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Este artigo tem como objetivo apresentar o uso de bioestimulador de colágeno atuando no rejuvenescimento corporal com o propósito de harmoniza-los. A demanda de procedimentos estéticos atualmente são cada vez mais utilizados, agregando assim novos procedimentos estéticos. Os procedimentos de bioestimuladores de colágeno veio para aumentar a produção de colágeno, suavisando as linhas de expressões causadas pelo envelhecimento, utilizando substâncias como ácido poli-L-áctico, hidroxiapatita de cálcio e policaprolactona que ao serem enjetadas na pele estimulam a produção de colágeno, hidratando o tecido cutâneo, estimulando novas fibras que dão sustentamento à pele. This article aims to present the use of collagen biostimulator acting in body rejuvenation with the purpose of harmonizing them. The demand for aesthetic procedures are currently increasingly used, thus adding new aesthetic procedures. The collagen biostimulator procedures came to increase collagen production, smoothing the lines of expressions caused by aging, using substances such as poly-L-lactic acid, calcium hydroxyapatite and polycaprolactone that, when injected into the skin, stimulate collagen production, moisturizing the skin tissue, stimulating new fibers that give support to the skin. Este artículo tiene como objetivo presentar el uso del bioestimulador de colágeno actuando en el rejuvenecimiento corporal con el propósito de armonizarlos. La demanda de procedimientos estéticos en la actualidad son cada vez más utilizados, sumando así nuevos procedimientos estéticos. Los procedimientos del bioestimulador de colágeno surgiron para aumentar la producción de colágeno, alisando las líneas de expresión provocadas por el envejecimiento, utilizando sustancias como el ácido poli-L-láctico, la hidroxiapatita cálcica y la policaprolactona que, al inyectarse en la piel, estimulam la producción de colágeno, hidratando el tejido cutáneo, estimulando nuevas fibras que dan sostén a la piel.

Background: Cryofrequency consists of the combination of cryotherapy and radiofrequency, acting simultaneously in the treatment of flaccidity and localized adiposity. Objective: To investigate the effects of cryofrequency at the dermal and hypodermic levels. Materials and methods: This is a case study, composed of one woman of 39-year-old, with interest to perform abdominoplasty surgery, presenting adiposity and flaccidity located in infra-umbilical region. Its treatment consists of eight cryofrequence applications. Results: There was reduction of 7 cm on supra-umbilical plicometry and 6 cm on infra-umbilical; a decrease of 2.7 kg of body weight. The ultrasound data show a decrease of 0.6 mm, in the thickness of the adipose layer. In the histological analysis: thicker epidermis, with more layers and dermis with greater number of fibroblasts and inflammatory cells, greater quantity of neoformed collagen tissue. Conclusion: The application of cryofrequence promoted reduction of adipose tissue and increased production of collagen. Level of Evidence: Level III, case-control study.

Background: A new technology called Tecar therapy, widely used in the orthopaedic area, has been studied in aesthetics in order to treat skin flaccidity. The equipment allows the association of radiofrequency with manual therapy. This study is an experimental research that aims to analyse the effects of the Tecar therapy associated with manual therapy on skin flaccidity of the gluteal region. Methods:Volunteers were individuals aged between 21 and 54, who presented skin flaccidity in the gluteal region. The sessions/applicationsoccurred once a week, totalling four applications with the TR THERAPY ELITE-6000 BTLTMdevice pre-set underthe following parameters: 500 KHz frequency, 100% duty cycle and 80% power, capacitive mode, in an area corresponding to twelve quarters measuring 7 cm² each, during60 minutes. Results:The evaluations were carried out in all the sessionsand included metric verification, photographic recording with subsequent photo submission to the AutoCAD software, and photogrammetric analysis. At the end of treatment, the volunteers answered anadaptedquestionnaire of satisfaction and a global aesthetic improvement scale form (GAIS). The results regarding AutoCAD, metric measurement, and photogrammetry did not present significant statistical differences. Conclusion:Although the statistical results were not satisfactorydespite its limitations regarding sample size,and possiblydue to the subjective analysis of the resources used as the evaluation methods. Still, the volunteers reported improvement in the texture and firmness of the skin in the treated region, indicating their satisfaction with the performed treatment.

The history of the development of today’s very dependable three-piece inflatable penile prostheses is fascinating. In its infancy, the three piece was plagued with frequent revisions and a relatively complex insertion and consequently unitary and two-piece prostheses flourished with the implanting urologists. While the surgery was less difficult because these devices did not require the dreaded reservoir insertion, they often proved unsatisfactory to patients in flaccidity, erection and longevity. By the turn of this century all of the unitary and two-piece inflatables had been withdrawn from the market except the Ambicor two-piece inflatable penile prosthesis. This paper covers the history of the various unitary and 2-piece inflatable models before examining a critical question: is the Ambicor 2-piece still a needed implant today?

Introduction: Cryofrequency is a non-abrasive and non-invasive aesthetic treatment method aimed at complaints related to localized adiposity and cutaneous flaccidity. The method consists of the generation of radiofrequency waves that in contact with the subcutaneous tissues produce heat. The differential of the cryofrequency is that this method uses a system of superficial cooling, producing a thermal shock by combining deep heat and superficial cold.

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

Muscle-aponeurotic plication is an essential component in abdominoplasty and lipoabdominoplasty because it allows correcting flaccidity and improves abdominal wall deformity. This plication can be vertical, horizontal, or mixed. Vertical plication is the most commonly used form, although there is a growing tendency to use horizontal plication as part of the TULUA technique. We propose the mixed plication in the form of “Fleur de Lys” as a more appropriate form of correction since it corrects the vertical and horizontal flaccidity. The horizontal plication is performed perpendicular to the straight muscles and allows correcting the vertical elongation of the abdominal wall. Material and Methods: From February 2015 to May 2019, we operated abdominoplasty and lipoabdominoplasty patients associated with the "Fleur de Lys” plication. Results: In this period, 144 “Fleur de Lys” plications have been performed in 140 women (97.2%) and four men (2.8%), with ages ranging from 25 to 63 years (average 48 years). One hundred thirty-six cases (94.4%) were primary surgeries, and 8 cases (5.56%) were patients with previous abdominoplasty. We had no complications related to the increase in intra-abdominal pressure, only small dehiscences in 5 cases (3.5%) and seroma in 10 cases (7.8%). Conclusion: The mixed plication technique in “Fleur de Lys” is a more anatomical manner of correcting the muscle- aponeurotic flaccidity because it fixes the vertical and horizontal flaccidity present in operated abdominoplasty and lipoabdominoplasty patients; its execution is technically easy and the results obtained are as expected, with minimal complications.

Background: In Southeast Asia, Japanese encephalitis (JE) is an important cause of viral encephalitis which may cause severe neurological sequelae. JE affects mostly children; therefore, clinical presentations and prognosis of adult JE patients are seldom addressed. This study aimed to describe the clinical characteristics and prognostic factors for the outcome of adult JE patients. Methods: Medical records of adult JE patients with acute encephalitis syndrome during 2001–2018 from five medical centers in southern Taiwan were reviewed. Clinical characteristics, brain images, and prognostic factors for outcomes were analyzed. Patients were divided into the good outcome (GO) group and poor outcome (PO) group according to their Glasgow Coma Scale (GCS) scores (GCS >8 vs. ≤ 8) at discharge. Results: Sixty-eight patients (men, 61.8%; median age, 50 years) were included. Summer is the epidemic season, and the number of cases peaked in June. The most common symptoms at initial presentation were altered consciousness and fever (both 94.1%), followed by headache (51.4%). The most commonly involved brain regions were thalamus (55.7%) and basal ganglion (37.7%). The median GCS score at nadir was 8, and the median time from onset to nadir was five days. Fifty-two patients were included in the GO group, while 16 were included in the PO group. On multivariate analysis, flaccidity, rigidity, and elevated CSF protein level were identified as independent prognostic factors for PO. Conclusion: Initial clinical presentations of abnormal muscle tone including flaccidity, rigidity and high CSF protein levels are independent prognostic factors for PO in adult JE patients. Keywords: Adult, Japanese encephalitis, Outcome, Prognostic factor

Penile prosthetic surgery is the definitive treatment for those patients with erectile dysfunction refractory to medical treatment. Although it associates satisfaction rates>90%, it is known that men with Peyronie's disease, body mass index>30kg/m2 or those previously operated on radical prostatectomy have lower satisfaction rates than the general population. The main reasons for dissatisfaction are the subjective loss of penile length and glans' flaccidity. Given such circumstance, several adjuvant surgical techniques have been described to improve aesthetic and functional outcomes after the implant. In our review, we wanted to investigate the different maneuvers used in patients with Peyronie's disease, those used to avoid the reduction of penile length and those used to avoid the floppy glans syndrome.

On the basis of publications in recent years, ideas about the deformation and strength properties of the flesh of potato tubers are being developed. The study is based on the analysis of experimental data on compression tests of cylindrical specimens cut from the flesh of potato tubers. The experiments were carried out taking into account the relaxation properties of the flesh. The diagrams of destruction of cylindrical samples by uniaxial compression revealed a number of features that made it possible to form an idea of the deformation-strength properties of potato pulp, taking into account the degree of its lethargy. Additional information is provided by experiments with intermediate unloadings, which start with ?> 0.1 MPa. A comparison of their graphs with the initial part of the diagram shows the absence of inelastic deformations within the limits of stresses in the samples from zero to values close to 0.1 MPa. Stresses ?> 0.1 MPa lead to the formation of inelastic deformations in the samples, which makes it necessary in the Hooke formula to abandon the use of the concept of a Young's modulus, which describes only elastic deformation. Instead of the Young's modulus, it was proposed to introduce a more general concept of the modulus of rigidity. Based on the analysis of the previously developed criteria for the rigidity of tubers of various flaccidity, two main ones were selected, which is associated with the simplicity of obtaining data for their calculation and sensitivity to changes in the flaccidity of tubers.

Background:. Volumizing muscles in the thighs by fat grafting to complement body contouring surgeries has not been adequately investigated. Our objective was to describe a technique (VDVFAT) that defines and volumizes thigh muscles by lipotransfer in the vastus medialis and vastus lateralis muscles. Methods:. VDVFAT was performed in 52 patients by the same surgeon at a private clinic in Lima, Peru, between 2018 and 2019. All patients were aged between 18 and 60 years, had no cutaneous flaccidity of the thighs, had a body mass index less than 28, and had Goldman surgical risk below Class II. Results:. A total of 45 women aged 19–41 years (mean: 29.2 years) and seven men aged 24–41 years (mean: 33 years) were included. A mean of 173.36 cm3 of intramuscular fat was grafted to the vastus lateralis, resulting in increased muscle thickness of 21.09 mm, which is equivalent to 88.31% of the initial size of the muscle (P < 0.0001). An intramuscular fat mass of 123.53 cm3 was grafted into the vastus medialis, resulting in increased muscle thickness of 30 mm, which is equivalent to 87.02% of the initial size of the muscle (P < 0.0001). Conclusions:. Volumizing and defining the vastus muscles by fat transfer is a safe and reproducible method for defining and volumizing muscles. However, further studies are necessary to determine the durability of fat grafts.

The aim of the present study was to evaluate the size of the penis in flaccidity and in erection of Italian men. A total of 4,685 men living in Italy and who have been visited at the Italian urology operating units were involved in the study between January 2019 and January 2020. Each patient was given details on how to measure their penis (erect length and circumference) in flaccidity and in erection, from the lower base to the distal penile tip. Mean (standard deviation [SD]) flaccid penis length was 9.47 (2.69), mean (SD) flaccid penis circumference was 9.59 (3.08), mean (SD) erect penis length was 16.78 (2.55) and mean (SD) erect penis circumference was 12.03 (3.82). At the linear regression analysis, height was associated with flaccid penis length (β = 0.04; p‐value = .01), and erect penis length was (β = 0.05; p‐value

Introduction: The structural changes in the face caused by age and/or by weight loss are mainly the consequence of fat compartment deflation in the temporal, malar, and subcutaneous regions. It directly influences flaccidity and the increase in wrinkles, mainly the vertical ones which, combined superficially with skin changes and deeply with bone, ligament and muscle changes, will accentuate aging. Volumetric expansion by the anesthetic fluid of these tissues allows their treatment with greater safety. Objective: To show the importance (Illouz YG. Tratamento do Envelhecimento face com Recurso da Lipoaspiracao: Lipoaspiracao. RJ Hipocrates; 1986. p. 226–231) of the treatment of facial fat volumes by liposuction and grafting, to replace the lost volumes of the fat compartments, lips, chin, subcutaneous tissue, and skin rides, to complete the techniques commonly used for facial lifting, and to demonstrate the importance of tissue expansion by anesthetic fluid. Method: Expansive anesthesia allows the necessary distension for subcutaneous detachment and preservation of vessels and nerves, besides making the aspiration of excess fat volume safe. The detachment of the subcutaneous tissue largely with 2-mm-wide cannulae facilitates exposure of the areas necessary for the treatment of SMAS and repositioning of the skin without excessive traction, which at the end of surgery will be complemented by fat grafting in the required areas. Conclusion: The volumetric expansion of the facial tissues by the anesthetic solution allows greater surgical safety, the treatment of fat volumes is extremely important, and the traction exerted by SMAS and platysma muscle allows to reposition the skin more naturally. Result: Facial rejuvenation surgery is not only to pull but also to remove and replace fat volumes where they would physiologically be at an early age.

Flaccid paralysis in the upper extremity is a severe motor impairment after stroke, which exists for weeks, months, or even years. Electroacupuncture treatment is one of the most widely used TCM therapeutic interventions for poststroke flaccid paralysis. However, the response to electroacupuncture in different durations of flaccid stage poststroke as well as in the topological configuration of the cortical network remains unclear. The objectives of this study are to explore the disruption of the cortical network in patients in different durations of flaccid stage and observe dynamic network reorganization during and after electroacupuncture. Resting-state networks were constructed from 18 subjects with flaccid upper extremity by partial directed coherence (PDC) analysis of multichannel EEG. They were allocated to three groups according to time after flaccid paralysis: the short-duration group (those with flaccidity for less than two months), the medium-duration group (those with flaccidity between two months and six months), and the long-duration group (those with flaccidity over six months). Compared with short-duration flaccid subjects, weakened effective connectivity was presented in medium-duration and long-duration groups before electroacupuncture. The long-duration group has no response in the cortical network during electroacupuncture. The global network measures of EEG data (sPDC, mPDC, and N ) indicated that there was no significant difference among the three groups. These results suggested that the network connectivity reduced and weakly responded to electroacupuncture in patients with flaccid paralysis for over six months. These findings may help us to modulate the formulation of electroacupuncture treatment according to different durations of the flaccid upper extremity.

Several surgical procedures from small incisions to multiple plane dissections have been developed over the last decades in order to address the face and neck flaccidity. These techniques have been described under the general heading of “facelifting”.

Facial rejuvenation surgery is the most complex procedure to treat the aging face. To remove excess skin caused by flaccidity is a constant challenge to provide a smooth facial appearance. Such surgery may be performed in both female and male patients because everybody later in life presents with some indication for it. Although a face lift does not provide eternal youth, at least the surgery can give to patients a palliative result that may last for several years, perhaps even decades. My surgical procedure presented a significant change in 1999 when I published my new concepts for abdominoplasty, which is a combination of traditional abdominoplasty with liposuction technique popularized as lipo-abdominoplasty. The main scientific contribution I described is to preserve the perforator vessels during abdominoplasty which work as multiple pedicles to the remaining abdominal panniculus, a major surgical improvement. As I concluded that this is a very important procedure, I employed the same surgical principles in other regions of the human body, including during rhytidoplasty, to avoid extensive cutaneous undermining. Ever since I introduced the new surgical principles for abdominoplasty in combination with liposuction in my face lifts, I have achieved a minimal rate of complications as well as a smooth facial contour.

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.

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.

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 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.

O envelhecimento é um processo multifatorial, resultado de diversos fatores, intrínsecos e extrínsecos. Consiste em um processo continuo que não afeta apenas a aparência, mas as diversas estruturas e funções da pele. Todo o organismo sofre com as alterações provocadas pelo envelhecimento, porém, é na face, uma das áreas mais foto exposta, que essas alterações são mais facilmente reconhecidas. A região facial envelhecida pode apresentar flacidez, rugas, linhas de expressão, entre outros distúrbios estéticos, que representam os sinais mais aparentes de uma pele senil. Na busca pela juventude, diversas técnicas de rejuvenescimento facial vêm sendo utilizado nos últimos anos, entre o quais acetilhexapeptídeo-3, um ativo de uso tópico que foi sintetizado com objetivo de mimetizar os efeitos da neurotoxina botulínica. Nesta perspectiva, o objetivo do presente trabalho foi analisar o processo de envelhecimento cutâneo e a ação do ativo acetilhexapeptideo-3 no processo de rejuvenescimento facial, por meio de uma revisão bibliográfica. O presente estudo caracterizou-se com uma revisão bibliográfica exploratória-descritiva com abordagem qualitativa, neste contexto buscou-se informações a respeito do processo de envelhecimento cutâneo e a ação do ativo acetilhexapeptídeo-3 no rejuvenescimento facial. Os resultados mostraram que o acetilhexapeptídeo-3, embora muito menos potente que a neurotoxina botulínica, promove melhoras significativas na aparência da pele envelhecida, justificando desta maneira seu uso em formulações cosméticas antienvelhecimento.

Background Phenol peeling is considered an important agent in the treatment of facial rejuvenation; however, its use has limitations due to its high potential for side effects. Objective This article proposes a new peeling application technique for the treatment of photoaging, aiming to evaluate, clinically and histopathologically, the efficacy of a new way of applying 88% phenol, using a punctuated pattern. Methods The procedure was performed in an outpatient setting, with female patients, on static wrinkles and high flaccidity areas of the face. Accompanying photographs and skin samples were taken for histopathological analysis before and after treatment. Results It was shown that 88% phenol applied topically using a punctuated technique is effective in skin rejuvenation. Conclusion The authors thus suggest, based on this new proposal, that further studies be conducted with a larger group of patients to better elucidate the action mechanisms of 88% phenol. This new form of application considerably reduced patients' withdrawal from their regular activities, besides reducing the cost, compared with the conventional procedure.

Introduction: Radiofrequency is a feature that has been frequently used in clinical practice for the treatment of facial flaccidity and appearance of wrinkles. Objective: To investigate the effects of radiofrequency on facial rejuvenation. Methods: This is a controlled clinical trial. The sample consisted of 40 female volunteers, with the age group between 35 and 55 years, arranged in 02 groups, being the control group and the group treated with radiofrequency. The control conducted 2 months of guidance on skin care and exercises for facial flaccidity. Results: Increase quality improvement of facial flaccidity In the treated group, but statistically there was no result in the comparison between groups. Conclusion: In the qualitative analysis, it was verified that the radiofrequency promoted a clinical improvement at the angle of the nasogenian sulcus.

Baclofen is a derivative of gamma-aminobutyric acid, used mainly for the treatment of muscle spasticity. Baclofen overdose can result in severe respiratory depression, autonomic disturbances, seizures and coma. Here we report a 15-year-old girl who was found unresponsive, intubated and admitted to the PICU. On initial presentation, her Glasgow Coma Score was 3, with fixed dilated pupils. EEG revealed cerebral bioelectric activity and ground amplitudes significantly lower than normal. Supportive treatments were administered. On the 2nd PICU day, she regained consciousness and was able to follow commands. She was extubated and discharged on hospital day 3. Conclusively emergency physicians should consider baclofen overdose in children presenting with acute loss of consciousness, flaccidity, and hyporeflexia.

Objective: to describe the chewing and swallowing pattern of obese individuals indicated for bariatric surgery/gastroplasty before the procedure, using standardized clinical protocols. Methods: a cross-sectional descriptive case-control study that presents preliminary data for a larger investigation. Eight participants matched for age and sex were divided into two groups (four in the research group and four as controls) and submitted to clinical speech therapy assessment using the “Questionnaire on eating behavior and the anatomofunctional conditions of the stomatognathic system” from the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E) and the maximum tongue pressure test. Results: when compared to controls, participants from the research group exhibited a predominantly unilateral chewing preference; reported that they just “swallowed food”; repeated swallowing of liquid and solid foods, with facial muscle tension; increased cheek volume and the presence of flaccidity; shorter meal and chewing times; increased tension of the lips, mentalis and facial muscles at rest and during swallowing; predominance of insufficient ability with associated movements and/or tremors during lip, tongue, jaw and cheek movements; and lack of knowledge regarding speech therapy. Conclusion: orofacial myofunctional dysfunctions were more frequent in patients from the research group when compared to controls. A need to increase the number of participants in this case series and conduct a post-surgery reassessment, in order to provide a longitudinal description of the chewing and swallowing pattern, was verified. RESUMO Objetivo: descrever o padrão de mastigação e deglutição de indivíduos com obesidade, indicados à realização de cirurgia bariátrica/gastroplastia, antes do procedimento, por meio de protocolos clínicos padronizados. Métodos: trata-se de um estudo descritivo transversal, do tipo caso controle, que apresenta dados preliminares de um estudo maior. Oito participantes, divididos em quatro casos controle e quatro casos pesquisa, pareados por idade e gênero, foram submetidos a avaliação clínica fonoaudiológica por meio do “Questionário sobre comportamento alimentar e as condições anatomofuncionais do sistema estomatognático”, do protocolo AMIOFE-E e do teste de pressão máxima de língua. Resultados: os participantes dos casos pesquisa apresentaram em comparação aos casos controle: predominância de mastigação unilateral preferencial; referiram que apenas “engole o alimento”; repetição de deglutição em alimentos líquidos e sólidos, com presença de tensão dos músculos faciais; bochechas com volume aumentado e presença de flacidez; tempo de refeição e mastigação menores; tensão aumentada de lábios, músculos mentual e faciais no repouso e na deglutição; predominância de habilidade insuficiente com movimentos associados e/ou tremor nas tarefas de mobilidade de lábios, língua, mandíbula e bochechas; e desconhecimento da atuação fonoaudiológica. Conclusão: os pacientes do grupo pesquisa, apresentaram maior ocorrência de alterações miofuncionais orofaciais quando comparados ao grupo controle. Identifica-se a necessidade do aumento do número de participantes nesta série de casos, assim como a possibilidade de reavaliação no momento pós-cirúrgico visando uma descrição longitudinal do padrão de mastigação e deglutição.

Penile erection is a perfect example of microcirculation modulated by psychological factors and hormonal status. It is the result of a complex neurovascular process that involves the integrative synchronized action of vascular endothelium; smooth muscle; and psychological, neuronal, and hormonal systems. Therefore, the fine coordination of these events is essential to maintain penile flaccidity or allow erection; an alteration of these events leads to erectile dysfunction (ED). ED is defined as the consistent or recurrent inability of a man to attain and/or maintain a penile erection sufficient for sexual activity. A great boost to this research field was given by commercialization of phosphodiesterase-5 (PDE5) inhibitors. Indeed, following the discovery of sildenafil, research on the mechanisms underlying penile erection has had an enormous boost, and many preclinical and clinical papers have been published in the last 10 years. This review is structured to provide an overview of the mediators and peripheral mechanism(s) involved in penile function in men, the drugs used in therapy, and the future prospective in the management of ED. Indeed, 30% of patients affected by ED are classified as “nonresponders,” and there is still an unmet need for therapeutic alternatives. A flowchart suggesting the guidelines for ED evaluation and the ED pharmacological treatment is also provided.

Studies on erectile dysfunction (ED) have revealed a relationship between smooth muscle atrophy and the accumulation of collagen in the corpus cavernosum (CC). Transforming growth factor s1 (TGF s1) is a cytokine which has been proposed to be involved in the fibrotic process in the CC. We aimed to evaluate the course of TGF s1 in the systemic and cavernous blood of 17 healthy males through different phases of the sexual arousal response (exemplified by the penile conditions flaccidity, tumescence, rigidity and detumescence). An enzyme-linked immunoassay was used to measure the concentration of TGF s1 (ng/ml) in both the systemic and cavernous blood at the stages of flaccidity, tumescence and detumescence. TGF levels were significantly higher in the cavernous compartment than in the systemic blood. A linear decrease was evident in the cavernous blood when the flaccid penis became tumescent (24.3 ± 14.5 to 13.9 ± 6.5) and rigid (to 8.7 ± 3.1). At detumescence, TGF increased to 18.3 ± 10.4. In contrast, the levels in the systemic circulation remained unchanged. The results are in support of the hypothesis that the concentration of TGF s1 in the CC is regulated by adequate blood flow and oxygenation.

Introduction The Ehlers-Danlos Syndrome (EDS) can presentis a reduction in fibroblast proliferation and collagen production. Microneedling a minimally invasive technique that through mechanical stimulus there is incentive to the production of collagen and elastin. Objective Present a case study in a patient with EDS complaining of flaccidity on large genital labia, using microneedling as a therapeutic proposal. Methodology A 36-year-old female with EDS type III. The external genitalia showed tissue flaccidity associated with hyperchromia. Microneedling was performed with 0.5 mm needles and the cosmetology was used soon after the application. The level of pain was questioned to the patient through a Likert scale. The clinical response to treatment was evaluated through self-report, visual analogue scale and analysis of photographic images. Five other people evaluated the results through before and after images. Results Microneedle was shown to be bearable in relation to pain and associated with cosmetology for tissue flaccidity due to EDS in the genital region proved to be very satisfactory for the patient, as well individuals who evaluated the comparative image. Conclusion Microneedle associated with cosmetology may be a new option for studies on skin flaccidity treatments on individuals with EDS and for treatments of genital hyperchromias.

In recent years, metabolomics using high-performance liquid chromatography (UPLC) has been used to study the metabolic profiles in plasma, urine, stool and tissue in animal model of chronic kidney disease (CKD). In the previous work, we found that traditional Chinese medicine (TCM) "Kidney Flaccidity Compound” (KFC) based on "kidney flaccidity theory” can improve renal function and quality of life of patients with kidney disease. This study aimed to investigate the metabolic profiles in peripheral blood of hemodialysis patients administrated by KFC for 1.5 and 3 months and explore the potential metabolic mechanism using UPLC. Results showed that 121 metabolites were different between KFC 3-months group and untreated control, of which 75 were significantly upregulated and 46 were significantly downregulated. In the 1.5-months treatment group, there were 365 metabolites, of which 164 were significantly upregulated and 192 downregulated. There were 6 metabolites and 15 metabolites upregulated 3-fold in 3-months and 1.5-months KFC treatment group, respectively. In addition, more than 60 new metabolites were identified in the peripheral blood in KFC treated patients, including two potential diagnostic markers MGDG 30:8 and 2-(hydroxymethyl)-6-[[(1R,4S) -2,2,4-trimethyl-3-oxabicyclo[2.2.2]octan-5-yl]oxy]oxane-3,4,5-triol. The pathway enrichment analysis showed thce differential metabolites mainly enriched in Arginine and proline metabolism, Urea cycle, Tyrosine metabolism, Methionine metabolism, Tricarboxylic acid cycle, and Androgen and estrogen metabolism. The findings are helpful to reveal the mechanism of KFC protects CKD, and to provide a new strategy for recovery renal function in hemodialysis patients.

Moisés AmselemClinica Dr. Moisés Amselem, Madrid, SpainAbstract: Nonsurgical esthetic improvement of the upper arms is a desirable goal for many individuals. Radiesse® (calcium hydroxylapatite) is an effective dermal filler for a number of indications because of its volumizing effect and the ability to stimulate neocollagenesis. No studies have reported on its safety and effectiveness for the treatment of the upper arm. In a prospective, open-label study, 30 subjects seeking improvement in the esthetic appearance of their upper arms received injections with Radiesse® (1.5 mL/arm) at two separate visits, 1 month apart. Subjects returned for a follow-up visit 4 months after the second treatment. The primary endpoint was the degree of overall subject and evaluator (investigators and study nurses) satisfaction assessed using the 5-point Global Satisfaction Scale (ranging from "1" very dissatisfied to "5" very satisfied). Secondary endpoints included assessments of skin quality (flaccidity and volume distribution) using a new Visual Analog Scale for upper arms and overall assessment of treatment using the Global Aesthetic Improvement Scale. All (100%) of both subjects and evaluators were "satisfied" or "very satisfied" with treatment. The mean Global Satisfaction Score for investigators and study nurses was 4.60 and for subjects 4.53 (satisfied to very satisfied). Assessments of flaccidity and volume improved significantly compared with baseline at the post-treatment visit and also between visits. Compared with baseline, 77% of subjects were rated as considerably improved (good or great improvement) by the investigator and study nurse; 73% of subjects rated themselves as considerably improved and 43% of these rated a "great improvement." All stated they would repeat the treatment and recommend it to others. No adverse events were reported. Radiesse® is an effective minimally invasive treatment option for improving upper arm contours and was associated with a 100% satisfaction rate for both subjects and evaluators.Keywords: esthetic improvement, calcium hydroxylapatite, contouring, Radiesse®, upper arm