Autologous platelet concentrates for facial rejuvenation

Autologous platelet concentrates (APCs) are promising therapeutic agents in facial rejuvenation since they are a great source of cytokines, growth factors and other biologically active substances. Obtained from the patient’s blood, they have the advantages of reducing immunological reactions, making the procedure safer, well tolerated, with minimal adverse effects and lower cost. Currently, they are used for facial rejuvenation both in combination with microneedling and in mesotherapy techniques, as well as to treat facial acne scars, melasma and wounds after laser ablative treatments. This review summarizes current knowledge on the use of APCs, ranging from basic concepts related to their composition and mechanisms of action to up-to-date information on their clinical efficacy. Methodology: MEDLINE (PubMed) was searched from inception through 2021 for English language publications on APCs for facial rejuvenation. Results: A total of 100 files were found. Based on the available literature, APCs for skin rejuvenation are safe and well tolerated. The most studied product is the first-generation material, platelet-rich plasma (PRP). Conclusions: The results are in general favorable, but the quality of the studies is low. The second and third generation products, platelet-rich fibrin (PRF) and injectable platelet-rich fibrin (i-PRF), respectively, are easier to be obtained and, at least in vitro , seem to induce greater collagen production than PRP, especially under lower relative centrifugation forces, but to date only a few clinical trials evaluating these products exist. More high-quality trials with appropriate follow-up are necessary to provide adequate evidence that may help to improve the treatment regimens with APCs. Many aspects should be considered when designing clinical trials to evaluate APCs, such as the patients’ characteristics that best predict a favorable response, the optimal number of sessions and the interval between them, the characteristics of the studies and the development of better instruments to evaluate skin aging

“RichBlend” protocol for full-face filling and collagen biostimulation

ABSTRACT The “RichBlend” protocol was designed for facial filling and collagen biostimulation, by means of a mixture of calcium hydroxyapatite (CaHA), hyaluronic acid (AH) and autologous platelet concentrates. This work reports the case of a 53-year-old patient with cutaneous photoaging, loss of facial volume, multiple rhythms in the frontal and periorbital regions, also marked skin flaccidity, especially the eyelid. The treatment was done with botulinum toxin (65 U) and the “RichBlend” protocol. Venipuncture was performed and the blood was centrifuged to obtain i-PRF (injectable platelet-rich fibrin) and plasma gel. After venipuncture and blood centrifugation, i-PRF and plasma gel were obtained. CaHA (Radiesse®) was diluted: a) in saline solution + i-PRF (hyperdilution) for biostimulationof the lower third of the face; and b) in AH (Juvederm Ultraplus XC®) + plasma gel, for hydrolifting on the forehead and dark circles, malar and temples. Plasma gel was applied to the nasogenian grooves and then the entire face was properly massaged. The “RichBlend” protocol rejuvenated the patient, as it promoted filling, volumizing, collagen formation (biostimulation), reduction of flaccidity, in addition to skin whitening. Since HA and CaHA are high-cost products, their mixture with autologous platelet concentrates, in liquid or gel form, allows the use of a greater amount of filled and biostimulator material on the face, at a more affordable cost

Characterization of white spot lesions formed on human enamel under microcosm biofilm for different experimental periods

The initial characteristics of white spot lesion (WSLs), such as the degree of integrated mineral loss (ΔZ), depth and pattern of mineral distribution, have an impact on further demineralization and remineralization. However, these lesion parameters have not been evaluated in WSLs produced from microcosm biofilms. Objective: This study characterized artificial white spot lesions produced on human enamel under microcosm biofilm for different experimental periods. Methodology: In total, 100 human enamel specimens (4x4mm) were assigned to 5 distinct groups (n=20/group) differing according to the period of biofilm formation (2, 4, 6, 8 or 10 days). Microcosm biofilm was produced on the specimens from a mixture of human and McBain saliva at the first 8h. Enamel samples were then exposed to McBain saliva containing 0.2% sucrose. WSLs formed were characterized by quantitative light-induced fluorescence (QLF) and transverse microradiography (TMR). Data were analyzed by ANOVA/Tukey or Kruskal-Wallis/Dunn tests (p<0.05). Results: A clear time-response pattern was observed for both analyses, but TMR was able to better discriminate among the lesions. Regarding QLF analysis, median (95%CI; %) changes in fluorescence ∆Z were -7.74(-7.74:-6.45)a, -8.52(-8.75:-8.00)ab, -9.17(-10.00:-8.71)bc, -9.58(-10.53:-8.99)bc and -10.01(-11.44:-9.72)c for 2, 4, 6, 8, and 10 days, respectively. For TMR, median (95%CI; vol%.µm) ∆Z were 1410(1299-1479)a, 2420(2327-2604)ab, 2775(2573-2899)bc, 3305(3192-3406)cd and 4330(3972-4465)d, whereas mean (SD; µm) lesion depth were 53.7(12.3)a, 71.4(12.0)a, 103.8(24.8)b, 130.5(27.2)bc, 167.2(39.3)c for 2, 4, 6, 8 and 10 days, respectively. Conclusion: The progression of WSLs formed on human enamel under microcosm biofilm can be characterized over 2-10 days, both by QLF and TMR analyses, although the latter provides better discrimination among the lesions

Do commercial whitening dentifrices increase enamel erosive tooth wear?

Objective: This in vitro study evaluated the effect of commercial whitening dentifrices on erosive tooth wear (ETW) of bovine enamel samples, in comparison with commercial regular dentifrices. Methodology: Sixty bovine crowns were embedded in acrylic resin, polished and then had their baseline profile determined. They were randomly assigned to 5 groups (n=12/group), according to the type of commercial dentifrice to be tested: GI – Crest Anti-cavity Regular; GII – Crest 3D White; GIII – Colgate Total 12 Clean Mint; GIV – Colgate Optic White; GV – Placebo (negative control, fluoride-free dentifrice). The samples were submitted to daily erosive and abrasive challenges for 3 days. The erosive challenges were performed 3 times a day by immersing the specimens in 0.1% citric acid solution (pH 2.5) for 90 s. Each day after the first and last erosive challenges, the specimens were subjected to the abrasive challenge for 15 s, using a toothbrushing machine (Biopdi, São Carlos, SP, Brazil), soft toothbrushes and slurry (1:3 g/ml) of the tested toothpastes (1.5 N). The specimens were kept in artificial saliva between the challenges. The final profile was obtained and the ETW (µm) was calculated. Data were analyzed by Kruskal-Wallis and Dunn’s tests (p<0.05). Results: All dentifrices tested significantly reduced the enamel wear in comparison with the Placebo, except GIII. The median (95% CI) ETW was 1.35 (1.25-1.46)bc for GI, 1.17 (1.01-1.34)cd for GII, 1.36 (1.28-1.45)ab for GIII, 1.08 (1.04-1.14)d for GIV and 2.28 (2.18-2.39)a for GV. Conclusion: When dentifrices from the same manufacturer were compared, the whitening dentifrices led to similar or less wear than the regular ones

NAIL AS A BIOMARKER OF CHRONIC FLUORIDE EXPOSURE FROM THE DIET IN FLUORIDATED AND NON-FLUORIDATED COMMUNITIES.

O objetivo do presente estudo foi verificar se a unha pode ser usada como biomarcador de ingestão crônica de flúor (F) a partir da dieta, em crianças residentes em comunidades com água fluoretada ou não, bem como estimar a ingestão de F a partir da dieta consumida pelas mesmas. A amostra constou de 15 crianças (2-6 anos) residentes em Bauru-SP e 15 residentes em Itápolis-SP, cidades fluoretada (0,6-0,8 ppm) e não, respectivamente. As concentrações de F [F] presentes nas unhas, no plasma e na dieta duplicada foram analisadas com eletrodo íon-específico (Orion 9409), após difusão facilitada por HMDS. Os dados foram analisados pelo teste \"t\" pareado e não pareado e por estatística de correlação (p<0,05). A [F] média (µg/mL) encontrada no plasma das crianças de Itápolis (0,024 ± 0,020) foi ligeiramente maior que a encontrada nas crianças de Bauru (0,019 ± 0,011), no entanto esta diferença não foi estaticamente significante. A [F] média (µg/g) presente nas unhas das mãos e dos pés foi de 3,557±1,297 e 2,815±1,288, respectivamente para Bauru e de 2,292±1,250 e 1,580±0,589, respectivamente, para Itápolis, sendo as diferenças entre Bauru e Itápolis, e entre a [F] presente nas unhas das mãos e nas unhas dos pés estatisticamente significantes. As crianças de Bauru ingeriram, de acordo com a estimativa, uma quantidade significantemente maior de F a partir da dieta (0,551±0,610 mg), quando comparadas com as de Itápolis (0,088±0,056 mg), o que correspondeu a uma ingestão diária de 0,029 e 0,004 mg F/Kg peso corporal, para Bauru e Itápolis, respectivamente. Encontrou-se uma correlação positiva significante entre a [F] das unhas e a ingestão de F pela dieta (r=0,566, p=0,00112). Concluiu-se que a unha pode ser usada como biomarcador de ingestão crônica de F a partir da dieta, para diferenciar crianças na idade de risco para fluorose dentária, residentes em comunidades fluoretada ou não.The aim of the present study was to verify if nails can be used as biomarkers of chronic fluoride (F) exposure from the diet in children living in fluoridated and non-fluoridated communities. Fluoride intake frorm the diet was also evaluated. Fifteen 2-6-year-old children living in the fluoridated (0.6 -0.8 ppm) Bauru-SP and 15 living in the non-fluoridated Itápolis-SP participated in the study. Fluoride concentrations in nails, plasma and duplicate diet were analyzed with the ion-specific electrode, following HMDS-facilitated diffusion. Data were analyzed by Student\'s t test and by linear regression (p<0.05). Mean plasma F concentration (µg/mL) found in Itápolis (0.024 ± 0.020) was slightly higher than in Bauru (0.019 ± 0.011), but this difference was not significant. Mean F concentrations (µg/g) in fingernails and toenails were: 3.557±1.297 and 2.815±1.288, respectively, for Bauru and 2.292±1.250 and 1.580±0.589, respectively for Itápolis. The differences between Bauru and Itápolis, as well as between F concentrations in fingernails and toenails were statistically significant. The estimated fluoride intake from the diet was significantly higher for the children living in Bauru (0.551±0.610 mg), when compared to those living in Itápolis (0.088±0.056 mg). This corresponds to a total daily F intake of 0.028 and 0.003 mg/Kg body weight for children living in Bauru and Itápolis, respectively. A significant positive correlation was found between nail F concentrations and estimated F intake from the diet (r=0.566, p=0.00112). It was concluded that nails can be used as biomarkers of chronic F exposure from the diet to differentiate children at the age of risk for dental fluorosis living in fluoridated and non-fluoridated communities

Avaliação da ingestão de flúor de crianças brasileiras de 2 a 6 anos de idade

Este estudo comparou a ingestão de flúor (F) de crianças de 2 a 6 anos residentes em área fluoretada (Bauru-SP, 0,6-0,8 ppm F) e não fluoretada (Pirajuí-SP), avaliada através do método da dieta duplicada associado à escovação simulada e do Questionário de Freqüência Alimentar semi-quantitativo (QFAsq) associado a questionário para estimativa de ingestão de F a partir do dentifrício. Inicialmente, o QFAsq foi aplicado em 398 crianças residentes no município de Pirajuí-SP. Posteriormente, foram avaliadas subamostras de 25 crianças residentes em Bauru e 24 residentes em Pirajuí. Nestas subamostras, a quantidade de F ingerida através da dieta foi determinada pelo QFAsq e também pela dieta duplicada, considerando seus diferentes constituintes (água, outros líquidos e sólidos). A ingestão de F através do dentifrício foi determinada pelo questionário para estimativa da ingestão de dentifrício e pela escovação simulada. O F foi analisado por eletrodo, depois de difusão facilitada por hexametildiloxano ou após tamponameno com TISAB. A analise estatística foi feita utilizando o software GraphPad InStat, aplicando os testes t pareado, t não pareado, Wilcoxon pareado, Mann-Whitney e estatística de correlação (p<0.05). O QFAsq aplicado à amostra de 398 crianças de Pirajuí encontrou valores de ingestão total de F significativamente menores que os relatados previamente para crianças residentes em Bauru (Miziara, 2006). Na subamostra de crianças avaliadas, a média (±DP, mg) da ingestão de F estimada a partir do QFAsq e da dieta duplicada, considerando-se a dieta total foi de 0,420±0,087 e 0,805±0,190 (Bauru) e 0,227±0,072 e 0,144±0,050 (Pirajuí), sendo a diferença entre os métodos significativa em ambos os municípios. Somente foi obtida uma correlação significativa entre os dois métodos no caso dos sólidos, para ambos os municípios. Considerando a estimativa da ingestão de F a partir do dentifrício obtida pela aplicação do questionário e pela escovação simulada, as médias (±DP, mg) compiladas (Bauru mais Pirajuí) foram 0,611±0,452 e 0,784±0,737, respectivamente, não havendo diferença e nem correlação significativas entre os métodos. Através da utilização dos questionários, foi possível detectar diferença significativa na ingestão total de F entre Bauru e Pirajuí. Entretanto, o mesmo não ocorreu quando se utilizou o método da dieta duplicada associado à escovação simulada. Face aos resultados obtidos, o QFAsq associado a um questionário para estimativa da ingestão de F a partir do dentifrício parece ter um bom potencial para utilização a nível epidemiológico, para se avaliar o risco de grupos de crianças à fluorose dentária. Alguns parâmetros do QFAsq podem ser melhor trabalhados para uma análise mais fidedigna, principalmente com relação à freqüência de ingestão de água e outros líquidos. Em adição, a aplicabilidade desses questionários a nível individual para detecção de risco à fluorose dentária ainda precisa ser melhor estudada.This study compared the fluoride (F) intake of 2-6-year-old children, living in fluoridated (Bauru-SP, 0,6-0,8 ppm F) and non-fluoridated (Pirajuí-SP) areas. The methods used were the duplicate diet associated to simulated toothbrushing and the semi-quantitative food frequency questionnaire (sqFFQ) associated to a questionnaire for estimation of F intake from dentifrice. Initially, the sqFFQ was applied to 398 children living in Pirajuí. In another phase, subsamples of 25 children living in Bauru and 24 living in Pirajuí were evaluated. In these subsamples the F intake from diet was determined using the sqFFQ as well as the duplicate diet method, considering the different constituents of the diet (water, other liquids and solids). The F intake from the dentifrice was determined using the questionnaire for estimation of F intake, as well as simulated toothbrushing. F was analyzed with the electrode, following hexamethyldisiloxanefacilitated diffusion or after buffering with TISAB. For statistical analysis, the GraphPad InStat software was used. The applies tests were paired and unpaired t tests, paired Wilcoxon test, Mann-Whitney test and correlation analysis (p<0.05). The sqFFQ, when applied to the sample constituted by 398 children living in Pirajuí, found values of total F intake significantly lower when compared to previous data reported by Miziara (2006) for children living in Bauru. In the subsample of evaluated children, the mean (±SD, mg) F intakes estimated by the sqFFQ and duplicate diet (total diet) were 0.420±0.087 and 0.805±0.190 (Bauru) and 0.227±0.072 and 0.144±0.050 (Pirajuí), respectively. The difference between the methods was significant for both municipalities. For both municipalities, a significant correlation between the methods was obtained in the case of solids only. Considering the estimation of F intake from dentifrice obtained by the application of the questionnaire and simulated toothbrushing, the compiled (Bauru plus Pirajuí) means (±SD, mg) were 0.611±0.452 and 0.784±0.737, respectively. The difference as well as the correlation between the methods were not significant. By using the questionnaires, it was possible to detect a significant difference in the total F intake between Bauru and Pirajuí. However, the same did not occur when using the method of duplicate diet associated with simulated toothbrushing. Due to the results obtained, it seems that the sqFFQ associated to a questionnaire for estimation of F intake from dentifrice has a good potential for use at epidemiological level in order to evaluate the risk of groups of children to dental fluorosis. Some parameters of the sqFFQ need to be better addressed for a more precise analysis, mainly with respect to the frequency of water and other liquids intake. In addition, the applicability of these questionnaires at the individual level for the detection of risk to dental fluorosis requires further studies

NAIL AS A BIOMARKER OF CHRONIC FLUORIDE EXPOSURE FROM THE DIET IN FLUORIDATED AND NON-FLUORIDATED COMMUNITIES.

O objetivo do presente estudo foi verificar se a unha pode ser usada como biomarcador de ingestão crônica de flúor (F) a partir da dieta, em crianças residentes em comunidades com água fluoretada ou não, bem como estimar a ingestão de F a partir da dieta consumida pelas mesmas. A amostra constou de 15 crianças (2-6 anos) residentes em Bauru-SP e 15 residentes em Itápolis-SP, cidades fluoretada (0,6-0,8 ppm) e não, respectivamente. As concentrações de F [F] presentes nas unhas, no plasma e na dieta duplicada foram analisadas com eletrodo íon-específico (Orion 9409), após difusão facilitada por HMDS. Os dados foram analisados pelo teste \"t\" pareado e não pareado e por estatística de correlação (p<0,05). A [F] média (µg/mL) encontrada no plasma das crianças de Itápolis (0,024 ± 0,020) foi ligeiramente maior que a encontrada nas crianças de Bauru (0,019 ± 0,011), no entanto esta diferença não foi estaticamente significante. A [F] média (µg/g) presente nas unhas das mãos e dos pés foi de 3,557±1,297 e 2,815±1,288, respectivamente para Bauru e de 2,292±1,250 e 1,580±0,589, respectivamente, para Itápolis, sendo as diferenças entre Bauru e Itápolis, e entre a [F] presente nas unhas das mãos e nas unhas dos pés estatisticamente significantes. As crianças de Bauru ingeriram, de acordo com a estimativa, uma quantidade significantemente maior de F a partir da dieta (0,551±0,610 mg), quando comparadas com as de Itápolis (0,088±0,056 mg), o que correspondeu a uma ingestão diária de 0,029 e 0,004 mg F/Kg peso corporal, para Bauru e Itápolis, respectivamente. Encontrou-se uma correlação positiva significante entre a [F] das unhas e a ingestão de F pela dieta (r=0,566, p=0,00112). Concluiu-se que a unha pode ser usada como biomarcador de ingestão crônica de F a partir da dieta, para diferenciar crianças na idade de risco para fluorose dentária, residentes em comunidades fluoretada ou não.The aim of the present study was to verify if nails can be used as biomarkers of chronic fluoride (F) exposure from the diet in children living in fluoridated and non-fluoridated communities. Fluoride intake frorm the diet was also evaluated. Fifteen 2-6-year-old children living in the fluoridated (0.6 -0.8 ppm) Bauru-SP and 15 living in the non-fluoridated Itápolis-SP participated in the study. Fluoride concentrations in nails, plasma and duplicate diet were analyzed with the ion-specific electrode, following HMDS-facilitated diffusion. Data were analyzed by Student\'s t test and by linear regression (p<0.05). Mean plasma F concentration (µg/mL) found in Itápolis (0.024 ± 0.020) was slightly higher than in Bauru (0.019 ± 0.011), but this difference was not significant. Mean F concentrations (µg/g) in fingernails and toenails were: 3.557±1.297 and 2.815±1.288, respectively, for Bauru and 2.292±1.250 and 1.580±0.589, respectively for Itápolis. The differences between Bauru and Itápolis, as well as between F concentrations in fingernails and toenails were statistically significant. The estimated fluoride intake from the diet was significantly higher for the children living in Bauru (0.551±0.610 mg), when compared to those living in Itápolis (0.088±0.056 mg). This corresponds to a total daily F intake of 0.028 and 0.003 mg/Kg body weight for children living in Bauru and Itápolis, respectively. A significant positive correlation was found between nail F concentrations and estimated F intake from the diet (r=0.566, p=0.00112). It was concluded that nails can be used as biomarkers of chronic F exposure from the diet to differentiate children at the age of risk for dental fluorosis living in fluoridated and non-fluoridated communities

Programa de agentes comunitários de saúde: a percepção de usuários e trabalhadores da saúde

Valorizar a família e a comunidade em que se insere, além de estimular a sua participação na promoção da saúde e na prevenção das doenças são linhas-eixo da filosofia do PACS (Programa de Agentes Comunitários de Saúde). Este trabalho teve como elemento de estudo as ações desenvolvidas no PACS do Município de Bauru, São Paulo, segundo a percepção dos agentes comunitários de saúde (ACS) e das famílias por eles atendidas. Como ponto de partida para realização deste trabalho, foram entrevistados 22 agentes e 22 representantes de famílias, selecionadas aleatoriamente segundo a microárea de sua residência. Formaram-se dois grupos focais, a partir do PACS ao qual estavam vinculados agentes e usuários. A análise qualitativa das respostas demonstrou correspondência entre a percepção de ACS e comunidade nos dois grupos focais, que, no entanto, diferiram entre si. Foram observadas realidades distintas, norteando a realização de algumas ações programáticas e o enfrentamento das dificuldades locais

Programa de agentes comunitários de saúde: a percepção de usuários e trabalhadores da saúde

Valorizar a família e a comunidade em que se insere, além de estimular a sua participação na promoção da saúde e na prevenção das doenças são linhas-eixo da filosofia do PACS (Programa de Agentes Comunitários de Saúde). Este trabalho teve como elemento de estudo as ações desenvolvidas no PACS do Município de Bauru, São Paulo, segundo a percepção dos agentes comunitários de saúde (ACS) e das famílias por eles atendidas. Como ponto de partida para realização deste trabalho, foram entrevistados 22 agentes e 22 representantes de famílias, selecionadas aleatoriamente segundo a microárea de sua residência. Formaram-se dois grupos focais, a partir do PACS ao qual estavam vinculados agentes e usuários. A análise qualitativa das respostas demonstrou correspondência entre a percepção de ACS e comunidade nos dois grupos focais, que, no entanto, diferiram entre si. Foram observadas realidades distintas, norteando a realização de algumas ações programáticas e o enfrentamento das dificuldades locais