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Bertholletia excelsa é uma espécie de florestas tropicais da família Lecythidacea. Fonte econômica primária para muitas populações extrativistas apresentando diversas características relevantes. Esta revisão tem como objetivo reunir artigos publicados nas bases de dados Periódico Capes, Pubmed, Science Direct e outros, utilizando descritores referentes a castanha do Brasil, sobre sua importância na saúde e economia. Foram encontrados 38387 artigos dos quais 107 foram avaliados subsequentemente com as leituras de título/resumos, destes 58 foram selecionados para nortear a revisão. Os resultados confirmam a importância do manejo econômico desta espécie nas comunidades tradicionais na cultura de coleta/beneficiamento, bem como suas propriedades biológicas as quais contribuem para a saúde da população. Estudos experimentais adicionais são necessários para a elucidação de mecanismos de ação, segurança e eficácia da espécie na tentativa do uso da planta como recurso biotecnológico.

Connaraceae is a plant family usually used in traditional medicine. Recently, we have reported the chemical composition and biological activity of 39 species around the world. This work highlights the application of these species to diabetes control, which has been reported at least to half of this family. In this line, there are several species of the Connaraceae without scientific evidence of traditional use, among these the four species study here. Thus, this work aims the chemical composition prospection of Connarus blanchetii, Connarus regnellii, Connarus suberosus and Rourea glazioui, as well as the identification of possible bioactivity. The leaves of these four species were collected, prepared and submitted to different extractive methods (aqueous decoction and infusion and ethanolic maceration), these being tested in a preliminary phytochemical investigation and subjected to antioxidant assay with 2,2-diphenyl-1-picrylhydrazyl and ferric reducing antioxidant power. Then, we selected the maceration extract to continue for fractions, with the ethyl acetate and n-butanol presenting the best results with antioxidant and anti-advanced glycation end products (AGEs) activity potential. Finally, the chemical composition was determinate by high-resolution mass spectrometry (HRMS) in combination with Global Natural Products Service (GNPS) data bank. As a result, this study indicated the presence of 29 phenolics compounds with reported activity as antioxidant and with potential of protein glycation, supported the diabetes activity of this plants. The n-butanolic fraction of R. glazioui showed compounds such as apigenin, kaempferol, quercetin, myricetin and chlorogenic acid, which have generated a half maximal inhibitory concentration (IC50) of 36.5 µg mL-1 for oxidative glycation inhibition, being highlighted as the most active.

A gestação é considerada tardia quando ocorre em mulheres com idade superior a 35 anos. Nessa faixa etária há maior probabilidade de ocorrerem resultados perinatais adversos para o binômio mãe e filho. Este trabalho tem como objetivo analisar os aspectos sociais e epidemiológicos da gestação acima de 35 anos no Brasil, e seus resultados perinatais, para uma melhor assistência à saúde dessa população. Trata-se de uma revisão integrativa da literatura realizada através de busca de artigos sobre o tema abordado nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysisand Retrieval System Online (MEDLINE) e Scientific Electronic Library Online (SCIELO), sendo selecionados, no final, 14 artigos com recorte temporário de 2004 a 2019 para servirem como base para a construção desse estudo, desenvolvido nos meses de julho a setembro de 2019. Com o crescimento do número de mulheres que desejam ser mães após os 35 anos, essas devem receber orientações, para que possam tomar uma decisão esclarecida e responsável, já que o aumento na idade nas gestações parece ser uma tendência global inexorável. É sabidamente comprovado em diversos estudos que é alta a prevalência de comorbidades maternas e fetais no período perinatal na faixa etária do presente estudo. Faz-se necessário, portanto, que os profissionais médicos de todos os níveis de atendimento, sejam capacitados para conduta adequada e individualizada frente a uma gestante com mais de 35 anos, não devendo direcionar seus cuidados exclusivamente as disfunções orgânicas da mesma. A equipe de saúde assistente deve ter um olhar atento para fatores de risco e diagnóstico precoce de possíveis comorbidades.

Carcinogenic metabolites of fungi such as aflatoxins play a toxic role in some tree nuts and need to be monitored in their by-products, such as oil. In this context, Brazil nut (Bertholletia excelsa) oil, which is a commodity of great economic importance to Brazil, requires attention to monitor the presence of these toxic agents. Therefore, this study aimed to evaluate the presence of aflatoxins in Brazil nut oil and relate it to the presence of fatty acids in the oil as a surveillance tool for food safety. Brazil nut oil samples (n= 25) were acquired in northern Brazil as (a) non-branded products (n= 07) produced by local farmers using artisanal methods from nuts to be discarded by the industry and (b) industrialized products (n= 18). The samples were analyzed for total aflatoxin content by high-performance liquid chromatography and fatty acid content by nuclear magnetic resonance imaging. Seven (28%) samples were positive for the aflatoxin fractions (B1 + B2 + G1 + G2), ranging from undetected (2.32) to 50.87 μg/kg. Of the aflatoxin positive samples evaluated by NMR analysis, it was not possible to state that the presence of a particular fatty acid can interfere or influence aflatoxin contamination. This was the first study with data on aflatoxin occurrence in Brazil nut oil. Nevertheless, further research is required to relate saturated or unsaturated fatty acid content with aflatoxin levels. We also suggest the implementation of systems to prevent contamination of the raw materials (seed) and detoxification of the oil to guarantee the product's safety and quality.

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.

A partir da decada de 1960, a industria de software grafico comecou a se desenvolver e o computador tornou-se uma ferramenta poderosa e imprescindivel. Na decada seguinte, o universo de projetos arquitetonicos foi surpreendido com o lancamento de uma tecnologia que mudaria os rumos dessa area, o Computer Aided Design (CAD), ou desenho auxiliado por computador. O desenvolvimento e a expansao dos softwares permitiram que um processo, antes inteiramente manual, passasse a ser desenvolvido num computador, garantindo, assim, melhor qualidade e eficiencia (1) . Tendo em vista a gama de ferramentas digitais, esse trabalho se resume nas quatros tecnologias – BIM, CAD, MATLAB e Sienge, que estao ocupando o mercado de softwares nos dias atuais, com o objetivo compara-las, produzindo assim um material informativo. A metodologia utilizada para a realizacao desse trabalho foi uma pesquisa exploratoria em artigos e sites contendo informacoes sobres as ferramentas digitais com intuido de produzir um material explicativo para os alunos de engenharia, de forma clara e concisa. Concluimos que as ferramentas digitais citadas sao de grande importância para as engenharias, cada uma com sua particularidade, cada uma com sua contribuicao para se obter um melhor aproveitamento no que diz respeito a execucao, qualidade e economia. O trabalho foi de extrema importância para nos, graduandos em engenharia civil, porque por meio dele foi possivel aprofundar mais no assunto e aperfeicoar nossas habilidades de investigacao e informacao.

O Scrum é atualmente o principal framework utilizado pelas empresas no desenvolvimento de sistemas complexos e aplicações de software, tendo valores e etapas que se assemelham a ferramenta do ciclo PDCA, utilizando práticas que buscam a melhoria contínua. Dentro deste framework, o evento Sprint Retrospective pode ser comparado ao Check do Ciclo PDCA, no qual o time deve inspecionar o trabalho executado dentro da Sprint, elencando pontos positivos e negativos, sugerindo e criando um plano de melhorias para que o trabalho seja executado de forma mais eficiente na próxima iteração. O Scrum não prescreve práticas de como o plano de melhorias deve ser criado e executado, levando muitos times a não conseguirem alcançar o kaizen, por não possuírem uma estrutura que dê suporte. Dentro deste contexto, este trabalho propõe mostrar a correlação e a adaptação do MASP e suas fases dentro do Scrum, visando criar um modelo enxuto e sistemático adaptado à Cultura Ágil para a análise de processo e solução de problemas no desenvolvimento de software.

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.

Wrinkles become more evident when the individual has thick or oily skin, which leads this lesion to a scar condition, difficult to be reversed. The deeper and older the wrinkles, the more frustrating attempts at correction become, resulting in a therapeutic challenge. Dermal fillers, such as hyaluronic acid, offer good results in association with botulinum toxin in cases where the skin is thinner or when fibrotic beams have not yet been installed. In these cases, there is a prior need to release the bottom of these wrinkles attached to the fibrotic beams, so that the last proposed association can achieve its objectives. According to the authors’ experience, when this release is neglected, the incarceration of the filler will be observed, interspersed with the fibrosis mentioned, consequently leading to, undesirable cosmetic results. Described by Orentreich and Orentreich (1995), Subcision™ is based on the rupture of fibrotic beams and the triggering of an inflammatory response, with bleeding, which culminates in neocollagenesis. As was done for scars, we propose to perform dermal tunneling (DT) for the correction of static wrinkles. The treatment is based on the release of the wrinkle bottom and its consequent filling by blood, which results in fibrin deposit and production of a new collagen, making the wrinkle shallower and offering cosmetic improved smooth skin surface.

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).

An electrosurgery device is composed of a current generating unit and two electrodes: one active and one dispersive. By using an electrode consisting of a series of eight needles 0.1 mm thick and 2.0 mm long, we will equally divide by eight the energy selected for contact. With the proper configuration of the device, we can realize eight columns of 0.1 mm per shot, with a depth of 2.0 mm. Thus it is plausible the epidermal restitution is in an integral form and mechanical and thermal dermal stimulus, producing tissue retraction and synthesis of collagen. The multi-needle radiofrequency (MNR) technique has its applicability on periorbital skin excess and flaccidity, periorbital hyperpigmentation, static facial wrinkles, acne scars, superficial skin flaccidity, xanthelasma, syringoma, surgical scars, and stretch marks, among others. The use of high-frequency randomized fractional energy triggered on the skin results in dermal regeneration at the papillary-reticular interface through the stimulation of fibroblasts with consequent synthesis of collagen and elastic fibers, as well as epidermal regeneration produced by the migration of keratinocytes.

PCI performs thousands of controlled microperforations in the papillary and reticular dermis. The objective is to execute a mechanical stimulation of the dermis with minimal damage to the epidermis, thus promoting the formation of collagen and increasing angiogenesis. Dermal vasodilatation and migration of keratinocytes occur immediately, resulting in the release of cytokines such as interleukin-1, interleukin-8, interleukin-6, TNF-α, and GM-CSF. Several studies have demonstrated the importance of PCI in cell stimulation and growth factor production, showing an increased expression of genes related to hair growth stimulation. The mechanisms proposed for the growth of new hair shafts using the PCI technique are the release of platelet-derived growth factors (PDGF), elevation of growth factor levels as epidermal growth factors (EGF), activation of regeneration mechanisms, activation of stem cells in the bulge area of the dermal papilla, overexpression of genes related to hair growth, vascular endothelial growth factors, β-catenin, and increased expression of Wnt proteins, especially Wnt3a and Wnt10b.

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.

Scarring lesions can result from inflammatory processes, accidents, surgeries, and present varied characteristics, which contemplate both changes in color and change in skin texture, as well as compromising the revelation and distortion by retraction. Multineedle radiofrequency (MNR) proposes a neocollagenesis with preservation of this noble structure. Even the widest and deepest scars will respond to microneedles, considering that the more superficial and narrower they are, the better the therapeutic result obtained. MNR is a promising therapeutic proposal for the treatment of various forms of scarring. A thorough knowledge of these lesions is essential so that the indication alone or in association with the technique offers good cosmetic results. In the author’s conception, the results achieved can be reproduced using the methodology and the electrodes presented here with precision. The procedure requires training and is technical-dependent. The operator must be properly enabled and have all the basic knowledge necessary to guarantee the excellence of the results.

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.

Business Process Management (BPM) é uma disciplina de gestão que auxilia as organizações a coordenarem seus processos de maneira mais efetiva. Tal abordagem de gestão tem como um de seus principais paradigmas a mudança da forma de entender as organizações de uma visão funcional (de dentro dos departamentos e isolados) para uma visão de processos holística end-to-end, ou seja, partindo da requisição inicial do cliente até a sua plena satisfação. Cada vez mais, organizações de diferentes setores buscam aprimorar suas operações e resultados utilizando BPM, assim como no setor de saúde. Na pesquisa clínica e, mais especificamente nos Centros de Pesquisa Clínica (CPCs), há carência de materiais que possam auxiliar na gestão de seus processos, diminuindo a qualidade dos centros e a atratividade por novos estudos para o ambiente nacional. A partir destes motivadores, o objetivo desta pesquisa foi desenvolver um framework de processos de negócio para a gestão de Centros de Pesquisa Clínica. Para isso, o trabalho utilizou uma abordagem metodológica dividida em cinco etapas: a Etapa 1 - Validação do problema, analisou a importância do tema estudado e validou a lacuna na literatura a partir de uma revisão sistemática da literatura; a Etapa 2 - Identificação dos processos, identificou os processos de negócio de um CPC a partir de um estudo de caso; a Etapa 3 - Avaliação com especialistas, avaliou e detalhou os processos da Arquitetura de Processos identificados na Etapa 2 de maneira iterativa com profissionais de pesquisa clínica a partir de entrevistas em profundidade; a Etapa 4 - Revisão da literatura, analisou os trabalhos científicos que tratam da gestão dos processos de um CPC, com base nos nomes dos processos da Arquitetura de Processos avaliada na Etapa 3; e Etapa 5 - Apresentação do framework: consolidou as informações das etapas anteriores, apresentando o framework construído. O resultado foi um framework de processos de negócios para a gestão de CPCs, contendo uma estrutura básica de processos e um conjunto de boas práticas para sua condução servindo como um guia inicial ou um ponto de comparação para autoavaliação e benchmark de Centros de Pesquisa Clínica com 27 processos de negócio divididos entre processos centrais, de gestão e de suporte que trata de todas as atividades de um CPC como uma unidade de negócio. A pesquisa supre a demanda de profissionais de centros de pesquisa clínica, a lacuna na literatura da área, mostra o potencial do uso empírico de BPM e ainda apresenta um método que pode ser reutilizado para a criação de frameworks em outras áreas de conhecimento. Espera-se que este estudo e o produto desenvolvido possam contribuir com a literatura de BPM e pesquisa clínica, fortalecer o conhecimento de profissionais de pesquisa clínica, promover a melhoria na condução de protocolos e promover BPM nos CPCs. Business Process Management (BPM) is a management discipline that help organizations to coordinate their processes more effectively. Such a management approach has as one of it paradigms the shift of understanding organizations from a functional view (from within departments and isolated) to a holistic view of end-to-end processes, starting from the clients\' initial requisition until they are fulfilled. Increasingly, organizations from different sectors have sought to improve their operations and results using BPM, as well as in the health sector. In clinical research and, more specifically, in Clinical Research Centers (CPCs), there is a lack of materials that can assist in the management of their processes, reducing the quality of the centers and the attractiveness of new studies for the national environment. Based on these motivators, the objective of this research was to develop a business process framework for the management of Clinical Research Centers. To achieve it, it was used a methodological approach divided into five stages: Step 1 - Validation of the problem, analyzed the importance of the studied theme and validated the gap in the literature from a systematic review of the literature; Step 2 - Process identification, identified a CPC\'s business processes from a case study; Step 3 - Evaluation with specialists, evaluated and detailed the processes of the Process Architecture identified in Step 2 in an iterative way with clinical research professionals from in-depth interviews; Step 4 - Literature review, analyzed the scientific studies regarding the management of the processes of a CPC, based on the names of the processes listed in the Process Architecture evaluated in Step 3; and Step 5 - Presentation of the framework, that consolidated the information from the previous steps, presenting the built framework. The result was a business process framework for the management of CPCs, containing a basic structure of processes and a set of good practices for conducting them, serving as an initial guide or point of comparison for self-assessment and benchmark of Clinical Research Centers with 27 business processes divided among central, management and support processes approaching all the activities of a CPC as a business unit. The research meets the demand of professionals from clinical research centers, the gap in the literature in the area, shows the potential of the empirical use of BPM and also presents a method that can be reused for the creation of frameworks in other areas of knowledge. It is expected that this study and the product developed can contribute to the literature on BPM and clinical research, strengthen the knowledge of clinical research professionals, promote improvements in the conduction of research protocols and promote BPM in CPCs.

In a context of rising demand for sustainable antiaging interventions, fruit processing by-products are a promising source of bioactive compounds for the production of antiaging dietary supplements. Piquiá (Caryocar villosum) is a native Amazonian fruit consisting of 65% nonedible shells. In the present study, the phytochemical profile of a hydroalcoholic extract of piquiá shells (CV) was characterized by LC-MS/MS analysis. Its antioxidant and antiaging activities were investigated using the nematode Caenorhabditis elegans as an in vivo model. CV is mainly composed by hydrolysable tannins and triterpenoid saponins. The extract enhanced stress resistance of wild-type and mutant worms by reducing the intracellular levels of reactive oxygen species (ROS) and by increasing their survival against a lethal dose of the prooxidant juglone. These effects involved the upregulation of sod-3 and downregulation of gst-4 and hsp-16.2, studied through the GFP fluorescent reporter intensity and at the transcriptional level by qRT-PCR analysis. CV extended the lifespan of wild-type worms in a DAF-16/FoxO- and SKN-1/Nrf-dependent manner. Taken together, our findings indicate piquiá shells as potential candidates for nutraceutical applications. Further studies are needed to validate the relevance of our findings to antiaging interventions in humans.