Pentoxifylline and tocopherol for the treatment of osteoradionecrosis of the jaws. A systematic review

Background: Osteoradionecrosis of the jaws (ORNJ) is a severe and challenging complication of head and neck radiation therapy. Despite its aggressiveness and controversy respect to its efficacy, surgical intervention remains the main treatment modality. Nevertheless, due to advances in the understanding of ORNJ physiopathology, new treatment alternatives such as the combination of pentoxifylline with tocopherol (PENTO) have emerged. The aim of this systematic review was to assess the reported efficacy of PENTO for the treatment of ORNJ. Material and Methods: Studies were search using Pubmed, The Cochrane Library, Scopus, and Web of Science data bases following the PRISMA guidelines. Inclusion criteria were cohort, case series, randomized or non-randomized clinical studies published in English including human subjects who received PENTO as treatment for ORN of the jaws. Results: Eleven articles met the inclusion criteria and were included for data analysis. All studies reported patients with complete mucosal coverage with no exposed bone (considered healthy) after PENTO treatment, ranging from 16.6% to 100% of the patients, depending on the study. Clinical improvement or disease stabilization was reported between 7.6% and 66.6% of studied individuals, while disease progression was seen in only 5 studies involving 7.6 - 32% of patients. Conclusions: PENTO treatment achieved a complete disease control in a significant number of patients in all studies. However, there is no standardized protocol for administering the therapy. It is necessary to determine the pharmacological doses and to evaluate the benefits of adding antibiotics and clodronate. Good quality clinical trials are needed to develop a successful algorithm for the management of ORN of the jaws. (AU)

Evaluación del estatus nutricional de vitamina E / Assessment of vitamin E nutritional status

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Evidencias para el empleo del aceite de rosa mosqueta en heridas y cicatrices cutáneas / Evidências para o uso de óleo de rosa mosqueta em feridas e cicatrizes cutáneas / Evidence for the use of sweetbriar rose oil in skin wounds and scars

La formación de cicatrices y queloides durante el cierre de las heridas puede limitar las funciones de la piel y supone un reto importante durante el tratamiento de lesiones cutáneas. El aceite de rosa mosqueta (Rosa rubiginosa L.), puro o como parte de formulaciones, se utiliza en varios países para la prevención de la aparición de cicatrices y para la atenuación de las existentes. Contiene principalmente ácidos grasos insaturados, entre los cuales destacan los ácidos a-linolénico, linoleico y oleico, que actúan como emolientes y antiinflamatorios. Éstos van acompañados de pequeños porcentajes de tocoferoles, fitosteroles, ácido trans-retinoico, carotenoides y ácidos fenólicos, que pueden contribuir también a la actividad cicatrizante del aceite. Diferentes estudios realizados con roedores demuestran que el aceite de rosa mosqueta acelera el proceso de la cicatrización de heridas y reduce la inflamación alrededor de las mismas. Por su parte, la mayoría de los estudios clínicos publicados evidencian la capacidad de reducir el tiempo de cicatrización y el tamaño de las cicatrices, así como la formación de queloides, tanto en el caso de heridas quirúrgicas como en otros tipos de alteraciones de la integridad cutánea: acné, úlceras varicosas, estrías gravídicas, epitelitis iatrogénica provocada por radioterapia, o quemaduras. No obstante, la mayoría de ellos adolecen de limitaciones de diseño, motivo por el cual es necesaria la realización de nuevos estudios farmacológicos y clínicos que permitan establecer un uso terapéutico racional del aceite de rosa mosqueta

A formação de cicatrizes e quelóides durante a cicatrização das feridas pode limitar as funções da pele e é um grande desafio para o tratamento de lesões cutâneas. O óleo de rosa mosqueta (Rosa rubiginosa L.), puro ou como parte de formulações, utiliza-se em muitos países para evitar o aparecimento de cicatrizes e atenuar as já existentes. Contém principalmente ácidos gordos insaturados, dos quais se destacam os ácidos a-linolénico, linoleico e oleico, que actuam como emolientes e anti-inflamatórios. Estes constituintes são acompanhados por pequenas percentagens de tocoferóis, fitoesteróis, ácido trans-retinóico, carotenóides e ácidos fenólicos, que também podem contribuir para a actividade de cicatrização do óleo. Diferentes estudos em roedores mostram que o óleo de rosa mosqueta acelera a cicatrização de feridas e reduz a inflamação em seu redor. Além disso, a maioria dos ensaios clínicos publicados demonstram a capacidade de reduzir o tempo de cicatrização, o tamanho das cicatrizes, assim como a formação de quelóides, tanto no caso de feridas cirúrgicas como noutras situações que envolvam alterações da integridade cutânea: acne, úlceras varicosas, estrias gravídicas, epitelitis iatrogénica causada por radioterapia ou queimaduras. No entanto, a maioria deles sofre de limitações de desenho, motivo pelo qual é necessário a realização de novos estudos farmacológicos e clínicos que permitam estabelecer um uso terapêutico racional de óleo de rosa mosqueta

The formation of scars and keloids during wound healing can restrain skin functionality and is a major challenge during the treatment of skin lesions. Sweetbriar (Rosa rubiginosa L.) oil, pure or as ingredient of formulations, is used in many countries to prevent scarring and to treat existing scars. It contains mainly unsaturated fatty acids, among which a-linolenic, linoleic and oleic acids are the most outstanding, which act as emollient and anti-inflammatory. Other minor constituents that can also contribute to the wound healing activity of the oil are tocopherols, phytosterols, trans-retinoic acid, carotenoids and phenolic acids. Different studies in rodents showed that sweetbriar oil accelerates wound healing and reduces inflammation around scars. In addition, most published clinical studies show the ability to reduce the healing time and the size of the scars, as well as keloid formation, both in the case of surgical wounds and in other types of lterations of skin integrity: acne, varicose ulcers, gravid striae, iatrogenic epithelitis caused by radiotherapy, or burns. However, most of them suffer from design limitations, thus new pharmacological and clinical studies to establish a rational therapeutic use of sweetbriar oil are required

Effects of d-alpha-tocopherol on skeletal muscle regeneration in crushed injury of diabetic rats

Muscular atrophy in diabetes is believed to be due to uncontrolled hyperglycemia and oxidative stress. Vitamin E, a natural antioxidant, is considered important to maintain skeletal muscle structures and functions. The current study is designed to explore the regenerative potential of d-α-tocopherol after crushed injury of skeletal muscle in healthy and diabetic rats. Diabetes was induced through single subcutaneous injection of alloxan at the dose of 100 mg/kg at hip region. Twenty four albino rats were divided into four groups; healthy control, diabetic control, healthy treated and diabetic treated. Treated groups were administered d-α-tocopherol orally and daily at the dose of 200 mg/kg for three weeks. A horizontal skin incision was made on the shaved right mid-thigh region and after splitting of the fascia between gluteus maximus and tensor fascia lata the gluteus maximus was crushed with Kocher's forceps. Skin wound was closed with an absorbable suture. The crushed muscle changes were studied by assessing the histopathological features, histomorphological measurements and biochemical analyses at the end of 3rd week. One way 'ANOVA' followed by Tukeys test and Student t test were used for statistical analysis. Results obtained through various methods indicate that the d-α-tocopherol helps in skeletal muscle regeneration by improving antioxidant status, myoblast proliferation, revascularization, reinnervation and connective tissue remodeling. Hence it is concluded that d-α-tocopherol is a useful therapeutic dietary supplement in the management of skeletal muscle crushed injuries in both healthy and diabetics

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Effect of carnosine alone or combined with alpha-tocopherol on hepatic steatosis and oxidative stress in fructose-induced insulin-resistant rats

A diet high in fructose (HFr) induces insulin resistance in animals. Free radicals are involved in the pathogenesis of HFr-induced insulin resistance. Carnosine (CAR) is a dipeptide with antioxidant properties. We investigated the effect of CAR alone or in combination with α-tocopherol (CAR + TOC) on HFr-induced insulin-resistant rats. Rats fed with HFr containing 60 % fructose received CAR (2 g/L in drinking water) with/without TOC (200 mg/kg, i.m. twice a week) for 8 weeks. Insulin resistance, serum lipids, inflammation markers, hepatic lipids, lipid peroxides, and glutathione (GSH) levels together with glutathione peroxidase (GSH-Px) and superoxide dismutase 1 (CuZnSOD; SOD1) activities and their protein expressions were measured. Hepatic histopathological examinations were performed. HFr was observed to cause insulin resistance, inflammation and hypertriglyceridemia, and increased triglyceride and lipid peroxide levels in the liver. GSH-Px activity and expression decreased, but GSH levels and SOD1 activity and expression did not alter in HFr rats. Hepatic marker enzyme activities in serum increased and marked macro- and microvesicular steatosis were seen in the liver. CAR treatment did not alter insulin resistance and hypertriglyceridemia, but it decreased steatosis and lipid peroxidation without any change in the antioxidant system of the liver. However, CAR + TOC treatment decreased insulin resistance, inflammation, hepatic steatosis, and lipid peroxidation and increased GSH-Px activity and expression in the liver. Our results may indicate that CAR + TOC treatment is more effective to decrease HFr-induced insulin resistance, inflammation, hepatic steatosis, and dysfunction and pro-oxidant status in rats than CAR alone

Critical difference applied to exercise-induced oxidative stress: the dilemma of distinguishing biological from statistical change

Even though intense exercise has traditionally been associated with a statistically significant accumulation of blood-borne biomarkers of free radical-mediated lipid peroxidation, it remains to be determined if the oxidative stress response is biologically significant. To examine biological significance, we calculated the critical difference of selected biomarkers of oxidants-antioxidants in the peripheral circulation of ten male subjects aged 24 ± 3 years. Venous blood was drawn in the resting supine position every hour over an 8-h period (Study 1). As proof-of-concept, supine venous blood was also obtained at rest and following maximal cycling exercise in a separate group of 13 males, mean age 22 ± 3 years (Study 2). The critical difference of electron paramagnetic resonance spin-trapped alkoxyl free radicals, lipid hydroperoxides, malondialdehyde, ascorbic acid, retinol, lycopene, Alpha-tocopherol, Beta-carotene and Alpha-carotene was calculated as 121%, 28%, 50%, 9%, 29%, 106%, 13%, 28% and 107%, respectively (Study 1). Maximal exercise was associated with a statistically significant (P < 0.05 vs. rest) reduction in Alpha-tocopherol and retinol, and a corresponding rise in alkoxyl free radicals and lipid hydroperoxides (Study 2). However, these changes were all within the critical difference percentage value. In conclusion, these findings highlight the importance of distinguishing biological from statistical significance when assessing the physiological and clinical impact of exercise-induced oxidative stress (AU)

Tratamiento y manejo actual de la fase aguda de la enfermedad de Peyronie / Current treatment and management of the acute phase of peyronie´s disease

La verdadera naturaleza fisiopatológica de la enfermedad de Peyronie sigue evolucionando. Esta patología suele traducirse en una placa (s) en el pene, deformidad, incurvación, dolor y disfunción eréctil. Clínicamente, hay dos fases definidas, aguda y crónica. Esta revisión se centrará en el manejo de la fase aguda de la enfermedad de Peyronie.Si bien existen pocos datos que manifiesten la resolución de la enfermedad, la estabilización es un objetivo clínico importante para los pacientes ya que permite a menudo una función sexual aceptable. Por lo tanto, el tratamiento médico durante la fase aguda de la enfermedad de Peyronie tiene como objetivo limitar y estabilizar el grado de fibrosis del pene, disminuyendo la curvatura del pene, y, reduciendo el dolor.Detallamos a continuación diferentes terapias para el tratamiento de la fase aguda de la enfermedad de Peyronie, tales como oral, tópica, inyección intralesional y otras como la Terapia Extracorpórea con Ondas de Choque (LEOC). Terapia de radiación y tracción del pene .Aunque no existe consenso para el tratamiento de la fase aguda de la enfermedad de Peyronie, la mayoría de los pacientes puede lograr la estabilización y en algunos casos la regresión de su enfermedad, con el tratamiento mé-dico adecuado. Los objetivos de la terapia deben ser ampliamente discutidos con cada paciente, teniendo en cuenta que la función eréctil es probable, a pesar de cierto grado de curvatura(AU)

The true pathophysiologic nature of Peyronie’s disease continues to evolve. This pathology often results in a penile plaque(s), penile deformity, curvature, pain, and erectile dysfunction. Clinically, there are two distinct phases, acute and chronic. The focus of this review will center on the management of the acute phase of Peyronie’s disease.While little data exists demonstrating disease resolution, disease stabilization is an important clinical goal for patients as this often allows acceptable sexual function. Thus, medical management during the acute phase of Peyronie’s disease is aimed at limiting and stabilizing the degree of penile fibrosis, decreasing penile curvature, and reducing penile pain.In this manuscript we explain different therapies; oral, topical, intralesional injection and others like extracorporeal shockwave (ESWT), radiation and penile traction for acute phase of Peyronie’s disease. AdeAlthoughno consensus exists for the treatment of acute phase Peyronie’s disease, a majority of patients can achieve stabilization and in some cases regression of their disease with proper medical therapy. The goals of therapy should be discussed extensively with each patient, noting that erectile function will be likely despite some degree of curvature(AU)

Aumento de antioxidantes en sangre y de las concentraciones de selenio en pacientes negros con fase activa de vitíligo / Increased in total blood antioxidant status and selenium levels in black patients with active vitiligo

Antecedentes; El estrés oxidativo es un fenómeno importante en la muerte de los melanocitos en el vitiligo. Recientemente se ha encontrado una acumulación de peróxido de hidrógeno (H2O2) y niveles bajos de catalasa en la epidermis de pacientes con vitiligo. Se han visto pocas alteraciones de los antioxidantes en la sangre de pacientes con vitiligo, excepto una elevación del selenio. No se han realizado estudios sobre el estrés oxidativo hasta ahora, en pacientes con un fototipo VI de piel (clasificación de Fitzpatrick). Objetivo: Estudiar el estado antioxidante en la sangre de pacientes negros con vitíligo generalizado activo. Métodos: Se evaluaron el estado antioxidante total Randox, y las concentraciones de selenio, ferritina, transferrina, ceruloplasmina, tocoferol y retinal en muestras de sangre de los pacientes de piel negra de las indias Occidentales Francesas (de Martinica) con lesiones activas recientes de vitíligo y de 8 voluntarios sanos equiparados en edad y sexo. Resultados: El estado antioxidante total de la sangre y las concentraciones de selenio aumentaron significativamente en los pacientes con vitiligo, en comparación con los controles equiparados en sexo y edad (p<0,01 y p<0,02, respectivamente). No se modificaron significativamente las concentraciones en sangre de ferritina, transferrina, ceruloplasmina, retinol y tocoferol. Conclusiones: Este es el primer trabajo sobre el estado antioxidante global en sangre en el vitíligo. El aumento del estado antioxidante total en sangre observado en pacientes negros fue un resultado inesperado que necesita confirmarse y explicarse por otros estudios. El aumento espontáneo de las concentraciones de selenio podría ser interesante, puesto que este elemento ha sido recomendado en el tratamiento del vitíligo (AU)

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