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The use of applications is part of people daily lives for various activities. In relation to development, the curiosity about the characteristics responsible for success arises. We use classifiers to meet the success requirements of the Google Play Store app store. Through the techniques of KNN and Random Forest, a statistical analysis was done performing the regressions of the applications according to some characteristics: as hypothesis test, correlation and regression metrics analysis. This work aims to create inference engines, allowing the prediction of application ratings, using the KNN and Random Forest regression techniques. The Random Forest showed better results than the KNN.

An estimated 100 million people per year in developed countries acquire scars following surgical procedures whether it be elective, therapeutic or reparative. Scarring from surgery can have a significant physical and psychological impact depending on the colour, relief, size, body location, surface area or function. Whether a procedure be life-saving such as a mastectomy, a caesarean, or a mole excision, or aesthetic such as breast reconstruction or laser treatment, patients are increasingly concerned with having an aesthetic scar outcome. With improved surgical and technological advances, elective surgery and cosmetic procedures are becoming safer and easier to perform in both hospitals and outpatient clinics. This means that more people elect to undergo procedures for an increasing number of indications on varied body areas including the face, back and limbs but also breasts, ears or genitalia. Therefore, taking the final scar outcome into consideration both before and after a procedure is becoming particularly important to ensure that controlled healing occurs with minimal discomfort. As the healing process varies from one procedure to another, and from one body part to another, each wound requires specific care. Dermatologists are well placed to manage wound healing but there remains a need for them to be involved in wound management and help surgeons better manage the wound healing process beyond wound closure and infection control. Basic skin care can play a role to protect the skin barrier function, control inflammation and enhance natural healing. The objective of this review is to provide recommendations based on published literature for the role basic skin care plays in supporting continued wound management following invasive procedures.

Although several cytokines and chemokines have been investigated as possible mediators of fibrosis in systemic sclerosis (SSc), specific correlation between cytokines and organ involvement have not been found yet, and a cytokine profile characteristic of SSc is far to be identified. We studied the profile of antifibrotic and profibrotic transcripts involved in skin of SSc patients. The mRNA expression was detected by fluorescence-based quantitative real-time PCR (qPCR) in skin's biopsies from 14 patients with SSc and 5 healthy controls. PDGF-A, CTGF, CCL3, IL-6, IL-13, IL-7, IFNγ, IL-17, IL-22 and RORc were analysed in these samples. CCL3, IL-7, IL-13 and IFN-γ were more expressed in skin's biopsy of patients with SSc (P = 0.0002, P = 0.0082, P = 0.0243, P = 0.0335, respectively) when compared with healthy controls. We also found a positive correlation between CCL3 and IL-7 transcripts (P = 0.0050 r = 0.7187). Furthermore, we observed that patients with lung involvement had lower expression of PDGF-A (P = 0.0385). We found an increase in IL-7, IFN-γ, CCL3 and IL-13 relative mRNA expressions on the skin's biopsy of patients with SSc, and a positive correlation between IL-7 and CCL3. These molecules are involved in the pathogenesis of SSc, and how their interactions occur should be the subject of further studies.

Scleroderma is a connective tissue disease of unknown etiology, characterized essentially by progressive fibrosis of the skin. An inflammatory response triggered by the destruction of the epidermis causes the production of parallel oriented thick bundles of collagen, unlike the interlacing network of collagen found in normal skin. Studies have shown that TGF-COPY3 plays a significant role: TGF-COPY16 and TGF-COPY2 promote the formation of scar tissue collagen, while TGF-COPY4 promotes wound regeneration and healing at the expense of collagen closer to physiological. When a parallel is made with the pathogenesis of scleroderma, it is observed that the GFR-β1 and the TGF-β2 are considered the main regulatory factors of both physiological fibrogenesis and pathological fibrosis with pleiotropic activities on several cell types. Thus, it was possible to suggest that the action of PCI on this sclerotic collagen, due to the modification of the inflammatory cascade triggered mostly by TGF-α1 and TGF-α3, would result in skin that looks closer to the physiological.

The ability of percutaneous induction of collagen (PCI) with needles to produce whitening and improvement of skin quality is already well studied. In parallel, intense pulsed light (IPL) whitens melanoses and also improves the appearance of the skin. The author then proposed the association of these two techniques for areas such as the face, neck, and limbs. The first observations already presented, by the dermatological evaluation and perception of the patients, results superior to those of the procedures performed alone. Later, the authors identified an advantage in the speed of recovery of the skin, with elimination of the crusts in a smoother way and uniformity of skin color more quickly, when compared to the isolated use of IPL. In order to further optimize its results, the author decided to add the well-known retinoic acid. See the following protocol description. PCI has its effect well demonstrated on scars. The author considers its introduction in the therapeutic arsenal of these lesions a water divisor, regardless if they are depressed or elevated scars. The association of IPL with PCI is chosen when dealing with recent high, neovascularized, or keloid lesions.

Cellulitis is a metabolic disorder located in subcutaneous cell tissue that causes changes in body contour. There are several treatments proposed to attenuate the waviness aspect observed in the skin affected by cellulite such as endermology, liposuction, use of topics with potential to thicken the epidermis and dermis such as retinoids, and the use of peelings, which also act for this purpose. The use of needles with the intention of breaking the fibrous septum and releasing the imprisoned skin and the incarcerated adipocytes has been recommended. Orentreich and Orentreich (Dermatol Surg 21(6):543–9, 1995) were the first to report the use of needles with the purpose of stimulating the production of collagen in the treatment of depressed scars and wrinkles, a technique spread with the name of Subcision™. Hexsel and Mazzuco (An Bras Dermatol 72(1):27–32, 1997) studied 46 patients with different degrees of cellulitis treated with Nokor 18 G needle. PCI offers the proposal to improve texture, coloring, waving, and relief of the area with cellulite by means of microneedles. It is considered a safe therapeutic approach with interesting cosmetic results in the treatment of modest cellulite conditions or as a complementary technique in association with dermal tunneling or Subcision™. To this end, it is essential that the operator is skilled and safe in the proposal and ensures its suitability for the individual to be treated.

Studies have shown that the beta tissue growth factor (TGF-β) plays a significant role in the first 48 hours of scar formation. So, as TGF-β1 and TGF-β2 promote the formation of scar collagen, TGF-β3 appears to promote wound regeneration and healing at the expense of normal collagen, virtually without the characteristics of scar tissue. Percutaneous collagen induction (PCI) with microneedling proposes a stimulus in the production of collagen without causing the total deepithelialization observed in ablative techniques. This intervention starts with the loss of the cutaneous barrier integrity, targeting the dissociation of keratinocytes, which results in the release of cytokines such as IL-1 alpha (predominantly), besides IL-8, IL-6, tumor necrosis factor alpha (TNF-α), and granulocyte-macrophage colony-stimulating factor (GM-CSF). This results in dermal vasodilatation and migration of keratinocytes to restore epidermal damage. Three phases of the healing process, consequent to needle trauma, can be didactically delineated for better understanding: injury, healing, and maturation.

The keloids initiated in the reticular dermis project to the skin and do not regress spontaneously. They are erythematous-violaceous, skin-colored, or hyperchromic and are distinguished from elevated scars by exceeding the limits of initial injury. It is believed that there are no spontaneous keloids. Lesions without apparent causes were probably the result of a mild injury, not perceived by the patient. Techniques for keloid management have been used with variable responses, such as intralesional injections with bleomycin and corticosteroids alone or in association, cryosurgery, use of silicone plates, lasers, intense pulsed light, in addition to topical assets such as 5-fluorouracil, interferone, retinoids, 5% imiquimode, tacrolimus, verapamil. Botulinum toxin has shown good results in specific cases. Corticosteroids present side effects such as risk of secondary infection, atrophy, telangiectasis, and hypopigmentation. Cryosurgery, when performed by not very experienced professionals, can lead to atrophy and hypochromia, and bleomycin can trigger hyperpigmentation. PCI proposes to destructure fibrosis and abnormal collagen, creating hematic columns with production of a new collagen, without causing the deepithelialization observed in ablative techniques.

When an intervention is made in Afrodescendant patients, the most significant difference in relation to Caucasians, for example, corresponds to the amount of melanin. This peculiarity of ethnic skin requires special attention from the dermatologist when choosing a treatment for scars, stretch marks, cellulite, wrinkles, flaccidity, and bleaching of spots, as well as extra care in the preparation, during treatment and post-procedure, in order to avoid complications. It is worth noting that in a mixed country like Brazil, where the majority of the population is ethnically diverse, interventions will always be subject to unexpected effects, even on skins considered less susceptible to complications. The percutaneous induction of collagen with needles presents a proposal to stimulate the production of collagen, without causing the deepithelialization observed in ablative techniques and without the heating of lights. The epidermis and dermis are perforated but not removed. The procedure is safe even when there is so much melanin.

The use of needles in order to stimulate the production of good quality collagen in the treatment of scars was initially described by Orentreich and Orentreich in 1995, who successfully reported the use of the Subcision™ technique. Shortly after, Camirand and Doucet (Aesthetic Plast Surg 21(1):48–51, 1997) reported cases of scar improvement after performing scar scarification using the needles of a tattoo machine. It is already well established that the perforation caused by needles triggers the cascade of wound healing, and in this process, through the release of growth factors, collagen production occurs. The origin of the instruments used is also important with respect to the quality of the needles. Different materials used in the manufacture of the needles interfere with the resistance, the characteristic of the injury caused, and, consequently, the results. The needles are diagonally arranged in some instruments, seeking optimization of results. The scanning microscopy shows the difference in length of the needles, which directly interferes in the intensity of the lesion caused in the skin. The microneedles attached to the device are made of stainless steel and generally pre-sterilized with gamma radiation. The rollers used for medical treatment are for single use. They should not be re-sterilized, as they lose their cut and buckle the needles, compromising the result and the safety of the procedure (Aust MC. Plast Reconstr Surg. 121(4):1421–9, 2008; Bal SM et al. Eur J Pharm Sci. 35(3):193–202, 2008; Brody HJ. Plast Reconstr Surg. 2(2):127–8, 1995).

The use of needles for cosmetic interventions is increasingly gaining ground and consolidating within the dermatologist’s therapeutic arsenal. Orentreich and Orentreich were the first to report the use of needles with the objective of stimulating the production of collagen in the treatment of depressed scars and wrinkles, a technique widespread under the name of Subcision™. Their studies were confirmed by other authors, who were based on the same precept: rupture and removal of the damaged subepidermal collagen, followed by substitution by new collagen and elastin fibers. The change in color, texture, elasticity, and uniformity of the skin surface in the presence of scars is secondary to inflammatory changes affecting the epidermis, dermis, and hypodermis en bloc or alone, and these sites are targeted by techniques that use needles. Needles with particular characteristics have been used by different authors in their procedures, among them 19 G, 20 G, 21 G, and 18 G 1.5 Nokor, presenting particular technical advantages in their experiments. Dermal tunneling (DT) proposes the release of fibrotic beams in the dermis into depressed scars, with the use of a new instrument and guided by an easy to perform methodology.

The ability to induce epidermal changes in the upper dermis and promote the migration of melanocytes forms the basis for our hypothesis that in the case of vitiligo, microneedling can act not only as an agent in the promotion of drug delivery but also as a therapeutic agent. However, thus far, microneedling has been neither reported nor investigated as an exclusive treatment for vitiligo. Lima et al. (Dermatol Surg 46(13):434–5, 2020) describe the satisfactory results for cutaneous microneedling tests as a clinical treatment in 12 patients with stable localized refractory vitiligo. There was pigmentation induction in ten (83%) of the treated patients. All 12 patients completed the 4 sessions. There were no adverse effects associated with the treatment that were considered to be of good tolerability. Those who observed some pigmentation reported greater satisfaction with the treatment. The pigmentary response was sustained for 12 months after treatment. The pathophysiology of vitiligo is complex, involving oxidative damage in the upper dermis, changes in melanocyte adhesion, loss of autophagy, and fibroblast senescence.

The use of needles for cosmetic interventions is increasingly gaining ground and consolidating within the dermatologist’s therapeutic arsenal. Orentreich and Orentreich were the first to report the use of needles with the objective of stimulating the production of collagen in the treatment of depressed scars and wrinkles, a technique widespread under the name of Subcision™, followed by other authors who presented adaptations to the technique, with needle variation and approach. As already mentioned in previous chapters, dermal tunneling (DT) was inspired by this detachment technique and guided by its principles of fibrotic beam rupture and collagen production stimulus. For this, the methodology and instruments themselves required the DT denomination to characterize this new approach. Post-acne inflammatory scars are a frequent complaint, which presents itself as a great challenge, even in the face of all the therapeutic options offered by qualified dermatologists. The technique offers its own methodology to be followed, seeking standardization, with the objective of presenting results, as far as possible, predictable. It is indicated for facial lipodystrophy, often observed in patients after cystic acne. The typical flaccidity of the genian region and the wrinkles resulting from this excess skin are improved by the technique.

The deeper the scar, the greater the challenge. Scars in which the epidermis has been completely destroyed with melanin loss and result in atrophic scarring are also more difficult to treat. The lesions on the face are more responsive to PCI when compared to those found on the chest or back; the latter need more interventions to offer the same result as the former. Scars located in more oily areas, in the author’s experience, offer a better response to treatment, when compared to those arranged in regions with fewer seborrheic glands. This characterizes a differential of PCI, a technique that only needle the skin, in relation to the incision. In the latter, the enlargement and often the worsening of the scar is evidenced, most commonly in oily skin. Cystic acne usually results in scars that are difficult to treat. The consumption of the dermis and hypodermis, as well as the deterioration of the epidermis resulting from the destructive action of inflammatory cytokines, gives rise to depressed, elevated, dystrophic lesions, in addition to loss of pigment, hyperpigmentation, flaccidity, and development of superficial and deep rhytides. This polymorphism, commonly observed in patients after severe and prolonged inflammatory acne, presents itself as a therapeutic challenge. For this reason, it is necessary to evaluate these lesions in a particular way, examining their architecture and directing the option of more specific intervention to the correction of each cicatricial unit.

The need to be absent for a long time from their work activities often limits the choice of the candidate for these interventions. In percutaneous collagen induction (PCI) with needling, the choice of a proposal for a mild, moderate, or deep lesion determines post-procedural care and guidance. The preparation of the skin to be treated is recommended in dermatological procedures, aiming to prevent complications. A treated skin, adapted to the sun filter and with less melanin available to the possibility of post-inflammatory hyperpigmentation, is always welcome. However, it is observed that the risks of complications, even in a skin that has not been previously prepared, are lower with the PCI if compared to the techniques that dehepithelialize. In this chapter, the factors involved and possible conducts prior to the procedure will be discussed. It is known that removal of the epidermis mechanically or chemically releases cytokines and the migration of inflammatory cells culminating in the replacement of damaged tissue with scar tissue, which happens with medium and deep chemical peelings. However, recovery from these procedures is long, and the result is more light-sensitive tissue subject to post-inflammatory hyperpigmentation and photosensitivity. In addition to these aspects, there is also an increased risk of complications, such as formation of hypertrophic scars, persistent erythema, and dyschromias (Aust MC. Plast Reconstr Surg. 121(4):1421–9, 2008; Bal SM, et al. Eur J Pharm Sci. 35(3):193–202, 2008; Brody HJ. Plast Reconstr Surg. 2(2):127–8, 1995; Cachafeiro T, et al. Dermatol Surg. 42:232–41, 2016; Camirand A and Doucet J. Aesthet Plast Surg. 21(1):48–51, 1997; Clementoni MT, et al. Lasers Surg Med. 42:150–9, 2010).

Percutaneous collagen induction (PCI) with needling is a technical-dependent intervention. The use of different needle lengths alone provides a versatility that requires direction between the lesion to be treated and the proposed level of injury. Therefore, it is necessary to establish a relationship between the depth of damage produced by the needles and the response to this trauma to better define the indications. Once the characteristics of the skin and the region to be treated have been evaluated, it is important to establish the objective of the treatment, which can be to break fibrotic beams, to uniform skin color, to improve its texture and brightness, to treat superficial wrinkles, to approach recent or old stretch marks, to stimulate collagen in a region of flaccid skin, or to restructure an abnormal collagen in a rigid skin area. All of this will influence the choice of the length of needles and the planning of the injury to be provoked. Emerson Lima et al. (Surg Cosmet Dermatol 5(2):1104, 2013) proposed, in an experimental study, a relationship between the length of the needle and the depth of damage achieved, using live pigskin because they consider it a model that approximates human skin. The interventions were performed by the same operator and at the same surgical time, establishing the same pattern of strength and number of needle roll passes. Macroscopically, it was possible to identify the difference in damage caused by needles with lengths of 0.5, 1.0, 1.5, 2.0, and 2.5 mm. It is essential to understand the relationship between needle length and degree of injury when indicating the PCI technique for each specific situation.

Several treatments have been proposed that offer better results in reddish striations when compared to alba striations. Topical tretinoin in cream in high concentrations, applied as home therapy, improves the appearance of these lesions; however, it may not be well tolerated by the patient, considering climatic conditions and maintenance of her average activities. Interventions such as chemical peelings, microdermabrasion, fractionated lasers, and intense pulsed light, alone or in association, are some of the therapeutic options used by dermatology for the management of these lesions. However, there is no treatment considered ideal, and the results many times modest signal its challenge. PCI, regarding treatments with microneedles that induce collagen production, offers a stimulus in the production of this protein, without causing the deepithelialization observed in ablative techniques. The epidermis and dermis are perforated but not removed. Thus, the penetration of its needles in the skin causes micropunctures in the stretch marks, modifying their surface, destructuring the abnormal collagen and favoring neovascularization and neoangiogenesis. Both violent and white stretch marks respond to PCI, but the former commonly present satisfactory results with a smaller number of sessions, while the former need a longer time to achieve such results.

Accidents that result in unaesthetic scars happen more and more frequently in our environment; they are a relatively common cause of visits to specialist offices. The sources and causes that cause these scars are diverse; for this reason there is almost always an injurious polymorphism that can be distinguished from normotrophic to hypertrophic and atrophic injuries, with variation in color and shape, which often requires the association of techniques aiming at the best therapeutic gain. Besides cosmetic improvement, functional correction of the area should be considered. With a certain frequency there is impairment of the elasticity of the affected region, with function deficit. Techniques using needles described in this work have the advantage of addressing scars without excision and synthesis, which could favor situations such as enlargement or dystrophy in the postoperative period. These are techniques that perforate, without cutting, cause punctures without deepithelialization of the area, and, therefore, offer more safety regarding the cosmetic results and reduction of complications. Whether isolated or in association, the proposals presented here have shown, in author’s experience, good options in the approach to scars after accidents and can be included in the therapeutic arsenal of challenging injuries.

Percutaneous collagen induction proposes a stimulus to the production of collagen by perforating the epidermis, reaching the dermis without causing deepithelialization. Thus, the author’s practice and the reports of scientific articles that offer the experience of specialists from around the world point to greater safety, less risk of adverse effects, and shorter recovery time when comparing the use of needles with ablative procedures. The preservation of this noble layer structure is the basis for the prevention of adverse effects, giving PCI ample advantage over other procedures. It is known that mechanical or chemical removal of the epidermis favors the release of cytokines and migration of inflammatory cells, culminating in the replacement of damaged tissue by a scar. Treatments with medium and deep chemical peelings, as well as mechanical abrasion, require long recovery of the skin and result in a more light-sensitive tissue, subject to post-inflammatory hyperpigmentation (IPH) and photosensitivity, adding to the risk of complications such as hypertrophic scarring, persistent erythema, and dyschromias. These conditions are likely to occur because it is a replacement of the epidermis and its basal membrane removed by a scar tissue with rectification of the dermal papillae. In these processes, the inflammatory response triggered by the destruction of the epidermis causes the production of parallel oriented thick bundles of collagen, differently from the interlacing network of collagen found in normal skin.

Current interventions seek to promote fractional skin damage, which allows the integrity of the microregion adjacent to the trauma to be maintained intact, favoring a shorter recovery time and reduced risk of complications. The fractionated CO2 laser is an example of this proposal, as is the PCI. It is important to note that, even when the patient is submitted to surgeries that remove skin leftovers, attenuating flaccidity and wrinkles, the resulting skin must offer a good quality. This is the PCI proposal, offering a good quality of skin based on neocollagenosis and neoangiogenesis. The needles, initially idealized for the treatment of scars, also demonstrated valuable therapeutic response in aged skin. The studies of Orentreich and Orentreich (Dermatol Surg 21(6):543–549, 1995) were the first to report their use with the objective of stimulating the production of collagen in depressed scars and wrinkles, a technique widespread under the name of Subcision™. Other authors confirmed the rupture and removal of the damaged subepidermal collagen followed by the substitution of new collagen and elastin fibers by the intervention of needles. More recently, it has been proposed the use of a system of microneedles applied to the skin in order to generate multiple micropunctures, long enough to reach the dermis and trigger, with bleeding, inflammatory stimulus and activation of an inflammatory cascade that would result in the production of collagen and, subsequently, its maturation.

The muscle activity on the skin deepens depressions, the laxity of structures compromises, and the support and the redistribution of fat adds more weight to the excess skin, whether in aging or in the process of consuming an inflammatory acne. The use of needles and microneedles in procedures seeks the remodeling of collagen degraded by aging or scarring after the inflammatory process. Percutaneous needle collagen induction PCI remodels the epidermis and dermis, without deepithelializing them, with a short recovery period. It acts releasing static wrinkles and replacing damaged skin with one closer to the physiological. This transformation of collagen has been able to correct wrinkles, furrows, flaccidity, and scars. There is a tendency, supported by literature and medical experience, for the association of techniques seeking the optimization of results. The reflection proposed in this chapter is to improve the quality of the affected tissue, before planning the application of an asset with volumerizing potential or even with the potential to relax the adjacent musculature.

Some treatments are proposed to correct the scars that occur after the surgeries. Among them we can mention the surgical removal of the scar, generating a new incision, the use of ablative techniques such as peelings and dermabrasion, besides the use of fillers, botulinum toxin, and technologies with light, which seek from the improvement of color to the treatment of relief and texture. Although they constitute a surgical procedure, the techniques with needles have the differential of not causing cuts, which are subject to enlargement. Instead, they cause multiple micropunctures that aim to break micro and macro fibrotic beams, restructuring and renewing the scar tissue. PCI provides good results in acne scars and, according to author’s experience, is a useful technique for the treatment of all forms of scars, regardless of their presentation. In shallower, normochromic, and elastic lesions, the gains are substantial, and in those deep, dyschromic, and rigid, they are more modest, but always happen. The use of dermal tunneling may be indicated when facing thick, rigid, and deep fibrotic beams that need loosening and release of the skin surface. Multi-needles associated with radiofrequency are a good option when a more delicate surgical approach is required. Not infrequently, the author’s experience demonstrates the optimization of results when associating these last three proposals. There is not necessarily a mandatory sequence to be followed, and the peculiarity of each case will determine how this association should be performed. Considering the linear characteristic of post-surgical scars, the instrument with motorized needles can be effective to perform the treatment with great practicality.

Melasma is a common acquired hypermelanosis, characterized by irregularly contoured macules with a lacy appearance, with a color ranging from light brown to dark brown. The lesions occur in photo-exposed areas, mainly on the face. Melasma predominantly affects women of intermediate phototype fertile age. It causes great impact on the quality of life of patients, which makes it a frequent complaint in the dermatological office. The standard treatment of melasma still consists of the use of broad-spectrum toned sunscreen and topical lighteners, particularly tyrosinase inhibitors. Home treatment, however, is limited in bleaching and relapses are frequent. Therefore, adjuvant treatments are proposed to improve outcomes and decrease relapses. Percutaneous collagen induction (PCI) has been shown to be effective in both bleaching and staining. In a recent study, PCI has been shown to add benefit to standard treatment and decrease the recurrence of melasma. When compared to the control group (use of sunscreen only and triple formula), the group that performed two additional PCI sessions showed a greater relative decrease in the severity score 1 month after the last session. However, during the 2 months of maintenance with only solar filter and topical bleaching, the groups that performed PCI had less relapse. In addition, the group that performed the two PCI sessions showed a higher quality of life improvement when compared to the other group. Besides bleaching, there was a perception of improvement in the quality of the skin. No post-inflammatory hyperpigmentation was observed after the procedure even in patients with higher phototype.

Lightening and depigmentation actives applied to the skin at home can be effective when associated with regular use of sunscreen, but they cannot offer good results in all cases. Complementary treatments performed in the office, such as peelings and lasers, have their responses linked to the experience of each dermatologist: some patients have good responses; others may even worsen their lesions. The experience of the authors treating scars and individuals with recalcitrant melasma with microneedles, with whitening in 100% of the cases and without the addition of any asset, led him to believe in the potential of needles as a whitening agent. This hypothesis was also validated by histopathological evaluations that present significant reduction of melanin granules in specimens stained by the Masson-Fontana method after which it was recommended as the Lima Protocol. PCI has been proposed as an effective treatment for IPH. In the author’s experience, when the methodology with all the recommended criteria is followed, the procedure always offers whitening. The number of sessions with an interval of 30 days depends on the intensity of BIPH, and there is no limit to the number of interventions. Moreover, according to the author’s experience, each intervention offers a gain in pigment reduction and improvement in skin quality.

Goal: Knowledge Management (KM) has been increasingly used by organizations to help innovation and gain competitive advantage; however, the implementation of KM may turn in bad results, because of functional isolation. In contrast, Business Process Management (BPM) is an approach that removes functional isolation, establishing end-to-end processes perspective through cycle promotion and usage of management techniques. Therefore, the aim is to understand how the techniques used to promote BPM contribute to KM. Design/ Methodology/ Approach: In step 1, a systematic review of the literature was carried out on the scientific bases, trying to understand how the literature dealt with the relationship between BPM and KM techniques in the last 10 years. In step 2, there was a project to promote BPM in a public hospital. Stage 3 sought to understand the leaders' perceptions about the possible contributions of BPM techniques to KM. Results: BPM acts promoting participation and sharing (social aspects); collecting information about the organization and identifies problems (cognitive aspects); allowing decision making to solve problems (strategic aspects); explaining tacit information, organizing and compiling explicit information (technological aspects) in order to enable changes in systems. Limitations of the investigation: single case study. Practical implications: BPM project collaborates to expand the diversity of information sources, opens the organization to external knowledge, with external consultant’s participation, also it provides communication expanding between areas, thus, improving customer service. Originality/ Value: this work contributes to show a valuable combination of techniques and how each one contributes to an essential resource as knowledge.

Image vector quantization (VQ) is sensitive to channel errors because they can lead to spurious blocks and consequent quality degradation of transmitted images. One way to increase the robustness of VQ to channel errors is to perform an index assignment to the codevectors. For wireless channels with Rayleigh fading, another challenge is the occurrence of burst errors. This work proposes the application of low discrepancy sequences to the interleaving of symbols, to improve the quality of reconstructed images considering those errors. Results obtained by preference tests, based on visual inspection of the reconstructed images, attest the success of the technique.

Psoriasis is a common, enigmatic, and recurrent disease. The precise etiology and pathogenesis of psoriasis are still unclear. Psoriasis has been treated as an inflammatory disorder related to an underlying Th1/Th17-dominated immune response. Interleukins are involved in the development of psoriasis lesions through Th-17-associated inflammation. Th1 and Th17 cytokines are found in skin lesions and in the peripheral blood of psoriasis patients. We sought to analyze serum levels of IL-1-β, IL-8, IL-9, IL-27, IL-29, IL-35, IFN-γ, TNF and TGF-β in patients with psoriasis and healthy control volunteers. Blood samples were collected from fifty-three patients with psoriasis and thirty-five healthy controls. Serum cytokines concentrations were determined using an enzyme-linked immunosorbent assay. Serum IL-8, IL-9, IL-27, IL-29 and TNF levels were statistically significant in psoriasis patients. Detectable serum IL-9 levels were found in 47 patients of the 53 in the psoriasis group. Interleukins-8, 27, 29 and TNF levels measured in the serum of psoriasis patients were slightly elevated as compared to healthy controls in a weakly significant way. On the other hand, there were highly significant differences in IL-9 levels between the two groups.

Psoriasis is a chronic and recurrent dermatitis, mediated by keratinocytes and T cells. Several proinflammatory cytokines contribute to formation and maintenance of psoriatic plaque. The Th1/Th17 pathways and some of IL-1 family members were involved in psoriasis pathogenesis and could contribute to disease activity. Therefore, we sought to analyse skin transcript levels of IL17A, IL22, RORC, IL8, IFNG, IL33, IL36A, FOXP3, and IL10 and correlate with clinic of patients with plaque-type psoriasis. In order to conduct that, we collected punch biopsies from lesional skin and obtained tissue RNA. After reverse transcription, qRT-PCR quantified the relative mRNA expression. The main results revealed increased transcripts levels of IL17A, IFNG, and FOXP3 in moderate-severe patients. Despite this, only IL17A can increase the chance to worsen disease severity. We also observed many significant positive correlations between each transcript. In conclusion, IL17A is elevated in lesional skin from psoriasis patients and plays crucial role in disease severity.

Made available in DSpace on 2018-12-11T17:16:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-28 Background: Melasma is a common chronic and relapsing acquired dyschromia. Skin microneedling was reported resulting sustained long-term improvement of recalcitrant melasma, however, the exact mechanism that promotes this skin lightening is not known. This study aimed to investigate clinical and histologic alterations promoted by skin microneedling in facial melasma. Methods: Open pilot trial including six women with facial refractory melasma submitted to two sessions of microneedling (1.5 mm) each 30 days followed by daily triple combination and broad-spectrum sunscreen. Comparison of pretreatment (T0) and 15 days after last microneedling procedure (T45) was made by standardized pictures, skin colorimetry, MASI, MELASQoL and histological parameters (haematoxylin-eosin, picrosirius-red, periodic acid Schiff and Fontana-Masson staining). Results: The age of the subjects varied from 34 to 46 years-old, the phototypes were III and IV (Fitzpatrick), and age of melasma onset was 20 to 38 years. Improvement of melasma was perceived in all subjects. There was a significant reduction of MASI score (-70%), MELASQoL (-55%) and increase in L* (+13%) colorimetric value (p < 0.03). All cases evidenced epithelium thickening, decrease in melanin pigmentation and densification of upper dermis collagen (p = 0.03). Patients were followed by 6 months under broad-spectrum sunscreen and triple combination without relapse. Conclusion: In addition to classic treatment (broad-spectrum sunscreen and triple combination), skin microneedling promoted clinical and histological improvement of refractory facial melasma. Santa Casa de Misericórdia, Praça Fleming, 35/1201 Jaqueira UNIFESP Unesp Medical School Campus da Unesp Departamento de Dermatologia SN Unesp Medical School Campus da Unesp Departamento de Dermatologia SN

In this paper, data analysis and modeling of gamma ray tomography taken into account spatial resolution and source of errors and the attenuation coefficient measurement in row data from tomography process are presented. The results showed that this method is simple, effective and should be prior to any data treatment for opaque vessel reactor and by reconstruction algorithm in process imaging.

The solid flow in air-catalyst in circulating fluidized bed was simulated with CFD model to obtain axial and radial distribution. Therefore, project parameters were confirmed and steady state operation condition was improved. Solid holds up axial end radial profiles simulation and comparison with gamma transmission measurements are in a good agreement. The transmission signal from an 241Am radioactive source was evaluated in NaI(Tl) detector coupled to multichannel analyzer. This non intrusive measuring set up is installed at riser of a cold pilot unit to determine parameters of FCC catalyst flow at several concentrations. Mass flow rate calculated by combining solid hold up and solid phase velocity measurements was compared with catalyst inlet measured at down-comer. Evaluation in each measured parameter shows that a relative combined uncertainty of 6% in a 95% interval was estimated. Uncertainty analysis took into account a significant correlation in scan riser transmission measurements. An Eulerian approach of CFD model incorporating the kinetic theory of granular flow was adopted to describe the gas–solid two-phase flows in a multizone circulating reactor. Instantaneous and local gas-particle velocity, void fraction and turbulent parameters were obtained and results are shown in 2 D and 3D graphics.

Psoriasis is a chronic inflammatory skin disease characterized by alterations in cytokines produced by both Th1 and Th17 pathways. The aim of this study was to evaluate serum levels of pivotal cytokines and correlate them with clinical parameters. Serum samples from 53 psoriasis patients and 35 healthy volunteers, matched by the proportion of sex and age ratios, were collected for ELISA cytokine detection. Psoriasis Area and Severity Index (PASI) was assessed at the time of sampling in psoriasis patients. Our findings demonstrate that IL-17A, IL-22, and IL-6 serum concentrations were significantly higher in psoriasis patients than in the control group. No statistical correlation could be found between cytokines concentrations, PASI score, and age in this study. Although our results do not show any correlation between serum levels of IL-17A, IL-22, and IL-6 and disease activity, the present study confirms that they were increased in Brazilian psoriasis patients in comparison to healthy volunteers.

This work presents a fast method for motion estimation by using low discrepancy sequences. The basic idea in this proposal is one based on the reduction of the computational effort involved in the matching of a given block with the reference block. Instead of using a metric that employs all corresponding pixels in both blocks, it uses one that selects a subset of pixels for which the coordinates are determined by the so called low discrepancy sequences. The proposed method is applied to the New Three Step Search (NTSS), typically used as a technique for motion estimation in video applications. The results show a reduction in computational complexity of about 80% with regard to the NTSS, with little degradation in the recovered frame. The block matching of this present method can couple nicely with virtually any motion estimation technique, requiring very little change.

Background Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker for the early diagnosis of acute kidney injury (AKI); however, a wide range in its predictive value has been reported. Study Design Meta-analysis of diagnostic test studies using custom-made standardized data sheets sent to each author. Setting & Population Different clinical settings of AKI. Selection Criteria for Studies MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were searched for studies reporting the value of NGAL to predict AKI. Index Tests Plasma/serum and urine NGAL within 6 hours from the time of insult (if known) or 24-48 hours before the diagnosis of AKI if the time of insult was not known. Reference Tests The primary outcome was AKI, defined as an increase in serum creatinine level > 50% from baseline within 7 days or contrast-induced nephropathy (creatinine increase > 25% or concentration > 0.5 mg/dL in adults or > 50% increase in children within 48 hours). Other outcomes predicted using NGAL were renal replacement therapy initiation and in-hospital mortality. Results Using a hierarchical bivariate generalized linear model to calculate the diagnostic odds ratio (DOR) and sample size–weighted area under the curve for the receiver-operating characteristic (AUC-ROC), we analyzed data from 19 studies and 8 countries involving 2,538 patients, of whom 487 (19.2%) developed AKI. Overall, the DOR/AUC-ROC of NGAL to predict AKI was 18.6 (95% CI, 9.0-38.1)/0.815 (95% CI, 0.732-0.892). The DOR/AUC-ROC when standardized platforms were used was 25.5 (95% CI, 8.9-72.8)/0.830 (95% CI, 0.741-0.918) with a cutoff value > 150 ng/mL for AKI compared with 16.7 (95% CI, 7.1-39.7)/0.732 (95% CI, 0.656-0.830) for "research-based" NGAL assays. In cardiac surgery patients, the DOR/AUC-ROC of NGAL was 13.1 (95% CI, 5.7-34.8)/0.775 (95% CI, 0.669-0.867); in critically ill patients, 10.0 (95% CI, 3.0-33.1)/0.728 (95% CI, 0.615-0.834); and after contrast infusion, 92.0 (95% CI, 10.7-794.1)/0.894 (95% CI, 0.826-0.950). The diagnostic accuracy of plasma/serum NGAL (17.9 [95% CI, 6.0-53.7]/0.775 [95% CI, 0.679-0.869]) was similar to that of urine NGAL (18.6 [95% CI, 7.2-48.4]/0.837 [95% CI, 0.762-0.906]). We identified age to be an effective modifier of NGAL value with better predictive ability in children (25.4 [95% CI, 8.9-72.2]/0.930 [95% CI, 0.883-0.968]) compared with adults (10.6 [95% CI, 4.8-23.4]/0.782 [95% CI, 0.689-0.872]). NGAL level was a useful prognostic tool with regard to the prediction of renal replacement therapy initiation (12.9 [95% CI, 4.9-33.9]/0.782 [95% CI, 0.648-0.917]) and in-hospital mortality (8.8 [95% CI, 1.9-40.8]/0.706 [95% CI, 0.530-0.747]). Limitations Serum creatinine level was used for AKI definition. Conclusions NGAL level appears to be of diagnostic and prognostic value for AKI.