Depth of invasion of oral squamous cell carcinoma in Nos2-knockout mice correlated to alterations in systemic inflammatory markers following 4NQO treatment.

BACKGROUND: Peripheral blood analysis is a non-invasive and low-cost technique of prognostic value for several diseases, including oral cancer. Considering the role of inducible nitric oxide synthase in tumor-associated inflammation, this study purposed to evaluate the influence of this enzyme on peripheral blood parameters and systemic inflammatory biomarkers during murine oral carcinogenesis. METHODS: A 50 µg/mL solution of 4-nitroquinoleine-N-oxide was provided to 15 C57BL/6J (Nos2+/+ ) and 16 B6.129P2-Nos2tm1Lau /J (Nos2-/- ) for 16 weeks. Animals were followed for 8 weeks after treatment. Blood samples and tongues were collected for hematological and histopathological analyses. Red blood cells, white blood cells, and platelet cell parameters were analyzed. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the systemic immune-inflammation index were also calculated. The depth of invasion of all carcinomas was measured. RESULTS: Differences were found in several blood parameters. The depth of invasion in Nos2-/- was lower than in Nos2+/+ (p = 0.009), and strong correlations were found between depth of invasion and neutrophil count (ρ = -0.68, p = 0.017), lymphocyte count (ρ = 0.72, p = 0.011), neutrophil-to-lymphocyte ratio (ρ = -0.65, p = 0.025), platelet-to-lymphocyte ratio (ρ = -0.73, p = 0.013), and systemic immune-inflammation index (ρ = -0.67, p = 0.037) in Nos2-/- mice. CONCLUSION: Inducible nitric oxide synthase seems to have an important role in OSCC invasion and progression, which might be associated to alterations in immune-inflammatory cell dynamics evidenced by peripheral blood and systemic inflammatory biomarkers.

Classification of Multiple H&E Images via an Ensemble Computational Scheme.

In this work, a computational scheme is proposed to identify the main combinations of handcrafted descriptors and deep-learned features capable of classifying histological images stained with hematoxylin and eosin. The handcrafted descriptors were those representatives of multiscale and multidimensional fractal techniques (fractal dimension, lacunarity and percolation) applied to quantify the histological images with the corresponding representations via explainable artificial intelligence (xAI) approaches. The deep-learned features were obtained from different convolutional neural networks (DenseNet-121, EfficientNet-b2, Inception-V3, ResNet-50 and VGG-19). The descriptors were investigated through different associations. The most relevant combinations, defined through a ranking algorithm, were analyzed via a heterogeneous ensemble of classifiers with the support vector machine, naive Bayes, random forest and K-nearest neighbors algorithms. The proposed scheme was applied to histological samples representative of breast cancer, colorectal cancer, oral dysplasia and liver tissue. The best results were accuracy rates of 94.83% to 100%, with the identification of pattern ensembles for classifying multiple histological images. The computational scheme indicated solutions exploring a reduced number of features (a maximum of 25 descriptors) and with better performance values than those observed in the literature. The presented information in this study is useful to complement and improve the development of computer-aided diagnosis focused on histological images.

OralEpitheliumDB: A Dataset for Oral Epithelial Dysplasia Image Segmentation and Classification.

Early diagnosis of potentially malignant disorders, such as oral epithelial dysplasia, is the most reliable way to prevent oral cancer. Computational algorithms have been used as an auxiliary tool to aid specialists in this process. Usually, experiments are performed on private data, making it difficult to reproduce the results. There are several public datasets of histological images, but studies focused on oral dysplasia images use inaccessible datasets. This prevents the improvement of algorithms aimed at this lesion. This study introduces an annotated public dataset of oral epithelial dysplasia tissue images. The dataset includes 456 images acquired from 30 mouse tongues. The images were categorized among the lesion grades, with nuclear structures manually marked by a trained specialist and validated by a pathologist. Also, experiments were carried out in order to illustrate the potential of the proposed dataset in classification and segmentation processes commonly explored in the literature. Convolutional neural network (CNN) models for semantic and instance segmentation were employed on the images, which were pre-processed with stain normalization methods. Then, the segmented and non-segmented images were classified with CNN architectures and machine learning algorithms. The data obtained through these processes is available in the dataset. The segmentation stage showed the F1-score value of 0.83, obtained with the U-Net model using the ResNet-50 as a backbone. At the classification stage, the most expressive result was achieved with the Random Forest method, with an accuracy value of 94.22%. The results show that the segmentation contributed to the classification results, but studies are needed for the improvement of these stages of automated diagnosis. The original, gold standard, normalized, and segmented images are publicly available and may be used for the improvement of clinical applications of CAD methods on oral epithelial dysplasia tissue images.

Immunoexpression of PD-L1, CD4+ and CD8+ cell infiltrates and tumor-infiltrating lymphocytes (TILs) in the microenvironment of actinic cheilitis and lower lip squamous cell carcinoma

Abstract Lower lip squamous cell carcinomas (LLSCC) could be associated with a previous history of potentially malignant oral diseases (PMOD), especially actinic cheilitis (AC), with high sun exposure being a well-described risk factor. Immune evasion mechanisms, such as the PD-1/PD-L1 (programmed cell death protein 1/programmed death-ligand 1) pathway has been gaining prominence since immunotherapy with immune checkpoint inhibitors showed a positive effect on the survival of patients with different types of neoplasms. Concomitant with the characterization of the tumor microenvironment, the expression of either or both PD-1 and PD-L1 molecules may estimate mutual relations of progression or regression of the carcinoma and prognostic values of the patient. Objective: Considering the importance of tumor microenvironment characterization, this study aims to determine the immunoexpression of PD-L1 and correlate with the frequency of CD4+ and CD8+ cells in AC and LLSCC lesions and with tumor-infiltrating lymphocytes (TILs) in LLSCC and its relationship with histopathological characteristics. Methodology: This sample includes 33 cases of AC and 17 cases of LLSCC. The cases were submitted to histopathological analysis and to CD4+, CD8+, and PD-L1+ cell determination by immunohistochemistry. Results: There was a significant difference among the frequencies of CD4+, CD8+, and PD-L1+ cells between AC and LSCC cases, higher in the last group. Moreover, histopathological and atypical changes in AC and LLSCC were correlated with the frequencies of PD-L1+, CD4+, and CD8+ cells. In AC, PD-L1+ cases had a low frequency of CD4+ cells, but on the other hand, PD-L1+ cases of LLSCC had a higher frequency of CD4+ and CD8+ cells. Conclusion: Therefore, the PD-L1 molecule may be a potential escape route for the immune response in oral lesions, but the mechanisms differ between AC and LLSCC. Future studies related to immune evasion and immunotherapy in oral lesions should consider the analysis of inflammatory infiltrate and TILs.

Combination of toothbrushing and chlorhexidine compared with exclusive use of chlorhexidine to reduce the risk of ventilator-associated pneumonia: A systematic review with meta-analysis

This study aimed to compare the effectiveness of 0.12% chlorhexidine alone and 0.12% chlorhexidine in combination with toothbrushing to prevent ventilator-associated pneumonia (VAP) in mechanically ventilated patients. The Embase, Latin American and Caribbean Health Science Literature, PubMed, Scientific Electronic Library Online, Scopus, LIVIVO, Web of Science, Cochrane Library, OpenThesis, and Open Access Thesis and Dissertations databases were used. Only randomized controlled trials without restrictions on the year or language of publication were included. Two reviewers assessed the risk of bias using the Joanna Briggs Institute Critical Appraisal Tool. A meta-analysis using a random-effects model estimated the combined relative risk (RR). The Grading of Recommendations, Assessment, Development and Evaluations approach was used to assess the certainty of the evidence. Initially, 2,337 studies were identified, of which 4 were considered in the systematic review and 3 in the meta-analysis (total sample: 796 patients). The studies were published between 2009 and 2017. All eligible studies had a low risk of bias. The meta-analysis revealed that the risk of VAP was 24% lower in patients receiving chlorhexidine combined with toothbrushing than in those receiving chlorhexidine alone (RR: 0.76; 95% confidence interval: 0.55-1.06), with moderate certainty of evidence and without statistical significance. In conclusion, considering the limitations of this study, a standard protocol for the prevention of VAP is not yet recommended. More studies with larger sample sizes are needed to draw strong conclusions. However, considering that toothbrushing is a simple intervention, it should be a common practice in mechanically ventilated patients, especially among patients with coronavirus disease.

Cisto odontogênico glandular tratamento cirúrgico por marsupialização e enucleação: relato de caso / Glandular odontogenic cyst surgical treatment by marsupialization and enucleation: case report

O cisto odontogênico glandular (COG) é o cisto de desenvolvimento mais agressivo e raro dentre todos os odontogênicos, portando características epiteliais glandulares ou salivares. O presente artigo visa retratar uma abordagem mais conservadora para esta importante lesão, no sentido de minimizar a morbidade decorrente da abordagem mais radical. Paciente com 57 anos, leucoderma, assintomático e edêntulo, compareceu ao ambulatório de estomatologia com notável expansão no fundo de saco vestibular e rebordo inferior direito, com tempo indeterminado de evolução. Os exames imaginológicos revelaram uma lesão radiolúcida unilocular extensa e bem delimitada na região anterior da mandíbula. Nas condutas propedêuticas, foi realizada uma punção aspiratória positiva para líquido cístico seguido de biópsia incisional. Diante destes achados, a marsupialização foi realizada no sentido de se conseguir a redução das dimensões lesionais, seguido da enucleação com estectomia periférica após 9 meses. Nos primeiros 2 anos de proservação o paciente mantém- -se sem recidivas e em constante acompanhamento. Conclui-se que o dentista pode preferir o método conservador pela técnica de marsupialização seguida de enucleação na abordagem de extenso cisto odontogênico glandular, desde que haja colaboração do paciente nos cuidados pós-operatórios.

The glandular odontogenic cyst (GOC) is the most aggressive and rare cyst of development among all odontogenics, with glandular or salivary epithelial characteristics. This article aims to portray a more conservative approach to this important lesion, in order to minimize the morbidity resulting from the more radical approach. Patient 57 years-old, leucoderma, asymptomatic and edentulous, attended the stomatology outpatient clinic with a remarkable expansion in the vestibular bag fundus and lower right border, with indeterminate evolution time. Imaging examinations revealed an extensive and well delimited unilocular radiolucent lesion in the anterior region of the mandible. In the propaedeutic procedures, a positive aspiration puncture was performed for cystic fluid followed by incisional biopsy. In view of these findings, marsupialization was performed in order to reduce lesion dimensions, followed by enucleation with peripheral ostectomy after 9 months. In the first 2 years of proservation, the patient remains without relapses and in constant follow-up. It is concluded that the dentist may prefer the conservative method by the marsupialization technique followed by enucleation in the approach of extensive glandular odontogenic cyst, provided there is collaboration of the patient in the postoperative care.

Interdisciplinaridade no tratamento de ceratocisto odontogênico: relato de caso / Interdisciplinary in the treatment of odontogenic keratocyst: case report

O Ceratocisto Odontogênico (CO) é um cisto de desenvolvimento odontogênico relativamente prevalente na população e com caráter eventual de agressividade com crescimento ântero- -posterior insidioso. Trata-se de uma lesão cuja apresentação é extremamente diversa com relação à faixa etária, gênero e aspectos imaginológicos mais prevalentes. O presente trabalho relata o caso de um garoto de 11 anos de idade, portador de uma extensa lesão mandibular, envolvendo desde o dente 33 até o 46, cuja microscopia foi compatível com CO. O artigo aborda toda a conduta propedêutica conduzida pela equipe a nível ambulatorial, bem como a interdisciplinaridade com a ortodontia, possibilitando um desfecho almejado e satisfatório do caso.

Keratocyst Odontogenic (KO) is a cyst of odontogenic development relatively prevalent in the population and with an eventual aggressive character with insidious antero-posterior growth. It is a lesion whose presentation is extremely diverse in relation to age, gender and most prevalent imaging aspects. This paper reports the case of an 11 - year - old boy with an extensive mandibular lesion, evolving from tooth 33 to 46, whose microscopy was compatible with KO. The article deals with all the propaedeutic conduct conducted by the team at the outpatient level, as well as the interdisciplinarity with orthodontics, enabling a desired and satisfactory outcome of the case.

Simple bone cyst: description of 60 cases seen at a Brazilian School of Dentistry and review of international literature

BACKGROUND: The aim of this study was to describe the relative frequency and the main demographic and clinic-radiographic features related to patients diagnosed with Simple bone cyst (SBC) in an Oral Diagnosis Service in Southeast Brazil and present a review and discussion of international literature on this topic. MATERIAL AND METHODS: SBC cases from our service encompassing the period between 1978 and 2017 were selected. In addition, a literature search was performed in the Pubmed/MEDLINE online electronic database published between 1951 and 2019. RESULTS: A total of 2,459 cystic lesions were documented in our service, thus 60 patients were diagnosed with the SBC representing 2.4% of all jaw cystic. Most of cases were asymptomatic. Multiple SBC lesions were seen in two patients (3.4%) and association with cemento-osseous dysplasia was seen in one female patient (1.7%). A total of 793 cases were enrolled in this literature review. CONCLUSIONS: The SBC is an asymptomatic lesion often discovered in routine image exams in young patients. The unilocular, well defined margin with scalloped appearance is characteristic and helps the definition of diagnosis. This review suggests a different epidemiologic trend concerning to the sex and it confirms the posterior region of mandible as the more frequent location. The conservative treatment with limited exploration and curettage remains as the gold-standard treatment

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Um raro diagnóstico de osteoma periférico em palato duro: relato de caso / A rare diagnosis of peripheral osteoma in the hard palate: case report

Objetivo: relatar uma biópsia excisional de um osteoma periférico no palato duro direito de uma paciente jovem, do sexo feminino e não sindrômica. Relato de caso: paciente do sexo feminino, 32 anos de idade, melanoderma e normossitêmico, buscou atendimento no ambulatório de diagnóstico estomatológico da Faculdade de Odontologia da Universidade Federal de Uberlândia com queixa quanto ao surgimento de lesão na região de palato. Após avaliação clínica e imaginológica, foi decidido realizar biópsia excisional sob anestesia local da lesão. Foram levantadas três hipóteses de diagnóstico: osteoma periférico, exostose ou osteossarcoma. O material coletado foi enviado para análise histopatológica, que confirmou a hipótese de osteoma periférico. Considerações finais: os osteomas periféricos na região de palato duro são raríssimos. Essa lesão geralmente é assintomática ­ exceto quando há impacto traumático durante a mastigação ­, de crescimento lento, podendo se desenvolver em osso cortical ou medular. O tratamento de escolha é a remoção cirúrgica e o índice de recorrência é raro. O caso enfatiza a condição rara, pois foram encontrados apenas seis casos semelhantes relacionados na literatura. (AU)

Objective: To report an excisional biopsy of a peripheral osteoma in the right hard palate in a non-syndromic young female patient. Case Report: A 32-year-old female patient, black, and normosystemic sought assistance in the stomatological diagnosis outpatient clinic of the School of Dentistry of the Federal University of Uberlândia, Brazil, complaining about the appearance of a lesion in the palate region. After clinical and imaging assessment, it was decided to perform an excisional biopsy under local anesthesia of the lesion. Three diagnostic hypotheses were raised - peripheral osteoma, exostosis, or osteosarcoma. The material collected was sent for histopathological analysis, which confirmed the hypothesis of peripheral osteoma. Final considerations: Peripheral osteomas in the hard palate region are very rare. This lesion is usually asymptomatic, except when there is a slow-growing chewing impact during mastication, which may develop in cortical or spinal bone. Surgical removal is the treatment of choice and the rate of recurrence is rare. The case emphasizes the rare condition, considering only six similar cases were found in the literature. (AU)

Differential molecular signature of human saliva using atr-ftir spectroscopy for chronic kidney disease diagnosis

Abstract The symptoms of chronic kidney disease (CKD) are often not specific or absent in the early stages of this illness. Therefore, there is a demand for developing low cost, non-invasive and highly accurate platforms for CKD diagnostics. We hypothesized that the level of specifics salivary components changes when CKD is emplace, which could be clinically used to discriminate CKD patients from healthy subjects. The present study aimed to compare salivary components between CKD patients and matched control subjects by using attenuated total reflection-Fourier Transform Infrared (ATR-FTIR) spectroscopy. The predictive power of salivary components was evaluated by receiver operating characteristic (ROC) curves. Several components were identified, and 4 of them showed different expression (p<0.05) between CKD and control subjects. Thiocyanate (SCN-, 2052 cm-1) and phospholipids/carbohydrates (924 cm-1) vibrational modes using original and second-derivative spectra by ATR-FTIR could potentially be used as salivary biomarkers to differentiate CKD than control subjects. The combination of original and second-derivative spectra by ATR-FTIR of 924 cm-1 vibrational modes could reach 92.8% sensitivity and 85.7% specificity for CKD detection. Despite, the limitation of our investigation, the acquired data indicates that salivary vibrational modes by ATR-FTIR platform should be further explored as an auxiliary diagnostic tool for CKD.

Resumo Os sintomas da doença renal crônica (DRC) são frequentemente inespecíficos ou ausentes nos estágios iniciais desta doença. Desta forma, existe uma demanda para o desenvolvimento de plataformas com baixo custo, não-invasivas e com alta acurácia para o diagnóstico da DRC. Nós hipotetizamos que o nível dos componentes salivares se alteram pela DRC, o que pode ser clinicamente utilizado para discriminar pacientes portadores de DRC de indivíduos controles. O objetivo deste estudo foi comparar componentes salivares entre pacientes portadores de DRC e sujeitos controles utilizando um sistema de reflectância total atenuada com espectroscopia infravermelho com transformada em Fourier (ATR-FTIR). O poder preditivo dos componentes salivares foi avaliado pela curva característica de operação do receptor (ROC). Diversos componentes salivares foram identificados e 4 destes apresentaram diferença na expressão (p<0,05) entre DRC e sujeitos controles. O modos vibracionais do tiocianato (2052 cm-1) e de fosfolipídeos/carbohidratos (924 cm-1) utilizando espectros originais e da segunda-derivada pelo ATR-FTIR podem potencialmente ser utilizados como biomarcadores salivares para discriminar a DRC de sujeitos controles. A combinação dos espectros originais e da segunda-derivada pelo ATR-FTIR do modo vibracional 924 cm-1 pode apresentar sensibilidade de 92.8% e especificidade de 85.7% para a detecção da DRC. Este estudo indicou que modos vibracionais da saliva pela plataforma ATR-FTIR podem ser uma ferramenta auxiliar no diagnóstico da DRC.

Upper airway assessment in obstructive sleep apnea patients: can computed tomography with lateral cephalometry replace drug-induced sleep endoscopy (DISE)? / Evaluación de la vía aérea superior en pacientes con apnea obstructiva del sueño: ¿puede la tomografía computarizada con cefalometría lateral reemplazar endoscopia del sueño inducida por fármacos por fármacos?

Objective To evaluate the association between results from drug-induced sleep endoscopy (DISE) and computed tomography with lateral cephalometry (CTLC) of the pharynx in obstructive sleep apnea (OSA) patients, regarding the same anatomic level, in order to understand if CTLC could replace DISE in selected patients. Study design Cross-sectional. Setting Tertiary hospital. Methods A total of 71 patients who attended the Sleep Medicine Consultation in the Otorhinolaryngology Department of Hospital CUF Tejo between 1.6.2019 and 30.9.2021, performed a polysomnographic sleep study and were elected to undergo DISE and CTLC of the pharynx for diagnostic purposes were selected. Obstructions at the same anatomic levels – tongue base, epiglottis and velum - were compared in both exams. Results Patients with reduction of epiglottis-pharynx space on CTLC had also a complete obstruction at epiglottis level on the VOTE classification of DISE (p = 0,027). Reduction of velum-pharynx space or tongue base-pharynx space were not related to complete obstruction of the velum (P = 0,623) or the tongue base (p = 0,594) found in DISE. Those with two or more space reductions had a tendency to multilevel obstruction observed in DISE (p = 0.089). Conclusion When evaluating the obstruction level(s) of an OSA patient, efforts should be made to perform DISE, since CTLC measures, though regarding at the same structures, don´t correlate completely with obstructions observed in DISE. (AU)

Objetivo Evaluar la asociación entre los resultados de la endoscopia del sueño inducida por fármacos (DISE) y la tomografía computarizada con cefalometría lateral (TCCL) de faringe en pacientes con apnea obstructiva del sueño (AOS), en el mismo nivel anatómico, para comprender si la TCCL podría reemplazar DISE en pacientes seleccionados. Diseño del estudio Transversal. Lugar Hospital de tercer nivel. Métodos Un total de 71 pacientes que acudieron a la Consulta de Medicina del Sueño en el Servicio de Otorrinolaringología del Hospital CUF Tejo entre el 1.6.2019 y el 30.9.2021, a los que se les había realizado un estudio polisomnográfico del sueño y fueron elegidos para realizar DISE y TCCL de faringe con fines diagnósticos, fueron seleccionados. Las obstrucciones en los mismos niveles anatómicos (base de la lengua, epiglotis y velo) se compararon en ambos exámenes. Resultados Los pacientes con reducción del espacio epiglotis-faringe en TCCL también tenían una obstrucción completa a nivel de epiglotis en la clasificación VOTE de DISE (p = 0,027). La reducción del espacio velo-faringe o base de la lengua-faringe no se relacionó con la obstrucción completa del velo (P = 0,623) o de la base de la lengua (p = 0,594) encontrada en DISE. Aquellos con dos o más reducciones de espacio presentaron tendencia a la obstrucción multinivel observada en DISE (p = 0,089). Conclusión Al evaluar el o los niveles de obstrucción de un paciente con AOS, se debe intentar realizar DISE, ya que las medidas de TCCL, aunque se refieren a las mismas estructuras, no se correlacionan completamente con las obstrucciones observadas en DISE. (AU)

Differential metallothionein expression in oral lichen planus and amalgam-associated oral lichenoid lesions

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease mediated by T cells, which manifests as reticular (white) or erosive (red) lesions, that are eventually painful. Oral lichenoid lesion (OLL) are distinguished from OLP by the presence of precipitating factors. The aim of this study was to evaluate whether the presence of metallothionein, which is involved in anti-apoptotic pathways and the anti-oxidative response, could serve as a differential diagnostic for OLP and OLL. MATERIAL AND METHODS: We evaluated the expression of metallothionein in 40 cases of OLP and 20 cases of OLL using immunohistochemistry. Results and CONCLUSIONS: White OLP has higher concentrations of metallothionein than red OLP in basal and parabasal layers. Moreover, metallothionein was more frequently observed in the cytoplasm and nuclei of basal cells in OLP patients compared to the same regions of OLL cases. Metallothionein levels are related to OLP severity and may contribute to a differential diagnosis between OLP and OLL

Ameloblastoma unicístico em criança: relato de caso / Unicystic ameloblastoma in a 11-year-old child: case report

O ameloblastoma é um tumor odontogênico benigno e raro, de comportamento biológico variado, crescimento lento e agressivo. Clinicamente, pode ser classificado em três grupos: multicístico ou sólido, unicístico, periférico ou extraósseo. A variante unicística plexiforme possui um padrão menos agressivo e responde melhor ao tratamento conservador, o qual consiste na marsupialização e posterior curetagem e enucleação. O presente caso relata um ameloblastoma unicístico que ocorreu no ramo mandibular direito de uma criança de 11 anos, submetida ao tratamento conservador, com resultado satisfatório.

Ameloblastoma is a benign and rare odontogenic tumor of varied biological behavior, slow and aggressive growth. Clinically, it can be divided into three groups: multicystic or solid, unicystic, peripheral or extraosseous. The plexiform unicystic form has a less aggressive pattern and responds better to the conservative treatment. This treatment consists of marsupialization and subsequent curettage and enucleation. The present case reports a unicystic ameloblastoma that occurred on the mandible of an 11 year old child, who was submitted to conservative treatment.

Ameloblastic Fibrosarcoma: A Case Report and Literature Review

Here is described a case of ameloblastic fibrosarcoma (AFS) affecting the posterior mandible of a woman who was treated surgically and recovered without signs of recurrence or metastasis after 12 years of follow-up. Tumor sections were immunostained for cell cycle, epithelial and mesenchymal markers. Immunohistochemical analysis evidenced high Ki-67 positivity in stromal cells (mean of 20.9 cells/High power field). Epithelial cells displayed strong positivity for p53, p63 and cytokeratin 19. In addition to the case report, a systematic review of current knowledge is presented on the AFS’s clinical-demographic features and prognostic factors. Based on the review, 88/99 cases were diagnosed as AFS, 9/99 as ameloblastic fibro-odontosarcoma and 2/99 as ameloblastic fibrodentinosarcoma. All these lesions displayed very similar clinical-demographic and prognostic features. Moreover, the review provided evidence that first treatment, regional metastasis, distant metastasis and local recurrence were significant prognostic values for malignant odontogenic mesenchymal lesions. Based on the findings, segregation among ameloblastic fibrosarcoma, ameloblastic fibrodentinosarcoma and ameloblastic fibro-odontosarcoma seems illogical, considering all these lesions have similar predilections and outcomes.

Resumo Aqui é descrito um caso de fibrossarcoma ameloblástico afetando região posterior da mandíbula de uma mulher. Após o tratamento, a paciente ficou livre da doença durante os 12 anos de acompanhamento. Foi realizado imunohistoquimica para marcadores epiteliais, mesenquimais e do ciclo celular. Além disso, uma revisão sistemática de literatura também foi realizada, na tentativa de descobrir as características clínico-demográficas e fatores prognósticos da lesão. 88/99 casos foram diagnosticados como fibrossarcoma ameloblastico, 9/99 como fibro-odontosarcoma ameloblastico e 2/99 como fibrodentinosarcoma ameloblastico. Todas estas lesões exibem características clínico-demográficas e prognósticos muito semelhantes. Além disso, esta revisão forneceu evidências de que primeiro tratamento, metástases regionais, metástases à distância e recorrência local são valores prognósticos significativos para lesões odontogênicas mesenquimais malignas. A análise imunohistoquímica demonstrou elevada marcação positiva em células do estroma para Ki-67 (média de 20,9 células /HPF). As células epiteliais exibiram forte marcação para p53, p63 e citoqueratina 19. A segregação entre fibrosarcoma ameloblastico, fibrodentinosarcoma ameloblastico e fibro-odontosarcoma ameloblastico é ilógica, uma vez que todas essas lesões têm predileções e resultados semelhantes.

Metodología para la revisión y control de calidad de análisis genéticos en los procesos de identificación masiva de víctimas: la experiencia en Chile / Methodology for quality review and control of genetic analyses in processes of mass identification of victims: the experience in Chile

En los últimos años la genética ha adquirido una gran importancia en los procesos de identificación masiva de víctimas y constituye, en muchos casos, la única herramienta útil. Algunas instituciones externalizan estos análisis en laboratorios especializados. Es el caso de la Unidad de Derechos Humanos del Servicio Médico Legal (SML) de Chile, creada con el objetivo de identificar y restituir a las familias los restos de las víctimas de la dictadura cívico-militar instaurada en el país entre 1973 y 1990, que provocó más de 1.300 desaparecidos y muertos sin entrega. La externalización de los análisis impone la necesidad de establecer una rigurosa sistemática de revisión y control de calidad de los análisis realizados por el laboratorio externo, lo que incluye asegurar la trazabilidad de las muestras y los análisis, además de reproducir tanto la comparación de los perfiles genéticos como su valoración estadística. En este trabajo se presenta la experiencia del SML en esta materia y se establecen una serie de recomendaciones que pueden ser utilizadas como guía por otras instituciones que decidan externalizar los análisis genéticos en procesos de identificación masiva de víctimas

In recent years, genetics has acquired great importance in the processes of mass victim identification and, in many cases, is the only useful tool. Some institutions outsource these analyses to specialized laboratories. This is the case of the Human Rights Unit of the Legal Medical Service (SML) of Chile, created with the objective of identifying and restoring to families the remains of the victims of the civic-military dictatorship established in the country between 1973 and 1990, which caused more than 1,300 missing and dead without delivery. The outsourcing of the analyses imposes the need to establish a rigorous systematic review and quality control of the analyses performed by the external laboratory, which includes ensuring traceability of the samples and analyses, in addition to reproducing the comparison of the genetic profiles and their statistical assessment. This paper presents the experience of the SML in this area and establishes a series of recommendations that can be used as a guide by other institutions that decide to outsource genetic analysis in processes of mass identification of victims

Expression of epithelial-mesenchymal transition markers at the invasive front of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is one of the most common malignances. In epithelial-mesenchymal transition (EMT), epithelial cells switch to mesenchymal-like cells exhibiting high mobility. This migratory phenotype is significant during tumor invasion and metastasis. Objective : The aim of this study is to evaluate the expression of the EMT markers E-cadherin, N-cadherin and vimentin in OSCC. Material and Methods : Immunohistochemical detection of E-cadherin, N-cadherin and vimentin was performed on 20 OSCC samples. Differences in the expression of each protein at the invasive front (IF) and in the central/superficial areas (CSA) of the tumor were assessed. Differences in the expression of each protein at the IF of both histologically high- and low-invasive OSCCs were evaluated. Associations among expression of proteins at the IF were assessed. Correlations between the expression levels of each protein at the IF and the tumor stage and clinical nodal status were also evaluated. Results : Reduced expression of E-cadherin was detected in 15 samples (75%). E-cadherin expression was reduced at the IF when compared to the CSA and in high-invasive tumors when compared to low-invasive tumors. All samples were negative for N-cadherin, even though one sample showed an inconspicuous expression. Positive expression of vimentin was observed in 6 samples (30%). Nevertheless, there was no difference in vimentin expression between the IF and the CSA regions or between the low- and high-invasive tumors. Furthermore, no association was observed among protein expression levels at the IF. Finally, no correlations were observed between each protein’s expression levels and tumor stage or clinical nodal status. Conclusions : Reduced E-cadherin expression at the IF and its association with histological invasiveness suggest that this protein is a noteworthy EMT marker in OSCC. Although vimentin was also detected as an EMT marker, its expression was ...

Avaliação da marcha em contexto clínico: uma revisão sistemática da literatura / Gait assessment in clinical context: a systematic literature review

Introdução: Em ambiente clínico é necessário recorrer a instrumentos de avaliação de rápida utilização e baixo custo, válidos, fiáveis e fáceis de interpretar. Nesta revisão, pretende-se identificar e caracterizar, do ponto de vista psicométrico e de interpretação clínica, instrumentos de avaliação da marcha utilizáveis na prática clínica. Métodos: A pesquisa foi realizada em cinco bases de dados utilizando combinações de várias palavras-chave. Elaborou-se uma lista dos instrumentos que cumpriam os critérios de inclusão, e fez-se nova pesquisa nas mesmas bases combinando o nome do instrumento com “validity”, “reliability”, “responsiveness” e “change score”. Resultados: Incluíram-se 15 instrumentos/ testes de avaliação. A maioria destes apresenta adequada a excelente confiabilidade e validade. A interpretação clínica dos dados recolhidos com os instrumentos analisados tem sido pouco estudada. Conclusão: São necessários mais estudos que avaliem os aspectos de interpretação clínica dos instrumentos/testes de avaliação da marcha e que validem estas ferramentas para a língua portuguesa.

Introduction: In clinical practice there is a need for instruments that are easy to use and affordable, but also, valid, reliable and from which clinical inferences are easy to make. This review aims to identify instruments for gait assessment that could easily be used in clinical practice and to characterize them in terms of psychometric properties and aspects of clinical interpretation. Methods : The search was conducted in five databases using combinations of different key words. A list of identified instruments that met the inclusion criteria was created and a second search conducted combining the name of the instrument with the words: “validity”, “reliability”, “responsiveness” and “change score”. Results: Fifteen instruments were included in this systematic review. Most of them showed adequate to excellent validity and reliability. Data regarding most aspects of clinical interpretation were missing. Conclusion: There is a need to study the identified instruments in terms of aspects of clinical interpretation and that validate them to Portuguese.

Surgical treatment for myelodysplastic clubfoot / Tratamento cirúrgico do pé equinovaro mielodisplásico

Objective: To analyze the results from surgical treatment of 69 cases of clubfoot in 43 patients with myelodysplasia according to clinical and radiographic criteria, at our institution between 1984 and 2004. Methods: This was a retrospective study involving analysis of medical files, radiographs and consultations relating to patients who underwent surgical correction of clubfoot. The surgical technique consisted of radical posteromedial and lateral release with or without associated talectomy. Results: The patients' mean age at the time of the surgery was four years and two months, and the mean length of postoperative follow-up was seven years and two months. Satisfactory results were achieved in 73.9% of the feet and unsatisfactory results in 26.1% (p < 0.0001). Conclusion: Residual deformity in the immediate postoperative period was associated with unsatisfactory results. Opening of the Kite (talocalcaneal) angle in feet that only underwent posteromedial and lateral release, along with appropriate positioning of the calcaneus in cases that underwent talectomy, was the radiographic parameter that correlated with satisfactory results...

Objetiuo: Analisar os resultados entre 1984 e 2004 em nossa instituição do tratamento cirúrgico de 69 pés equinovaros em 43 pacientes portadores de mielodisplasia segundo os critérios clínico e radiográfico. Métodos: Estudo retrospectivo com análise de prontuário, radiografias e consulta com pacientes portadores de mielomeningocele que foram submetidos a correção cirúrgica de pés equinovaros. A técnica cirúrgica foi a liberação posteromediolateral (LPML) radical associada ou não a talectomia. Resultados: A média de idade na época da cirurgia foi de quatro anos e dois meses e o seguimento médio pós-operatório, de sete anos e dois meses. Foram encontrados resultados satisfatórios em 73,9% dos pés e insatisfatórios em 26,1% (p < 0,0001). Conclusão: A deformidade residual no pós-operatório imediato está relacionada com resultados insatisfatórios e a abertura do ângulo de Kite (talocalcaneano) nos pés submetidos somente a LPML, além do posicionamento adequado do calcâneo, nos casos em que foi feita a talectomia, é o parâmetro radiográfico relacionado aos resultados satisfatórios...

Failure of dental implants in cemento-osseous dysplasia: a critical analysis of a case / Insucesso na instalação de implantes dentários em áreas de displasia cemento-óssea: análise crítica de um caso clínico

Introduction: Osseointegrated dental implants have been routinely used in oral rehabilitation. Patients with dysplastic bone diseases represent a particular challenge for oral rehabilitation with dental implants. Nevertheless, the installation of implants in patients with cemento-osseous dysplasia (COD) has been reported with apparent success. Objective: In this paper, we present a case of a patient with COD in which a dental implant had been installed and lost six months later. In this regard, we analyzed pertinent aspects of the indications for dental implants in patients with COD considering the pathogenesis, dysplastic nature, and behavior of the disease. Conclusion: The present case report illustrates that COD can be considered a limiting factor in the recommendation for a dental implant. Because of this, it is imperative to inform the patient about the risks of surgically manipulating the diseased bone. .

Introdução: Implantes dentários têm sido rotineiramente utilizados como excelente alternativa para a reabilitação oral. Pacientes com doenças ósseas displásicas representam um desafio especial para a reabilitação oral com implantes dentários. No entanto, a instalação de implantes em pacientes com displasia cemento-óssea (DCO) tem sido relatada com aparente sucesso. Objetivo: Neste artigo, apresentamos um caso de um paciente com DCO florida em que um implante dentário fora instalado em paciente com lesões da variante florida da displasia cemento-óssea, seguido de insucesso seis meses após a cirurgia. Diante dos achados clínicopatológicos, foi realizada uma análise da pertinência da indicação da instalação do implante dentário em área acometida pela lesão, considerando a natureza displásica da doença, sua patogenia e comportamento biológico. Conclusão: O presente caso é ilustrativo em caracterizar a impertinência da indicação dos procedimentos de implantes dentários em pacientes portadores da DCO, considerando imperativo fornecer informações ao paciente a propósito dos riscos em manipular tecido ósseo portador destas lesões. .