic., (© 2016 The American Society for Aesthetic Plastic Surgery, Inc.)

Objective: The peroxisome proliferator-activated receptor gamma (PPARgamma) is a member of the nuclear receptor superfamily of ligand-dependent transcription factors related to retinoid, steroid, and thyroid hormone receptors. The thiazolidinedione rosiglitazone is a PPARgamma ligand that modulates the transcription of target genes. The aim of this study was to investigate the effects of rosiglitazone on the inflammatory response in mice with collagen-induced arthritis (CIA)., Methods: CIA was induced in DBA/1J mice by an intradermal injection of 100 microl of an emulsion of bovine type II collagen (CII; 100 microg) in Freund's complete adjuvant (CFA) at the base of the tail. On day 21, a second injection of CII in CFA was administered. Rosiglitazone (10 mg/kg/day) or vehicle (10% DMSO) was administered beginning on day 25 (arthritis onset) until day 35. Clinical, radiographic, histopathologic, and laboratory assessments were performed., Results: Mice immunized with CII in CFA developed erosive arthritis of the hind paws. Macroscopic evidence of CIA first appeared as periarticular erythema and edema of the hind paws. The incidence of CIA was 100% by day 27 in the CII-challenged mice, and the severity progressed over the 35-day study period. Radiographic evaluation revealed focal resorption of bone. Histopathologic features of CIA included erosion of cartilage at the joint margins. Rosiglitazone treatment ameliorated the clinical signs on days 26-35 and improved the histologic findings in the joint and paw. The degree of oxidative and nitrosative damage was significantly reduced in rosiglitazone-treated mice, as indicated by elevation of malondialdehyde levels, formation of nitrotyrosine, and activation of poly(ADP-ribose) polymerase. Plasma levels of the proinflammatory cytokines tumor necrosis factor, interleukin-1beta, and interleukin-6 were also significantly reduced by rosiglitazone treatment., Conclusion: These data demonstrate that rosiglitazone exerts an antiinflammatory effect on chronic inflammation and is able to ameliorate the tissue damage associated with CIA.

Purpose: The Internet expands the range and flexibility of teaching options and enhances the ability to process the ever-increasing volume of medical knowledge. The aim of this study is to describe and discuss our experience with transforming a traditional medical training course into an Internet-based course., Method: Sixty-nine students were enrolled for a one-month course. They answered pre- and post-course questionnaires and took a multiple-choice test to evaluate the acquired knowledge., Results: Students reported that the primary value for them of this Internet-based course was that they could choose the time of their class attendance (67%). The vast majority (94%) had a private computer and were used to visiting the Internet (75%) before the course. During the course, visits were mainly during the weekends (35%) and on the last week before the test (29%). Thirty-one percent reported that they could learn by reading only from the computer screen, without the necessity of printed material. Students were satisfied with this teaching method as evidenced by the 89% who reported enjoying the experience and the 88% who said they would enroll for another course via the Internet. The most positive aspect was freedom of scheduling, and the most negative was the lack of personal contact with the teacher. From the 80 multiple-choice questions, the mean of correct answers was 45.5, and of incorrect, 34.5., Conclusions: This study demonstrates that students can successfully learn with distance learning. It provides useful information for developing other Internet-based courses. The importance of this new tool for education in a large country like Brazil seems clear.

1. In C6 glioma cells exposed to chemical hypoxia a massive release of lactate dehydrogenase (LDH) occurred at 3 and 6 h, coupled with an increased number of propidium-iodide positive dead cells. 2. Extracellular Na+ removal, which activates the Na(+)-Ca2+ exchanger as a Na+ efflux pathway and prevents Na+ entrance, significantly reduced LDH release and the number of propidium iodide positive C6 cells. 3. During chemical hypoxia, in the presence of extracellular Na+ ions, a progressive increase of [Ca2+]i occurred; in the absence of extracellular Na+ ions [Ca2+]i was enhanced to a greater extent. 4. The blockade of the Na(+)-Ca2+ exchanger by the amiloride derivative 5-(N-4-chlorobenzyl)-2',4'-dimethylbenzamil (CB-DMB), lanthanum (La3+) and the Ca2+ chelator EGTA, completely reverted the protective effect exerted by the removal of Na+ ions on C6 glioma cells exposed to chemical hypoxia. 5. The inhibition of the Na(+)-Ca2+ antiporter enhanced chemical hypoxia-induced LDH release when C6 glioma cells were incubated in the presence of physiological concentrations of extracellular Na+ ions (145 mM), suggesting that the blockade of the Na(+)-Ca2+ antiporter during chemical hypoxia can lead to increased cell damage. 6. Collectively, these results suggest that activation of the Na(+)-Ca2+ exchanger protects C6 glioma cells exposed to chemical hypoxia, whereas its pharmacological blockade can exacerbate cellular injury.