Newell Brands inc (NWL) Q3 2021 Earnings Call Transcript – Motley Fool

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Newell Brands inc (NASDAQ:NWL)
Q3 2021 Earnings Call
Oct 29, 2021, 11:00 a.m. ET
Operator
Good morning, and welcome to the Newell Brands’ Third Quarter 2021 Earnings Conference Call. [Operator Instructions] As a reminder, today’s conference is being recorded. The live webcast of this call is available at ir.newellbrands.com.
I will now turn the call over to Sofya Tsinis, Vice President of Investor Relations. Ms. Tsinis, you may begin.

Sofya TsinisVice President of Investor Relations
Thank you. Good morning, everyone. Welcome to Newell Brands’ third quarter earnings call. On the call with me today are Ravi Saligram, our President and CEO; and Chris Peterson, our CFO and President, Business Operations.
Before we begin, I’d like to inform you that during the course of today’s call, we will be making forward-looking statements, which involve risks and uncertainties. Actual results and outcomes may differ materially, and we undertake no obligation to update forward-looking statements. I refer you to the cautionary language and risk factors available in our earnings release, our Form 10-K, Form 10-Q and our SEC filings available on our Investor Relations website for a further discussion of the factors affecting forward-looking statements.
Please also recognize that today’s remarks will refer to certain non-GAAP financial measures, including those we refer to as normalized measures. We believe these non-GAAP measures are useful to investors, although they should not be considered superior to the measures presented in accordance with GAAP. Explanations of these non-GAAP measures and available reconciliations between GAAP and non-GAAP measures can be found in today’s earnings release and tables as well as in other material on Newell’s Investor Relations website. Thank you. And now I’ll turn the call over to Ravi.
Ravi SaligramPresident and Chief Executive Officer
Thank you, Sofya. Good morning, everyone, and welcome to our call. We delivered solid results in the third quarter, which reflect the effectiveness of our strategy as well as the resilience and agility of our operating model and portfolio. Year-to-date, core sales grew 15.2% versus 2020 as each business unit contributed to such a terrific outcome. Normalized operating profit improved over 21% and normalized earnings per share increased about 14%. We further strengthened our track record as the third quarter marked the fifth consecutive quarter of core sales growth and sixth straight quarter of domestic consumption growth for the company.
Core sales in the quarter increased 3.2% driven by excellent performance across five business units, Writing, Baby, Home Appliances, Home Fragrance and Outdoor & Recreation. This was no small feat given the difficult year ago comparison of 7.2% core sales growth, which embedded a recovery across the majority of Newell’s businesses. To normalize for pandemic-related shifts, we think it’s useful to compare this year’s top line to 2019. On a two-year stack basis, Newell’s core sales grew low single digits in the third quarter. We also saw strong domestic consumption relative to 2019 across each of our business units, a terrific result and a testament to the significant progress we’ve been — that we’ve made in forging stronger relationships with shoppers as we leverage consumer insights and foresights in new product launches.
The resurgence in our Writing business continue. The team has done a superb job during the important back-to-school season with outstanding performance in consumption and share momentum. As anticipated, top line trends moderated against elevated year ago results in our Food and commercial businesses. However, sales as well as domestic consumption for both business units remain about 2019 levels.
Consumer behavior will undoubtedly evolve and categories will continue to normalize, but we believe that home-as-hub mindset will linger on, as well the heightened interest in outdoor activities and personal well-being. It’s also evident in the company’s consumption trends as domestic POS remains well ahead of 2020 and 2019 levels both in the third quarter and year-to-date, despite supply constraints.
Core sales in North America mirrored that of the total company. Outside North America, Latin America stood up once again, delivering another quarter of double-digit growth despite elevated comparisons. I’m also delighted that the strength of our iconic brands continue to come through this year, harnessing the benefits from the fortified innovation funnels and our brand-building efforts. Year-to-date, many of our largest brands such as Graco, Coleman, Oster, Yankee Candle, Sharpie, Rubbermaid, First Alert, Paper Mate, Dymo, EXPO, Ball and Mr. Coffee delivered excellent top line growth. Our brand strength has also helped to successfully implement price increases.
We are laser-focused on protecting the company’s gross margin. And if necessary, we will take additional pricing actions to ensure that we fully recoup the impact of inflation over time.
Similarly, to the second quarter, e-commerce top line grew mid-single digits with digital penetration close to 22%, slightly above last year and significantly ahead of the mid-teens level from 2018. We continue to invest behind our omni capabilities and are well positioned to capitalize on consumer demand regardless of where they shop.
Let me spend a few minutes on our business units beginning with Writing, the third quarter superstar. Core sales increased at a double-digit rate, driven by broad-based strength in the U.S. and international markets. Core sales grew on a two-year stack basis as well, even though the commercial channel has not fully recovered yet. This is a testament to the excellent health of our Writing business. Consumption in the U.S. has been strong throughout 2021 and accelerated sequentially in the third quarter as we leaned into the business momentum with higher A&P investment.
The vast majority of K-12 schools in the U.S. returned to in-person learnings. During the back-to-school season, we saw a strong rebound in everyday Writing business. which benefited from innovations such as Sharpie S-Gel and Sharpie S-Note, strong merchandising plans and distribution gains. We picked up considerable share during the quarter in our Writing business as a whole, including key back-to-school categories such as pens, pencils, glue, permanent markets, dry erase markers and highlighters.
Over the past two years, we’ve meaningfully enhanced Newell’s position in the pen category, where we’ve gained over 850 basis points of share. Thus far, in 2021, within highlighters, Sharpie S-Note has tripled its share of the growing highlighter market segment. Core sales for our Baby business increased at a double-digit rate, supported by terrific domestic consumption growth, both relative to 2020 and ’19. Q3 marked the fifth consecutive quarter of core sales growth driven by expanded points of distribution, innovation, continued strength in e-commerce as well as stimulus funding.
While Baby is the most highly penetrated business online with the Newell’s portfolio, we leveraged our omni progress to further boost our digital penetration in the quarter into the mid-50s. We believe child tax credits as well as increases in disposable income and durable goods consumption have all benefited the gear market over the past several quarters. While the category is likely to moderate, we expect it to remain healthy. In the U.S., Graco continued to gain momentum and picked up share in the rapidly growing market.
Home Fragrance turned in its fifth consecutive quarter of core sales improvement as core sales grew both versus the elevated 2020 level as well as relative to 2019, driven in large part by EMEA. In the U.S., Yankee Candle retail stores maintained their positive growth momentum, benefiting from consumers increased mobility. As we continue to expand our omni capabilities, we rolled out buy online and pick up in stores as well as ship from store options across our Yankee Candle retail stores, which drove a favorable response from consumers and helped us to fulfill consumer demand. As anticipated, consumption moderated relative to the elevated base period but was significantly ahead of the 2019 level.
Home Fragrance, along with Writing and Food are our growth and value accelerator businesses, and I see tremendous run rate for growth ahead. The team is gearing up for the holidays as Q4 is a crucial period for the business.
In the third quarter, the Food business lapped its toughest double-digit core sales growth comparison of 2020 and was exacerbated by supply challenges, including a COVID-related lockdown of our Sistema plant in New Zealand, resulting in core sales decline. However, both top line and domestic consumption were meaningfully ahead of the 2019 base, which highlights the stickiness of the habits that consumers developed throughout the pandemic. We expect the category to continue to normalize, and that’s been most evident on the cookware side.
We drove strong share momentum in Food Storage and Food Preserving. Recent innovations such as Rubbermaid TakeAlongs meal prep, the updated Rubbermaid beverage line as well as Brilliance Glass have been instrumental in driving market share improvement for Rubbermaid as they elevate the consumer experience. In Fresh Preserving, Ball pantry storage latch and Ball nesting jars have contributed to share gains for Ball.
In Home Appliances, core sales increased for the sixth consecutive quarter, even as we lapped the toughest double-digit comparison of the year. Latin America once again led the charge. In this market, our beloved Oster brand is spearheading the trend for multicooking functions and recently launched Oster toaster oven with air fry as well as Oster rice cooker with air fry. Throughout 2021, Oster blenders are celebrating the 75th anniversary in the U.S. and Latin America with brand activation and new product launches in each region.
Domestic POS remained significantly ahead of 2019 levels and only modestly below last year’s level, although the category continues to normalize relative to the outsized growth levels seen throughout the pandemic. Despite the fact that people have come back to dine-in restaurants, consumers continue to show interest in cooking at home post the pandemic.
In our commercial business, core sales declined versus the elevated base as the business cycled against a significant surge in washroom solutions. On a two-year stack basis, gross sales increased nicely during the third quarter. The team has done a great job in landing new wins, both on the B2B and retail sides, across a wide swap of categories ranging from cleaning and refuse to material handling and others. We saw healthy POS and tracked channels but have been significantly challenged on the supply side. The team is diligently addressing these constraints as well as inflationary pressures.
During the third quarter, core sales for Connected Home & Security business were under pressure despite very strong consumption in the U.S. Core sales softness reflects both a challenging year ago comparison as we were restocking inventory at retail last year as well as component availability challenges in the current year mostly due to the well-publicized chip shortage.
Our Outdoor & Recreation business delivered its third straight quarter of core sales growth at nearly 2% against a difficult year ago comparison of 8%. Core sales improvement was fueled by the strength in the outdoor equipment and on-the-go beverage categories with the latter continuing to rebound during improved consumer mobility. We are encouraged by the momentum in the outdoor and equipment unit with POS exceeding 2019 levels.
The consumer continues to show interest in outdoors, a trend we think will endure and one we will continue to leverage throughout our innovation. Coleman turned another quarter growth benefiting from enhanced product lineup in 2021 with strong plans in place for next year as well. Many of our Coleman products such as the Skydome tent, cooler bag and two-burner stove are featured by USA today as perfect gifts for people who love to travel. So keep them in mind for the holidays.
Strong results thus far gave us confidence to improve our outlook on both top line and normalized earnings per share in 2021 despite significant inflationary and supply chain-related pressures that continue to plague the industry. Our updated guidance for 2021 implies that normalized operating profit is expected to grow high single digits, a great outcome, particularly in the context of a difficult operating environment.
Although we are certainly not immune to the external forces the strategic decisions we have actioned over the past several years have substantially strengthened the company and have made our portfolio much more resilient.
First, we invested in omnichannel capabilities that have been instrumental in capturing consumer demand across all channels and, on the direct-to-consumer side, recently completed migration of our sites in North America to one consolidated platform with a dedicated team focused on continuous improvement on consumer experience. We substantially strengthened our innovation and marketing muscle, leveraging consumer insights and foresights.
And we’ve sharpened brand positioning for many of our top brands. We have established joint business plans and enhanced relationships with key strategic retail partners. We’ve instituted a new hybrid organizational model that brings our domain experts closer to our customers and consumers while leveraging the center for scale and efficiencies.
We have made productivity a way of life. We’ve reduced complexity and overheads, improved cash conversion cycle and strengthened the balance sheet.
2021 has been a turning point for Newell despite challenges posed by supply and inflation. Our teams have done an incredible job executing in this environment. And we are poised to deliver 10-plus percentage core sales growth this year, a first for our company in recent history. We recognize that 2021 has been a tale of two cities, a first half and second half story. We delivered 23% core sales growth in the first half. And in the second half, we are lapping strong growth from 2020. The fact that we grew 3.2% in Q3 on top of last year’s growth is an indication that our brands are resilient, are being rejuvenated, and we have the ability to grow even in this context of strong comps. The power of our diverse portfolio is coming through.
The macro issues in the pandemic have taught us that we just cannot be reactive. We’re laser focused on continuing to strengthen the fundamentals and reducing complexity, including lowering SKU count, improving forecast accuracy, simplifying our IT infrastructure and making it easier for customers to do business with us. We are creating an integrated one Newell distribution network through the consolidation of over 20 supply chains under the banner of Project Ovid.
Looking forward, we expect supply challenges and inflation to persist. Therefore, our stance is one of preparedness and realism and taking proactive actions to successfully navigate the macro environment. If 2021 was a year of turbocharging the top line, 2022 will be focused on improving margins, improving margins through five primary levers.
First, an intense focus on pricing and optimizing promotional spending. We have now taken price increases in 2021 across all of our eight businesses in most geographies. Our posture will be to maximize the impact of carryover pricing from ’21 into ’22. And we will be prepared to take further increases in ’22 based on inflationary trends to protect gross margin. Of course, we’ll do this in consultation with our customers and ensure that our brands remain a great value for consumers. Second, we’ll accelerate our efforts to improve the profitability of our international business. by reducing duplication, consolidating operations and adopting a one new approach. Third, we will price innovations to be margin accretive. Fourth, we will continue to be more efficient with our overheads. And finally, we’ll continue to be — strive to be best-in-class in our productivity efforts and drive about 3% to 4% improvement in COGS as we have done over the last few years.
I’m extremely thankful to our 31,000 hard-working employees for their unwavering commitment, tenacity and perseverance. I remain optimistic that Newell can create tremendous shareholder value, and our best days are ahead of us, onwards and upwards. And now over to Chris.
Christopher PetersonChief Financial Officer & President, Business Operations
Thank you, Ravi, and good morning, everyone. During the third quarter, we delivered solid results as we continue to drive our strategy into action. Strong operational execution, coupled with financial discipline, enabled us to generate better-than-anticipated operating profit and sustained progress on the cash conversion cycle. We accomplished this in the context of a choppy operating environment as our teams did a terrific job navigating through a myriad of supply and logistical bottlenecks.
Before getting into the details, I want to provide a little color on the current operating environment and proactive choices we are making. Similar to other companies, throughout the third quarter, we continued to experience significant inflation and supply chain disruption. Escalation in cost has been an ongoing dynamic throughout 2021. While inflationary pressures have been broad-based, the largest impact for us has been around commodities, particularly resin, ocean freight, sourced finished goods and labor.
The expected headwind from inflation on 2021 cost of goods sold is now forecast to be about $40 million worse relative to our expectations last quarter. We currently expect inflation to represent 9% of our full year cost of goods sold as compared to our expectation of about 3% at the start of the year.
We have taken numerous actions to alleviate the headwind from inflation, including leading in on our productivity initiatives, implementing price increases across all of our businesses with some announcing multiple rounds, continuing to exercise disciplined control over expenses, driving efficiencies from promotional spend and leveraging strong top line growth.
The full benefit from the mitigating actions to offset the unprecedented inflationary pressures will not flow through until next year, given the timing lag on pricing. We do expect that Q3 represents the largest gap between the pricing and inflation impact to the P&L and expect this gap to narrow sequentially from here.
Despite this dynamic and the continued escalation in costs for Q4, we are raising our normalized EPS guidance for this year toward the higher end of the previous range. a strong outcome and a testament to the resilience and excellent execution by our teams.
Moving on to supply chain. Lead times for sourced products, some components and raw materials have increased significantly from pre-pandemic levels as a result of port congestion, limited container availability as well as shortages in the labor force and truck drivers. This has been an ongoing challenge throughout 2021. However, the significant progress we have driven on SKU rationalization over the past few years, along with an early start on mitigating tactics, have put us in an advantage and allowed us to largely meet the strong demand.
Some of the actions we’ve taken early in 2021 and throughout the year include the following: building inventory on top-selling and high priority SKUs, improving our forecasting process and adjusting it for longer lead times, diversifying our supplier base where feasible, accelerating automation across our factories and distribution centers and enhancing compensation, benefits, training opportunities and working conditions for our frontline employees. In fact, during the third quarter, we announced meaningful wage increases across many of our factories and distribution centers starting in Q4.
We do not expect the supply pressures to dissipate in the near term, but we are confident that we are taking appropriate steps to both effectively manage them and create more agility within our supply chain in the future. We recently announced a new supply chain initiative, Ovid, which is expected to transform Newell’s go-to-market capabilities and end-to-end customer experience in the U.S., enhance customer service levels and drive significant operational efficiencies. We are planning to optimize the company’s distribution network in the U.S. by consolidating 23 business unit-centric supply chains into a single integrated supply chain. We expect it will take about 18 months to fully implement Ovid.
To minimize any potential disruption we intend to roll it out in waves. During Q3, we passed an important milestone as we completed blueprinting and the integrated design phase. We are now moving into the testing and implementation phase. Upon completion, Ovid is expected to streamline, automate and digitize our supply chain and position us as a reliable retailer partner of choice. While Ovid was being contemplated, prior to the recent events, once implemented, it should position us on a much stronger footing going forward.
Let’s now move to third quarter results. Net sales grew 3.3% year-over-year to $2.8 billion mostly driven by a core sales increase of 3.2%. This was an excellent outcome as we cycled against 7.2% core sales growth in the year ago period with difficult comparisons across every segment, except for learning and development.
Normalized gross margin contracted 330 basis points year-over-year to 30.6%. Gains from fuel productivity savings, favorable business mix as well as pricing were more than offset by the inflationary headwind, which was nearly 800 basis points in the quarter. Normalized operating margin came in at 11.4%, down from 14.9% a year ago, reflecting gross margin pressure as well as a significant step-up in advertising and promotion expense.
We continued to tightly manage costs and drive overhead to sales ratio lower year-over-year. Net interest expense came down by $6 million year-over-year to $65 million reflecting debt reduction of about $750 million relative to last year. The normalized tax rate was 8% versus a normalized tax benefit of nearly 7% in the year ago period due to a lower contribution from discrete items. Normalized diluted earnings per share amounted to $0.54 as compared to $0.84 in Q3 of 2020. The unfavorable move in the tax rate accounted for about $0.12 year-over-year.
Now turning to our segment performance. Core sales for the Commercial Solutions segment decreased 9.2% due to declines in both the commercial and Connected Home & Security business units, which faced tough year-ago comps. Core sales for Home Appliances grew 1.9%, primarily driven by Latin America. Core sales for the Home Solutions segment were down 3.6% as core growth in the Home Fragrance business was more than offset by a decline in food, which lapped its toughest quarterly comparison of 2020.
Core sales for the Learning & Development segment grew 19.6% as both the Writing and Baby business units delivered strong double-digit increases. Core sales in the Outdoor & Recreation segment increased 1.7%.
Newell’s net sales were 8.5% above the third quarter of 2019 with each of the company’s segments exceeding levels from two years ago. On a two-year stack basis, core sales increased in the low double digits during Q3 as well as year-to-date periods. Year-to-date, in 2021, the company’s operating cash flow was $490 million versus $820 million in the year ago period. This reflects an increase in working capital to support top line momentum and elevated in-transit times for inventory, which more than offset significant operating income growth. We continue to drive improvement in cash conversion cycle, which came down by another 10 days to 79 days.
At the end of the third quarter, Newell’s leverage ratio was 3.1 times, down from 3.9 times a year ago. The improvement reflects our proactive choice to pay down debt as well as a mid-teen increase in trailing 12-month normalized EBITDA. In Q3, the company redeemed approximately EUR300 million of its 3.75% notes that were due in October 2021. Furthermore, in mid-October, we announced our intention to redeem the remaining $250 million of the company’s 4% senior notes next month.
We have significantly strengthened Newell’s balance sheet over the past several years and recently indicated that we are targeting a leverage ratio of 2.5 times, below our prior goal of 3 times. We intend to grow our EBITDA into this target with no immediate plans for additional new debt tender offers.
This morning, we updated our outlook for 2021, accounting for the stronger-than-anticipated performance in Q3, further escalation in costs in the fourth quarter, continuation of supply chain disruption as well as a relatively healthy consumer backdrop in the U.S. We are pleased to once again raise our top line forecast for 2021 as a result of healthy consumption and the early actions we have taken to alleviate the supply chain constraints.
Our revised top line guidance implies that core sales are expected to grow versus 2019 during each quarter of 2021. Our outlook also indicates that core sales will be up versus 2020, in the first and second halves of 2021 as well as for the full year.
Let’s go through the details of the full year 2021 outlook. We currently forecast net sales of $10.38 billion to $10.46 billion, up from $10.1 billion to $10.35 billion previously. This represents about 11% year-over-year growth. We are raising our core sales outlook to 10% to 11% from 7% to 10% previously with the majority of the upside in the fourth quarter. While the U.S. dollar has strengthened recently, currency favorability is still expected to modestly outweigh the impact from Yankee Candle retail store closures and other minor business exits.
As a result of further escalation in costs, including our decision to raise wages for the front line, starting in Q4, we now expect full year normalized operating margin to be slightly down relative to 11.1% in 2020. Our updated forecast implies that normalized operating profit grows at a high single-digit rate, a solid result when factoring in the unprecedented level of inflation. We anticipate an increase in the absolute level of advertising and promotion spending. This forecast assumes a mid-teens normalized effective tax rate and a slight increase in shares outstanding.
We are pleased to improve our full year normalized earnings per share outlook to $1.69 to $1.73 from a previous range of $1.63 to $1.73. There is no change in our full year operating cash flow guidance of approximately $1 billion as we continue to expect acceleration in Newell’s cash conversion cycle.
Focusing on the fourth quarter, we are guiding for net sales of $2.6 billion to $2.68 billion with core sales expected to be within a range of down 2% to up 1%. Our guidance assumes normalized operating margin of 8.7% to 9.2% versus 11.4% in the year ago period as inflation is expected to outweigh the continued benefits from productivity and pricing. We are forecasting a normalized effective tax rate around 20% and normalized earnings per share in the $0.29 to $0.33 range.
While we are still early in our budgeting cycle for 2022, I wanted to provide a high-level perspective on how we are approaching it. We are encouraged by the progress our teams have made on the innovation side and have a strong funnel of new ideas planned for next year. However, we anticipate a more muted top line delivery due to a very difficult comparison.
While inflation is expected to remain above normal levels, we are looking at significant benefits from carryover pricing as well as productivity. This should result in stronger margin performance in 2022 relative to 2021. We will continue to build operational excellence across the organization as we roll out additional automation projects and make strides with Ovid implementation. We intend to provide more specifics during the fourth quarter call, as has been the norm in recent years. We believe we have a strong path for value creation, and we’ll continue to diligently execute on our strategic agenda to ensure that we position Newell Brands for sustainable and profitable growth. Operator, let’s now open the call for Q&A.
Operator
Thank you. [Operator Instructions] Your first question comes from Bill Chappell with Truist Securities.
Bill ChappellTruist Securities — Analyst
Thanks. Good morning.
Ravi SaligramPresident and Chief Executive Officer
Good morning, Bill.
Bill ChappellTruist Securities — Analyst
Just a question on Writing in particular, I mean, how that played versus your expectations in the quarter, whether there’s still kind of some carryover as you move into next year and how much of that maybe contributed to the upside. I know you had kind of a muted outlook. We’re not really sure on kind of the tail of back-to-school and back to office. So any color there would be great.
Ravi SaligramPresident and Chief Executive Officer
Sure, Bill. Good morning. How are you? This is Ravi. Look, Writing really performed very well. I think the big thing was we weren’t sure when we went into the quarter, we knew we’d have a good back-to-school, but there was some worries about the Delta variant. I think what became evident was this is one of the issues. Keeping the schools open for in-person learning was a fairly bipartisan view. And so we watched it by week and saw that the super majority of schools opened — and so that was great. But also a credit to our team because they really hit the ball out of the park on merchandising, on e-commerce, on getting distribution, on innovation. They just have the whole package. And this is, as we have said before, one of the business — this business because we manufacture most of our products, except for Dymo, which comes from China, in Tennessee. And so we were able to have good supply. So I think that really helped. And this is still in the backdrop because we had expected maybe offices to start opening up, but because of Delta, they didn’t as much.
So despite all of that, the fact that the business did extremely well, I think, is positive, and we’re seeing that positive momentum continuing. So we’re very pleased. And yes, it is probably a bit better than our expectation. But look, when you have the highest margin business, we will take that any day.
Bill ChappellTruist Securities — Analyst
Sure. No, absolutely. And then kind of on that same — in terms of supply chain, as I don’t think you really said anything there. But as you look at kind of Home Appliance and getting things from Asia going into the holiday season, are you — is it any concerns you don’t have enough inventory for what looks to be a pretty strong upcoming holiday season? I know Home Fragrance, you make it all here but thinking more of anything that you’re bringing overseas.
Christopher PetersonChief Financial Officer & President, Business Operations
Yes. So Bill, on that one, we’re actually in very good shape. So one of the things that we did early on when we saw the supply chain pressure starting to build, and particularly with ocean freight, is we adjusted our planning process to add expected lead time to the planning process. We did that probably about six months ago, four to six months ago. And as a result, we sort of early ordered a bunch of our top-selling SKUs. And that’s why — if you look at our balance sheet, part of the reason why our inventory levels are significantly higher than they were last year, and we’ve used cash to build inventory. So we feel, particularly in the appliance category, that we are well positioned to meet strong demand from an inventory standpoint.
Bill ChappellTruist Securities — Analyst
That’s great. Thanks so much.
Christopher PetersonChief Financial Officer & President, Business Operations
Thank you, Bill.
Operator
Our next question comes from Andrea Teixeira with JPMorgan.
Andrea TeixeiraJPMorgan — Analyst
Thank you. And I wanted to just go back to what you just said, Chris, on building inventory ahead of the holidays. And you had done, I mean, a fantastic work in terms of getting market share in the small appliances, but we also have to be cognizant of the cycle of these products, right? And some of these have been bought in, and I would say household penetration probably increased.
So I was wondering what is your take on that? And what are your customers saying in terms of demand ahead of the holiday? And I also wanted to double check when the cadence of pricing and what is the carryover that you mentioned before into 2022. And you said that you want to take additional actions into ’22. So I’m hoping to see the cadence of your gross margin progression as we enter ’22.
Ravi SaligramPresident and Chief Executive Officer
Andrea, we’ll split the question into two pieces. I’ll have Chris answer the pricing piece, and I’ll just give you a view on appliances. Clearly, the number one business for us when you go into holiday, the Super Bowl is for Home Fragrances. And we believe we are well poised on the Home Fragrance side not only with all our customers but also in our own retail stores. As far as small appliances goes, but we’ve had — we’ve been very — I’m very pleased to see the progress the team has been making and that we’ve had so many quarters of growth.
Yes, clearly, as we look down the future, you have to say, is it — has there been some acceleration of consumer purchases. But having said that, I think there are several categories within appliances, and we’re driving a lot of innovation. So with the whole Mr. Coffee iced, we now have ice coffee frappe. We’ve got hot and cold. So we’ve got a lot of new innovations coming into the market there, that will help us. So — and we’ve actually brought in new users. So I think in the main, I feel we’re in a good place. But at the end of the day, look, you have to view you will not — you can’t look at it just as one particular business for the entire portfolio. And that has been the beauty of how we manage the portfolio in entirety to work each quarter and to work the long term to say how do you drive growth as a whole.
Christopher PetersonChief Financial Officer & President, Business Operations
On the pricing front, let me try to provide a little bit of perspective. So at this point, we have announced pricing on every single one of our business units. The inflation impact is affecting our business units a little bit differently. The two most significantly affected business units are the Commercial business and the Food business. And then there are other businesses like Writing and Home Fragrance, for example, that are much less affected by inflation, but everybody is affected. Because of that difference in terms of how the inflation is impacting the business units and because the inflation picture has continued during the year to get significantly more of a headwind, we’ve announced pricing on different timings. And so the first set of pricing, broadly, that we put into place went into place kind of in the April, May, June time period. The good news about that pricing is that pricing is now fully reflected in retail. And at least to date, we have not seen any negative reaction to consumer demand from the pricing that we put in so far. And so that — we take that as a very positive sign.
There is a second round of pricing, broadly, that’s going into effect that we’ve already announced that largely is going into effect in either November or beginning of January. And so when you look at the pricing impact in the P&L, the pricing impact in the P&L is going to get significantly bigger as we go forward sequentially from here. So pricing will be a bigger help in Q4 than it was in Q3. In Q1 of next year, pricing should be largely implemented and it will be a bigger help in Q1 of next year than it is in Q4 of this year. At the same time, inflation, we think, Q3, is if spot rates stay where they are, inflation will have been the biggest impact for us in Q3 of this year, and we’ll begin to mitigate as we lap base periods. And so that gap, if you will, between inflation, pricing and productivity, we think Q3 was the biggest delta of that gap, and we think that gap starts to close and reduce sequentially each quarter going forward.
Andrea TeixeiraJPMorgan — Analyst
That’s great. Super helpful. I’ll pass it on. Best of luck.
Operator
Your next question comes from Olivia Tong with Raymond James.
Olivia TongRaymond James — Analyst
Great. Thank you. Good morning. My question is first around project Ovid. I know this was planned before the global supply chain challenges start. But can you just talk about why now is the right time for it? Presumably, there will likely be some disruption as you do switchovers and consolidate. So could you just expand a little bit more on that and if you had to expand the plan more recently given all the logistics challenges globally?
Christopher PetersonChief Financial Officer & President, Business Operations
Yes. So let me try a couple of things. So we kicked off Project Ovid about 10 or 11 months ago. We didn’t announce it until Barclays, but we kicked it off 10 or 11 months ago. And the reason why we thought now is the right time is because we’ve made a lot of progress on SKU rationalization. So if you recall, at the end of 2018, when we started with the turnaround plan, the company was trying to sell over 100,000 SKUs. We’ve now reduced that through last year to 47,000. As of today, we’re at 42,000, and we’re on our way down to 30,000. And so because we’ve taken that SKU count reduction out and improved the fundamentals of the operation, we believe we’re now at a point where we can take the next step, which is to go from unique supply chains into a single integrated supply chain. We think this is going to allow us to move from shipping less-than-truckload shipments in small quantities, enforcing our retailers to order from us 23 different ways and to the ability to order from us in a single way and ship full truckloads. And so from both a service and a cost standpoint, we think that this is going to be a major step forward for the company and really leverage the scale of Newell going forward.
Now when we kicked Project Ovid off, the supply chain constraints were not how they are today. And so we kicked the project off without that external backdrop in place. I think the team has done a pretty amazing job of keeping on track. And fortunately, we secured the two big new mixing distribution centers prior to the current supply constrained dynamics. And so we’re monitoring it. We’re going to be prudent on the implementation dates that we go and make sure that we execute the transition with excellence. But if anything, the savings from the project have only gotten bigger as transportation costs have gotten bigger. So in fact, we think the project is likely going to generate more value to us today than when we first started the project nine months ago or 10 months ago.
Ravi SaligramPresident and Chief Executive Officer
Chris, if I could add some context. Olivia, we have to think about sort of the new journey. I’ve been here two years, Chris close to three. And look, we’ve embarked on — we started it as a turnaround, but we’re really talking about a transformation of the company in terms of capabilities and looking at the long term while making sure that the short term is healthy. And so if you think about sort of the first year, we spent a lot of time on stabilizing the organization, getting the culture, revving up the people, bringing the team in the hybrid structure, etc.
Next, our next phase is all about innovation of our brands, about e-commerce and really getting the top line, which is why you’re seeing that momentum. The next one is really all about how do we get our gross margins up. And in addition to the pricing, the supply chain, whether it’s automation or Ovid, we think are critical because we have to be easier to do business with, with our customers. This has been going on for years and years. We have to make it easier for our size of the company. So with that — and then the next one is — will be international.
So all of this is about a journey of driving shareholder value. And we obviously manage very carefully the execution burden on our teams and make sure that we don’t slip up. But I think these have been managed to a good cadence, and we are very confident that all of these will go along quite well as we progress forward.
Olivia TongRaymond James — Analyst
Very helpful. Thanks. If I could just ask a follow-up on sales. So you mentioned this is the first quarter where every subsegment was below 2019. So do you think this is the right base now off of which to grow? Or were there any comp issues that make this not the right way to think about it?
And then just specifically, for Q4, the sales outlook assumes a pretty big deceleration on the two-year stack. So is this more the uncertainty of the environment or relative to success of recent pricing? Or is there something else that’s going into that?
Ravi SaligramPresident and Chief Executive Officer
Yes. So let me just give a quick view on that, Olivia. First, 2019 is sort of a good way. We think about that as sort of pre-pandemic, and that serves as a good guide. But over time, that will change. So — but 2019 is a good base. So having said that, look, as we approach Q4, recognize a couple of things. One is that we’ve had a Baby business that has just been growing fantastically like in the teens and for all the reasons I mentioned in the prepared remarks. But one of the things that’s happened, the stimulus did end. And so — and without the huge rise in birth rates, there’s only so many how — and there’s a huge comp last year in the Q4, which is also very strong. So where — the Baby business is comping very high on Q4. So that clearly, we don’t have that. We still have Writing, which is growing in pretty well and so far the businesses.
So I think we shouldn’t get hung up about any particular part of our business because we’ve got puts and takes. The overall thing is, look, what we’re striving to do, Olivia, is to get to sustainable profitable growth over time. And I really think that we’re well on our way to do that.
Christopher PetersonChief Financial Officer & President, Business Operations
The only thing I would add to that, Olivia, is that last year, in Q4, there was Amazon Prime Day, which moved to Q2 of this year. And so we are in Q4, lapping the loss of Amazon Prime Day.
Olivia TongRaymond James — Analyst
Great. Thank you.
Operator
Your next question comes from Peter Grom with UBS.
Peter GromUBS — Analyst
Hey. Good morning, everyone.
Christopher PetersonChief Financial Officer & President, Business Operations
Good morning.
Peter GromUBS — Analyst
So I just wanted to ask around the phasing of margin progression as we think about next year. Because when I look at the guidance, you’re still kind of exiting this year with operating margins down north of 200 basis points year-over-year. And Chris, I totally understand the commentary that the pricing benefits and productivity will ramp in Q1. But is it still fair to assume that you think margins will be under pressure in the first half of the year?
And I guess kind of going back to Ravi’s initial comments around 2022 being the year of margin expansion, how should we think about your ability to hit your long-term target of 50 basis points for next year? Thanks.
Christopher PetersonChief Financial Officer & President, Business Operations
Yes. I think it’s — so thanks for the question. I think it’s premature for us to give quarterly guidance for next year. But what I would say is that we certainly believe that next year is going to be a year of margin growth for the company. And the reason for that is what I said earlier, which is a lot of the inflation impact that’s hit us this year, there’s a timing lag between pricing and inflation. And even if you look at the two business units that we have suffered the most inflation, which are Commercial and Food, we’re on LIFO accounting, which means in those businesses that the inflation hits us immediately in those businesses, and those have been the two biggest impacts.
So we’ve probably taken the big inflation impact from the move in resins already in the P&L. The lag in pricing creates a drag in the short term. But when we get into next year, we’re expecting the benefit of carryover pricing plus productivity to be higher than the inflation impact next year if based on our current forecast, which is based on spot rates going forward.
By the way, we’re also — as we think about the planning for next year, we are not assuming that inflation is going to be transitory. We are assuming that inflation is going to be significantly above normal next year, and we are building our plan, assuming that. And we are still confident despite that, that we are going to have significant margin growth next year
Ravi SaligramPresident and Chief Executive Officer
And one quick add, and Chris did a great job of giving you a view on it. When we started this process on taking price increases on way back when, I think the whole world, including us, thought that inflation was going to be transitory. So sounds probably initial pricing moves were more on that because we felt, hey, there’s productivity and pricing. We may not have tried to cover it. Over time, as we’ve seen, this will become very realistic. And now our pricing posture is very clear. We are going to recoup inflation, and that stance will continue into 2022. And so I think that should give some reassurance on the margin front.
Peter GromUBS — Analyst
Great. Thank you.
Operator
Your next question comes from Chris Carey with Wells Fargo Securities.
Chris CareyWells Fargo Securities — Analyst
Hi. I guess it’s still morning, at least. So good morning. So just — I just wanted to follow-up on that pricing commentary, if I could. Pricing and productivity will be higher than your forecast for inflation next year, and you expect significant margin progression. So just — and when you say margin progression, you’re speaking about the full year, the cadence will grow over time. So this is more just a clarification question, and I have a follow-up.
Christopher PetersonChief Financial Officer & President, Business Operations
Yes. That’s right. I think it’s premature for us to give quarterly guidance for next year as we’re just in the middle of our budget plan. But for the full year, that’s what we’re expecting.
Chris CareyWells Fargo Securities — Analyst
Okay. All right. Thanks for that. And then it’s connected to the prior questions. But I guess, the — historically, a criticism or perhaps an observation of the business is that it’s quite disparate. Clearly, that’s improved with SKU rationalization and some businesses that have been sold. I guess with this Project Ovid, is the idea that these businesses can all actually make sense together to create a more scaled efficient platform or the — historically, this combination of an opco and a platform company come together, creating a more scaled organization that makes sense together over time? Or are there still going to be decisions that need to occur over time about pruning and improving the portfolio, which I suppose is always an observation but more in the context of the supply chain initiatives that you’re doing to try and create a more scaled organization of one, I suppose?
Christopher PetersonChief Financial Officer & President, Business Operations
Yes, I think that’s exactly the vision. And it’s well said in your question. If you look at our businesses, the eight businesses we have today, the place where we have a lot of commonality is in the top retailers. And so if you look at the top four retailers that the company does business with in the U.S., Walmart, Target, Amazon and Costco, those top four retailers are pretty consistent across every one of our business units. And the thing that’s good about that is that’s why this integrated supply chain network makes a lot of sense because we’re shipping to the same customers, the same locations. And instead of forcing those retailers to give us 23 separate orders and then we ship from 23 locations and we have 23 invoices and we’re shipping 23 small less-than-truckload shipments, if we can have them give us one order on one set of terms and ship on full truck, that is a huge efficiency for both us and for the retailer. And I think it allows us to create a competitive advantage versus many of our subscale competitors. So that’s largely the thinking behind that.
On the portfolio pruning point, I think we’ve been pretty consistent there, which is we think we’ve got strong organic growth opportunities in both top and bottom line in each of our business units. It doesn’t mean that we’re not going to do some portfolio moves in the future but we’re likely going to be more on the tuck-in or acquisition or tuck-out divestiture side. But we’re going to be driven by shareholder value creation as we think about any portfolio moves.
Ravi SaligramPresident and Chief Executive Officer
One connection that, look, as we think about it and the pandemic has helped that really Newell is all about the home, both indoors and outdoors, and products really cater to that. And so whether it is the mom, whether it is the kitchen, there’s a lot of connections. And we’re just not in the past, that’s more for holding company approach. Now we’re really integrating the back investor set but also the front, where you’ll see us do more connections between our brands, more promotional opportunities because we think that there’s a lot of connections, which we have just not exploited. And I think we’re going to do that as we become more and more mature on the turnaround and go forward.
Chris CareyWells Fargo Securities — Analyst
Okay. Thanks so much.
Operator
Your next question comes from Kevin Grundy with Jefferies.
Kevin GrundyJefferies — Analyst
Great. Thanks. Good morning, everyone. Two for me this morning, if I may. The first one on Ovid for Chris. Can you comment now on the margin and working capital opportunity there, but particularly within the context of what you’ve already outlined, Chris? So that would be the gross margin benchmarks and the overhead benchmarks, which in aggregate, are some 500 to 700 basis points of opportunity. Can you just comment on will Ovid be incremental to that? Or do you see it more as an accelerant to reaching those targets over time? So that’s the first question.
And then just the second question. I didn’t hear any commentary, I guess, on share repurchases. I think you guys have kind of left the door open that in the past. I think your updated thoughts to the Board’s kind of updated thoughts there. And whether, Chris, the small suite to your capital structure target now down to 2.5 from 3, if that changes your thinking at all with respect to returning cash to shareholders. So thank you for both of those.
Christopher PetersonChief Financial Officer & President, Business Operations
Very good. Thanks, Kevin. So on Ovid, certainly, we expect Ovid to be a significant contributor to gross margin improvement. I think that we view it not incremental to the 37, 38 target that we had put out previously. I think we view it as a building block to getting to that target over time. On the overhead part, we do not expect Ovid to have a material impact on overhead. What I will say is that embedded in this year’s guidance is a pretty significant overhead investment that we’ve made in the team and consulting costs, etc., for the Ovid project, but that’s already embedded in our existing guidance. And when we actually complete the project, that cost will come out. And so eventually, that sort of above going cost that we’ve got built in this year on overhead is likely to go away as we get to 2023.
On the share repurchase question, just to be clear, as I mentioned in the prepared remarks, we retired about EUR300 million of debt in Q3. In Q4, we’ve called our June 22 notes of $250 million, which we expect to retire in Q4 of this year. From — as we go into next year, we do not expect any more reduction in the level of our gross debt. And we think that, as we move into next year, we are going to move to our leverage target through EBITDA growth not through debt reduction. And as a result, we think that as we move into next year, it’s going to open up the opportunity for share repurchase as we expect to generate more than enough cash to cover investment in the business and the dividends fully. And so we are moving into a period next year where the capital allocation begins to get freed up.
Kevin GrundyJefferies — Analyst
Very good. Very clear. Thank you, guys. Good luck.
Operator
The final question comes from Lauren Lieberman with Barclays.
Lauren LiebermanBarclays — Analyst
Great. Thank you. I just had one question on your relative competitive positioning because I think the fact that you were so forward thinking in building inventory ahead of the holiday season, knowing what you know about the length of your supply chain and ocean freight, etc., etc., I was just curious how your in-stock positions are comparing in key categories to competitors. I know market share is a very tough thing to measure in a lot of your businesses. But just even, qualitatively, how would you describe that environment, the degree to which you’re picking up, whether it’s share or it’s already enhancing your relationship with retailers because of your service levels during the upcoming holiday season? Thanks.
Ravi SaligramPresident and Chief Executive Officer
Hi, Lauren. I think let me give that a shot. I think it really varies. It’s not a one-size-fits-all because despite building up the inventory, some of the businesses where we’re importing that has an impact. But I’ll just tell you on shares, the Writing business, as I mentioned, really a big winner on the share front not just in pens but overall. We think throughout the year this year on a year-to-date basis, the candle business, I’d hate to use the word saying it’s been on fire, but it’s been doing amazingly well. And we do believe that we’re making a lot of traction in the Baby business. We’ve been gaining share. So I think we’ve got different businesses where we are gaining share. But there are some businesses where the demand has been so high and unexpected that — and also it depends on the price points we played out. Like in appliances, while we’ve had terrific growth, we operate more on the opening price points. And so there were — so on a dollar basis, even though we’ve had good growth, we may not be seeing the share improvement. So I think it varies.
Outdoor, where we bring stuff — I mean, we’re really pleased to see the good growth that is happening. And I think we’re beginning to really get supply right. We had some issues during July, August, but I think we’re now back on track there. And the Outdoor, the beverage side, especially, we’re getting back on track. So I think it varies.
Our Food business, some of the demand has been so high on things like Ball. Certainly, that has been a challenge for us. And — but Ball, that is really the very — it’s got such a dominant share of that business. So that’s sort of — that has been complicated for us from lids, bottles, et. So it varies and — but let’s put it this way, everything we can do to maximize the top line opportunity, we’re doing, working in close collaboration with our customers. But it’s been tough on service levels because I wish our service levels were better. But every competitor today, I think, is wishing there be better.
So I can’t say it’s nirvana, but I do think that we’re doing our best. And I really feel the one thing I can tell you, Lauren, our brands are in a better shape and rejuvenated far better today than they were. And I know one of your favorite businesses of ours is Baby. I’ll tell you about — you didn’t ask me, but I’ll tell you because you usually asked about our baby innovation. So I’m very excited about the Baby Jogger City Turn, where you can turn the car seat to how the baby face you. Now I wish I had grandkids. My daughter is going to get married. So hopefully, I can start using this someday, but that — and the city turn strollers. So I think Baby Jogger, we’re doing a lot to rejuvenate that business. So look, brands are in good shape. So we’ll get the top line and the share where we can.
Lauren LiebermanBarclays — Analyst
That’s great. Thank you for such a thorough and candid answer. Have a great, weekend.
Christopher PetersonChief Financial Officer & President, Business Operations
You too, Lauren.
Ravi SaligramPresident and Chief Executive Officer
Thank you, Lauren.
Operator
[Operator Closing Remarks]
Duration: 66 minutes
Sofya TsinisVice President of Investor Relations
Ravi SaligramPresident and Chief Executive Officer
Christopher PetersonChief Financial Officer & President, Business Operations
Bill ChappellTruist Securities — Analyst
Andrea TeixeiraJPMorgan — Analyst
Olivia TongRaymond James — Analyst
Peter GromUBS — Analyst
Chris CareyWells Fargo Securities — Analyst
Kevin GrundyJefferies — Analyst
Lauren LiebermanBarclays — Analyst
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Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study – BMC Women's Health – BMC Blogs Network

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BMC Women's Health volume 21, Article number: 379 (2021)
Metrics details
Genitourinary syndrome of menopause (GSM) involves vaginal dryness (VD), pain during sexual activity (SAPain), vaginal itching (VI), burning, pain, and symptoms in the urinary organs. Non-ablative radiofrequency (RF) is a type of current with electromagnetic waves with a thermal effect that generates an acute inflammatory process with consequent neocolagenesis and neoelastogenesis. We aimed to describe the clinical response to VD, SAPain, vaginal laxity (VL), VI, burning sensation, pain in the vaginal opening, urinary incontinence, sexual dysfunction, cytological changes, and adverse effects of non-ablative RF in patients with GSM.
This single-arm pilot study included 11 women diagnosed with GSM with established menopause. Patients with hormone replacement initiation for six months, who used a pacemaker, or had metals in the pelvic region, were excluded. Subjective measures (numeric rating scale of symptoms, Vaginal Health Index-VHI) and objective measures (vaginal maturation index-VMI, vaginal pH, sexual function by the FSFI, and urinary function by the ICIQ-SF) were used. A Likert scale measures the degree of satisfaction with the treatment. Five sessions of monopolar non-ablative RF (41°C) were performed with an interval of one week between each application. The entire evaluation was performed before treatment (T0), one month (T1), and three months (T2) after treatment. Adverse effects were assessed during treatment and at T1 and T2.
The symptoms and/or signs were reduced after treatment in most patients (T1/T2, respectively): VD 90.9%/81.8%, SAPain 83.3%/66.7, VL 100%/100%, VI 100%/100%, burning 75%/87.5%, pain 75%/75%, and VHI 90.9%/81.9%. Most patients did not show changes in VMI (54.5%) and pH (63.6%) at T1, but there was an improvement in VMI in most patients (54.5%) at T2. Nine patients were satisfied, and two were very satisfied at T1. The treatment was well tolerated, and no adverse effects were observed. There was an improvement in sexual function (72.7%) and urinary function (66.7% in T1 and 83.3% in T2).
Intravaginal RF reduced the clinical symptoms of GSM in most patients, especially during T1, and women reported satisfaction with treatment. The technique showed no adverse effects, and there were positive effects on sexual and urinary function.
Trial registration This research was registered at clinicaltrial.gov (NCT03506594) and complete registration date was posted on April 24, 2018.
Peer Review reports
Genitourinary syndrome of menopause (GSM) is traditionally defined as a set of signs and symptoms due to altered estrogen production, both physiologically or as a result of a therapeutic approach. It involves physical and sensory changes in the external and internal genitalia and lower urinary tract region, such as loss of collagen and elastin, altered smooth muscle cell function, reduction in the number of blood vessels, and an increase in connective tissue, leading to epithelial thinning, decreased blood flow, and reduced elasticity [1]. Women may have some or all the signs and symptoms. The most common symptoms are vaginal dryness (VD), pain during sexual activity (SAPain), and urinary incontinence (UI) [2]. It is estimated that 10%- 45% of these women live with some discomfort due to GSM. However, only 25% seek treatment, and symptoms are unlikely to improve spontaneously [2,3,4].
GSM treatment aims to alleviate symptoms and reverse atrophic anatomical changes. Hormonal therapy is the current gold standard treatment that can be administered systemically or locally [1, 5, 6]. However, there are contraindications such as history of breast cancer, coronary artery disease, previous venous thromboembolic event or stroke, and adverse effects, such as vaginal bleeding, endometrial hyperplasia, breast pain, and perineal pain, which limit its use [3, 6, 7]. Approximately 23% of women using hormonal therapy reported that they felt incomplete or no relief of vaginal/vulvar symptoms and 36% of patients noted that the vagina did not restore their natural state [8].
With the contraindications and limitations of standard therapy for GSM, a search for new therapeutic options for GSM management is needed. Radiofrequency (RF), a new alternative technique for GSM [9], is a high-frequency current used for therapeutic purposes, based on the mechanism of heat production by conversion, that is, ionic and molecular mobilization, favoring oxygenation, nutrition, and vasodilation of tissues [10]. The heating of the tissues also promotes the denaturation of collagen with a subsequent contraction of its fibers, retraction of fibrous septa, and activation of fibroblasts. Neocolagenization, neoelastogenesis, and reorganization of collagen fibers may occur, resulting in tissue remodeling [10,11,12].
Based on the knowledge of the physiological responses of the tissues submitted to RF and on the results of its use on the treatment of genitourinary signs and symptoms related to GSM, this research aimed to describe the clinical response (VD, SAPain, vaginal laxity (VL), vaginal itching (VI), burning sensation, pain in the vaginal opening, UI, and sexual dysfunction), cytological changes, and adverse effects of non-ablative RF in patients with GSM.
This was a single-arm pilot study preceding a randomized controlled trial (RCT) in progress, followed the precepts of the Declaration of Helsinki, with the approval of the Ethics and Research Committee of the Bahiana School of Medicine and Health (EBMSP) with CAAE 72147317.9.0000.5544 on September 5, 2017, and registered at clinicaltrial.gov (NCT03506594) and complete registration date (first date posted) on April 24, 2018. Written informed consent was obtained from all patients.
Adult women with established menopause (at least 12 months after their last period and/or bilateral oophorectomy) and who had complaints of at least one of the symptoms of GSM (VD, SAPain, VL, VI, burning sensation, and pain in the vaginal opening) participated in the study. The women were referred by gynecology services, and the service took place at the teaching outpatient clinic of the Physiotherapy Clinic at EBMSP. For inclusion in the study, they should have a vaginal pH of ≥ 5 and vaginal cytology from the last 12 months, or three previous normal tests, without any malignancy and/or atypia. We excluded patients with hormone replacement initiation for six months, who used a pacemaker, or had metals in the pelvic region, hemophiliacs, using vasodilators and/or anticoagulants, and those with chronic neurological degenerative diseases and/or diagnosis of current vaginal infection.
Initially, we administered a basic anamnesis questionnaire for collecting sociodemographic and clinical data. Each participant subjectively assessed their symptoms (VD, SAPain, VL, VI, burning sensation, and pain in the vaginal introitus) using the Numeric Rating Scale (NRS), which consists of a scale from 0 to 10 points, with 0 indicating no symptoms and 10 indicating as many symptoms as possible.
The physical examination was to assess the vaginal health index (VHI), which consists of a graduated scale from 1 to 5 for each item (vaginal elasticity, fluid volume, pH, epithelium integrity, and humidity). Vaginal elasticity varies between 1 (no elasticity) and 5 (excellent elasticity), assessed through mucosal distention upon palpation and in the placement of the speculum. Fluid volume, assessed at inspection, varies between 1 (no secretion) and 5 (normal secretion) (white flocculent). Epithelium integrity varies between 1 (petechiae already detected on inspection) and 5 (tissue not friable and normal mucosa). Moisture varies between 1 (no moisture detected in the inspection and presence of an inflamed mucosa) and up to 5 (normal humidity). The pH was quantified using a pH indicator strip between 0 and 14 (MColorpHast™—pH-indicator strips) which was placed directly on the right lateral vaginal wall for one minute, giving 1 point for the pH of 6.1, and 5 for the pH ≤ 4.6, in which the last one was considered normal. The sum of all items represents the vaginal health score, with 25 representing the best vaginal health [13].
The Vaginal Maturation Index (VMI) was evaluated from a vaginal secretion collection, in the middle third of the vaginal canal, fixed in absolute alcohol and sent to a laboratory, in which a biomedical doctor performed the percentage counting of the parabasal (P), intermediate (I), and superficial (S) cells, characterizing the vaginal epithelium in hypotrophic (I > S), normotrophic (I = S), hypertrophic (I < S), mild atrophic (I > P), moderate atrophic (I >  = P) and marked atrophic (I < P). The sum of the three cell types totals 100% and is presented as follows: P/I/S [14].
Participants answered the Female Sexual Function Index (FSFI) [15] questionnaire to objectively assess sexual function, gathering responses in six different domains: desire, arousal, lubrication, orgasm, satisfaction, and discomfort/pain. The cut-off point of ≤ 26.5 was considered for sexual dysfunction and the increase in the score was considered an improvement. The Sexual Quotient-Female Version (QS-F) assessed women’s sexual activity. This questionnaire was developed and validated in 2006, specifically for the Brazilian population [16]. Through ten self-answering questions, the QS-F assesses all phases of the sexual response cycle with a total index ranging from 0 to 100. Higher values indicate better sexual performance and satisfaction.
To assess the impact of UI on quality of life and characterize urinary loss, we used the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) [17], composed of five questions that assess the frequency, severity, and impact of UI, in addition to a set of eight items of self-diagnosis related to UI situations experienced by patients. The maximum sum of the response values indicates a score of 21 points, referring to the high impact of UI on an individual’s life.
At the end of the treatment, the participants were asked about their degree of satisfaction with the treatment using a five-point Likert scale, which classified the patient’s level of satisfaction as 1 (very dissatisfied), 2 (dissatisfied), 3 (unchanged), 4 (satisfied), 5 (very satisfied) [18].
To assess the clinical response, we considered an improvement when there was a decrease in values in self-reported symptoms, verified by the NRS; the increase in the value of the VHI; the decrease in parabasal cells (deep) and/or increase in superficial cells evaluated by VMI, a decrease in vaginal pH, an increase in FSFI and QS-F scores, a decrease in the sum of the ICIQ-SF questions, and improved satisfaction according to the five-point Likert scale.
We used all outcome measures before, one month, and three months after the end of treatment, respectively, times T0, T1, and T2, performed by the same initial evaluators.
To test safety, we considered existing adverse effects if they had erythema, ulcers, fistulas, burns, blisters, bleeding, and/or pain. They were evaluated during each application at T1, T2, or at any contact by the patients’ self-reports. We considered it to be at risk if it had one or more of these effects. If an adverse effect occurs, the patient was referred for evaluation and treatment by the team’s gynecologist. The RF treatment would be interrupted, and the data are presented in the results.
RF was used in the form of capacitive electrical transfer, monopolar configuration (Capenergy® device, model C500), which has two electrodes: an intracavitary active electrode placed in the vagina with a non-lubricated condom and water-soluble gel and another electrode, dispersive, positioned in the lumbosacral region (Fig. 1). For the application, the participants were placed in the supine position with the lower limbs abducted and the knees bent. The temperature was set at 41°C, with a frequency of 1 MHz and power of 75 kJ. When the established temperature was reached, the physiotherapist maintained it for 2 min with semicircular movements on the anterior wall of the vagina. The movement and time on the posterior vaginal wall was repeated, totaling 4 min of after reaching the established temperature (Fig. 2). Each patient underwent five RF sessions, with an interval of seven days between them.
Radiofrequency device (Capenergy®)
Radiofrequency application (Capenergy®) intracavitary with semicircular movements
For the elaboration of the database, we used the software Statistical Package for Social Sciences (SPSS), version 14.0 for Windows. The results were reported descriptively in the text or through tables and graphs; categorical variables are expressed as absolute and percentage values—n (%), and continuous variables with normal distribution in mean and standard deviation (± SD), and those with asymmetric distribution in the median and interquartile range (IQ).
The sample consisted of 11 patients with GSM, with an average age of 59.6 ± 3.93 years, with data collected from October 2017 to August 2018. Table 1 presents the sociodemographic and clinical characteristics of the study population. The main characteristic was VD, as they all had this symptom. Menopause duration ranged from two to 17 years, with a median of 14 years (6–15).
We observed the clinical improvement of GSM in the NRS scores of the symptoms of VD, SAPain, VL, VI, burning, and vaginal pain, as shown in Table 2, especially in T1.
Ten patients (90.9%) showed an increase in the VHI score in T1, which represents an improvement, and one worsened (patient five). Regarding pre-treatment, in T2, nine patients (81.8%) had an increase in VHI, while two (18.2%) had a reduction in this index during the initial value (Table 3).
In T1, most patients (7–63.6%) did not change, three (27.3%) showed a decrease in pH, representing improvement, and one (9.1%) showed an increase. In T2, there was also a predominance of maintaining baseline values (Table 3).
The cytological analysis showed that six patients (54.5%) remained unchanged in the cell count, and five (45.5%) showed an improvement in T1, with two patients of the latter changing their category from moderate or severe atrophic to mild atrophic. In T2, six patients (54.5%) showed improvement compared to the beginning, three (27.3%) remained at the beginning, and two (18.2%) worsened. One patient maintained the category of severe atrophy, and the other went from hypotrophic to severe atrophy (Table 3).
In the FSFI analysis, all patients experienced sexual dysfunction during pre-treatment. There was an increase in the total index in nine patients (81.8%) in T1, with three patients without sexual dysfunction. In T2, eight patients (72.7%) had improved compared to the beginning, but half had a decrease compared to T1, and two continued without sexual dysfunction. According to the QS-F, seven patients (63.6%) had sexual dysfunction at T0. Ten (90.9%) and seven (63.6%) patients improved their scores at T1 and T2 respectively, compared to the beginning. We observed worsening of the two periods evaluated in Patient 11 (Table 3).
In this study, six patients had pre-treatment urinary complaints. When assessing the impact of UI on quality of life (QoL) using the ICIQ-SF questionnaire, we found a decrease in the score in four patients (66.7%) in T1, one of whom had no symptoms; two (33.3%) increased the score and one who had no symptoms started to complain (patient nine). In T2, almost all patients (five—83.3%) had an improvement in the beginning, in which two had their symptoms disappeared, and two had a higher score than the initial one (Table 3).
Regarding treatment satisfaction, nine patients (81.8%) reported being satisfied and two (18.2%) were very satisfied at T1. In T2, nine patients (81.8%) remained satisfied, one (9.1%) very satisfied, and one (9.1%) very dissatisfied (Fig. 3). The patient who reported being very dissatisfied with the reassessment during T2 showed improvement in all other parameters evaluated and reported being satisfied after one month.
Satisfaction with the treatment of 11 patients with GSM, 1 month and 3 months after 05 radiofrequency sessions
We did not observe erythema, ulcers, fistulas, blisters, burns, bleeding, and/or pain at any time during treatment or follow-up. The treatment was well tolerated. One patient reported a little discomfort in the lower abdominal region during the first two sessions, which ceased in the third application.
We found an improvement in genitourinary symptoms such as VD, SAPain, VL, VI, burning sensation, pain in the vaginal opening, UI, and sexual dysfunction in most patients, especially in T1, in this pilot study that used non-ablative RF in postmenopausal women with GSM. The application of RF was considered safe because only one light adverse effect in one patient was found up to T2. To our knowledge, this is the first study to assess symptoms of GSM associated with cytological analysis and patient satisfaction after using non-drug and non-ablative treatment with intracavitary monopolar RF.
VD was the main symptom reported by patients in this study and showed an important improvement when assessed by both self-report and by VHI. Based on the histological changes observed in previous studies, the process of neocolagenesis and neoelastogenesis that occurs after exposure to controlled RF thermal energy in the vaginal tissue restores most vaginal functions such as secretion, absorption, elasticity, lubrication, and tissue consistency, which are decreased in GSM [9, 19, 20]. This hypothesis is supported by previous knowledge that this high-frequency current induces collisions and movements between atoms and molecules, resulting in energy transfer to the tissue in the form of heat and a consequent controlled increase in temperature, promoting an increase in the arterial circulation, and vasodilation, and improving tissue oxygenation [21].
VD can generate or contribute to SAPain, just as abstinence from intimate relationships is involved in the decline of lubrication, often forming a cycle. Vaginal trophism is fundamental for a comfortable sexual intercourse, which depends on the lubrication promoted by vasodilation of the lamina propria and the vaginal epithelium [22, 23]. In this study, a patient who did not have SAPain in the pre-treatment started to report this symptom in T2. An assumption is that an increase in the frequency of sexual activity may favor the appearance of this symptom. To confirm this hypothesis, an investigation of sexual frequency before and after treatment must be included. We are developing an RCT in which this variable has been included and, therefore, we may soon have this information. The increase in sensory perception by neurogenesis can occur after using RF [20], which can lead to a greater perception of the vagina; therefore, some patients may start to report these symptoms. However, further morphometric investigations of neuronal analysis are necessary.
Other studies have also found positive results for SAPain. Alinsod (2015) studied RF with controlled temperature (TTCRF) with intra- and extra-vaginal application in six menopausal women and 10 in the peri-menopausal period with SAPain symptoms, demonstrating the safety and beneficial effects of the treatment [24]. An RCT with 20 postmenopausal women applied three sessions of intra- and extra-vaginal TTCRF (ThermiVa) once a month with reduced VD and SAPain [25].
RF has also been widely used to improve collagen levels. Its diathermic effects cause the collagen denaturation. As the temperature rises, some of the cross-links are broken, causing the triple helix to unwind. Thus, there is a consequent activation of fibroblasts, with subsequent neocolagenesis, neoelastogenesis, and tissue remodeling [26]. Coad et al. (2013) evaluated the histological effect of non-ablative RF on the vaginal introitus of sheep before, after seven, 30, and 90 days. There was a significant increase in the activation of the submucosa fibroblasts and an increase in collagen compared to the control group [27]. In a histological study in multiparous sows, a significant progressive increase in the amount of elastin and collagen in the vaginal mucosa was observed. The treatment consisted of weekly intravaginal radiofrequency administrations for three weeks, with follow-up at both one week and one month after treatment [28]. The evaluation of the vaginal wall, performed by ultrasound, showed an increase in thickness, but it was not statistically significant [28]. In our study, the NRS was used to grade VL, and all patients noted improvement. Three patients who did not have the complaint initially reported mild intensity in the reassessments, which can also be justified by the increase in sensory perception after treatment. Assessing the symptoms of GSM is challenging because of its subjective nature. The development of a specific score with a cut-off point for the quantification of these symptoms and clinical improvement may be of great relevance to better evaluate these patients and verify the treatment effect.
Previous studies have obtained positive results with the use of monopolar RF with cryogenic surface cooling in pre-menopausal women with a history of at least one vaginal delivery and complaints of vulvovaginal atrophy/symptoms of GSM or VL [26, 29]. Alinsod (2015) used the TTCRF in 23 pre-menopausal women with VL, with improvement on a seven-point scale, called the vaginal laxity questionnaire (VLQ) [30]. Krychman et al. (2017) carried out a multi-center study with 189 premenopausal women complaining of VL during sexual intercourse with significant improvements in self-report and sexual function by FSFI [29].
Symptoms such as VI, burning, and pain are common complaints in GSM. Hypoestrogenia results in reduced number of epithelial layers and vessels, thinning of smooth muscles [31], and an increase in nociceptive sensory afferents [32]. In addition, the increase in tissue friction caused by the decrease in trophism and moisture causes greater mucosal fragility, contributing even more to the condition [22, 33]. In this study, there was an important improvement in these symptoms. This clinical improvement is supported by the thermal effect of RF, which significantly affects the tissue layers. As a consequence of local peripheral vasodilation and increased blood flow, there is an improvement in trophism, oxygenation, cellular metabolism, and lubrication [10, 34]. High-frequency thermal therapy seems to act through the effects of analgesia, but the mechanisms by which RF controls pain are still unclear, seemingly involving the transduction of C fiber signals [35].
The analysis of vaginal cytology through the VMI and the measurement of pH are well-used measures to establish diagnostic parameters of GSM [36, 37], but have not yet been analyzed in RF research in GSM. Brizzolara et al. (1999) carried out a study in 70 postmenopausal women determining a specific vaginal pH range that correlates with high levels of parabasal cells in the VMI, defined as at least 20%, and found a correlation between these two objective measures [38]. In this study, pH values ≥ 6.0 were compatible with a greater number of parabasal cells (≥ 20%). However, these results showed that there was no pattern of clinical/objective findings with the symptoms reported by the patients. VMI and pH, unlike NRS, remained similar in most patients (six-54.6% and seven-63.3%, respectively) in T1. In T2, most patients showed an improvement in VMI (54.6%) and in pH (36.4%). Vaginal cytology, in part, has been inconsistent with clinical findings [36]. A smaller-scale and more sensitive tape is recommended to detect minor variations.
Two patients presented with worsening VMI, which may have happened at random, because it is a small sample or due to the aging process. This change could be better controlled by an RCT. In the literature, there is no evaluation made of the agreement between evaluators of the VMI, which is a dependent evaluation instrument.
GSM has adverse effects on sexual function and general well-being. The FSFI is an instrument used worldwide to assess sexual function. In this study, it improved in most of the samples in T1 (81.8%) and T2 (72.7%). Patients were also evaluated using QS-F, a questionnaire specifically developed for the Brazilian population [16]. In terms of the total score, we observed an increase in QS-F in most of the participants. The promising results and the last position statements published by the European Society of Sexual Medicine [39] stimulated our group to carry out an RCT of RF in the treatment of signs and symptoms of GSM that is in progress. Using the non-ablative RF technique, Lordelo et al. (2016) carried out an RCT with 43 women dissatisfied with the appearance of their genitalia. They applied RF to the external genitalia, with an improvement in sexual function by 3.51 points in the group treated in the evaluation by FSFI [11].
RF is considered one of the most innovative non-surgical modalities for treating UI and VL [40]. In addition to modifying the trophism of the vaginal canal, it also targets the urethral mucosa and seems to improve not only the symptoms of GSM but also those of UI. This change could be better controlled by an RCT. In our study, although the type of UI has not been classified, 66.7% and 83.8% of the patients improved urinary symptoms at T1 and T2, respectively. Lalji & Lozanova (2017) in a pilot study, conducted three treatment sessions with monopolar RF, intra- and extra-cavitary, in 27 women with stress urinary incontinence (SUI). They found that 96.3% decreased the frequency of urinary loss by at least one level, and 59.3% reported a decrease in the amount of loss [41]. Another study with 10 patients with SUI showed improvement in the pad test one month after treatment with monopolar non-ablative RF in the urethral meatus [42]. Despite different outcome measures and application forms, RF therapy appears to be a good alternative for the treatment of SUI. Histological studies have observed a reduction in collagen in the urethral walls in the event of loss of urethral support and/or internal sphincter dysfunction [43], which supports the use of RF in this dysfunction.
Treatment satisfaction was assessed using a five-point Likert Scale, with most patients reporting satisfaction with treatment. This was reinforced by the decrease in symptoms recorded in that study. On the other hand, we observed that although most of the outcome measures have improved, the indication of patient satisfaction was greater, showing that the degree of satisfaction do not always correspond to the clinical results. Thus, satisfaction is not only linked to the therapeutic result, but also to the level of expectations of the people involved. It is important to consider the Hawthorne effect, which states that when individuals believe they are experiencing a form of treatment, they are more likely to respond and be satisfied with therapeutic responses [44]. In this sense, we also justified carrying out an RCT to better assess this issue.
Our safety analysis showed that the technique was well tolerated by patients and no side effects were observed or reported. In one patient, only mild discomfort was noted in the first two sessions. Also in the study by Lalij and Lozanova (2017), using intravaginal and extracavitary radiofrequency, no side effects were reported [41]. In this study, no description about possible side-effects was given either. The parameters of this study were also different from ours (e.g.: we measured temperature; had five treatment sessions instead of three; applied RF laterolateral instead of longitudinal; and we included a follow-up after three months). Because it was not entirely clear to what extent the different therapeutic parameters would influence safety, we decided to include a safety assessment in our research. We therefore chose to initially conduct a single-arm pilot study with patients presenting GSM. And we only moved on to a Phase 2 trial with a control group and sample calculation [45] once the therapeutic protocol was found to be safe and if there was a therapeutic response. In a safety study conducted in an animal model in treated sows, additional aspects were evaluated, such as the presence of edema, histological changes in the composition of the vaginal wall, change in urination frequency, erythema, and antalgic position, and no side effects were found [28]. A long-term effect that was not evaluated in our study and, to our knowledge, in any other study in the literature, is the possibility that non-ablative radiofrequency enhances the development of tumor cells. A biological effect takes place in the treated area as the electromagnetic field causes a temperature increase [10], and an increased blood circulation. The possibility of cell multiplication is hypothesized, including malignant cells [46]. Therefore, as a safety inclusion, patients had to undergo a vaginal cytology test and show a normal outcome, prior to treatment. For many years the literature has described the effect of thermotherapy (including radiofrequency), which, at a temperature of 41°C or more, and if maintained for at least 30 min, brings a possible therapeutic effect against cancer cells by reducing cellular DNA and RNA synthesis and respiratory depression [47]. The application of radiofrequency in the present study took place at a temperature of 41ºC, but the total treatment time was lower than the recommended time to treat cancer cells, and for this reason it may be important to perform a new long-term cytopathological evaluation to confirm the safety of the treatment technique.
Although some of the patients continued to show improvement in their symptoms in T2, some symptoms were accentuated in that period. Studying the frequency of reapplication after the end of treatment to maintain clinical improvement is essential in future studies, especially since we already have evidence from histological studies (in animals) that show that the peak of RF action occurs within 21 days after its application [10].
This is a pioneer research on the application of intracavitary non-ablative radiofrequency (RF), in women with Genitourinary Syndrome of Menopause (GSM). The study combines clinical symptoms of GSM, including sexual and urinary functions, with cytological results, patient satisfaction and treatment outcomes.
As it is a non-medicated pharmacological approach, applied locally, it opens up a new field for the treatment of this syndrome. In addition to being a new field for physiotherapy professionals.
As limitations of the study, we found a short follow-up time, the use of independent symptom outcome measures (such as sexual and urinary function questionnaires) for symptoms associated with a syndrome, the use of evaluator dependent indices (VHI and VMI) and a subjective index (VHI).
Based on these limitations, we understand the need to create a specific rating scale for GSM symptoms, intra- and inter-rating comparisons for rater-dependent scales for longer follow-up period and, since intracavitary non-ablative RF has been proven safe, the realization of an RCT.
The symptoms of VD, SAPain, VL, VI, burning sensation, pain in the vaginal opening, UI, and sexual dysfunction of GSM with non-ablative RF showed clinical improvement in most of the patients, with improvement in the self-report of the symptoms and the VHI, especially at T1. The cytological analysis, through the VMI, remained unchanged in most evaluations in T1, but there was a greater improvement in T2. There was no change in vaginal pH in most patients after RF treatment. There was no adverse effect in the 11 patients evaluated, which is considered a safe and well-tolerated technique, and patients reported satisfaction with treatment.
The data is available if requested by the corresponding author.
Burning
Bahiana School of Medicine and Health
Female Sexual Function Index
Genitourinary syndrome of menopause
International consultation on incontinence questionnaire—short Form
Interquartile range
Numeric Rating Scale
Sexual quotient—female version
Radiofrequency
Pain during sexual activity
Standard deviation
Stress urinary incontinence
Radiofrequency with controlled temperature
Urinary incontinence
Vaginal dryness
Vaginal Health Index
Vaginal itchy/pruritus
Vaginal laxity
Vaginal laxity questionnaire
Vaginal Maturation Index
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All authors would like to thank the members of the Pelvic Floor Care Center (CAAP), the Bahian School of Medicine and Public Health, and the government institutions, CNPQ and FAPESB, for promoting this research.
This study was funded through Public Notice No. 10/2014 of the Emerging Nucleus Support Program—PRONEM/FAPESB/CNPQ.
Pelvic Floor Care Center (CAAP), Bahiana School of Medicine and Public Health, Av Dom João VI, 275 – Brotas, Salvador, Bahia, 40290000, Brazil
Cintia Pinheiro, Teresa Costa, Raira Amorim de Jesus, Raquel Campos, Rosa Brim, Alcina Teles, Andrea Vilas Boas & Patrícia Lordêlo
Pelvic Floor Center Care, Av. ACM, 1034, Itaigara, Salvador, Bahia, 41825-906, Brazil
Cintia Pinheiro, Teresa Costa, Raira Amorim de Jesus, Raquel Campos, Rosa Brim, Alcina Teles, Andrea Vilas Boas & Patrícia Lordêlo
Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, Bahia, 41150-000, Brazil
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C.P. and P.L. developed the project concept and wrote the main manuscript text, R.A, R.C., R.B., and T.A, collected data and A.T. and A.Q. prepared Figs. 1, 2 and 3 and tables. All authors read and approved the final manuscript.
Correspondence to Patrícia Lordêlo.
All patients signed or fingerprint signature an informed consent form and followed the precepts of the Declaration of Helsinki; the study was approved by the ethics and research committee of the Bahiana School of Medicine and Health (EBMSP) with CAAE 72147317900005544 and registered with clinicaltrial.gov (NCT03506594). The fingerprint signature as informed consent procedure was approved by the ethics and research committee of the EBMSP.
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Pinheiro, C., Costa, T., Amorim de Jesus, R. et al. Intravaginal nonablative radiofrequency in the treatment of genitourinary syndrome of menopause symptoms: a single-arm pilot study. BMC Women’s Health 21, 379 (2021). https://doi.org/10.1186/s12905-021-01518-8
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Received: 15 February 2021
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Published: 30 October 2021
DOI: https://doi.org/10.1186/s12905-021-01518-8
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Saints roster moves: David Onyemata, Kevin White activated vs. Bucs – Saints Wire

The New Orleans Saints announced a series of roster moves before their Week 8 kickoff with the Tampa Bay Buccaneers, including the activation of defensive tackle David Onyemata and the loss of left guard Andrus Peat to injured reserve. Here’s everything you need to know from Saturday’s update to the daily NFL transactions wire:
This was expected after Onyemata’s six-game suspension ended, which allowed him to join the team with a one-week roster exemption. That had to be waived before its Nov. 1 expiration as a formality in order for him to play this week. Expect “Big O” to get a lot of snaps on Sunday.
NewOrleans.Football’s Nick Underhill reported earlier this week that Peat had surgery on the pectoral muscle he injured against the Seattle Seahawks, and the recovery timeline he’s facing runs far enough to justify putting him on injured reserve. It’s unclear just yet whether this is a season-ending issue, but it’s worth remembering defensive end Marcus Davenport was able to return to play without surgery after a similar injury this season.
Ozigbo played sparingly after the Saints signed him from the Jacksonville Jaguars practice squad, and the addition of Mark Ingram has minimized his role in the offense even further. Now he’s being released. He’ll have an opportunity to return to the Saints practice squad if he so chooses, where they only have Lamar Miller waiting in reserve after cutting Ryquell Armstead a few days earlier.
This isn’t a standard game-week elevation — Mills has done twice already (against the New York Giants and Washington Football Team), which meets the NFL-mandated two-game limit. So he has to be signed to the 53-man roster if the Saints want to dress him out for any more games this year. Expect the 90-game veteran to back up Calvin Throckmorton at left guard after Peat went to injured reserve.
White was also elevated last week, so he can’t play for the Saints again this year unless he is promoted to the active roster (like Mills). And he won’t play for the Saints again this year if he continues to drop well-thrown passes from Jameis Winston. New Orleans needs a big-play threat at receiver in the worst way, and White needs to show he can play at this level even more. This is a very real make-or-break game for his pro football career.
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Will Clapp returns to Saints practice squad among latest roster moves
6 quick takeaways from Saints’ final roster moves for Week 7
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Muscular Dystrophy Association Awards 18 Grants Totaling Over $1.6 Million for Development Grants and Idea Awards – StreetInsider.com

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NEW YORK, Oct. 28, 2021 /PRNewswire/ — The Muscular Dystrophy Association (MDA) announced today the awarding of 18 new MDA grants totaling over $1.6 million toward neuromuscular disease research. The grants are awarded in two categories: Development Grants and Idea Awards. Development Grants are awarded to investigators at the beginning of their careers and who are on the brink of becoming independent investigators. In 2021, MDA awarded 7 Development Grants totaling $1.4 million. The MDA Idea Award Program seeks bold, innovative research ideas that can have an impact in the field of neuromuscular disease. This year, MDA awarded 11 Idea Grants totaling more than $273,000.
Muscular Dystrophy Association Awards 18 Grants Totaling Over .6 Million for Development Grants and Idea Awards
This round of grant funding reinforces MDA’s unwavering commitment to the progress of neuromuscular disease research and builds on the more than $1 billion MDA has already invested in research to uncover new treatments and cures for neuromuscular diseases since its inception. The newly funded projects will aim to advance research discoveries and new therapy development in multiple areas including amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD), spinal muscular atrophy (SMA), Charcot Marie Tooth disease (CMT) and myotonic dystrophy.
“These grants do two very important things – help grow the next generation of neuromuscular disease investigators and provide seed funding for those creative, hard-to-fund projects that just need a little boost at this early stage,” said Sharon Hesterlee, PhD, Chief Research Officer, MDA.
For a complete list of individual awards for this grant cycle, visit MDA.org and explore the Grants at a Glance section.
Highlights from the grant awards for this grant cycle include:
Development Grants
Alba Timón-Gómez, PhDRole of mitochondrial hypoxia inducible factors in respiratory chain biogenesisMiller School of Medicine of the University of Miami
The muscles and brain have high energy demands, which makes them the most affected organs in mitochondrial disorders. Findings from this work could help gain insights into the pathogenesis of mitochondrial encephalomyopathies.
Jae-Sung You, PhDTargeting Leucyl-tRNA synthetase and autophagy in Duchenne muscular dystrophyThe Board of Trustees of the University of Illinois at Urbana-Champaign
Studies have shown that an autophagy suppressor, mammalian target of rapamycin complex 1 (mTOR1), was observed in mouse and human DMD skeletal muscles. It has also been shown that inhibition of mTOR1 by rapamycin or low protein diet that autophagy was rescued and improved dystrophic phenotypes in DMD mice. Dr. You’s work will help fill in the current knowledge gap in DMD pathology and discover new therapeutic targets for the treatment of the disease.
“MDA’s development grant allowed me to investigate the pathogenic mechanisms of Duchenne muscular dystrophy and its potential therapeutic targets and helped me establish my early career in neuromuscular disease research,” said You.  
Idea Awards
Valérie Allamand, PhDSuppression of COL6 premature termination codons by anticodon-edited tRNAsSorbonne Université-Inserm
COL6 mutations that introduce premature stop codons show the most severe clinical presentations. Individuals who are affected by these mutations, about 10% of patients with COL6-RD, typically do not have COL6 synthesized in the extracellular matrix. Dr. Allamand will correct the production of COL6 by using anticodon engineered tRNAs. The findings will provide data for in vivo approaches on treated cells and pre-clinical studies in COL6-RD mouse models with nonsense mutation. Additionally, the technique used in this project can be applied to other neuromuscular diseases caused by nonsense mutations.
“The funded project relies on a collaboration with Dr. Christopher Ahern (University of Iowa, Iowa City, IA) who published in 2019 a very elegant approach to correct premature termination codons (PTC). My group in the Research Center in Myology (Paris, France) focuses on congenital muscular dystrophies (CMD), notably COL6-related diseases (COL6-RD). The grant will allow us to assess the efficacy of Dr. Ahern’s approach in cells (fibroblasts) derived from patients’ skin biopsies. The next step will be to move to a mouse model developed in my group. This research is important to me because I believe that the results obtained can have a significant impact on patients’ lives,” said Dr. Allamand. “I am very grateful to MDA for this Idea Grant Program that will enable us to obtain in vitro proof-of-concept results and hopefully move quickly to pre-clinical studies. Developing therapeutic strategies for patients is our motivation and the grant allows us to move forward with this promising strategy that we plan on developing also for other types of CMDs.”
Nick Menhart, PhDComputational Design of Modified DystrophinsIllinois Institute of Technology
Exon skipping can only occur at exon skipping areas, which can lead to protein structure instability. Dr. Menhart’s lab discovered that edit-mediated structural disruption did not occur near the edit site, but rather located outside of the edit side and exhibited at domain junctions. With their computational framework, they can search for new ways to edit the dystrophin message that may produce better, more functional modified dystrophin proteins than the options available with skipping specific exons.
2021 MDA Research Grants
Development Grants
Idea Awards
About the Muscular Dystrophy Association
For 70 years, the Muscular Dystrophy Association (MDA) has been committed to transforming the lives of people living with muscular dystrophy, ALS, and related neuromuscular diseases. We do this through innovations in science and innovations in care. As the largest source of funding for neuromuscular disease research outside of the federal government, MDA has committed more than $1 billion since our inception to accelerate the discovery of therapies and cures. Research we have supported is directly linked to life-changing therapies across multiple neuromuscular diseases. MDA’s MOVR is the first and only data hub that aggregates clinical, genetic, and patient-reported data for multiple neuromuscular diseases to improve health outcomes and accelerate drug development. MDA supports the largest network of multidisciplinary clinics providing best-in-class care at more than 150 of the nation’s top medical institutions. Our Resource Center serves the community with one-on-one specialized support, and we offer educational conferences, events, and materials for families and healthcare providers. MDA Advocacy supports equal access for our community, and each year thousands of children and young adults learn vital life skills and gain independence at summer camp and through recreational programs, at no cost to families. During the COVID-19 pandemic, MDA continues to produce virtual events and programming to support our community when in-person events and activities are not possible. MDA’s COVID-19 guidelines and virtual events are posted at mda.org/COVID19. For more information, visit mda.org.
 
(PRNewsfoto/Muscular Dystrophy Association)
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Andhra CM Jagan To Inaugurate Tirupati’s Rs 684 Crore Flyover Funded By Tirumala Temple – Swarajya

Andhra Pradesh Chief Minister YS Jaganmohan Reddy is going to inaugurate the Srinivasa Setu elevated expressway project in Tirupati in November.
The six km long flyover between the Tiruchanur highway junction and Kapila Theertham is taken up to decrease traffic congestion in Tirupati by providing easy access to Tirumala bound pilgrims arriving through Chennai and Bengaluru routes by avoiding traffic congestions.
The flyover also has exit routes from Renigunta and Karakambadi meant for vehicles from Vijayawada and Hyderabad, respectively.
The Rs 684 crore project funded by Tirumala Sri Venkateswara Swamy Temple is expected to decrease the 40-minute drive amid heavy traffic in the past to just 10 to 12 minutes by avoiding half a dozen junctions.
The Tirumala Tirupati Devasthanams (TTD) and the Tirupati smart city corporation limited are funding this project at a 67 per cent and 33 per cent ratio.
Following a review with Tirupati municipal commissioner on Friday (29 October), TTD Chairman YV Subba Reddy directed the temple officials to speed up the release of funds to the contractors engaged in the flyover works so that the project will be completed on time without any delay, reports The Times Of India.
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36,000 Babies Tested for Muscular Dystrophy in PPMD Pilot in New York – Muscular Dystrophy News


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by Yedida Y Bogachkov PhD | October 26, 2021
The Newborn Screening Pilot program run in New York by Parent Project Muscular Dystrophy (PMDD) is now complete, having screened more than 36,000 babies across the state for a muscular dystrophy over the last two years.
Significantly high levels of creatine kinase, an enzyme released by damaged muscle cells that can indicate a muscular dystrophy, were found in 34 newborns as of July 31, leading to more testing. Duchenne (DMD) or Becker MD was later confirmed in four of these babies.
A fifth child, an infant girl, was confirmed to be a carrier, meaning she would not develop the disease but carried a disease-causing mutation that could be passed to her children.
The pilot program was launched in October 2019 with a goal of preventing diagnostic delays, and ensuring timely resources and clinical care for children with a muscular dystrophy.
“Newborn screening is the most effective way to ensure that infants with Duchenne are diagnosed early, when therapies will likely be the most beneficial,” Pat Furlong, PPMD’s founding president and CEO, said in a press release. “It is the goal of PPMD and the Duchenne community to help eliminate the diagnostic delay, the two or more painful, expensive and uncertain years that many families experience.”
Families with babies identified through screening as having Duchenne, the most common muscular dystrophy, or another form of the disease are able to access genetic counseling and neuromuscular care, allowing an early start to treatment. The children are also eligible to participate in clinical trials and other studies of potential treatments and interventions.
“This is a hopeful time in Duchenne therapy development. We have a robust experimental therapy pipeline targeting multiple physiological pathways. Yet it is believed that therapeutic interventions may be optimally effective the earlier they can be offered,” Furlong said.
Screening data are now going through a final analysis, and PPMD is working to extend pilot programs nationwide.
“This pilot has been a huge group effort, and we’re incredibly grateful to all of those who have been willing to share their expertise, from the initial planning stages more than 5 years ago to the final analysis of the data, which is currently underway,” said Niki Armstrong, PPMD’s Newborn Screening Program Manager.
Pilot program families are being asked to provide feedback to improve the newborn screening process. According to PPMD, this pilot — guided by a broad steering committee of Duchenne community stakeholders — can be a model for widespread Duchenne newborn screening.
“Obviously no one wants their child to be diagnosed with Duchenne muscular dystrophy, but I am a firm believer that knowledge is power in our fight to end the progression of this deadly disorder,” Furlong said. “This pilot, in combination with all of the past and ongoing pilots, lays the groundwork for Duchenne newborn screening to be performed across the country.”
The pilot was funded and led by PPMD and industry partners that included PTC Therapeutics, Sarepta Therapeutics, PerkinElmer, Solid Biosciences, and Pfizer.
Its steering committee consisted of representatives from healthcare professional groups, expert clinicians, and other Duchenne stakeholders, including the American Academy of Pediatrics, the Centers for Disease Control and Prevention, the EveryLife Foundation for Rare Diseases, and the Genetic Alliance’s Expecting Health.
“We are grateful to all of our collaborators, including the NIH-funded Newborn Screening Translational Research Network (NBSTRN) and the New York State Department of Health, for all of their work on this pilot,” Furlong said.
Added Armstrong: “We’re deeply appreciative of our clinical sites at Northwell Health and New York Presbyterian Hospitals and the New York State Newborn Screening lab for their resourcefulness and resiliency, as they safely and successfully screened babies throughout a pandemic.”
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This site is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Indian Navy Receives First P15B Stealth Guided-Missile Destroyer From MDL Mumbai – Swarajya

The Navy received its first P15B stealth guided-missile destroyer from Mazagon Dock Shipbuilders on Thursday, an official statement said on Saturday.
The construction and delivery of this ship — named “Visakhapatnam” — is another testament of impetus given by the government and the Navy to the indigenous warship construction programmes, it said.
A guided-missile destroyer has the capability to launch guided anti-aircraft missiles from its deck.
“Visakhapatnam – first of the indigenous P15B stealth guided-missile destroyers being built at Mazagon Dock, Mumbai delivered to Indian Navy on October 28, 2021,” the Indian Navy said on Twitter.
Yet another testament of impetus given by Govt of India & the Navy towards #indigenous warship constn programmes.#Visakhapatnam#first of the indigenous P15B stealth Guided Missile destroyers being built at #MazagonDock, #Mumbai delivered to #IndianNavy on 28 Oct 21.
(1/2). pic.twitter.com/sECvXvhl4R
“Induction of the destroyer will not only enhance combat readiness of Indian Navy but will also be a major leap forward towards our quest for Aatmanirbhar Bharat (self-reliant India),” it added.
Notably, the contract for four ships of Project 15B, as the Visakhapatnam class ships are known, was signed on 28 January 2011. This project is a follow-on of the Kolkata class (Project 15A) destroyers commissioned in the last decade.
As per the statement by the Ministry of Defence, the 163 metres long warship has a full load displacement of 7400 tonnes and maximum speed of 30 knots. The overall indigenous content of the project is approx. 75 per cent. Apart from myriad indigenous equipment in the ‘Float’ and ‘Move’ categories, the destroyer is also installed with major indigenous weapons which include: –
Medium Range Surface-to-Air Missiles (BEL, Bangalore).
BrahMos Surface-to-Surface Missiles (BrahMos Aerospace, New Delhi).
Indigenous Torpedo Tube Launchers (Larsen & Toubro, Mumbai).
Anti-Submarine Indigenous Rocket Launchers (Larsen & Toubro, Mumbai).
76mm Super Rapid Gun Mount (BHEL, Haridwar).
With PTI Inputs
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Our business model is you and your subscription. And in challenging times like these, we need your support now more than ever.
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Exipure: Don’t Buy Exipure Weight Loss Pills Until See This Review – Bellevue Reporter

Exipure is an innovative weight loss regimen that is only currently available online. It offers users a combination of 8 different ingredients to naturally bring the user’s body into balance.
As interesting a parallel as one could imagine, since Exipure debuted on the open market for sale to consumers on October 21, 2021, there has since been even newer scientific insight into the world of brown fat, the crux of how Exipure works and is formulated to target one of the primary forces behind obesity.
When the October 2021 headlines start to come out about “Modulating glycogen metabolism in fat cells may offer new approaches for weight loss” and opening taglines about the “Discovery of new metabolic pathway for stored sugars helps explain how cellular energy is produced and expended in obesity, advancing therapeutic potential“, it might be time to start paying attention.
As this Exipure review will clearly explain in great detail, there is so much goodness surrounding these new exotic fat burning weight loss pills that expose a tropical loophole for truly enhancing brown fat, or beige/brown adipose tissue levels, but it is vital to not buy Exipure until reading this entire investigative report.
Let’s start at the beginning and explore the organic origins of how Exipure came to be and why some are calling it the biggest weight loss secret in the past century.

What is Exipure?

Everyone wants to find a way to lose weight that works for their needs. Some people discover diet plans with their favorite foods, while others seek out a workout with a few changes from the typical routine. Using a supplement offers a little more ease during this exhausting time, leading a medical professional and his team to develop Exipure in October 2021. This remedy aims to get rid of the leading cause of excessive weight gain with only natural ingredients.
For reference, this is the definition behind Obesity, serious life-threatening health condition that affects nearly 650 million people worldwide, or 13% of the global population: “Obesity is an energy balance disorder in which energy intake exceeds energy expenditure, resulting in excessive accumulation of white adipose tissue (WAT). (here)”
As the creators explain, the cause behind belly fat is having LOW levels of brown adipose tissue (BAT) and now they have figured out how BAT is a metabolically active tissue rich in mitochondria that supports with subsequent heat production and more energy-enhancing effects. This type of fat increases the speed of burning calories by 300 times what users would get with regular fat. Without enough BAT in the body (which is a newer scientific discovery that adults even had brown fat (Brown adipose tissue in adult humans: a metabolic renaissance), the likelihood of obesity increases exponentially. Leaner figures help users improve how they burn through fat at a rapid pace, reducing the amount of fat that the body burns while at rest or active.
Based on the science behind BAT, the Expire formula seems to be the only product on the market that focuses on the low brown adipose tissue levels of some consumers. Here are a few basics on the Exipure formula to get a clearer idea of what it provides before getting into a deep dive into the science behind brown fat and the BAT-boosting Exipure supplement for supporting the activation of adaptive non-shivering thermogenesis (NST). The reason this becomes of significance is that there are already new breakthroughs in the news when reading remarks from esteemed researchers saying, “the potential of inducing even small amounts of brown fat in adult humans could provide a new approach to the treatment and/or prevention of obesity and its metabolic complications.” But is it too good to be true about Exipure results? Right now some may argue that it’s still unclear to what extent BAT might play a role in balancing energy in grown up humans. But one thing is for certain, Exipure is the first weight loss supplement of its kind to create a formula that looks to convert white fat into metabolically active brown fat (Adipose tissue is central to the regulation of energy balance, brown adipose tissue, which is specialized in energy expenditure and can counteract obesity (here)),
Here are some of the best Exipure details to know upfront before making a decision to order Exipure weight loss pills from the official website.

Formula:
  • Exipure
Introduction:
  • Exipure is a new fat-burning weight loss supplement formulated by Jack Barrett and doctors Wilkins and Lam that targets the primary cause of obesity, low brown fat levels, and boosts brown adipose tissue activation (beige fat development), igniting the induction of brown adipogenesis and overall cellular thermogenesis.
Form:
  • Take one (1) Exipure capsule daily, recommend taking it with food in the morning or at lunchtime with an 8 oz. glass of water and be sure to stay active and hydrated throughout the day with simple stretches and a few glasses of fresh filtered water for optimal effects
Official Site:
Expectations:
  • when first starting to take Exipure, these 8 premium ingredients go right to work inside your body as designed. Over time your body will adapt and adjust to taking Exipure and rapidly speed up your metabolism and establish healthy brown fat levels, the way nature intended.
Ingredients:
  • 300mg dosage of 8 Exipure ingredients:
  • Olive Leaf Extract’s 20% Oleuropein Blend (200mg dosage)
  • Holy Basil leaf extract with Ursolic and Oleanolic acids 2.5% (ocimum sanctum)
  • Bee Propolis (loaded with 300+ BAT boosting antioxidants)
  • Berberine extract from Amur Cork Bark
  • Kudzu root extract (Pueraria Lobata)
  • Quercetin (quercetum)
  • Panax Ginseng root extract at 5% ginsenosides (White Korean Ginseng root extract)
  • Luteolin extract at 90% from Perilla leaves (perilla frutescens)
Payment:
  • Best Value Exipure Deal 6 bottles at $39 each
  • Most Popular Exipure Deal 3 bottles at $49 per
  • Starter Package Exipure Deal 1 bottle at $59
  • The 6 and 3 bottle orders come with 2 bonuses (value $109)
  • All Exipure orders come with 6-month iron-clad refund policy
  • Order on safe, secure and trusted marketplace vendor Clickbank
Free Perks:
  • 1-day Kickstart Detox (over 20 doctor-made tea recipes and health guide)
  • Renew You (enhances the Exipure supplement results)
Phony Ripoffs:
  • Exipure will ONLY be sold on Exipure.com official website
  • All Exipure Amazon, eBay, Walmart, GNC, CVS etc are fake!!
  • Exipure is not offered in any local health shops and stores
  • Only the Exipure official store offers 180 day money back policy
Contact:
  • try [email protected] for fastest response
  • Phone can be reached at 1-800-390-6035 (USA) and 1-208-345-4245 (Outside USA)
Where to Buy

What is Brown Adipose Tissue?

Brown adipose tissue exists in everyone’s body. Though it is found in higher amounts in individuals with a lean figure, this type of body fat primarily exists to maintain body heat. The heat production keeps the user’s overall temperature within a healthy range if dangerous circumstances arrive. However, white adipose tissue is the typically stored fat that is found in plentiful amounts in overweight and obese bodies.
Anyone who wonders how one person can stay so slender without making an extra effort can blame it on their body’s high brown adipose tissue level. Brown fat offers more significant mitochondria to serve their purpose. They use the energy from these fat cells to keep the body warm, which burns more calories. Burning the calories prevents drops in body temperature.
Theoretically, increasing brown adipose tissue increases the number of calories burned, leading to weight loss.

How Does Exipure Work?

The only reason Exipure seems to have such a positive effect on the body is that the creators use eight specific ingredients at clinically-effective dosages. These plants and herb extracts target the brown adipose tissue that already exists in every lean body. With constant research regarding how BAT works in the body, the exponentially faster calorie burning has led many companies to seek out ways to use it to their advantage. Exipure has a unique concoction to take advantage of the calorie deficit created by their remedy, ensuring that users constantly have a calorie deficit.
Raising BAT levels with these ingredients is the only way that the body starts to use more fat and calories. The ingredients mentioned to achieve that effect include:

  • Oleuropein extract from olive leaf extract (here)
  • Perilla
  • Holy Basil
  • White Korean Ginseng
  • Amur Cork Bark
  • Quercetin
  • Propolis
  • Kudzu Root

Please read below to learn more details about the Exipure ingredients and how they help users.

Perilla Leaves

Perilla leaves are one of the star players in this remedy because they naturally increase the user’s BAT levels, which is what this entire product is centered around. The formula improves the user’s brain health, triggering better cognition and memory for the user. Some people improve their healthy cholesterol levels with the use of Perilla.
Perilla also goes by the name Perilla frutescens.

Holy Basil

Holy Basil is also included for the boost that it offers BAT levels, making it a crucial weight loss solution component. It eases stress, which causes the body to reduce the amount of cortisol it produces. Cortisol is the stress hormone, and excessive amounts trigger the appetite, leading users to have a much more active appetite. With more cravings, consumers eat more calories and gain the weight that they want to.

White Korean Ginseng

White Korean Ginseng increases BAT levels, and this ingredient ensures that users keep a healthy immune system. The immune system has a significant role in the body to prevent illness and keep cells healthy. Most diets go to extreme lengths to shed the extra pounds, and people who actively pursue these routines tend to lose the nutrients their bodies need.
White Korean ginseng is also known as Panax ginseng. It reduces oxidative stress.

Amur Cork Bark

Amur Cork Bark doesn’t get the same attention as some of the other ingredients on this list, but it is still equally important to the Exipure formula. Scientific research is necessary to see a greater connection between BAT levels and amur cork bark. However, some early information shows that it eases both digestion and bloating for consumers.
In some cases, the use of amur cork bark improves the health of the liver and heart.

Quercetin

Quercetin is one of the best-known ingredients in the supplement space, which is primarily because it improves healthy blood pressure and keeps aging cells youthful. As an antioxidant, it benefits most health formulas, though its use in weight loss supplements is an innovative way to keep the body feeling and looking young.

Oleuropein

Oleuropein may seem a little random to add to this type of formula, but most consumers use it all the time in olive oil. Including this ingredient keeps the arteries healthy, reducing the harmful cholesterol that builds up. However, it also increases the heart’s health, which is especially beneficial for individuals who need to reduce the stress that obesity has on this organ.
The ingredients inside Exipure weight loss capsules are meant to hit the nail on the head when it comes to tackling the root problem of weight gain, low brown fat levels. Even the key points of so many studies cite, “Targeting thermogenesis in adipose tissue and muscle might be a promising therapeutic tool against obesity and associated metabolic diseases” or “Cold-induced thermogenesis is an important component of total energy expenditure and contributes to overall energy balance” and “The recent discovery of metabolically active BAT in human adults has made it clear that cold-induced thermogenesis is of physiologic and potentially therapeutic relevance”. As an opening abstract it also mentions, “Brown fat is emerging as an interesting and promising target for therapeutic intervention in obesity and metabolic disease. Activation of brown fat in humans is associated with marked improvement in metabolic parameters such as levels of free fatty acids and insulin sensitivity.”

Features & Benefits of Exipure

When taking Exipure, the formula:

  • Provides an entirely natural weight loss formula.
  • Offers plant-based support for individuals pursuing weight loss.
  • Contains all of the necessary nutrients within capsules that users can easily swallow.
  • Is non-GMO
  • Uses ingredients with scientific proof.

Though this remedy is powerful, there is no risk of addiction, and the creators used no stimulants in the making.

How Much Weight Do Users Shed with Exipure?

Anyone who begins a new regimen wants to know the results they can expect from it. Exipure’s official website explains that it doesn’t take much time to lose massive amounts of weight while taking the formula.
The website contains the experiences of other people that have already tried Exipure with great success. One of the customer reviews from a woman named Lauren states that she lost 35 lbs. when she took the remedy. She adds that she now has much more energy than before, and she no longer experiences the stress and anxiety that she formerly did.
Another customer – Zach – reports a 26-lb. loss with Exipure, even though he is in his 40s. He expressed greater happiness with his current figure than that from his 30s. He is still taking the formula, so his ongoing progress has yet to be seen.
Cassie – another female who took Exipure – expressed happiness over losing 40 lbs. without much time at all. For her, this loss was the equivalent of four dress sizes. Her success has been so good so far that she still uses Exipure to help.

Scientific Evidence for Exipure

So many people seem to go for the benefits offered in Exipure because of the scientific evidence behind the ingredients. Realistically, this combination doesn’t have any clinical trials or peer-reviewed studies that it has gone through as a whole, but the elements still have opened the door for anyone that wants to shed the extra pounds. Even on the official website, potential customers can peek at the scientific studies on which Exipure bases its research.
As recently as 2004, brown adipose tissue has been on the minds of researchers as they sought to understand how it makes the energy from food become heat. In this research, the professionals learned that brown adipose tissue makes it possible to break apart the fat and sugar that individuals consume in the mitochondria of cells. Basically, it triggered the use of fat and calories to help users shed weight.
Most doctors and scientists alike find the exact cause of weight loss – establishing a calorie deficit. Losing weight requires dedication to a plan, which means that the body will use and burn more calories than the digestive system processes. Diet and exercise demonstrate easy ways to address these concerns, but brown adipose tissue helps individuals have more significant results. Ultimately, the goal of Exipure is to increase the brown adipose tissue in the user to shed more weight and resist gaining it back naturally.
Outside of using Exipure, some professionals say that boosting brown adipose tissue happens as individuals build up their muscles through exercise. The exercise allows the brown adipose tissue beneath the muscles to thrive, naturally increasing these levels. Unfortunately, Exipure wouldn’t be much of a weight loss supplement if the user had to work out to achieve something that they want to create without changing their routine.
With ingredients like ginseng and holy basil, the creators behind Exipure confidently state that users won’t have to spend hours at the gym. Instead, the customers can take the recommended serving size each day to alter their fat levels from a digestive standpoint.
Ginseng has been the subject of many studies, but one in 2014 discovered a significant connection between obesity and gut microbiota. The researchers decided to test the effect of consuming ginseng by giving it to a group of Korean women in their 40s to 60s. This group continued to use ginseng for eight weeks, after which time the researchers observed significant weight loss. They also found that the participants improved their overall gut health.
Holy basil doesn’t have quite the same notoriety as ginseng, but researchers still seem to find connections between its use and weight loss. With centuries of use in both Ayurvedic and Siddha medicine, researchers decided to combine the findings of other lab reports in their 2017 study. Across many of these studies, the researchers showed a positive change in body mass and the user’s average weight after supplementation.
As beneficial as this formula might be for specific users, the research and evidence behind the unique formula are limited.

Exipure Pricing and Purchasing

As effective as the creators work to make Exipure, the only way that users can buy it is by going to the official website, which is Exipure.com. Customers have the chance to buy up to six bottles in an order, but the creators decided to place a discount on the larger packages as an incentive to order more at once.
Currently, the packages offered include:

  • One bottle for $59 with $9.95 for shipping (STARTER PACK!)
  • Three bottles for $147 with $9.95 for shipping ($49 per MOST POPULAR!)
  • Six bottles for $234 with free shipping ($39 per BEST VALUE! )

The bottles have 30 capsules each to offer exactly enough of the product to get through 30 days of use since the daily serving is one capsule. Shoppers that choose either of the larger packages will get two bonuses delivered without any additional cost.

Bonuses Included with Exipure

The bonuses associated with the Exipure are both to help users to alleviate other issues surrounding weight loss.
The first bonus is more of a direct approach to weight loss with the 1-Day Kickstart Detox. Available as a digital eBook, consumers will learn what they need to do to start the Exipure supplement. The guide includes 20 different tea recipes that take just 15 seconds each. The ingredients come from the average pantry staples that users probably already have in their kitchen.
The second bonus is also an eBook called Renew You. The book takes on the stress and other issues that come in everyday life. Individuals that experience stress are more likely to snack on the foods that cause them to gain weight in the first place. The techniques reduce anxiety and promote better confidence as well.

Other Available Products from Exipure

Users who want to see everything that the Exipure remedy offers can check out one of the additional products provided.
For instance, the website offers an additional package with nine discounted bottles. The package includes free shipping, but this opportunity gives users a chance to stock up while inventory is still provided.
The Exipure Wellness Box is another opportunity for individuals that don’t want to be at risk of losing the inventory. It has a value of $620, allowing users to order five more nutritional supplement bottles. The box includes multiple new remedies for customers, like MCT Oil Pure, Deep Sleep 20, Immune Boost, Biobalance Probiotic, and Ultra Collagen Complex. The purpose of these remedies is to help users improve their sleep, enhance the immune system, and shed weight how they want.

MCT Oil Pure

MCT Oil Pure provides users with 2000 mg medium-chain triglycerides in every serving. The entire point of this formula is to increase the user’s weight loss by at least ten times over. Typically commented people take this type of ingredient to induce a state of satisfaction after meals. This full feeling occurs by stimulating the release of a hunger hormone – leptin.

Immune Boost

Immune Boost offers support to the user with a proprietary blend of ingredients for the immune system. One of the leading ingredients in this formula is echinacea, a known antioxidant with nine other ingredients known for equally powerful effects.

Biobalance Probiotics

Biobalance Probiotics help users to regulate their digestive system with probiotic bacteria that keeps the gut under control. With the MAKTrek 3-D Probiotic Delivery System, users eliminate the toxic bacteria that cause inflammation, discomfort, and other problems. It also increases the number of healthy bacteria, nourishing the intestinal balance of the user.

Ultra Collagen Complex

Ultra Collagen Complex offers a powdered supplement to rebuild the collagen that is lost as the body ages. With hydrolyzed collagen peptides, users significantly reduce the fine lines and wrinkles from within, rather than using typical ointments and expensive procedures.

Deep Sleep 20

Deep Sleep 20 promotes better rest at night with natural ingredients like ashwagandha, melatonin, chamomile, goji, passionflower, and lemon balm. Customers should primarily use the remedy at night due to the naturally relaxed feeling that users experience.

Exipure Refund Policy

Any customer who doesn’t get the desired benefits has a 180-day moneyback guarantee that protects their investment.

Contacting Exipure

To reach Jack, Dr. Wilkins, and the Exipure team, customers can either call 1-800-390-6035 or 1-208-345-4245
Customers can also reach the team by sending an email to [email protected]

Final Thoughts on Exipure

Exipure with a weight loss formula that shoppers can only find on their official website. The only way users can lose weight through this regimen is by reducing the white adipose tissue in their body and increasing the brown adipose tissue instead. Though growing brown adipose tissue ordinarily takes exercise and other physical activity, the use of Exipure can help.
Taking chunks of extracted essence from the esteemed medical establishment will only further highlight the need for optimal weight management solutions in the form of natural supplementation. In a nutshell, no one can say it better than this, “Obesity is the consequence of chronic positive energy balance and considered a leading risk factor for cardiovascular and metabolic diseases. Due to its epidemic trends among children and adults, there is an increasing interest in implementing new therapeutic interventions to tackle overweight and obesity. Activation of brown adipose tissue (BAT) represents today a promising strategy to enhance energy expenditure (EE) through heat production. More recently, “browning” of white adipose tissue (WAT) has gained increasing attention in the research area as an alternative method in stimulating energy dissipation. This minireview aims to summarize the current knowledge of some dietary compounds that have been shown to promote BAT activation and WAT browning with subsequent beneficial health effects. (here)
The frontier of brown fat boosting health supplementation is just now ripening and much more concrete evidence and feedback will need to be aggregated as a whole to know completely, but so far the foundational understanding of the beneficial brown fat weight loss effects are just now ripening with sound science starting to support its special discovery.
Since brown adipose tissue can burn up to 300 times the calories that ordinary fat does, it creates a deficit automatically. Whether Exipure does work with its ingredients for supporting the induction of BAT thermogenesis, which by now is clearly stated to be a promising protective and proactive strategy to fight obesity in humans, a condition plaguing over 650 million people worldwide, or not, the official presentation at Exipure.com is extremely compelling to watch.
With a last look at this Exipure review verdict, here are the primary pros and cons consideration list to contemplate about before buying Exipure today.

Pros:
  • any adult age of 21 and up can use into 30s, 40s, 50s, 60s, 70s+
  • is said to yield same results in both women and men
  • scientifically proven ingredients with clinically-effective dosages
  • targets low brown adipose tissue levels, a first of its kind
  • 100% safe, plant-based ingredients with no stimulants
  • All capsules are tested and made at FDA-registered cGMP
  • 180 day, 6-month refund policy for risk free purchase deal
  • no auto-biller function or hidden charges that add extra fees
  • free guides as a bonus for ordering in the three or six month packs
  • bulk pricing options that range from $59 all the way down to $39 per
Cons:
  • exact Exipure ingredient dosage strengths unknown due to proprietary formula
  • NOT available on Amazon.com, Walmart.com, GNC.com or CVS.com
  • two free guides valued at $109 are not available for 3/6 packs
  • exotic tropical ingredient composition calls for limited stock sourcing, best to order now while supplies last
  • last but not least, Exipure is largely unproven so far given it has just been made available in October 2021. The shocking real Exipure customer success stories shared on the official site and during the video presentation are impressive, but as the latest science confirms that BAT is a metabolically active tissue rich in mitochondria that helps with subsequent heat production and creates more energy and fat shrinking benefits, the ability to boost BAT naturally has only been done once and that is with Exipure.
ACT NOW:

The title “do not buy Exipure until reading this review” was hopefully fulfilled using necessary requirements to make a complete and comprehensive overview of one of the most exciting supplements to exist as of late in the natural health and wellness weight loss industry, a $78 billion dollar market. With the average consumer spending roughly $110,000 of cold-hard cash in attempts to help support healthy weight loss, a risk-free option of today until 6 months of now to use Exipure as your choice for the main catalyst to accelerate your white fat burning into brown fat boosting efforts seems to be a no-brainer at this point.
Act now, and make Exipure work for you or simply request your money back within the next 180 days after making an order on the Exipure official website today.
RELATED: Java Burn: Do Not Buy JavaBurn Until You See This Review Now
Affiliate Disclosure:
The links contained in this product review may result in a small commission if you opt to purchase the product recommended at no additional cost to you. This goes towards supporting our research and editorial team and please know we only recommend high quality products.
Disclaimer:
Please understand that any advice or guidelines revealed here are not even remotely a substitute for sound medical advice from a licensed healthcare provider. Make sure to consult with a professional physician before making any purchasing decision if you use medications or have concerns following the review details shared above. Individual results may vary as the statements made regarding these products have not been evaluated by the Food and Drug Administration. The efficacy of these products has not been confirmed by FDA-approved research. These products are not intended to diagnose, treat, cure or prevent any disease. <!–

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2022 Honda Passport Debuts with New TrailSport Off-Road Model – Car and Driver

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All Passports receive a fresh face and more standard safety tech, while the TrailSport prepares the crossover for off-road duties.
UPDATE 9/23/21: This weekend, at Overland Expo West in Flagstaff, Arizona, Honda is unveiling the Passport TrailSport Rugged Roads Project, a collaboration with overlander and YouTuber Jon Tuico. This upgraded Passport TrailSport (pictured below) features a JSport lift kit, Firestone Destination A/T2 all-terrain tires, roof crossbars, and a Dirt Complex tow-hitch tire carrier. There are also thicker fender flares and unique 18-inch wheels, and Honda custom built the orange recovery points on the front bumper and stainless steel skid plates to shield the oil pan and fuel tank. A Roofnest Sparrow XL tent is perched atop the Rugged Roads Project Passport.

Earlier this month Honda announced that it would launch a new TrailSport trim line focused on off-road performance, and now the first TrailSport model has arrived with the refreshed 2022 Honda Passport. Along with the new all-terrain version, all 2022 Passports gain a revised front fascia, new wheels, and more standard safety tech. The full lineup will be on sale this winter, Honda told Car and Driver.
Most of the visual changes to the Passport occur ahead of the A-pillars, where the fairly anonymous face of the outgoing model has been replaced by a snarled, bulldog-esque mug that calls to mind the Ridgeline pickup. The rear bumper has been tweaked slightly, and the 2022 Passport will also be available with a HPD accessories package which alters the grille and wheel designs and adds black fender flares and HPD graphics.
The new Passport TrailSport, the only version of the 2022 Passport that Honda has showed to date, receives a unique grille design, chunky front and rear bumpers, and orange TrailSport badges throughout. The track has been widened by 0.4 inch at the front and rear for increased stability, and the 18-inch wheels are wrapped in TrailSport-specific 245/60R-18 tires. The TrailSport uses Honda’s i-VTM4 torque-vectoring all-wheel drive and Intelligent Traction Management systems to tackle unpaved roads. The interior features orange contrast stitching, TrailSport logos, and amber ambient lighting.
All 2022 Passports continue to be powered by the same 3.5-liter V-6, which makes 280 horsepower and 262 pound-feet of torque. It’s mated to a nine-speed automatic transmission. The i-VTM4 torque-vectoring system, which is standard on the TrailSport and Elite, is now optionally available on the EX-L as well. Honda says all Passports now have 8.1 inches of ground clearance, and the EX-L and Elite models have a new 20-inch wheel design. Honda says that the Passport TrailSport is the first in a new series of off-road-focused models and that the future could bring bigger upgrades like beefier tires and a revised suspension.
In the interior comfort and safety department, there’s a standard 8.0-inch infotainment screen with Apple CarPlay and Android Auto compatibility, plus the Honda Sensing system of driver-assist features, also standard. A rear-seat reminder will tell drivers to check the rear seat for children, pets, and anything else when turning the crossover off, and a rear seatbelt reminder lets the driver know if the rear passengers aren’t strapping in; both warning systems are standard.
The Ridgeline pickup truck is likely to be the next Honda to receive the TrailSport treatment, and the badge could potentially expand to the Pilot and CR-V as well. The TrailSport lineup will compete against Ford’s Timberline for the Explorer and Hyundai’s XRT package for the Santa Fe, both of which are expected to migrate across the automakers’ rosters as well.

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