Influence of p16 Protein Immunostaining on Histopathological Features of Pleomorphic Adenoma and Carcinoma ex- Pleomorphic Adenoma.

The objective of this study was to evaluate the role of p16 in histologic characteristics and transition of Pleomorphic Adenoma (PA) to Carcinoma ex-PA (CxPA). So, 60 PA and 4 CxPA were histologic reviewed based on microscopic characteristics proposed by Hellquist, Triantafyllou and Dulguerov (PA) and Morais, Antony and Toluie (CxPA). Immunostaining for p16 was associated in different parenchyma and stroma of both tumors and Fisher's/chi-square tests and Mann-Whitney test were performed (SPSS v20.0, p<0.05). In PA the periductal cells were predominantly p16- and that ductal and myoepithelial cells showed a significant increase in p16+ cells (p<0.001). In CxPA, none of the cases showed p16+ in periductal cells, most parotid cases showed p16+ in ductal cells, and one case of parotid and the submandibular case showed mild immunostaining for myoepithelial cells. There was a small reduction in p16+ in CxPA compared to PA (p=0.537), but in both tumors there was less p16+ cells in solid stroma than other (p<0.001). The p16+ cases of PA had a higher capsular thickness (p=0.047). So, the loss of p16 immunostaining does not seem to be associated with the transition from PA to CxPA, but in both tumors the loss of p16+ cells are related to microscopic aggressiveness.

Sociodemographic factors affect the quality of life and burden of caregivers in special care in dentistry.

AIMS: To analyze the epidemiological profile and quality of life (QoL) of patients with special needs and overload their caregivers. METHODS AND RESULTS: Health-related QoL was assessed in a quantitative, observational, cross-sectional study of prospective characteristics using the WHOQOL-BREF and ZARIT-22 questionnaires. This study included 122 patients were included; they were divided into patients without caregiver assistance (n = 63) who answered WHOQOL-BREF, 49 caregivers (n = 49) who responded to ZARIT-22, and 10 patients were secondarily caregivers of their parents and answered the ZARIT-22 + WHOQOL-BREF questionnaires. The WHOQOL-BREF general score was 71.94 ± 10.58, and patients born in urban areas and married had positive correlations (p < .05) with the QoL scores in the physical and social domains. ZARIT-22 scores showed an average of 58.63 ± 14.07. Data cross-checking revealed that patients of white races (p = .030) and who lived in urban regions (p = .003) generated less overload to caregivers. CONCLUSION: In the WHOQOL-BREF analysis, family income was a factor with direct impact, and all caregivers referred to moderate-to-high overload, with an increase in prevalence as far away from the service the patient resides.

Acidentes ocupacionais entre cirurgiões-dentistas: exposição a material biológico / Occupational accidents among dental surgeons: exposure to biological material / Accidentes ocupacionales entre cirujanos dentistas: exposiciones a materiales biológicos

RESUMO Objetivo Determinar o perfil dos acidentes ocupacionais entre cirurgiões-dentistas, envolvendo material biológico, em Fortaleza, CE. Métodos O estudo tem caráter transversal de natureza descritiva e analítica, realizado em Fortaleza, CE, em 2020, a partir de uma amostra de 206 cirurgiões-dentistas. Além das frequências absolutas e percentuais, utilizaram-se testes de Qui-quadrado de Pearson e/ou Razão de verossimilhança, ao nível de significância de 5%. Encontraram-se 120 (58.3%) profissionais que sofreram acidentes e destes 107 (89%) através de lesão percutânea. Resultados Dos cirurgiões-dentistas que sofreram acidentes, envolvendo material biológico, identificou-se associação significativa entre ocorrência de acidentes com cirurgiões-dentistas que possuíam uma especialidade (p<0,001) e entre faixa etária e sexo (p=0,008). A maioria relatou ter sido imunizada contra hepatite B 193 (98%) e buscou testes de confirmação sorológica 101 (52%). A procura por atenção especializada após um acidente foi baixa 45 (38%). Conclusão Cirurgiões-dentistas no exercício do atendimento clínico estão passíveis de sofrerem acidentes. Medidas preventivas são importantes, como a utilização correta de equipamentos de proteção individual.

ABSTRACT Objective This study aimed to determine the profile of occupational accidents among dental surgeons involving biological material, in the city of Fortaleza, CE, Brazil. Methods This is a cross-sectional study of descriptive and analytical nature, conducted in the city of Fortaleza, CE, in 2020, from a sample of 206 dental surgeons. Pearson's Chi-square and/or Likelihood Ratio tests at a 5% of significance level were used as well as absolute and percentage frequencies. Results A total of 120 (58.3%) professionals underwent accidents and 107 (89%) of these suffered from percutaneous injury. Considering dental surgeons who had accidents involving biological material, a significant association was identified between the occurrence of accidents with specialized professionals (p<0.001) and between age group and sex (p=0.008). The majority reported having been immunized against hepatitis B 193 (98%), and 101 (52%) of them sought serological confirmation tests. The demand for specialized care after an accident was low with a total of 45 (38%). Conclusion Dental surgeons in their exercise of clinical care are susceptible to under-going accidents. Preventive measures are important, such as the correct use of personal protective equipment.

RESUMEN Objetivo Determinar el perfil de los accidentes de trabajo que afectan a cirujanos dentistas al utilizar material biológico. Métodos El estudio ha tenido un carácter transversal de tipo descriptivo y analítico. Se hizo en Fortaleza, CE, el 2020, con una muestra de 206 cirujanos dentistas. Más allá de las frecuencias absolutas y porcentuales, se hicieron pruebas de Chi-cuadrado de Pearson y Razón de verosimilitud, al nivel de significación del 5%. Se encontraron 120 (el 58,3%) profesionales que sufrieron accidentes y, de estos, 107 (el 89%) con lesión percutánea. Entre los cirujanos que se han accidentado con material biológico se ha identificado una asociación significativa entre la ocurrencia de accidentes con cirujanos dentistas expertos (p>0,001) y entre la edad y sexo (p=0,008). Resultados La mayoría, 193 (el 98%), ha informado haber recibido inmunización contra hepatitis B y 101 (el 52%) se ha buscado confirmar por serología. La búsqueda por atención médica especializada después de un accidente ha sido baja 45 (el 38%). Conclusión Los cirujanos dentistas en servicio clínico son susceptibles de sufrir accidentes. Medidas de prevención como la utilización correcta del equipo de protección individual son importantes.

Analysis of the Immunoexpression of Opioid Receptors and their Correlation with Markers of Angiogenesis, Cell Proliferation and Apoptosis in Breast Cancer.

OBJECTIVE: Breast cancer is a disease of great concern. The prognosis of this tumor is related to its staging. Opioids are widely used to minimize pain in oncology clinics; however, the relationship between the administration of opioids and their effects on tumor cells has yet to be elucidated. Therefore, this study aimed to evaluate the immunoexpression of mu- (µ) and kappa- (κ) opioid receptors and their correlation with markers of angiogenesis, cell proliferation, and apoptosis in biopsies of breast tumors. METHODS: Demographic data, tumor characteristics, opioid use, and prognostic factors were collected from medical records. After the selection of the excisional biopsies, immunohistochemistry was performed for µ- and κ-opioid receptors, vascular endothelial growth factor (VEGF), Ki-67, and TUNEL. RESULTS: A significant predominance of Ki-67 and µ-opioid receptor immunoexpression in the lymph nodes was observed in patients administered opioid medications. The luminal A subtype showed higher apoptosis levels (TUNEL) compared to the luminal B subtype. Patients with T4 tumor who had recurrence demonstrated a reduced expression of κ-opioid receptors at the lymph node location. Correlation analyses between the µ and κ opioid markers, VEGF, Ki-67, and TUNEL showed that these findings are likely involved in the same mechanisms the cancer of T4 stage breast cancer. CONCLUSION: The κ-opioid receptor has a lower immunoexpression in nodal tumor metastasis with recurrence, whereas the µ-opioid receptor is directly related to expression of TUNEL-positive cells  in tumors and indirectly to Ki-67 in nodal metastasis. Neither of the two receptors was expressed in the primary tumor or nodal metastasis in relation to VEGF.

Do Protocadherins Show Prognostic Value in the Carcinogenesis of Human Malignant Neoplasms? Systematic Review and Meta-Analysis.

BACKGROUND: Protocadherins (PCDHs) have been reported as tumor suppressor genes, implying that these genes may be involved in tumor suppression in a variety of cancers. However, a thorough understanding of the functions and mechanisms of PCDHs remains limited. Our aim was to investigate the methylation profile of PCDHs in human malignant neoplasms. METHODS: This systematic review has been recorded in PROSPERO (#42019117844) and conducted according to PRISMA's checklist; search was conducted in LILACS, PubMed, Science Direct, Scopus, and Web of Science databases, manually, with search queries and without date or language restrictions. RESULTS: We found 91 articles, of which 26 were used for this meta-analysis and categorized according to the origin of the neoplasia. In total, 3,377 cases were compiled, with PCDH10, PCDH17, and PCDH8 being the most studied; males were 2.22 times more affected than females. Studies have shown significant heterogeneity (p <0.001), with the odds ratio varying between cases and controls [2.20 (95% CI = 1.11- 4.35) to 209.05 (95% CI = 12.64- 2,457.18)], and the value of association between methylation and cancers studied was 26.08 (95% CI = 15.42-44.13). CONCLUSION: In this systematic review, we have demonstrated using meta-analysis that PCDHs could emerge as potential tumor suppressor genes and that a significant increase in methylation may be useful for early detection of different cancers. This work may help in the identification of new prognostic biomarkers in malignant neoplasms.

Photobiomodulation Therapy Reduces the Inflammatory Process without Inhibiting Bone Deposition in Rats in an Extraction Model.

Objective: We evaluated the influence of photobiomodulation therapy (PBMT) application during bone healing postexodontia in rats. Methods: We divided 84 male Wistar rats into a control group (CG), which received placebo treatment without PBMT, and a test group (TG), which was treated with PBMT. After exodontia, the animals were subjected to PBMT (TG) with an AsGaAI diode laser at 810 nm, 100 mW, 2 J, and 70 J/cm2 or placebo treatment (CG) every 72 h. After 1, 3, 7, 14, 21, and 28 days, the animals were weighed and euthanized to remove the left hemimandibles for radiographic (alveolar filling) and histomorphometric (inflammatory polymorphonuclear cell (PMN), mononuclear cell (MN), osteoclast (OC), and blood vessels counting) analysis. Statistic approach used two-way variance analysis followed by Bonferroni post hoc (p < 0.05, GraphPad Prism 5.0). Results: There was no significant difference in body mass variation (p = 0.828) and bone neoformation (p = 0.365) between the two groups, but the TG presented lower PMN (p < 0.001), MN (p < 0.001), and OC counts (p < 0.001) and higher blood vessels count (p < 0.001) throughout the repair process. Conclusions: PBMT attenuated the inflammatory process after exodontia without interfering with bone neoformation.

CD133 Role in Oral Carcinogenesis.

OBJECTIVE: to investigate CD133 immunoexpression, cancer stem cells marker, in oral epithelial dysplasias (OEDs) and oral squamous cells carcinomas (OSCCs) and understandits possible involvement in the malignant transformation process of these lesions and to better elucidate their biological behavior. MATERIAL AND METHODS: Tissue samples of 15 cases of OSCCs and 15 OEDs were subjected to CD133 antibody immunohistochemistry reactions. The analysis used quantitative parameters (number of immunostained cells regardless of immunostaining sublocations). RESULTS: All samples of OSCCs and OEDs showed positive immunostaining, with no significant difference between these groups (p = 0.283). We did not observe statistical difference between the degree of dysplasia and the amount of CD133+ cells (p = 0.899). CD133 immunoexpression showed no association with the OEDs and OSCCs sites. It was observed that nuclear and cytoplasmic immunostaining was more evident with the progression of the malignant process. CONCLUSION: It is suggested that the CD133 cellular localization together with the histopathological criteria of OEDs classification can contribute to provide more concrete indications about the oral carcinogenesis process.

Clinical-pathological and sociodemographic factors associated with the distant metastasis and overall survival of oral cavity and oropharynx squamous cell carcinoma

BACKGROUND: The objective of this study was to evaluate the influence of clinical-pathological and sociodemographic factors on the prevalence of distant metastasis (DM) and overall survival in patients with oral cavity and oropharynx squamous cell carcinoma (OOSCC). MATERIAL AND METHODS: Cross-sectional study based on the records of 404 OOSCC patients evaluated for DM, covering the period 2000-2014. We analysed the influence of age, sex, level of schooling, primary tumor subsite, treatment, marital status, family history of cancer, history of smoking and alcohol consumption, type of health care coverage (private vs. public) and overall survival. Findings were submitted to Fisher's exact test, Pearson's chi-squared test, Mantel-Cox log-rank testing and multinomial and Cox regression analysis (SPSS V. 20.0; p < 0.05). RESULTS: The prevalence of DM was 5.4% (22/404). The respiratory tract was the most affected DM site (n=9; 40.9%). Male sex (p = 0.049), oropharyngeal primary tumor (p = 0.008), stage T3-4 (p = 0.022), lymph node metastasis (N+) (p < 0.001) and palliative treatment (p = 0.005) were directly associated with DM. Patients with oral primary tumours (p = 0.343) and primary oropharyngeal tumours (p = 0.242) did not differ significantly with regard to the prevalence of DM. N+ was an independent risk factor for DM (p = 0.017). Five variables independently reduced overall survival: male sex (p = 0.035), age >65 years (p = 0.046), indigenous/brown racial type (p = 0.045), palliative treatment (p = 0.035) and DM (p = 0.048). CONCLUSIONS: Lymph node metastasis independently increased the prevalence of DM and, along with male sex, older age, brown racial type and palliative treatment, was independently associated with poor prognosis in patients with OOSCC

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Mast Cells and Blood Vessels Profile in Oral Carcinogenesis: An Immunohistochemistry Study.

BACKGROUND: The objectives of the present study were to evaluate angiogenesis and mast cell density in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: This was an observational, retrospective and quantitative study. The samples consisted of 60 tissue specimens from patients with squamous cell carcinoma, epithelial dysplasia and controls (n=20/group). Immunohistochemistry was performed using an anti-tryptase antibody to mast cells and anti-CD31 and anti-CD34 for blood vessels and we count the number of mast cells and determine the percentage of CD31 and CD34 antibody staining (vascular density). RESULTS: The mast cells had lower density in OSCC compared to control and dysplasia (p = 0.009). In angiogenesis, the expression of CD31 showed a higher percentage of blood vessels in OSCC (p < 0.001), however, CD34 showed no difference between groups (p=0.092). The CD31 antibody presented as a high immunostaining in oral mucosa than CD34. CONCLUSIONS: The increased vascularity in squamous cell carcinoma suggests that angiogenesis begins when malignant transformation starts that seems to be inversely associated with the number of mast cells.

Influence of infliximab therapy on bone healing post-dental extraction in rats.

OBJECTIVE: TNF-α, which acts directly on osteoclastogenesis, may modify bone turnover. Thus, the objective of this study was to evaluate the influence of infliximab on extraction socket healing. MATERIAL AND METHODS: Eighty-four Wistar rats were randomized into two groups (infliximab EV 5 mg / kg or saline EV 1 ml / kg) and submitted to lower first molar extraction protocol. The animals were sacrificed 1, 3, 7, 14, 21 and 28 days after surgery. The jaws were subjected to radiographic, histomorphometric, histochemical (picrosirius red) and immunohistochemical (TNF-α, RANKL and OPG) analysis. RESULTS: No differences were observed between the groups in surgical difficulty parameters: mass of teeth, number of root fractures and surgical time. Lower area filling with bone as well as increased amounts of remaining cicatricial tissue were observed in the infliximab group at 14 days (p < 0.001). Lower scores for polymorphonuclear neutrophils were seen at 3 (p < 0.01) and 7 days (p < 0.001), lower mononuclear counts at 7 days (p < 0.01) and lower osteoclast counts at 7 and 14 days (p < 0.01 and p < 0.001, respectively). Additionally, reduced TNF-α, RANKL and OPG immunoreactivity were observed, especially at 7 days (p < 0.05). CONCLUSION: TNF-α inhibitor may alter the bone repair capacity after tooth extraction, especially in the initial repair periods, by lower expression of TNF α, RANKL and OPG. Thus, additional caution may be needed in patients who use this class of medication after dental extraction.

Role of Inflammatory Markers in Prognosis of Oral Squamous Cell Carcinoma.

BACKGROUND: This estudie evaluated the immunostaining of cytokines in oral carcinoma, in tissue of margin of surgical resecate (MSR) and metastatic lymph nodes, as well as their role in patient prognosis. METHODS: A retrospective study was carried out in patients with oral squamous cell carcinomas, and sociodemographic and clinical-pathological data were evaluated. In addition, surgical site analysis of the patients was conducted by immunohistochemistry, using a tissue microarray for inflammatory (Tumor Necrosis Factor-alpha, Interleukin-1beta, Interleukin-6, interleukin-10), transcription NF-kappa B and CD68 markers. Immunoexpression was assessed qualitatively and quantitatively using ImageJ software, and data were correlated with the prognostic factors and patient survival rates. RESULTS: There was a greater immunoexpression of inflammatory and CD68 cytokines in primary tumour and lymph node metastasis than in MSR. In a multinomial logistic regression model, patients with low education (p = 0.041) and a high histoscore for TNF-α (p = 0.021) showed a survival rate of 15.64 (95% CI = 1.13-217.24) and 6.81 (95% CI = 1.02-105.96). CONCLUSION: Therefore, despite there is an increased immunoexpression of cytokines in the primary tumour, only TNF-α was the inflammatory cytokine that influenced the survival of patients with oral cancer.

Smoking History Decreases Survival in Patients with Squamous Cell Carcinoma of the Mouth: A Retrospective Study with 15 Years of Follow-up.

Background: The purpose of this study was to evaluate the influence of smoking history on the clinical-pathological, sociodemographic and prognostic characteristics of patients with oral squamous cell carcinoma (SCC). Materials and Methods: A retrospective cohort study was carried out with the records of 136 smokers with SCC and 68 nonsmokers with oral SCC who were diagnosed and treated at Haroldo Juaçaba Hospital (2000-2014). Data on patient sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, treatment type, marital status, method of health care access (public or private health systems) and overall survival (15 years) were analyzed by the X² test, Mantel-Cox tests and multinomial and Cox logistic regression models (SPSS 20.0, p <0.05). Results: Smoking history was directly associated with male sex (p <0.001), low levels of education (p = 0.001), tumors of the mouth and palate (p = 0.001), stage T3/4 tumors (p = 0.014), lymph node metastasis (N+) (p = 0.024), palliative treatment (p = 0.024) and receiving health care through the public health system (p = 0.006), with education level being the only independently associated factor (p = 0.039). Lower survival was observed in patients who were smokers (p = 0,002), with low levels of education (p = 0.001), who had stage T3/4 tumors (p = 0.004), with N+ (p = 0.021), and had received palliative treatment (p = 0.002). Age (>65 years old, p = 0.015) and T staging (T3/4, p = 0.033) decreased the survival of SCC patients regardless of the other factors. Conclusions: Smoking history had an independent association with low education level and a history of alcoholism, and survival was negatively associated with older age and larger tumor size, which were more prevalent in smokers.

Prevalence of carotid artery calcifications among 2.500 digital panoramic radiographs of an adult Brazilian population

BACKGROUND: The aim of the present study was to analyze the epidemiological data of digital panoramic radiographs revealing suggestive images of carotid artery calcifications (CAC) from a Northeast Brazilian population. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted with 2,500 digital panoramic radiographs obtained from a single imaging reference center in Northeast Brazil. Images from individuals of both sexes and older than 18 years were included and those that did not cover the region of cervical vertebrae or presented low radiographic quality were excluded. Data were analyzed regarding prevalence, location (bilateral, right or left), sex, and age using the Chi-square test at the significance level of 5%. RESULTS: An amount of 96 (4%) patients presented suggestive images of CAC. The female sex (p = 0.003) and individuals aged up to 70 years (p = 0.002) were statically significant. 40.4% were found bilaterally, 37.6% on the right side (p < 0.001) and 22% on the left side. CONCLUSIONS: In conclusion, this study showed a low prevalence of suggestive images of CAC in digital panoramic radiographs from a Northeast Brazilian population. It was observed a higher prevalence of CAC associated with female sex, older patients, and right side location

Effects of dexamethasone and nimesulide on bisphosphonate-related osteonecrosis of the jaw: An experimental study.

OBJECTIVE: To evaluate the effects of dexamethasone (DEX) and nimesulide (NIM) on Bisphosphonate-related Osteonecrosis of the Jaw (BRONJ) in rats. DESIGN: BRONJ was induced by zoledronic acid (ZA) infusion (0.2mg/kg) in Wistar rats (n=8), followed by extraction of the left lower first molar (BRONJ groups). Control groups (n=40) received saline (IV). For eight weeks, DEX (0.04, 0.4, 4mg/kg) or saline (SAL) were administered by gavage 24h before each infusion of ZA or saline (IV), or NIM (10.3mg/kg) was administered 24h and 12h before each infusion of ZA or saline (IV). The haematological analyses were conducted weekly. After euthanasia (day 70), the jaws were submitted to radiographic and microscopic analysis. Kidney, liver, spleen and stomach were analysed histopathologically. RESULTS: The BRONJ groups showed a higher radiolucent area compared with the control groups (p<0.05). Histomorphometric analysis revealed healing and new bone formation in the control groups, while the BRONJ groups exhibited devitalized bone with bacterial colonies and inflammatory infiltrate. The BRONJ-DEX 0.4 and 4mg/kg groups had a greater number of bacterial colonies (p<0.05) and an increased polymorphonuclear cell count compared to the saline-BRONJ group, while the BRONJ-NIM group had a lower polymorphonuclear count (p<0.05). The BRONJ groups had leucocytosis, which was reduced by DEX administration. Treatments with DEX with or without ZA caused white pulp atrophy. CONCLUSION: Thus, DEX or NIM therapy was not effective in preventing radiographic and histopathologic events associated with BRONJ. Treatment with DEX attenuated leucocytosis post-infusion with ZA.