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The possibilities for facial and body treatments are wide, but when it comes to treatment for the cervical region, the options are more restricted and among them, the use of poly-l-lactic acid (PLLA) stands out. PLLA is used for collagen biostimulation and improvement of skin turgor with good results; however this procedure is not free of complications, and for the treatment of these, a correct diagnosis is essential. As it is esthetic medicine, the guarantee of results requires that complications are not tolerated, and thus, any resource that enriches the diagnostic and therapeutic arsenal is of great value. The objective of this study is to report the diagnosis of a PLLA nodule with the help of high-frequency ultrasound, establishing a clinical, radiological, and histopathological correlation, in a patient submitted to PLLA injection for esthetic improvement of the cervical region. We present a case in a female patient presenting a nodule in the cervical region after the application of PLLA, where we performed the excision guided by high-frequency ultrasound. Mastering the diagnostic technique with high-frequency ultrasound can play a valuable role in indicating early surgical exeresis, also contributing to complete patient care. It allows the application of the product, monitoring, diagnosis of the complication, and treatment to be carried out dynamically and precisely by the injector.

SummaryBackground The escalating urge for a youthful-looking skin instigates continuous innovations with minimally invasive procedures. Readymade growth factors and autologous platelet-rich plasma (PRP) represent such therapeutic interventions. Objective Compare the efficacy and safety of PRP to readymade growth factors in skin rejuvenation. Patients and Methods Twenty adult females with Fitzpatrick skin types III-IV and Glogau photoaging types II and III were enrolled in this study. They underwent a split face therapy where each side was randomly assigned to treatment by either readymade growth factors (area A) or autologous PRP (area B). All patients received six sessions at 2-weeks interval. Evaluation was carried out using Global Aesthetic Improvement Scale (GAIS) and optical coherence tomography (OCT). Patients were followed up for 6 months. Results Both procedures yielded significant improvement regarding both GAIS (skin turgor and overall vitality) and OCT (epidermal and dermal thickness) assessment. Significant negative correlation was detected between patients' age, sun exposure, and GAIS. Burning sensation was significantly higher in area A. Patient satisfaction was significantly higher in area B. Improvement was more sustained in area B on follow-up. Conclusion Platelet-rich plasma is effective and safe for skin rejuvenation, comparable to readymade growth factors with noticeable higher longevity.

OBJECTIVE To determine usefulness of skin turgor and capillary refill time (CRT) for predicting changes in hydration status of working dogs after a 15-minute exercise period. ANIMALS 9 exercise-conditioned working dogs between 8 and 108 months of age. PROCEDURES Skin tent time (SkTT; time for tented skin on the forehead to return to an anatomically normal position) and CRT (time for occluded mucous membrane capillary vessels to return to the color visible before occlusion) were measured on dogs in a field setting and by video review. Body weight (BW), SkTT, CRT, and core body temperature were measured before and after a 15-minute exercise period. Exercise challenge was performed on days 1 and 8. RESULTS Time (day 1 vs day 8) did not significantly affect results; therefore, data were pooled for the 2 trial days. Mean ± SE BW decreased (but not significantly) by 0.83 ± 0.27% after exercise. The SkTT increased significantly (both field setting and video review) after exercise. Correlation between SkTT results for the field setting and video review (r = 0.68) was significant. The CRT decreased (but not significantly) after exercise. CONCLUSIONS AND CLINICAL RELEVANCE Dogs became mildly dehydrated (mean BW loss, 0.83%) during a 15-minute exercise period, and the mild dehydration was evident as a visually detectable change in skin turgor. Monitoring the SkTT appeared to be a useful strategy for predicting small shifts in hydration status of dogs during exercise. The CRT decreased and was not a significant predictor of a change in hydration status.

Objective: Identify nursing care performed by nurses to evaluate, prevent, and treat cutaneous xerosis in the elderly. Materials and Methods: Descriptive study with quantitative approach, conducted with 101 care nurses working in the medical clinic and in the intensive care units of four hospitals in Paraíba, Brazil. The data collection took place between July and September 2018 through an instrument composed of sociodemographic variables and by items related with nursing care. The statistical analysis was performed by distribution and frequency calculations, central tendency measures, standard deviation, and chi-squared test for categorical variables. Results: The majority stated always considering the age range (84.2 %), assessing skin color (83.2 %), evaluating skin turgor and elasticity (64.4 %), looking for the existence of skin fissures (53.5 %), and noticing the existence of lesions on the skin (90.1 %). Of the participating professionals, 83.2 % reported never having used imported equipment to evaluate skin hydration. Conclusions: The study showed that nurses emphasized the importance of considering age range, assessing skin color, being aware of areas with hyperemia, and noticing the existence of lesions, as well as the need for continuing education to improve the quality of care. RESUMEN Objetivo: identificar los cuidados de Enfermería realizados por enfermeros para evaluar, prevenir y tratar la xerosis cutánea en personas ancianas. Materiales y métodos: estudio descriptivo, con enfoque cuantitativo, realizado con 101 enfermeros asistenciales que ejercen actividades en la clínica médica y la unidad de terapia intensiva de cuatro hospitales de Paraíba, Brasil. La recolección de los datos ocurrió entre julio y septiembre del 2018 por medio de un instrumento compuesto por variables sociodemográficas y por ítems relacionados con los cuidados de Enfermería. El análisis estadístico se realizó por cálculos de distribución y frecuencia, medidas de tendencia central, desviación estándar y prueba chi-cuadrado para variables categóricas. Resultados: la mayoría afirmó siempre considerar el rango de edad (84,2 %), evaluar la coloración de la piel (83,2 %), evaluar la hinchazón y la elasticidad de la piel (64,4 %), buscar la existencia de hendiduras (53, 5 %), observar la existencia de lesiones en la piel (90,1 %). De los profesionales participantes, el 83,2 % dijo nunca haber usado equipo importado para evaluar la hidratación de la piel. Conclusiones: el estudio encontró que los enfermeros enfatizaron la importancia de considerar el grupo de edad, evaluar la coloración de la piel, estar atento a áreas con hiperemia y observar la existencia de lesiones, así como la necesidad de la educación continuada para mejorar la calidad del cuidado. RESUMO Objetivo: identificar os cuidados de Enfermagem realizados por enfermeiros para avaliar, prevenir e tratar a xerose cutânea em pessoas idosas. Materiais e métodos: estudo descritivo com abordagem quantitativa, realizado com 101 enfermeiros assistenciais que exercem atividades na clínica médica e na unidade de terapia intensiva de quatro hospitais da Paraíba, Brasil. A coleta dos dados ocorreu entre julho e setembro de 2018 por meio de um instrumento composto por variáveis sociodemográficas e por itens relacionados aos cuidados de Enfermagem. A análise estatística realizou-se por cálculos de distribuição e frequência, medidas de tendência central, desvio-padrão e teste qui-quadrado para variáveis categóricas. Resultados: a maioria afirmou sempre considerar a faixa etária (84,2 %), avaliar a coloração da pele (83,2 %), avaliar o turgor e a elasticidade da pele (64,4 %), buscar a existência de rachaduras (53,5 %), observar a existência de lesões na pele (90,1 %). Dos profissionais participantes, 83,2 % disseram nunca ter usado equipamento importado para avaliar a hidratação da pele. Conclusões: o estudo demonstrou que os enfermeiros enfatizaram a importância em considerar a faixa etária, avaliar a coloração da pele, estar atento a áreas com hiperemia e observar a existência de lesões, bem como a necessidade da educação continuada para melhorar a qualidade do cuidado.

Dehydration is known to lead to serious health conditions and diseases, and a convenient way to check one’s hydration level may help reduce risk of dehydration. A widely used method by clinicians is skin turgor test, which is based on the visual inspection of skin mechanical properties. The test does not require special equipment, but it lacks quantification and is hard to practice by non-experts. Here, we demonstrate the detection of hydration state based on analyzing skin mechanical properties with a mobile phone camera. The camera captures and quantifies the dynamic processes of skin stretching and relaxation related to hydration using two methods: 1) tracking of a mark drawn on the skin and 2) the natural skin texture change during the turgor test. Tests on a small cohort of human subjects have been carried to validate the methods.

Biology and Reproduction Due to their size and anatomical similarity to humans, baboons make an excellent model for reproductive studies. Baboons have a simple short cervix, muscular uterus, ovaries just lateral to the uterus and similar vasculature to that of humans. Because of the size of the animals, instruments designed for use in women can be readily used on baboons. Noninvasive determination of phase of estrous cycle is readily made by observation of changes in perineal sexual skin turgor and color. Advantages Some advantages of use of baboons compared to other nonhuman primates is that they are nonseasonal breeders allowing for studies to be conducted year round, have minimal infectious disease risks to humans as they do not carry Herpes B and have a social structure allowing for easy group formation. Baboons serve as good models for many conditions in humans and should be considered for studies investigating reproductive issues.

OBJECTIVES: As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatational tracheostomy. To optimize the learning curve, we propose a home-made pig model obtained from a slaughterhouse for training residents in the technical aspects of performing percutaneous dilatational tracheostomy. The satisfaction of the residents' training experience using this model was compared with that using a standard manikin model. METHODS: Fifty residents participated in the present study. At the end of the session, each participant completed a questionnaire assessing the pig model and the manikin by assigning a score (ranging from 1 to 4) to five specific characteristics including (i) reality of skin turgor; (ii) landmark recognition; (iii) feasibility of the procedure; (iv) reality of the model and (v) preference of each model. The differences between models were statistically analysed. RESULTS: Forty-five participants completed the study. The pig model, compared with the manikin model, presented a higher value regarding the reality of skin turgor (1.7 ± 0.5 vs 0.4 ± 0.8; respectively, P < 0.0001); landmark recognition (3.8 ± 0.5 vs 2.0 ± 0.5; respectively; P < 0.0001) and reality of the model (3.0 ± 0.8 vs 1.3 ± 1.0; respectively; P < 0.0001). No difference was found regarding the feasibility of the procedure (3.7 ± 0.6 vs 3.5 ± 0.5; respectively, P = 0.1). The pig model was preferred to the manikin (3.2 ± 0.7 vs 1.6 ± 1.0; respectively, P < 0.0001). CONCLUSIONS: Our pig model allowed residents to develop the skills required for successful percutaneous dilatational tracheostomy. In particular, they developed confidence with certain manoeuvres such as needle and guide-wire placement, dilatation of the trachea and insertion of a cannula, before attempting the procedure on a live patient. OBJECTIVES: As airway management specialists, thoracic surgeons should be familiar with percutaneous dilatational tracheostomy. To optimize the learning curve, we propose a home-made pig model obtained from a slaughterhouse for training residents in the technical aspects of performing percutaneous dilatational tracheostomy. The satisfaction of the residents' training experience using this model was compared with that using a standard manikin model.METHODS: Fifty residents participated in the present study. At the end of the session, each participant completed a questionnaire assessing the pig model and the manikin by assigning a score (ranging from 1 to 4) to five specific characteristics including (i) reality of skin turgor; (ii) landmark recognition; (iii) feasibility of the procedure; (iv) reality of the model and (v) preference of each model. The differences between models were statistically analysed.RESULTS: Forty-five participants completed the study. The pig model, compared with the manikin model, presented a higher value regarding the reality of skin turgor (1.7 +/- 0.5 vs 0.4 +/- 0.8; respectively, P < 0.0001); landmark recognition (3.8 +/- 0.5 vs 2.0 +/- 0.5; respectively; P < 0.0001) and reality of the model (3.0 +/- 0.8 vs 1.3 +/- 1.0; respectively; P < 0.0001). No difference was found regarding the feasibility of the procedure (3.7 +/- 0.6 vs 3.5 +/- 0.5; respectively, P = 0.1). The pig model was preferred to the manikin (3.2 +/- 0.7 vs 1.6 +/- 1.0; respectively, P < 0.0001).CONCLUSIONS: Our pig model allowed residents to develop the skills required for successful percutaneous dilatational tracheostomy. In particular, they developed confidence with certain manoeuvres such as needle and guide-wire placement, dilatation of the trachea and insertion of a cannula, before attempting the procedure on a live patient.

Yeasts utilize different mechanisms to release ascospores of different lengths from bottle-shaped asci. Using electron microscopy, confocal laser scanning microscopy, gas chromatography–mass spectrometry and digital live imaging, the individual release of oval ascospores from tight-fitting narrow bottle-necks, is reported in the yeast Dipodascus albidus. These ascospores are surrounded by compressible, oxylipin-coated sheaths enabling ascospores to slide past each other when forced by turgor pressure and by possible sheath contractions towards the narrowing ascus-neck. In this paper, the release mechanisms of ascospores of various lengths from bottle-shaped asci and produced by different yeasts are compared. We suggest that different release mechanisms, utilizing compressible sheaths or geared-alignment, have possibly evolved to compensate for variation in ascospore length. Alternatively, sheaths and ridges might be two evolutionary solutions to the same biomechanical problem, i.e. to release ascospores irrespective of length from bottle-shaped asci.

Background. The cosmetic dermatologic surgeon can improve facial scars by using a variety of techniques. Chemical peels, lasers, and dermabrasion are among the most common modalities used. In recent years, laser resurfacing has enjoyed great popularity; however, there is still a role for the time-honored and effective technique of dermabrasion. The recent withdrawal of Freon from the market has made dermabrasion more difficult. Objective. To introduce a novel technique of using solid carbon dioxide (CO2) to freeze the skin before dermabrasion. Method. Twenty-five consecutive patients with facial acne scars underwent a combination of procedures including chemical peeling and CO2 laser resurfacing, followed by freeze-dermabrasion. Compressed CO2 was then used to make a solid ball of dry ice. The ice was used to freeze the skin prior to dermabrasion. After the application of the dry ice ball to the skin for about 4 seconds, the scares were dermabraded with the large mushroom wheel. As the tissue defrosted, the operator started at the outer edge of the freeze and planed into the center. This procedure was repeated until the desired improvement was achieved. Results. With dry ice, a good skin turgor was achieved. This provided a good foundation for the sanding of the acne scars. The patients were pleased with the results and complications were minimal. Conclusion. “Home-made” dry ice works as well as Freon in providing skin turgor for dermabrasion. CO2 dry ice has the added benefits of being inexpensive and environmentally friendly.

The purpose of this study was to determine the dominant factor that clinically influent the occurrence of dehydration in goats aged 10-14 days old, in order to enhance the accuracy in diagnoinge the state of hydration. Ten native kacang goatlings were used as research objects. Kacang goatlings were dehydrated until loss 10% of their bodyweight by inducing diuretics furosemide (2mg/kg body weight every 4 hours) using intramuscularly, orally administration of spironolactone (50 mg every 8 hours) and hydrochlorothiazide (50 mg every 8 hours). Regression analysis was used to verify the correlation between clinical factors that considered potential, which are enopthalmus, skin turgor (back, neck and upper eyelid), capillary refill time, pulsus, breath, and body temperature. The results showed that enopthalmus, skin turgor on back and eye region has close correlation with dehydration occurrence with coefficient determinant R2 are 0.92; 0.90 and 0.81 respectively. It can be concluded that these three parameters can be used as predictor towards dehydration occurrence.

A complete study of the flank region's unaesthetic distortions is reported. Comments regarding and illustrations of the different clinical appearances of local skin turgor and fat deposits are also noted. A classification of the different types of flank distortions, whether or not combined with similar problems of the surrounding regions, complete the study for the indication of correct treatment. Liposuction, surgery, or both, combined in the same or different stages, complete the main steps of the procedure.

Yeasts use different mechanisms to release ascospores of different lengths from bottle-shaped asci. Round to oval-shaped ascospores are enveloped in oxylipin-coated compressible sheaths, enabling ascospores to slide past each other when they reach the narrowing ascus neck. However, more elongated ascospores do not contain sheaths, but are linked by means of oxylipin-coated interlocked hooked ridges on the surfaces of neighboring ascospores, thereby keeping them aligned while they are pushed towards the ascus tip by turgor pressure. In this study, we found elongated, oxylipin-coated sheathed ascospores in Dipodascus geniculatus that are released effectively from bottle-shaped asci without alignment. This is possible because the ascus neck and opening have a diameter that is the same as the length of the ascospore, thus allowing the ascospores to turn sideways without blocking the ascus when they are released. We found that increased concentrations of acetylsalicylic acid inhibit both ascospore release and 3-hydroxy oxylipin production in this yeast, thereby implicating this oxylipin in sexual reproduction.

Report by O Fayomi, Specialist Registrar Accident & Emergency Medicine, Wycombe General Hospital Search checked by I Maconochie, R Body, Consultant Paediatric Accident & Emergency Medicine; Clinical Research Fellow St Mary’s Hospital, London A short cut review was carried out to establish whether skin turgor is a reliable indicator of hydration status in children. 478 papers were found in Medline and 107 in Embase using the reported searches, of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and …

I have been fortunate. By conducting a series of workshops that demonstrated operative procedures at my office in La Jolla during 1990–1991, I was able to work side by side with Toledo and Gasparotti. Actually, we worked together on several occasions that extended over several days, and we treated numerous patients for body and facial contouring at each session.

• This study was undertaken to evaluate the usefulness of skin turgor or capillary refilling in estimating the degree of dehydration in infants with diarrhea. After initial standardization of the technique, capillary filling time was found to be more reproducible when measured in the fingernail bed after applying just the amount of pressure necessary to blanch the nail bed. Capillary refilling time in 30 normal infants 2 to 24 months of age was 0.81± 0.31 seconds. Capillary filling time was then measured in 32 infants with diarrhea admitted to the hospital and correlated to the degree of dehydration as estimated from the difference in weight from the time of hospital admission to the weight after rehydration. A turgor time of 1.5 seconds or less was found to be indicative of a less than 50-mL/kg deficit or of a normal infant; 1.5 to 3.0 seconds suggests a deficit between 50 and 100 mL/kg, and more than 3 seconds suggests a deficit of more than 100 mL/kg. ( AJDC . 1991;145:296-298)

Liposuction is used most often to contour the body. Usually, it is done on an outpatient basis under general or regional anesthesia. Results are better in patients who have good skin turgor and are at or near their ideal weight. The recovery period is short and relatively pain-free. While there have been serious complications in a few cases, the procedure is safe when done by experienced physicians who are careful in selecting patients and cautious about the magnitude of the procedure they perform. Patient satisfaction is high, particularly when patients are selected carefully and are well-informed concerning the expected outcome.

The dermatologist assesses skin turgor in his patients by the simple manoeuvre of pinching the skin. The experienced finger and thumb can obtain invaluable qualitative information about mechanical functions of the skin in order to correlate them to the general clinical conditions of the patient. In fact, such functions depend on skin structure and skin structure varies in relation to a lot of factors, among which: age, sex, race, test-site, particular physiological and pathological conditions, pharmacological and/or cosmetic treatments. Raising and then releasing a fold of skin, the clinician assesses cutaneous estsensibility and plastoelasticity (that is elastic recovery and residual deformation). In an attempt at quantifying and analyzing the above mentioned mechanical parameters, we took part in the development of a pre-existing device for the objective study of skin plastoelasticity “in vivo” (1).

I was delighted to read the critique of the recent Best Evidence Topic (BET) summary on the reliability of skin turgor as a method for assessing dehydration in children,1 and would like to accept your invitation to respond. My contribution, as third author for this paper, was to check and update the search strategy and to review the final manuscript. While I am sorry that the BET did not provide Dr Smith with the information he desired regarding the diagnostic accuracy of skin turgor in assessing dehydration in children, I fear that he may perhaps be looking in the wrong …

Figure 1. A 74-year-old man was found unconscious at home and brought to the emergency department. He was obtunded and moved only with painful stimuli. His blood pressure was 95/55 mm Hg, with a heart rate of 115 beats per minute and a temperature of 35.8°C. His mucous membranes were dry, and his skin turgor was markedly decreased. Volume status was evaluated by squeezing the skin of the patient's abdomen (Panel A) and assessing the response 15 seconds (Panel B) and 40 seconds (Panel C) after the pressure was released. The following values were recorded on admission: serum sodium, 186 . . .

To the Editor.— The term ectodermal dysplasia (ED) describes a group of inherited, nonprogressive disorders affecting skin and structures derived from embryonic ectoderm 1 (primarily hair, teeth, nails, and sweat glands). Cape Verde is a cluster of islands in the Atlantic Ocean. Two immigrant families from Cape Verde are described with a newly defined form of ED. Report of Cases.—Case 1.— A 10-year-old girl had white spots on her skin for several years. She was otherwise healthy and active. One brother (out of nine siblings) reportedly had similar lesions. The examination revealed a child of normal size and intelligence for her age. Skin turgor and texture were normal, but there were multiple 2- to 5-mm depigmented macules on her extremities (Fig 1). The frontal hairline was considerably displaced toward the posterior aspect; the density was otherwise normal, and no shaft anomalies were appreciated on a hair mount examination.

A little over 40 years ago, anesthesiology in the United States became recognized as a specialty. At that time, its practice was largely that of an art, the science of which was yet to come. A finger on the pulse, observation of color, skin turgor, perspiration, and perhaps a blood pressure cuff in adults, and an estimation of the reflex signs of anesthesia were the standards for the assessment of the patient status and 'the depth of anesthesia'. How far have we come in the intervening years? The journey, as reflected in the experience of one physician, will be held up to the looking-glass; easily as astounding as that through which Alice passed. Caught as we are in the socio-economic climate of the present, how shall we react? Has the gadgetry and electronics of this day given us a meaningful cost-effective handle on a decreased morbidity and mortality? What impact is there on decision-making and outcome? What indeed is the contribution of the machine versus the newer agents, techniques, and the advanced educational milieu. The first attempts at monitoring were clearly directed toward the cardiovascular system. The devices developed were simple and non-invasive. The Riva-rocci method of measuring blood pressure was first applied in anesthesia by Harvey Cushing at the turn of the century. But it was 40 years before the electrocardiogram was introduced as an instrument of potential importance. It took another 25 years for it to have general acceptance, and even later for the anesthesiologist to become comfortable with it as a diagnostic tool.(ABSTRACT TRUNCATED AT 250 WORDS)

ADMISSIONS to hospitals in many areas of the world are still composed to a great extent of infants with severe dehydration secondary to diarrhea, vomiting, heat prostration and the like. Laboratory facilities are sometimes unavailable; frequently even when at hand, their analytic results are not returned with sufficient promptness to help in the initial therapeutic decisions. Thus, there are needed easy and at least semiquantitative methods of estimation of the extent of dehydration. Preferably these methods should be such that they can be carried out at the patient's bedside. In pediatric and medical textbooks1-3 loss of skin turgor is often mentioned as a sign of dehydration. Apparently few efforts have been made to see whether there is a quantitative correlation between changes in skin turgor and extent of water boss. In the experiments to be reported, skin turgor has been quantitatively related to the extent of dehydration in rats. The correlation has been studied in two types of deficiency state, primary water depletion with relatively small loss of solute and, alternatively, primary solute depletion with concomitant water deficiency. The results obtained suggest that a standardized clinical technique of estimation of skin turgor may be of value in assessing degrees of dehydration and fill the aforementioned need for a simple bedside index. MATERIAL AND METHODS Albino rats weighing 230 to 310 gm were used. Two groups were studied: Group I consisted of 36 rats dehydrated for periods up to 50 hours by simple water deprivation, dry rat chow* being offered ad libitum meanwhile in order to reduce weight loss from inanition.