Uso do laser de baixa potência para o tratamento de parestesia: uma revisão de literatura / Use of low-level laser to treat paresthesia: a literature review

Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

Occupational Diffuse Alveolar Hemorrhage Due to Metal Fume and Nitric Acid Exposure: A Case Report.

A 52-year-old male welder, who had been exposed to metal fumes and nitric acid without adequate protective measures, presented with symptoms of cough, dyspnea, and fever. He was admitted to our hospital, where bronchoscopy revealed hemorrhagic bronchoalveolar lavage fluid. He was diagnosed with diffuse alveolar hemorrhage (DAH) due to occupational inhalation of metal fumes and nitric acid. Treatment with corticosteroids led to a rapid recovery without pulmonary sequelae. The case highlights the potential for metal fumes and/or nitric acid to induce DAH, the effectiveness of corticosteroids in treating the condition, and the critical importance of occupational protective measures.

Comparison of Histological, Clinical, and Radiographic Outcomes of Postextraction Ridge Preservation by Allogenic Bone Grafting With and Without Injectable Platelet-Rich Fibrin: A Double-Blinded Randomized Controlled Clinical Trial.

Objectives: This randomized controlled clinical trial compared the histological, clinical, and radiographic outcomes of postextraction ridge preservation by allogenic bone grafting with and without injectable platelet-rich fibrin (I-PRF). Materials and Methods: Twenty single-rooted maxillary and mandibular teeth to be extracted and replaced by dental implants were randomly divided into two groups (n = 10). Cone-beam computed tomography (CBCT) scans were obtained preoperatively to assess bone dimensions and ridge width. The teeth were then extracted, and tooth socket preservation was performed with allograft and collagen type 1 in the control group and allograft, collagen type 1, and I-PRF in the intervention group. CBCT scans were obtained again 3 months after the first stage of surgery, and the second stage of surgery was performed for implant placement, ridge width measurement, and obtaining a biopsy sample. Radiographic bone width, clinical bone width, and radiographic bone height were measured. A histomorphometric method was applied to quantify residual graft material, new bone formation, and nonmineralized tissues. The data were analyzed with Student's t-test and Mann-Whitney U test (α = 0.05). Results: The intervention group showed a significantly smaller reduction in radiographic bone width (P=0.038) and clinical bone width (P=0.033), reduction in radiographic bone height (P=0.213) was not significant. A significantly lower percentage of residual graft particles (P=0.021) and a significantly higher mean percentage of newly formed bone (P=0.038) than the control group. However, the difference in the percentage of nonmineralized tissue (P=0.208) was not significant. Conclusion: Despite the optimal outcome of ridge preservation in both groups, the application of allograft plus I-PRF yielded superior histological, clinical, and radiographic results compared with allograft alone, and this difference was significant in most variables.

Autoimmune pulmonary alveolar proteinosis presenting as localized multifocal GGOs: A case report.

Pulmonary alveolar proteinosis (PAP) is a rare disease, which is characterized by the alveolar accumulation of surfactant. A crazy-paving appearance on chest thin-section computed tomography (TSCT) is a characteristic feature of this disease. We report an unusual case of PAP, which presented as multiple localized ground glass opacites (GGOs) on TSCT in an 80-year-old female. As one of these lesions at the apex of the right lung increased in size, it was suspected to be a pulmonary adenocarcinoma. However, the others became smaller during the follow-up period. Right upper lobectomy was performed, and PAP was histologically diagnosed. In cases exhibiting multiple localized GGOs, PAP should be considered, even if GGOs with a crazy-paving-like appearance are distributed in a lobular rather than diffuse manner.

New dimensions in alveolar fracture treatment: Open reduction and internal fixation by minimally invasive approach combined with computer-assisted surgery.

Alveolar fractures are a common type of maxillofacial trauma, and the conventional treatment involves closed reduction and dental splinting fixation. However, closed treatment is not suitable for some complex segmental alveolar fractures. In this case report, we introduce an innovative method for segmental alveolar fracture by using open reduction and internal fixation by minimally invasive approach combined with computer-assisted surgery. In this case, the new dimensions in the treatment followed AO principles of fracture management, achieving anatomical reduction of the fracture, absolute stability of the fracture ends, proper preservation of vascular supply to soft tissues and bone, and promoting recovery through early postoperative functional training. This case provides new insights into the treatment of the complex segmental alveolar fractures with tenuous vascular supply and cannot be treated by conventional splinting fixation.

Coronectomy: A Knowledge, Attitude and Practice Survey (KAP) Among Oral and Maxillofacial Surgeons.

Introduction: Since mandibular third molars are frequently impacted, third molar extractions are among the most common procedures performed by oral surgeons (35.9-58.7% of all surgical procedures). Inferior alveolar nerve (IAN) injury is major postoperative complication in 0.81-22% of the cases leading to a permanent injury in 1-4% of the cases. Prior studies have proven that coronectomy, a procedure that involves the removal of the crown and coronal one-third of the roots of the third molar with intentional retention of the two-third apical roots to protect the IAN, can thus prove to be a viable alternative in such cases of close proximity to the IAN. Aim: This study was conducted in India to determine the knowledge, attitudes, and practices of oral and maxillofacial surgeons regarding coronectomy and its role in the prevention of IAN injury. Methodology: The questionnaire entitled: "Coronectomy: A Knowledge, Attitude and Practice (KAP) Survey among Oral and Maxillofacial Surgeons" was sent to 120 oral and maxillofacial surgeons. Five questions in each domain, i.e., knowledge, attitude, and practice were designed to know the level of awareness, acceptance, and current status of the performance of coronectomy among oral and maxillofacial surgeons (OMFS). Teeth with acute infection and mobile teeth were excluded from the consideration of coronectomy procedures. Results: Out of the 120 questionnaires sent, 50 responses were obtained, thus producing a response rate of 41.6%. The male-to-female ratio in the study was 34:16. 52% of the surgeons had performed up to 5 coronectomies during their entire practice, while 16 % had never even attempted the procedure. Only 42% of the respondents preferred coronectomy, but most of the surgeons were in support of practice-oriented continuing.

Impact of photobiomodulation in alveolar ridge preservation and implant stability after a dental extraction: a systematic review.

The bone volume preservation after dental extraction is challenging in case of implant rehabilitation for functional and aesthetics results. Photobiomodulation (or LLLT) is used in medicine for its properties of accelerating the healing process. The aim of the systematic review was to determine if the use of photobiomodulation had an impact on implant stability and on alveolar bone healing, either in quality or in quantity. A systematic review following the PRISMA guidelines was conducted on the databases PubMed, Science Direct, Scopus and Google Scholar. The review was registered on Prospero under the number CRD42023467581. 414 articles were screened, of which 12 were selected for the review. In 10 of the 12 articles, LLLT seemed to show a positive impact on bone healing and implant stability. Regarding alveolar preservation, 6 out of 8 studies found statistically significant results. Regarding implant stability, 3 out of the 4 articles found a statistically significant impact of photobiomodulation versus control group. Despite the great heterogeneity of the studies, some LLLT protocols seemed consensual: the use of a Ga-Al-As laser with an emission over 800 nm with a continuous emission consisting of 3 to 4 sessions each with a duration of 4 to 5 min, on a sole application point. The use of photobiomodulation seemed to inhance the alveolar bone healing after a dental extraction, and the implant stability in case of immediate extraction-implantation. Further randomized controlled trials with a placebo group seem mandatory to corroborate the results.

Macrophage Dysfunction in Respiratory Disease.

Our understanding of the origin, phenotype, and function of pulmonary macrophages has evolved over recent years. The use of lineage tracing and single-cell RNA sequencing has led to a greater understanding of how these cells regulate homeostasis in the lung. The primary function of alveolar macrophages is to clear any inhaled particles or pathogens and they as well as tissue-resident cells also play a role in the clearance of apoptotic cells and the resolution of inflammation. Lung diseases affect over half a billion people globally and are attributable to 7% of all deaths each year. The common diseases are chronic obstructive pulmonary disease (COPD) and asthma but others that contribute to this statistic include cystic fibrosis and idiopathic pulmonary fibrosis (IPF). Macrophages are aberrant in all these diseases with a reduced phagocytic capacity and a high proinflammatory phenotype with changes to their capacity to resolve inflammation. The pathways leading to these macrophage dysfunctions differ with disease and may relate to the specific lung environment in each condition. However, there are clear changes in metabolic profiles and mitochondrial activity in many of these conditions that contribute to a change in macrophage phenotype towards a more proinflammatory, less homeostatic cell. Understanding the mechanisms that drive these changes will allow for more targeted therapies for the treatment of these long-term and debilitating conditions.

Clinical outcomes of using operating microscope for alveolar ridge preservation: A randomized controlled trial.

BACKGROUND: The use of the operating microscope (OM) for extraction and alveolar ridge augmentation (ARP) is increasing due to enhanced magnification and illumination. The primary objective was to compare the wound healing and crestal bone quality after the use of OM and dental loupes (DL) for ARP. METHODS: Forty non-molar teeth with periapical lesions in need of extraction and ARP from 33 patients were randomly assigned to 2 groups: DL (control) or OM (test). All procedures were performed by 1 surgeon and assessments done by masked examiners. ARP was performed with an allograft and a resorbable collagen membrane. The presence of granulomatous tissue remnants after debridement was recorded. Cone-beam computed tomography (CBCT) and ultrasound (US) scans were taken during the healing phase up to 16-week visits. Bone cores were retrieved from implant osteotomies for histologic analysis. Patient-reported outcome measurements (PROMs) were assessed. RESULTS: All patients completed all study visits except 1 who dropped out before the last visit. After socket debridement, the test group exhibited significantly fewer sites with tissue remnants (p = 0.01) and a better healing score at 2-week (p = 0.04) and 4-week (p = 0.01) time points. There were no significant differences in 12-week crestal bone healing by histology (p = 0.1), US (p = 0.85), and CBCT healing (p = 0.64) at 12 weeks, as well as PROMs (p > 0.1). CONCLUSION: Within the limitation of the study, the use of OM for ARP resulted in significantly fewer tissue remnants and favorable early visual wound healing. CBCT and US-derived-crestal bone quality did not show a difference between the 2 groups. PLAIN LANGUAGE SUMMARY: Alveolar ridge preservation (ARP) by placing bone particulates in the extraction socket, covered by a wound dressing material, is commonly applied immediately after tooth extraction to reduce jawbone shrinkage in preparation for implant placement later. The jawbone healing varies, depending largely on the ability to remove the etiology, socket features, extent of surgical trauma, and wound stability. Healed jawbone with good quality is favorable for easiness of implant placement and could be related to maintenance of long-term implant health. The surgical microscope with high magnification (up to ∼25×) and co-axial illumination is ideal for assistance in the removal of granulomatous tissue that is believed to interfere with healing, performance of minimally invasive extraction, and stabilization of the wound with meticulous tissue management and fine sutures. This study compared the use of the surgical microscope to dental loupes for ARP in a randomized controlled design. The microscope-assisted ARP is associated with a significantly higher chance of removing granulomatous tissue, favorable early healing, and similar crestal bone quality. Removal of granulomatous tissue is significant for immediate implant placement. This study serves as a model for testing the benefits of the surgical microscope for encouraging early healing in more challenging intraoral surgical procedures.

[Coronectomy as a surgical treatment of impacted lower molars with mandibular canal close relationship]. / Koronektomiya kak metod khirurgicheskogo lecheniya retentsii nizhnikh molyarov s tesnym prileganiem nizhnechelyustnogo kanala.

Searching for third molars atraumatic removal method remains a challenge in oral surgery. Method of partial removal of impacted tooth leaving a non-extracted root in the wound becomes more popular recently. Determining medical indications for this method, as well as searching for standards for its implementation is important. The paper presents a review on latest technique of performing a coronectomy, and the long-term results of this method. However, the technique of incomplete tooth extraction is highly controversial in terms of harm to the patient's health. There are also uncertain medical indications for this method and the legal treatment consequences.

Comparative Study of Photobiomodulation Effects on Alveolar Socket Hard Tissue Healing in Rats: Application of 980 nm Versus 810 nm Lasers.

Background: This study aimed to explore the differential effects of photobiomodulation (PBM) via 980 nm and 810 nm lasers on the hard tissue healing of rat alveolar sockets, with a focus on a comparative analysis of hard tissue regeneration and osteogenic gene expression. Objective: This study aimed to explore the effects of PBM using 980 nm and 810 nm lasers on hard tissue healing of rat alveolar sockets, focusing on hard tissue regeneration and osteogenic gene expression. Materials and Methods: Thirty-six male Wistar rats (5 weeks old) had both right and left maxillary first molars extracted. Post extraction, the right alveolar sockets received PBM treatment with either 980 nm (0.3 W, 18 J/cm2) or 810 nm (0.1 W, 6 J/cm2) lasers for seven days, whereas the left sockets served as controls. Rats were euthanized on days 3, 7, 14, and 28 for histopathological, immunohistochemical, micro computed tomography (micro-CT), and quantitative polymerase chain reactionanalyses. Results: On day 3, early granulation tissue, neovascularization, and inflammatory cell aggregates were observed in all groups. By day 7, active osteoclasts and osteoblasts were noted, with a significant increase in CD31-positive cells in the 980 nm group (p < 0.05). Day 14 showed new bone formation, and by day 28, increased cancellous bone and collagen content were present in all groups, with no significant differences between them (p > 0.05). Gene expression analysis revealed higher BMP-2 and Runx-2 levels in laser-treated groups on day 14 (p < 0.05), with the 980 nm group having higher BMP-2 levels than the 810 nm group (p < 0.05). Bone sialoprotein expression was higher in laser-treated groups on days 14 and 28 (p < 0.05), and osteocalcin expression was highest in the 980 nm group on both days (p < 0.05). Micro-CT analysis showed no significant differences among groups in bone mineral density, bone surface (BS)/bone volume (BV), or bone volume (BV)/TV (total volume) indices. Conclusion: PBM with 980 nm and 810 nm lasers promotes early-stage hard tissue healing in extraction sockets, with the 980 nm laser more effectively enhancing osteogenic gene expression, suggesting its potential as an adjunctive therapy in dental and oral surgery.

Bioinspired Glycopeptide Hydrogel Reestablishing Bone Homeostasis through Mediating Osteoclasts and Osteogenesis in Periodontitis Treatment.

Irreversible alveolar bone resorption is one of the important clinical manifestations of periodontitis, which is initiated by a plaque biofilm and exacerbated by the imbalance of osteoclast activity and osteogenesis, affecting a patient's masticatory function and resulting in a high recurrence rate of periodontitis. Herein, to reestablish bone homeostasis in periodontitis, a minocycline hydrochloride (MH)-loaded glycopeptide hydrogel (MH/GRWgel) is fabricated to mediate alveolar bone absorption through sequential antibacterial and RANKL-blocking activities. GRWgel shows an ECM-like fibrous and porous microstructure serving as a scaffold for cell proliferation and differentiation and holds the merits including injectability, self-healing properties, and good biocompatibility. After injection in situ, MH is released rapidly from the hydrogel in the early stage, demonstrating a potent antimicrobial effect to combat the biofilm in the deep periodontal pocket. Moreover, MH/GRWgel exhibits a high specific binding efficiency with RANKL to suppress osteoclast maturation by shielding the RANKL/RANK interaction and enhancing osteogenic differentiation, thereby synergistically regulating bone homeostasis. In the rat periodontitis model, MH/GRWgel significantly curtails periodontitis progression through antimicrobial activity, inhibition of alveolar bone resorption, and promotion of bone regeneration, which is superior to the treatment of a commercial gel. These findings suggest that MH/GRWgel with superiority in regulating bone homeostasis provides a promising therapeutic strategy for periodontitis.

A 3D-Planned Inward Fragmentation Technique for the Removal of Impacted Mandibular Third Molars: A Case Series.

Background/Objectives: The extraction of impacted mandibular third molars (M3Ms) carries significant risks, especially regarding the inferior alveolar nerve (IAN). This study aimed to evaluate the effectiveness of a 3D-planned inward fragmentation technique (3Dp-IFT) to improve surgical outcomes, reduce complications, and preserve bone structure in cases involving complex M3M impactions. Methods: Twenty-three patients aged between 18 and 36 years requiring M3M removal were included. Preoperative planning involved the use of cone-beam computed tomography (CBCT) for precise localization of the furcation area, followed by the creation of a 3D navigation template using PlastyCAD software version 1.7. The surgical procedure was performed under local anesthesia, with meticulous endoscopic assistance to ensure accurate access and minimize trauma. Postoperative outcomes, such as bone loss, pain, swelling, and mouth opening range, were carefully measured. The data were systematically organized and analyzed descriptively using Microsoft Excel. Results: No disturbances to the IAN or lingual nerve were observed. The mean buccal bone loss was 2.2 mm, with a standard deviation of 1.2 mm. Postoperative pain and swelling were generally low, with significant reductions within the first week. The use of the 3D navigation template significantly improved surgical access, enhancing safety and minimizing complications. Conclusions: The 3Dp-IFT technique represents a significant advancement in the minimally invasive removal of M3M by allowing precise access to critical anatomical areas while minimizing bone loss and postoperative complications. This approach is particularly beneficial for complex cases involving M3M near the IAN, thereby improving surgical safety and patient outcomes.

The Role of Macrophages in Airway Disease Focusing on Porcine Reproductive and Respiratory Syndrome Virus and the Treatment with Antioxidant Nanoparticles.

Lung macrophage cells play a critical role in various lung diseases, and their state can change depending on the progression of the disease by inducing either an inflammatory or anti-inflammatory state. In this review, the potential therapeutic effects of treatment with antioxidant nanoparticles in air-borne diseases focusing on porcine reproductive and respiratory virus (PRRSV), considering reactive oxygen species (ROS) as one of the factors that regulate M1 and M2 macrophages in the inflammatory and anti-inflammatory states, respectively, was described. In addition, the author examines the status of protein structure research on CD163 (one of the markers of anti-inflammatory M2 macrophages) in human and veterinary lung diseases.

Alveolar Ridge Regeneration With Open Versus Closed Healing in Damaged Extraction Sockets: A Preclinical In Vivo Study.

OBJECTIVE: The objective of this study was to compare open versus closed healing of soft and hard tissue following alveolar ridge preservation (ARP) procedures in damaged extraction sockets. MATERIALS AND METHODS: ARP was performed in five mongrel dogs using collagenated deproteinized bovine bone mineral (cDBBM) and a resorbable non-cross-linked collagen membrane (NCCM) in damaged extraction sockets, with each socket entrance left either open (open group) or closed (closed group). Clinical wound epithelization at the socket entrance and the dimensions of keratinized tissue were evaluated over time. Additionally, the augmented ridge dimensions and new bone formation were assessed radiographically and histologically at 8 weeks after surgery. RESULTS: The dimensions of the socket entrance gradually decreased in the open group, and wound epithelization was almost complete within 4 weeks. The mucogingival junction was maintained more apically in the open group than in the closed group (0.14 ± 0.40 mm vs. -0.86 ± 0.71 mm [mean ± SD], p < 0.05). The augmented ridge dimensions did not differ significantly between the open and closed groups (93.1% ± 5.4% vs. 88.3% ± 11.2%, p > 0.05). Histological analyses revealed no significant differences in the amount of newly formed bone. However, membrane resorption in the crestal region was more pronounced in the open group. CONCLUSION: Open and closed healing approaches for ARP in extraction sockets with damaged buccal wall resulted in similar ridge dimensions and new bone formation. However, there was less reduction of the buccal bone crest and wider keratinized tissue width after open healing.

Phillyrin prevents sepsis-induced acute lung injury through inhibiting the NLRP3/caspase-1/GSDMD-dependent pyroptosis signaling pathway.

Acute lung injury (ALI) is a severe pulmonary disorder of sepsis with high clinical incidence and mortality. Nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3)-cysteinyl aspartate specific proteinase 1-gasdermin D (GSDMD)-dependent pyroptosis of alveolar epithelial cells (AECs) has emerged as a crucial contributor to ALI during sepsis. Phillyrin (PHI), a natural lignan isolated from the traditional Chinese herbal medicine Forsythia suspensa, has been shown to have anti-inflammatory, antioxidant and antiviral properties. However, little is known about the protective role and potential mechanism of PHI in sepsis-induced ALI, and it is uncertain whether the protective effect of PHI in sepsis-induced ALI is connected to pyroptosis. This study aims to examine the preventive effects of PHI on sepsis-induced ALI via the inhibition of NLRP3/caspase-1/GSDMD-mediated pyroptosis in AECs. Our findings demonstrate that preadministration of PHI successfully reduces sepsis-induced pulmonary edema, systemic/pulmonary inflammation, and pulmonary histological damage in lung tissues, bronchoalveolar lavage fluid, and the serum of septic mice. Intriguingly, PHI preadministration suppresses sepsis-induced protein expressions of pyroptosis-specific markers, especially their active forms. In vitro assays show that PHI pretreatment also protects type II AECs (MLE-12) from lipopolysaccharide-induced pyroptosis by preventing the activation of the pyroptosis signaling pathway. The results from molecular docking and surface plasmon resonance reveal that PHI has a significant affinity for direct binding to the GSDMD protein, suggesting that GSDMD is a potential pharmacological target for PHI. In conclusion, PHI can prevent sepsis-triggered ALI by effectively suppressing the activation of the canonical pyroptosis signaling pathway and pyroptosis of AECs.

Alveolar capillary dysplasia with misalignment of the pulmonary veins: A surgical lung biopsy and autopsy in a full-term newborn.

Alveolar capillary dysplasia with misalignment of the pulmonary veins (ACD/MPV) is a rare and lethal interstitial lung disorder, caused by a congenital abnormality affecting the development of the parenchyma and pulmonary vessels. We report the case of a newborn at the end of 40 weeks of pregnancy, who showed no cardiopulmonary anomalies in prenatal control ultrasounds. However, after delivery, pulmonary hypertension and hypoxemic respiratory failure became apparent. She died after 12 days from refractory hemodynamic and respiratory failure despite intensive therapy. A surgical lung biopsy and clinical autopsy were performed, both revealing the same histopathological signs consistent with this disorder. In our case, the findings of digestive and genital malformations, together with the genetic result of the alteration in the FOXF1 gene, led us to conclude the definitive diagnosis of alveolar capillary dysplasia.

Transmission electron microscopy of transbronchial lung cryobiopsy samples in a cohort of fibrotic interstitial lung disease patients - feasibility and implications of endothelial alterations.

We evaluated the utility of transmission electron microscopy (TEM) in transbronchial lung cryobiopsy (TBLC) samples from 16 consecutive patients undergoing routine evaluation of fibrotic interstitial lung disease (ILD). Next to routine pathology examination, 1 to 2 TBLC samples were prepared for TEM analysis and evaluated using a Zeiss LEO EM 910. Subpleural cryobiopsies and unfrozen excision biopsies from fresh lobectomy tissue of non-ILD lung cancer patients served as controls. TEM provided high-quality images with only minor cryoartifacts as compared to controls. Furthermore, in several ILD patients we found marked microvascular endothelial abnormalities like luminal pseudopodia-like protrusions and inner surface defects. These were extensively present in four (25%), moderately present in seven (43.8%), and largely absent in five (31.3%) patients. A higher degree of TEM endothelial abnormalities was associated with younger age, non-specific interstitial pneumonia pattern, higher broncho-alveolar lavage lymphocyte count, positive autoantibodies, and lower spirometry, diffusion capacity and oxygenation biomarkers. We conclude that TEM evaluation of TBLC samples from ILD patients is feasible, while the observed microvascular alterations warrant further evaluation.

Evaluation of soft tissue profile changes around the nose and upper lip following maxillary anterior alveolar osteotomy with Wassmund and Wunderer technique in Japanese.

PURPOSE: The extent to which maxillary anterior alveolar osteotomy alters the facial profile remains unclear. The present study retrospectively analyzed and evaluated changes in maxillary anterior fragments and soft tissue from the nose to upper lip from pre- to postoperatively in patients who underwent the Wassmund and Wunderer (WW) technique. METHODS: Thirty-seven Japanese patients with maxillary prognathism underwent orthognathic surgery with the WW technique were retrospectively included in the present study. Changes in both hard- and soft-tissue landmarks and correlations between both tissues were evaluated using lateral cephalograms taken immediately before and ≥6 months after orthognathic surgery. RESULTS: The maxillary anterior segment showed predominantly posterior movement, with only slight upward movement. Posterior shift and lingual inclination of the maxillary anterior teeth were prominent. As for soft tissues, the change in the nasal tip was small and posterior change was large in the subnasal and upper lip areas. Nasolabial angle, nasal height, and inclination of nasal tip increased, while upper lip protrusion, nasal tip angle, and philtrum length decreased. Correlations were found between posterior changes in hard tissues and posterior changes in soft tissues. Among these, posterior changes and lingual inclination of the maxillary anterior teeth strongly correlate with posterior changes of the upper lip. CONCLUSION: Posterior shift of the maxillary anterior segment using the WW technique is useful because it can greatly improve the protrusion of the upper lip while minimizing nasal morphological changes, and the positioning of the maxillary anterior teeth may be an important key factor.