Bone aluminum accumulation in the current era / Acúmulo de alumínio no tecido ósseo na era atual

In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.

Nos últimos anos, evidências do Registro Brasileiro de Biópsia óssea (REBRABO) apontaram uma alta incidência de intoxicação por alumínio (Al) no tecido ósseo de pacientes com DRC em diálise. Essa surpreendente informação parece representar não apenas um acúmulo passivo deste metal, visto que dados prospectivos do REBRABO sugerem que a presença de Al no tecido ósseo pode estar independentemente relacionada a eventos cardiovasculares adversos maiores. Essas informações contrastam com a percepção mundial do controle epidemiológico dessa condição. Neste artigo de opinião, discutimos por que o diagnóstico de acúmulo ósseo de Al não é relatado em outras partes do mundo, e também discutimos uma gama de possibilidades para entender por que nós acreditamos que o acúmulo de Al no tecido ósseo ainda ocorre, não como se apresentava no passado, ou seja, como uma síndrome com sinais e sintomas sistêmicos de intoxicação.

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy / Análise das relações neutrófilo/linfócito e plaqueta/linfócito como marcadores inflamatórios na doença renal crônica: impacto da paratireoidectomia

Abstract Introduction: Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. Methods: A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. Results: There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. Conclusion: N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) é uma das causas de inflamação na DRC. Avaliamos o impacto da paratireoidectomia (PTX) nas relações neutrófilo/linfócito (N/L) e plaqueta/linfócito (P/L) em pacientes com HPTS. Métodos: Foram analisados 118 pacientes [hemodiálise (HD, n = 81) e transplantados (TX, n = 37)] submetidos à PTX entre 2015 e 2021. Resultados: Houve redução significativa de cálcio e PTH nos dois grupos, além de elevação de vitamina D. No grupo HD, a PTX não mudou as relações N/L e P/L. Já no grupo TX, houve redução nas relações N/L e P/L acompanhadas de elevação significativa do número de linfócitos totais. Conclusão: As relações N/L e P/L não são marcadores fidedignos de inflamação em pacientes com HPTS submetidos à PTX. A uremia, que induz um estado de inflamação crônica em pacientes dialíticos, e o uso de imunossupressão em pacientes transplantados renais são alguns dos fatores de confusão que impedem o uso dessa ferramenta na prática clínica.

Renal osteodystrophy and clinical outcomes: a prospective cohort study / Osteodistrofia renal e desfechos clínicos: um estudo de coorte prospectivo

Abstract Introduction: Renal osteodystrophy (ROD) refers to a group of bone morphological patterns that derive from distinct pathophysiological mechanisms. Whether the ROD subtypes influence long-term outcomes is unknown. Our objective was to explore the relationship between ROD and clinical outcomes. Methods: This study is a subanalysis of the Brazilian Registry of Bone Biopsies (REBRABO). Samples from individual patients were classified as having osteitis fibrosa (OF), mixed uremic osteodystrophy (MUO), adynamic bone disease (ABD), osteomalacia (OM), normal/minor alterations, and according to turnover/mineralization/volume (TMV) system. Patients were followed for 3.4 yrs. Clinical outcomes were: bone fractures, hospitalization, major adverse cardiovascular events (MACE), and death. Results: We enrolled 275 participants, of which 248 (90%) were on dialysis. At follow-up, 28 bone fractures, 97 hospitalizations, 44 MACE, and 70 deaths were recorded. ROD subtypes were not related to outcomes. Conclusion: The incidence of clinical outcomes did not differ between the types of ROD.

Resumo Introdução: Osteodistrofia renal (OR) refere-se a um grupo de padrões morfológicos ósseos que decorrem de mecanismos fisiopatológicos distintos. É desconhecido se os subtipos de OR influenciam desfechos em longo prazo. Nosso objetivo foi explorar as relações entre OR e desfechos. Métodos: Este estudo é uma subanálise do Registro Brasileiro de Biópsias Ósseas (REBRABO). As amostras de cada paciente foram classificadas em osteíte fibrosa (OF), osteodistrofia urêmica mista (MUO), doença óssea adinâmica (ABD), osteomalácia (OM), alterações normais/menores, e pelo sistema Remodelação / Mineralização / Volume (RMV). Os pacientes foram acompanhados por 3,4 anos. Os eventos clínicos foram: fraturas ósseas, hospitalizações, eventos cardiovasculares adversos maiores (MACE), e óbito. Resultados: Analisamos 275 indivíduos, 248 (90%) deles estavam em diálise. No acompanhamento, 28 fraturas ósseas, 97 hospitalizações, 44 MACE e 70 óbitos foram registrados. Os subtipos de OR não foram relacionados aos desfechos clínicos. Conclusão: A incidência de desfechos clínicos não diferiu entre os tipos de OR.

Upper and lower limb bone mass accrual in adolescent footballers across a short period of training and competition

Abstract Objectives: To analyze bone mineral content (BMC) and area bone mineral density (aBMD) accrual in adolescent male footballers who started their first football season. Methods: 17 athletes (14.8 ± 0.4 years) were monitored across 15 weeks of football training. Participants were evaluated for somatic maturation (HPHV), BMC, and aBMD at three time points: before (M1) and after (M2) a preparatory phase, and at the end of the competitive phase (M3). BMC and aBMD were measured using DXA scans. Participants were divided into groups according to maturation status (circa-PHV and post-PHV), and the amount of accumulated training load (median split). Results: A significant effect (12.1 g/week, standard error (SE) = 2.6 g/week) was observed for lower limbs BMC across the three time points. There were no significant effects of time for upper limbs BMC. There was a significant effect of time for total body aBMD (0.007, SE = 0.003 g/cm2/week) across the three time points. Adolescents at post-PHV had a significant 245.6 g (SE = 56.1 g) higher BMC compared to adolescents at circa-PHV. No significant effects were observed for the accumulated training load. Conclusion: Systematic football training, even during the growth spurt, has a positive impact on adolescent bone markers despite the accumulated training load and maturation.

Study on Body Composition of Patients with Diabetes Mellitus by Dual-Energy X-Ray Absorptiometry: A Morphological Study

SUMMARY: Diabetes is a form of endocrine disease. Dual-energy X-ray Absorptiometry (DXA) provides a detailed view of the body composition to find out what makes people with diabetes different from those with other diseases. We scanned 371 patients with DXA to analyze their body composition parameters. Three hundreds and seventy one patients (178 women/193 men), who with different diseases, with a mean±SD Body Mass Index (BMI) of 25.32±8.3 kg/m2 were included. The body composition of 371 patients was assessed. Bone Mineral Density (BMD), Fat Weight, Lean Weight, waist-to-hip ratio, Lean Mass Index (LMI), Fat Mass Index (FMI), the relationship between Fat percentage and BMI were analyzed. The 371 patients included 156 diabetics and 215 non-diabetics. Non-diabetic patients also included 5 obesity patients, 9 patients with fatty liver, 39 patients with hypertension, 22 patients with hyperlipidemia, 18 patients with cardiovascular disease, 11 patients with chest and lung disease, 4 patients with chronic disease, 14 patients with brain disease and 93 patients with other diseases. Among 156 diabetic patients, 129 had VAT > 100 cm2 and 27 had VAT ≤100 cm2. The lean weight (LW) of male diabetic patients was significantly higher than that of female diabetic patients. The fat weight (FW) of female patients with diabetes was significantly higher than that of male patients. The waist-hip ratio (WHR) was 1.37 ± 0.25 in male diabetic patients and 1.18 ± 0.21 in female diabetic patients. Among the 215 non-diabetic patients, the obese and fatty liver patients, which the weight (WT) (obesity: 83.87 ± 8.34 kg fat liver: 85.64±28.60 kg), FW (obesity: 28.56 ± 4.18 kg fat liver: 28.61 ± 10.79 kg), LW (obesity: 52.62 ± 9.64 kg fat liver: 54.29±17.58 kg), BMI (obesity: 28.76 ± 1.88 kg/m2 fat liver: 29.10 ± 5.95 kg/m2), was much higher than other patients. Diabetes patients had less fat mass than non- diabetic patients; the difference was around 2 kg. BMI is also a modest number. BMD doesn't differ all that much. Non-diabetic patients with fatty liver obesity and cardiovascular disease had higher fat mass and BMI than patients with other illnesses. Body composition can provide precise information on the makeup of different body areas, but further in-depth exams are required to ascertain the body's endocrine profile.

La diabetes es una enfermedad endocrina. La absorciometría de rayos X de energía dual (DXA) proporciona una vista detallada de la composición corporal para descubrir qué diferencia a las personas con diabetes de aquellas con otras enfermedades. Escaneamos a 371 pacientes con DXA para analizar sus parámetros de composición corporal. Se incluyeron 371 pacientes (178 mujeres/193 hombres), con diferentes enfermedades, con un Índice de Masa Corporal (IMC) medio ± DE de 25,32 ± 8,3 kg/m2. Se evaluó la composición corporal de 371 pacientes. Se analizaron la densidad mineral ósea (DMO), el peso graso, el peso magro, la relación cintura-cadera, el índice de masa magra (LMI), el índice de masa grasa (FMI), y la relación entre el porcentaje de grasa y el IMC. De los 371 pacientes 156 eran diabéticos y 215 no diabéticos. Los pacientes no diabéticos también incluyeron 5 con obesidad, 9 con hígado graso, 39 con hipertensión, 22 con hiperlipidemia, 18 con enfermedad cardiovascular, 11 con enfermedad torácica y pulmonar, 4 con enfermedad crónica, 14 con enfermedad cerebral y 93 pacientes con otras enfermedades. Entre los 156 pacientes diabéticos, 129 tenían un IVA > 100 cm2 y 27 tenían un IVA ≤100 cm2. El peso magro (PV) de los hombres diabéticos fue significativamente mayor que el de las mujeres diabéticas. El peso graso (FW) de las mujeres diabéticas fue significativamente mayor que el de los hombres diabéticos. El índice cintura-cadera (ICC) fue de 1,37 ± 0,25 en hombres diabéticos y de 1,18 ± 0,21 en mujeres diabéticas. Entre los 215 pacientes no diabéticos, los pacientes obesos y con hígado graso, cuyo peso (WT) (obesidad: 83,87 ± 8,34 kg hígado graso: 85,64 ± 28,60 kg), FW (obesidad: 28,56 ± 4,18 kg hígado graso: 28,61 ± 10,79 kg), PV (obesidad: 52,62 ± 9,64 kg, hígado graso: 54,29 ± 17,58 kg), IMC (obesidad: 28,76 ± 1,88 kg/m2, hígado graso: 29,10 ± 5,95 kg/m2), fue mucho mayor que otros pacientes. Los pacientes diabéticos tenían menos masa grasa que los pacientes no diabéticos; la diferencia fue de alrededor de 2 kg. La DMO no difiere mucho. Los pacientes no diabéticos con obesidad debido al hígado graso y enfermedades cardiovasculares tenían mayor masa grasa e IMC que los pacientes con otras enfermedades. La composición corporal puede proporcionar información precisa sobre la composición de diferentes áreas del cuerpo, pero se requieren exámenes más profundos para determinar el perfil endocrino del cuerpo.

Injertos Óseos en Quistes de los Maxilares. Reporte de un Caso

Los quistes de los maxilares son las lesiones óseas más comunes en la región maxilofacial. La enucleación de las lesiones y el cierre primario de los defectos, son en conjunto, el tratamiento óptimo hoy en día. En algunas ocasiones el defecto óseo resultante puede ser de un tamaño tan grande que afecta la estabilidad de dientes vecinos, comprometa la indemnidad del hueso o produce un retraso cicatrizal que incluso puede impedir una regeneración ósea completa. Se considera que esta falta de regeneración expone al paciente a riesgos de infección tardía, retraso de los tratamientos rehabilitadores en zonas de alta demanda estética y pérdida de vitalidad dentaria. Para disminuir el riesgo de alteraciones en la regeneración ósea completa de cavidades quísticas, se ha propuesto la posibilidad de que tras la enucleación del quiste se rellenen estos defectos con injertos óseos u otras técnicas de preservación alveolar para favorecer la cicatrización. Teóricamente el uso de estos injertos mejora la calidad y disminuye el tiempo de cicatrización ósea, permitiendo que el paciente recupere rápidamente las funciones habituales del componente dentoalveolar, acortando el periodo de cuidados postoperatorios que restringen la alimentación, los deportes o la rehabilitación oral. El actual trabajo tiene como objetivo realizar una revisión de la literatura respecto a los beneficios del uso de injertos óseos en el tratamiento quirúrgico de los quistes maxilares y presentar un caso clínico con los detalles quirúrgicos de esta técnica.

Jaw cysts are the most common bone lesions in the maxillofacial region. Enucleation of the lesions along with the primary closure of the defects are the optimal treatment nowadays. On some occasions, the resulting bone defect can be so large that it affects the stability of neighboring teeth, compromises the integrity of the bone, or produces a delayed healing that can even prevent complete bone regeneration. It is considered that the lack of regeneration exposes the patient to risk of infection, delay of rehabilitation treatments in areas of high aesthetic demand and loss of dental vitality. To reduce the risk of alterations in complete bone regeneration of cystic cavities, the possibility of filling these defects with bone grafts or other alveolar preservation techniques to promote healing, has been proposed after cyst enucleation. Theoretically, the use of these grafts improves the quality and decreases the bone healing time, allowing the patient to quickly recover the usual functions of the dentoalveolar component, limiting the period of postoperative care that restricts eating, sports or oral rehabilitation. The present work aims to carry out a review of the literature regarding the benefits of the use of bone grafts in the surgical treatment of maxillary cysts and to present a clinical case with the surgical details of this technique.

Conhecimento de graduandos sobre doação de medula óssea / Knowledge of undergraduates about bone marrow donation

Caracterizar o conhecimento dos graduandos de uma instituição de ensino superior acerca do processo de doação de medula óssea. Método: Trata-se de um estudo descritivo com abordagem quantitativa. Foram entrevistados 266 graduandos, de ambos os sexos, entre 17 e 21 anos de idade. Foi utilizado um questionário estruturado, contendo perguntas sobre o conhecimento a respeito do processo de doação de medula óssea. Resultados: A maioria dos participantes não conhece o processo de cadastro e doação de medula óssea, tendo como a falta de informação a principal causa para a desinformação a respeito do tema abordado, consequentemente resultando em pouca demanda para que mais pessoas sejam cadastradas no REDOME. Conclusão: os estudantes do ensino superior desconhecem os processos que envolvem desde ao cadastro até a doação de medula óssea, devido à desinformação e pouca divulgação sobre a temática. (AU)

To characterize the knowledge of undergraduates from a higher education institution about the bone marrow donation process. Method: This is a descriptive study with a quantitative approach. 266 undergraduates were interviewed, of both sexes, between 17 and 21 years old. A structured questionnaire was used, containing questions about their knowledge about the bone marrow donation process. Results: Most participants do not know the bone marrow registration and donation process, with lack of information being the main cause for misinformation about the topic addressed, consequently resulting in little demand for more people to be registered in REDOME. Conclusion: the higher education students are unaware of the processes that involve from registration to bone marrow donation, due to misinformation and little dissemination on the subject. (AU)

Caracterizar el conocimiento de estudiantes de grado de una institución de educación superior sobre el proceso de donación de médula ósea. Método: Se trata de un estudio descriptivo con abordaje cuantitativo. Se entrevistaron 266 estudiantes universitarios, de ambos sexos, entre 17 y 21 años. Se utilizó un cuestionario estructurado que contenía preguntas sobre el conocimiento sobre el proceso de donación de médula ósea. Resultados: La mayoría de los participantes desconocen el proceso de registro y donación de médula ósea, siendo la falta de información la principal causa de la desinformación sobre el tema abordado, por lo que se genera poca demanda para que más personas se registren en REDOME. Conclusión: los estudiantes de educación superior desconocen los procesos que involucran desde el registro hasta la donación de médula ósea, debido a la desinformación y poca difusión sobre el tema. (AU)

Assessment of atherosclerosis and endothelial dysfunction risk factors in patients with primary glomerulonephritis / Avaliação dos fatores de risco de aterosclerose e disfunção endotelial em pacientes com glomerulopatias primárias

Abstract Introduction: Glomerulonephritis are the third cause of chronic kidney disease (CKD) requiring dialysis in Brazil. Mineral and bone disorder (MBD) is one of the complications of CKD and is already present in the early stages. Assessment of carotid intima-media thickness (CIMT) and flow-mediated vasodilatation (FMV) are non-invasive ways of assessing cardiovascular risk. Hypothesis: Patients with primary glomerulonephritis (PG) have high prevalence of atherosclerosis and endothelial dysfunction, not fully explained by traditional risk factors, but probably influenced by the early onset of MBD. Objective: To evaluate the main markers of atherosclerosis in patients with PG. Method: Clinical, observational, cross-sectional and controlled study. Patients with PG were included and those under 18 years of age, pregnants, those with less than three months of follow-up and those with secondary glomerulonephritis were excluded. Those who, at the time of exams collection, had proteinuria higher than 6 grams/24 hours and using prednisone at doses higher than 0.2 mg/kg/day were also excluded. Results: 95 patients were included, 88 collected the exams, 1 was excluded and 23 did not undergo the ultrasound scan. Patients with PG had a higher mean CIMT compared to controls (0.66 versus 0.60), p = 0.003. After multivariate analysis, age and values for systolic blood pressure (SBP), FMV and GFR (p = 0.02); and FMV and serum uric acid (p = 0.048) remained statistically relevant. Discussion and conclusion: The higher cardiovascular risk in patients with PG was not explained by early MBD. Randomized and multicentric clinical studies are necessary to better assess this hypothesis.

Resumo Introdução: Glomerulopatias são a terceira causa de doença renal crônica (DRC) com necessidade de diálise no Brasil. Distúrbio mineral e ósseo (DMO) é uma das complicações da DRC e está presente já nos estágios iniciais. A avaliação da espessura médio-intimal de carótidas (EMIC) e da vasodilatação fluxo-mediada (VFM) são maneiras não invasivas de avaliação do risco cardiovascular. Hipótese: Pacientes com glomerulopatias primárias (GP) apresentam alta prevalência de aterosclerose e disfunção endotelial, não explicada totalmente pelos fatores de risco tradicionais, mas provavelmente influenciada pela instalação precoce do DMO. Objetivo: Avaliar os principais marcadores de aterosclerose em pacientes com GP. Método: Estudo clínico, observacional, transversal e controlado. Foram incluídos portadores de GP e excluídos menores de 18 anos, gestantes, menos de três meses de seguimento e os com glomerulopatia secundária. Também foram excluídos aqueles que, no momento da coleta, apresentavam proteinúria maior que 6 gramas/24 horas e uso de prednisona em doses superiores a 0,2 mg/kg/dia. Resultados: 95 pacientes foram incluídos, 88 colheram os exames, 1 foi excluído e 23 não realizaram a ultrassonografia. Os pacientes com GP apresentaram maior EMIC média em relação ao controle (0,66 versus 0,60), p = 0,003. Após análise multivariada, mantiveram relevância estatística a idade e os valores de pressão arterial sistólica (PAS), VFM e TFG (p = 0,02) e VFM e ácido úrico sérico (p = 0,048). Discussão e conclusão: Pacientes com GP apresentaram maior risco cardiovascular, entretanto esse risco não foi explicitado pelo DMO precoce. Estudos clínicos randomizados e multicêntricos são necessários para melhor determinação dessa hipótese.

Resveratrol Alleviates Osteoporosis by Promoting Osteogenic Differentiation of Bone Marrow Mesenchymal Stem Cells via SITR1/PI3K/AKT Pathway / El Resveratrol Alivia la Osteoporosis al Promover la Diferenciación Osteogénica de las Células Madre Mesenquimales de la Médula Ósea a Través de la Vía SITR1/PI3K/AKT

SUMMARY: Senile osteoporosis is mainly caused by reduced osteoblast differentiation and has become the leading cause of fractures in the elderly worldwide. Natural organics are emerging as a potential option for the prevention and treatment of osteoporosis. This study was designed to study the effect of resveratrol on osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in osteoporosis mice. A mouse model of osteoporosis was established by subcutaneous injection of dexamethasone and treated with resveratrol administered by gavage. In vivo and in vitro, we used western blot to detect protein expression, and evaluated osteogenic differentiation of BMSCs by detecting the expression of osteogenic differentiation related proteins, calcium deposition, ALP activity and osteocalcin content. Resveratrol treatment significantly increased the body weight of mice, the level of serum Ca2+, 25(OH)D and osteocalcin, ration of bone weight, bone volume/total volume, trabecular thickness, trabecular number, trabecular spacing and cortical thickness in osteoporosis mice. In BMSCs of osteoporosis mice, resveratrol treatment significantly increased the expression of Runx2, osterix (OSX) and osteocalcin (OCN) protein, the level of calcium deposition, ALP activity and osteocalcin content. In addition, resveratrol treatment also significantly increased the expression of SIRT1, p-PI3K / PI3K and p-AKT / AKT in BMSCs of osteoporosis mice. In vitro, resveratrol increased the expression of SIRT1, p-PI3K / PI3K and p-AKT / AKT, Runx2, OSX and OCN protein, the level of calcium deposition, ALP activity and osteocalcin content in BMSCs in a concentration-dependent manner, while SIRT1 knockdown significantly reversed the effect of resveratrol. Resveratrol can attenuate osteoporosis by promoting osteogenic differentiation of bone marrow mesenchymal stem cells, and the mechanism may be related to the regulation of SIRT1/PI3K/AKT pathway.

La osteoporosis senil es causada principalmente por una diferenciación reducida de osteoblastos y se ha convertido en la principal causa de fracturas en las personas mayores en todo el mundo. Los productos orgánicos naturales están surgiendo como una opción potencial para la prevención y el tratamiento de la osteoporosis. Este estudio fue diseñado para estudiar el efecto del resveratrol en la diferenciación osteogénica de las células madre mesenquimales de la médula ósea (BMSC) en ratones con osteoporosis. Se estableció un modelo de osteoporosis en ratones mediante inyección subcutánea de dexametasona y se trató con resveratrol administrado por sonda. In vivo e in vitro, utilizamos Western blot para detectar la expresión de proteínas y evaluamos la diferenciación osteogénica de BMSC detectando la expresión de proteínas relacionadas con la diferenciación osteogénica, la deposición de calcio, la actividad de ALP y el contenido de osteocalcina. El tratamiento con resveratrol aumentó significativamente el peso corporal de los ratones, el nivel sérico de Ca2+, 25(OH)D y osteocalcina, la proporción de peso óseo, el volumen óseo/ volumen total, el espesor trabecular, el número trabecular, el espaciado trabecular y el espesor cortical en ratones con osteoporosis. En BMSC de ratones con osteoporosis, el tratamiento con resveratrol aumentó significativamente la expresión de las proteínas Runx2, osterix (OSX) y osteocalcina (OCN), el nivel de deposición de calcio, la actividad de ALP y el contenido de osteocalcina. Además, el tratamiento con resveratrol también aumentó significativamente la expresión de SIRT1, p-PI3K/PI3K y p-AKT/AKT en BMSC de ratones con osteoporosis. In vitro, el resveratrol aumentó la expresión de las proteínas SIRT1, p-PI3K/PI3K y p- AKT/AKT, Runx2, OSX y OCN, el nivel de deposición de calcio, la actividad de ALP y el contenido de osteocalcina en BMSC de manera dependiente de la concentración, mientras que La caída de SIRT1 revirtió significativamente el efecto del resveratrol. El resveratrol puede atenuar la osteoporosis al promover la diferenciación osteogénica de las células madre mesenquimales de la médula ósea, y el mecanismo puede estar relacionado con la regulación de la vía SIRT1/PI3K/AKT.

Temporal evolution of postsurgical bone repair in a rabbit model: A [99mTc]Tc-MDP scintigraphic study

Abstract Bone regeneration is crucial for repairing bone tissue following various injuries. Research techniques that enable the study of metabolic changes in bone tissue under different conditions are important for understanding bone repair and remodeling. This study used bone scintigraphy to evaluate osteogenesis secondary to osteotomy in a preclinical model of New Zealand rabbits. For this purpose, we conducted a longitudinal, prospective, case-control study in which scintigraphic variables were measured in both the right forearm (case-operated) and the left forearm (control - non-operated). The study sample consisted of 10 rabbits subjected to osteotomy, followed by a 12-week postoperative evaluation period, divided into six imaging stages at 1, 2, 3, 4, 8, and 12 weeks. We observed that the operated forearm showed significantly higher external radiation than the control side, using the pinhole collimator, denoting an increase in the biodistribution and tropism of the radiopharmaceutical to the operated forearm. Among the three evaluated time points, osteoblastic activity was highest in the second week and presented a significant decline in the 8th and 12th weeks, denoting regeneration and resolution of the surgical injury; the control forearm was also influenced by the inactivity imposed by the operated forearm. This fact was notably evidenced by the reduction in the metabolic activity of osteoblasts in the left forearm. Our study suggested that bone scintigraphy was sensitive enough to semi-quantitatively differentiate the metabolic activity of osteoblasts in the operated forearm in the three temporal landmarks evaluated in the study.

Integrative analyses of genetic characteristics associated with skeletal endothelial cells

Abstract The osseous vascular endothelium encompasses a vast intricate framework that regulates bone remodeling. Osteoporosis, an age-associated systemic bone disease, is characterized by the degeneration of the vascular architecture. Nevertheless, the precise mechanisms underpinning the metamorphosis of endothelial cells (ECs) with advancing age remain predominantly enigmatic. In this study, we conducted a systematic analysis of differentially expressed genes (DEGs) and the associated pathways in juvenile and mature femoral ECs, utilizing data sourced from the Gene Expression Omnibus (GEO) repositories (GSE148804) and employing bioinformatics tools. Through this approach, we successfully discerned six pivotal genes, namely Adamts1, Adamts2, Adamts4, Adamts14, Col5a1, and Col5a2. Subsequently, we constructed a miRNA-mRNA network based on miRNAs displaying differential expression between CD31hiEMCNhi and CD31lowEMCNlow ECs, utilizing online repositories for prediction. The expression of miR-466i-3p and miR-466i-5p in bone marrow ECs exhibited an inverse correlation with age. Our in vivo experiments additionally unveiled miR-466i-5p as a pivotal regulator in osseous ECs and a promising therapeutic target for age-related osteoporosis.

Fibroma ameloblástico mandibular: caso clínico / Fibroblastic fibroma mandibular: a clinical case

El fibroma ameloblástico (FA) se describe como una neoplasia benigna de origen odontogénico mixto que suele presentarse entre la primera y segunda década de vida, frecuentemente en los molares permanentes inferiores. Por lo general es asintomático, pero las lesiones de gran tamaño suelen acompañarse con dolor e inflamación. Su tratamiento por lo regular es conservador. Se describe el caso de un fibroma ameloblástico en un paciente de 13 años de edad, que involucraba cuerpo y ángulo mandibular izquierdo, tratado de manera conservadora, se realiza extirpación del tumor, regeneración ósea guiada y rehabilitación con implante dental (AU)

Ameloblastic fibroma (AF) is described as a benign neoplasm of mixed odontogenic origin that usually presents between the first and second decade of life, frequently in lower permanent molars. It is usually asymptomatic, but large lesions are usually accompanied by pain and inflammation. His treatment is generally conservative. The clinical case of an ameloblastic fibroma in a 13-year-old patient is described, involving the left mandibular body and angle, treated conservatively, tumor removal, guided bone regeneration and rehabilitation with dental implants are performed (AU)

"Penumbra sign" in knee pain: a case of distal femur osteomyelitis

"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery due to osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.

Masa nasal como único compromiso extrapulmonar de infección por M. Tuberculosis / Nasal mass as the only extrapulmonary compromise of M. Tuberculosis infection / Massa nasal como único compromisso extrapulmonar da infecção por M. Tuberculose

La tuberculosis aún es un problema de salud pública mundial. La infección causada por Mycobacterium tuberculosis se manifiesta de forma principal a nivel pulmonar. Sin embargo, alrededor del 20 % de los casos se presentan en otras localizaciones anatómicas y solo el 2 % tiene afectación del tracto respiratorio superior. Se presenta el caso de una mujer de 75 años, reconsultante al servicio de otorrinolaringología por epistaxis, lesiones postillosas en cavidad nasal y hallazgo de masa nasal. Posterior a la resección quirúrgica de la lesión, se logró la comprobación microbiológica de infección por M. tuberculosis. Se realizan estudios para descartar compromiso pulmonar y de otras localizaciones. Posterior al inicio de tratamiento antituberculoso se logró resolución completa de la lesión y no recurrencia de los síntomas. Las formas extrapulmonares de la infección por M. tuberculosis y, en especial las que afectan la región de la cabeza y el cuello, requieren un alto índice de sospecha para su diagnóstico. Los métodos de diagnóstico como la prueba de PCR y los cultivos de tejidos permiten un óptimo inicio del manejo médico de acuerdo con la epidemiología local y las condiciones del paciente.

Tuberculosis is still a global public health burden. Infection caused by the bacillus Mycobacterium tuberculosis (M. Tuberculosis) manifests mainly in the lungs. However, around 20 % of cases occur in other anatomical locations and only 2 % have upper respiratory tract involvement. We present the case of a 75-year-old female patient, who returned to the otorhinolaryngology service due to epistaxis and postillomous lesions in the nasal cavity with a finding of a nasal mass. After surgical resection of the lesion, microbiological confirmation of M. tuberculosis infection is achieved. Studies are performed to rule-out lung involvement, as well as other locations. After the initiation of tuberculosis treatment, complete resolution of the lesion and no recurrence of symptoms is documented. Extrapulmonary forms of M. tuberculosis infection, and especially those involving the head and neck region, require a high index of suspicion for their diagnosis. Diagnostic methods such as PCR testing and tissue cultures allow optimal initiation of medical management according to local epidemiology and patient conditions.

A tuberculose ainda é um problema de saúde pública global. A infecção causada pelo Mycobacterium tuberculoses manifesta-se principalmente nos pulmões. Entretanto, cerca de 20% dos casos ocorrem em outras localizações anatômicas e apenas 2% apresentam comprometimento do trato respiratório superior. É apresentado o caso de uma mulher de 75 anos que retornou ao serviço de otorrinolaringologia por quadro de epistaxe, lesões com crostas em cavidade nasal e descoberta de massa nasal. Após ressecção cirúrgica da lesão, foi realizada verificação microbiológica de infecção por M. tuberculoses. Estudos são realizados para descartar envolvimento pulmonar e otras localizações. Após início do tratamento antituberculoso, houve resolução completa dalesão e não houve recidiva dos sintomas. As formas extrapulmonares da infecção por M. tuberculoses, especialmente aquelas que acometem a região de cabeça e pescoço, requerem alto índice de suspeita para diagnóstico. Métodos de diagnóstico, como testes de PCR e culturas de tecidos, permitem o início ideal do tratamento médico de acordó com a epidemiologia local e as condições do paciente.

The intra- and inter-rater reproducibility of bone level measurements at strategic mini-implants using dental panoramic radiography

Abstract Objectives: This experimental study focused on the intra- and inter-rater reproducibility of vertical bone level (VBL) measurements at strategic mini-implants (MI) using digital panoramic radiographs (PR). Study design: VBLs of 152 MIs for removable partial denture stabilization at 50 randomly chosen PRs from a clinical trial were digitally evaluated by three ratters. Rater deviations exceeding 0.5 mm were re-examined. The intra-class correlation coefficient (ICC) was applied to estimate reliability. The smallest detectable change (SDC) was interrelated to the minimal clinically important change of 0.2 mm. Results: The first measurement round revealed intra- and inter-rater ICCs of > 0.8. However, 28 sites (9 %) were unreadable, and 97 sites (32 %) revealed differences between observers of ≥ 0.5 mm. Following a consensus session and re-training, an additional 8 sites were excluded and all remaining VBL differences were ≤ 0.5 mm. Thus, the SDCs with 95 % credibility were improved from 0.73 to 0.31 mm in the intra-rater and from 1.52 to 0.34 mm in the interrater statistics. Given a 50 % credibility for this special setting, both the intra- and inter-rater SDCs were 0.11 mm. Conclusions: Digital PR can be reliably utilized to determine VBLs around MIs under conditions of at least two trained observers, mutual calibration sessions, and exclusion of unquantifiable radiographs. German Clinical Trials Register ID:DRKS00007589, www.germanctr.de

Common mental disorders in hematopoietic stem cell transplant patients: a scoping review / Trastornos mentales comunes en pacientes con trasplante de células madre hematopoyéticas: revisión del alcance / Transtornos mentais comuns em pacientes transplantados com células-tronco hematopoéticas: revisão de escopo

ABSTRACT Objective: to map common recurrent mental disorders in patients undergoing hematopoietic stem cell transplantation. Methods: this is a scoping review carried out in January 2022 in electronic databases and repositories of dissertations and thesis. Studies that answered the research question, met the objective of the study and were available in full electronically, in any language, were included. Results: the sample consisted of 28 studies, 14 of which were published in the United States of America. The common mental disorders found were depressive, anxiety, post-traumatic stress and mood disorders. Twenty symptoms were mentioned, among the most prevalent are fatigue and sleep disorders/insomnia. Conclusions: the difficulty and importance of carrying out the differential diagnosis of these disorders were highlighted, since their symptoms can be confused with other health problems and have a strong potential to interfere with patients' evolution.

RESUMEN Objetivo: mapear los trastornos mentales recurrentes comunes en pacientes sometidos a trasplante de células madre hematopoyéticas. Métodos: se trata de una revisión de alcance realizada en enero de 2022 en bases de datos electrónicas y repositorios de disertaciones y tesis. Se incluyeron publicaciones que respondieron a la pregunta de investigación, cumplieron con el objetivo del estudio y estaban disponibles en su totalidad en formato electrónico, en cualquier idioma. Resultados: la muestra estuvo compuesta por 28 estudios, 14 de los cuales fueron publicados en los Estados Unidos de América. Los trastornos mentales comunes encontrados fueron depresión, ansiedad, estrés postraumático y trastornos del estado de ánimo. Se mencionaron 20 síntomas, entre los más prevalentes se encuentran fatiga y trastornos del sueño/insomnio. Conclusiones: se destacó la dificultad e importancia de realizar el diagnóstico diferencial de estos trastornos, ya que sus síntomas pueden confundirse con otros problemas de salud y tienen un fuerte potencial de interferir en la evolución del paciente.

RESUMO Objetivo: mapear os transtornos mentais comuns recorrentes em pacientes submetidos ao transplante de células-tronco hematopoéticas. Métodos: trata-se de revisão de escopo realizada em janeiro de 2022 em bases de dados eletrônicas e repositórios de dissertações e tese. Foram incluídas publicações que respondessem à questão de pesquisa, atendessem ao objetivo do estudo e que estivessem disponíveis na íntegra em meio eletrônico, em qualquer idioma. Resultados: a amostra foi composta por 28 estudos, dos quais 14 foram publicados nos Estados Unidos da América. Os transtornos mentais comuns encontrados foram os transtornos depressivos, de ansiedade, estresse pós-traumático e de humor. Foram citados 20 sintomas, entre os mais prevalentes estão a fadiga e distúrbios do sono/insônia. Conclusões: evidenciaram-se a dificuldade e a importância de realizar o diagnóstico diferencial desses transtornos, uma vez que seus sintomas podem ser confundidos com outros problemas de saúde e têm forte potencial para interferir na evolução do paciente.

Reabilitação auditiva com sistemas Baha® transcutâneo e percutâneo / Hearing rehabilitation with Baha® transcutaneous and percutaneous systems

RESUMO Objetivo Verificar longitudinalmente a influência dos limiares tonais auditivos obtidos com as próteses auditivas ancoradas no osso transcutâneas e percutâneas na percepção da fala em indivíduos com malformação de orelha externa e/ou média e Otite Média Crônica. Método Estudo observacional, retrospectivo, de seguimento longitudinal de 30 indivíduos usuários unilaterais de sistema Baha® transcutâneo e percutâneo, para coleta de dados secundários dos limiares tonais obtidos por meio da audiometria em campo livre e do limiar de reconhecimento de sentenças no silêncio e no ruído nas condições: sem a prótese; no momento de ativação; no primeiro mês de uso (pós 1); e no terceiro mês (pós 2). Resultados Houve diferença significante entre os limiares tonais obtidos nas frequências de 3 e 4kHz, com melhores resultados para o percutâneo em todos os momentos de avaliação. Para os dois sistemas, observou-se melhor desempenho no reconhecimento de sentenças no silêncio e ruído, com diferença significante na ativação (p<0,001), porém manteve-se estável nos demais momentos de avaliação. O sistema percutâneo mostrou melhor benefício no reconhecimento de sentenças no ruído apenas na ativação (p=0,036), quando comparado ao transcutâneo. Conclusão O sistema percutâneo possibilitou melhor audibilidade para as frequências altas; contudo, tal audibilidade não influenciou no reconhecimento de sentenças na situação de silêncio para ambos os sistemas. Para a situação de ruído, melhores respostas foram observadas no sistema percutâneo; porém, a diferença não se manteve no decorrer do tempo.

ABSTRACT Purpose Longitudinally verify the influence of auditory tonal thresholds obtained with transcutaneous and percutaneous bone-anchored hearing aids on speech perception in individuals with external and/or middle ear malformation and chronic otitis media. Methods Observational, retrospective, longitudinal follow-up study of 30 unilateral users of the transcutaneous and percutaneous Baha® system for the collection of secondary data on pure tone thresholds obtained through free field audiometry and sentence recognition threshold in silence and noise in conditions: without the prosthesis; at the time of activation; in the first month of use (post 1); and in the third month (post 2). Results There was a significant difference between pure tone thresholds obtained at frequencies of 3 and 4kHz with better results for the percutaneous technique at all evaluation moments. For both systems, better performance was observed in sentence recognition in silence and in noise, with a significant difference in activation (p<0.001), but it remained stable during the other evaluation moments. The percutaneous system showed better benefit in recognizing sentences in noise only on activation (p=0.036), when compared to the transcutaneous system. Conclusion The percutaneous system provided better audibility for high frequencies; however, such audibility did not influence sentence recognition in the silent situation for both systems. For the noise situation, better responses were observed in the percutaneous system, however, the difference was not maintained over time.

Association between childhood anthropometric indicators and bone mineral density in adulthood / Associação entre indicadores antropométricos na infância e densidade mineral óssea na idade adulta

ABSTRACT Objective: This study aimed to verify the association between childhood anthropometric indicators and areal bone mineral density (aBMD) in adulthood. Methods: Repeated measures of 137 subjects (68 females) were obtained in childhood (9.2±1.5 years of age) and adulthood (22.3±1.7 years of age). aBMD (g/cm2) was assessed for whole body, lumbar spine, upper and lower limbs, and femoral neck in adulthood using dual-energy X-ray absorptiometry. Anthropometric measurements of body weight (BW), height, triceps and subscapular skinfolds were obtained in childhood. The anthropometric indicators used were BW, body mass index (BMI), and sum of skinfolds (ΣSF). Simple linear regression was used to assess the association between childhood anthropometric indicators and aBMD in adulthood, controlled by chronological age and stratified by sex, with 5% statistical significance. Results: In females, multiple associations were observed between anthropometric indicators and aBMD, with higher coefficients for BMI (β=0.020; R2=0.20; p<0.01 for right femoral neck to β=0.008; R2=0.16; p<0.01 for upper limbs), followed by BW (β=0.003; R2=0.21; p<0.01 for upper limbs to β=0.008; R2=0.20; p<0.01 for right femoral neck) and ΣSF (β=0.001; R2=0.06; p<0.01 for upper limbs to β=0.005; R2=0.12; p<0.01 for right femoral neck). In males, associations were observed only for the lumbar spine region (β=0.016; R2=0.09 for BMI to β=0.004; R2=0.06; p<0.01 for ΣSF). Conclusions: Anthropometric indicators of childhood proved to be sensitive predictors of aBMD in adulthood, especially in females. BMI indicated a greater association with aBMD in both sexes.

RESUMO Objetivo: O objetivo do estudo foi verificar a associação entre os indicadores antropométricos da infância com a área da densidade mineral óssea (aDMO) na idade adulta. Métodos: Medidas repetidas de 137 sujeitos (68 do sexo feminino) foram obtidos na infância (9,2±1,5 anos de idade) e idade adulta (22,3±1,7 anos de idade). A aDMO (g/cm2) foi avaliada para todo o corpo, coluna lombar, membros superiores e inferiores e colo do fêmur na idade adulta usando a absorciometria radiológica de dupla energia (DXA). Medidas antropométricas de peso corporal, estatura e dobras cutâneas das regiões tricipital e subescapular foram obtidas na infância. Os indicadores antropométricos utilizados para as análises foram o peso corporal (PC), o índice de massa corporal (IMC) e o somatório de dobras cutâneas (ΣDC). Regressão linear simples controlada pela idade e estratificada por sexo foi empregada para avaliar a associação entre os indicadores antropométricos do período da infância na aDMO na idade adulta, com significância estatística de 5%. Resultados: No sexo feminino, múltiplas associações foram observadas entre os indicadores antropométricos e a aDMO, com maiores coeficientes para IMC (β=0,020; R2=0,20; p<0.01 para colo do fêmur direito a β=0,008; R2=0,16; p<0,01 para membros superiores), seguido da PC (β=0,003; r2=0,21; p<0,01 para membros superiores a β=0,008; r2=0,20; p<0,01 para colo do fêmur direito) e ΣDC (β=0,001; R2=0,06; p<0,01 para membros superiores a β=0,005; R2=0,12; p<0,01 para colo do fêmur direito). No sexo masculino, associações ocorreram apenas na região da coluna (β=0,016; R2=0,09 para IMC a β=0,004; R2=0,06; p<0,01 para ΣDC). Conclusões: Indicadores antropométricos da infância mostraram ser sensíveis preditores da aDMO na idade adulta, especialmente no sexo feminino. O IMC indicou maior associação com a aDMO em ambos os sexos.

Assessing bone mineral density in children and adolescents living with HIV and on treatment with tenofovir disoproxil fumarate: a systematic review / Avaliação da densidade mineral óssea em crianças e adolescentes que vivem com HIV e em tratamento com tenofovir disoproxil fumarato: uma revisão sistemática

ABSTRACT Objective: To investigate the impact of tenofovir disoproxil fumarate on bone mineral density and bone mineral content in children and adolescents infected with the human immunodeficiency virus. Data source: The search procedure was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The search was carried out until April 2022 in Medical Literature Analysis and Retrieval System Online (Medline), Embase, Cochrane Central, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, and MedRxiv. The combination of terms used was: (Children OR Youth OR Teenagers) AND HIV AND (Tenofovir OR "Antiretroviral therapy") AND ("Bone density" OR Osteoporosis OR Osteopenia). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022312851) Data synthesis: The initial searches resulted in 1156 papers. After the exclusion of duplicate studies, three blinded reviewers analyzed the title and abstract of 563 papers, of which 57 remained to be read in full. Only nine papers met the eligibility criteria and were included in descriptive and risk-of-bias analyses. Regarding study design, four were cross-sectional, three were longitudinal before-after studies without a control group, and two were prospective cohorts. Among these nine papers, seven showed no significant association between tenofovir disoproxil fumarate use and reduced bone mass in young people. However, these papers did not have high methodological quality. Conclusions: Although most of the selected papers found no harmful effect of tenofovir disoproxil fumarate on bone mass, further primary research with higher methodological quality is needed so robust scientific evidences can be obtained.

RESUMO Objetivo: Investigar o impacto do tenofovir disoproxil fumarato sobre a densidade mineral óssea e o conteúdo mineral ósseo em crianças e adolescentes infectados pelo vírus da imunodeficiência humana. Fontes de dados: O procedimento de busca foi executado de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. A busca foi realizada até abril de 2022 nas seguintes bases de dados: Medical Literature Analysis and Retrieval System Online (Medline), Embase, Cochrane Central, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Web of Science, Scopus, and MedRxiv. A combinação de termos utilizada foi: (Children OR Youth OR Teenagers) AND HIV AND (Tenofovir OR "Antiretroviral therapy") AND ("Bone density" OR Osteoporosis OR Osteopenia). O protocolo foi registrado na base International Prospective Register of Systematic Reviews — PROSPERO (CRD42022312851). Síntese dos dados: As pesquisas iniciais resultaram em 1.156 artigos. Após a exclusão dos estudos duplicados, três revisores cegos analisaram título e resumo de 563 estudos, dos quais 57 permaneceram para leitura na íntegra. Somente nove artigos atenderam aos critérios de elegibilidade e foram incluídos para análises descritivas e de risco de viés. Com relação ao desenho dos estudos, quatro foram transversais, três foram estudos longitudinais antes-depois sem grupo controle e dois foram coortes prospectivas. Dos nove artigos, sete não mostraram associação significativa entre uso de TDF e redução de massa óssea em pessoas jovens. Entretanto, esses estudos não tiveram alta qualidade metodológica. Conclusões: Embora a maioria dos estudos selecionados não tenha encontrado efeito prejudicial do TDF sobre massa óssea, novas pesquisas primárias com maior qualidade metodológica são necessárias para que sejam obtidas evidências científicas robustas.

Histomorphometric comparison of two different preclinical models to evaluate the bone repair in grafted areas

Aim: This study was performed to compare two different rat defect models (critical calvaria defects versus guided bone regeneration in the mandibular ramus) used to evaluate bone repair in grafted areas. Methods: A total of 12 rats were allocated in two groups according the experimental model used to evaluate the bone repair in grafted areas: a critical sized-calvaria defect of 5 mm filled with bone graft (n=6) and a mandibular ramus filled with the bone graft associated with a Teflon dome-shaped membrane (n=6). Both groups were grafted with deproteinized bovine bone graft. After 60 days, the animals were euthanized and the samples obtained were submitted to histomorphometry analysis to evaluate the relative amount of bone, remaining bone substitute, and soft tissue within the grafted areas. Results: No differences were observed between the preclinical models evaluated in relation to the amount of bone tissue formation (19.93 ± 4.55% in calvaria vs. 21.00 ± 8.20% in mandible). However, there was a smaller amount of soft tissue (43.20 ± 10.97% vs. 57.79 ± 7.61 %; p<0.01) and a greater amount of bone substitute remaining (35.80 ± 5.52% vs. 22.28 ± 4.36 %; p<0.05) in the grafted areas in the mandible compared to calvaria defect. Conclusion: Preclinical models for the analysis of bone repair in grafted areas in the mandible and critical sized-calvaria defects showed different responses in relation to the amount of soft tissue and bone substitute remnants