Transcranial direct current stimulation modulates autonomic nervous system and reduces ambulatory blood pressure in hypertensives.

Purpose: Transcranial direct current stimulation (tDCS) seems to positively modulate the autonomic nervous system in different clinical conditions and healthy subjects; however, its effects on hypertensive (HTN) patients are not completely known. This study aimed to evaluate the effects of a tDCS or SHAM session (20 min) on blood pressure (BP) and autonomic variables of HTN patients.Materials and Methods: Subjects (n = 13) were randomly submitted to SHAM and tDCS sessions (1 week of washout). Hemodynamic and autonomic variables were measured at baseline, during, and immediately after tDCS or SHAM stimulation (Finometer®, Beatscope). Ambulatory BP measurement (ABPM) was evaluated after the experimental period.Results: Hemodynamic variables were not changed by tDCS, except for the fall in peripheral vascular resistance (Δ = -1696.51 ± 204.65 dyn.s/cm5). After the tDCS, sympathetic modulation was decreased (-61.47%), and vagal modulation was increased (+38.09%). Such acute autonomic changes may have evoked positive results observed in 24 hs-systolic blood pressure (Δ = -8.4 ± 6.2; P = .0022) and 24hs-diastolic blood pressure (Δ = -5.4 ± 4.2; P = .0010) in tDCS subjects compared with that in SHAM.Conclusion: These findings suggest that the tDCS could promote positive acute adjustments on cardiac autonomic control and reduced values on 24-hs BP of HTN patients. More than a proof-of-concept, these results may point out to the future, where brain stimulation (tDCS) can be used to HTN syndromes, such as refractory HTN.

Aggressive ameloblastic fibrosarcoma in maxilla: case report and new perspectives based on the current literature / Fibrossarcoma ameloblástico agressivo em maxila: relato de caso e novas perspectivas com base na literatura atual

ABSTRACT Ameloblastic fibrosarcoma (AFS) is a rare malignant tumor characterized by benign epithelial component within a malignant fibrous stroma. It occurs as a de novo lesion or from a previous ameloblastic fibroma. The aim of this paper is to report an aggressive and recurrent case of AFS in the maxilla of a 38-year-old patient. Histopathological diagnosis can be challenging, especially when it is based on incisional biopsy specimens. Hence, this report highlights not only the importance of the histological features for diagnosis but also the clinical behavior of AFS based on current literature evidence.

RESUMO O fibrossarcoma ameloblástico (FSA) é um tumor maligno raro caracterizado pela presença de componente epitelial benigno em um tecido conjuntivo fibroso maligno. Pode desenvolver-se a partir de um fibroma ameloblástico ou como uma lesão nova. O objetivo deste estudo é relatar um caso de um FSA agressivo e recorrente em maxila em um paciente de 38 anos. O diagnóstico histopatológico desse tumor pode ser difícil, principalmente a partir de biópsias incisionais. Este trabalho também discute fatores em relação aos aspectos histopatológicos para o seu diagnóstico, assim como seu comportamento clínico, com base em revisão atual da literatura.

Squamous odontogenic tumor: report of a case of unusual involvement / Tumor odontogênico escamoso: relato de um caso de envolvimento incomum

ABSTRACT The squamous odontogenic tumor (SOT) is defined as a very rare benign neoplasm, locally infiltrative and can extend to neighboring structures. This study aimed to report a case of SOT unusual involvement. A female patient, 56-year-old, smoker showed mild swelling in the chin region in the portion between the left canine and right first premolar. Axial, coronal and sagittal images showed expansive hypodense lesion in the mandibular symphysis and parasymphysis. Partial removal of the lesion was performed, which led to the diagnosis of SOT. The patient presented no recurrence during 4 years and 2 months follow-up.

RESUMO O tumor odontogênico escamoso (TOE) é definido como uma neoplasia benigna rara, localmente infiltrativa, podendo estender-se a estruturas vizinhas. Objetivou-se relatar um caso de TOE de acometimento incomum. Paciente do sexo feminino, 56 anos de idade, fumante, demonstrou leve aumento de volume na região do mento na porção compreendida entre o canino esquerdo e o primeiro pré-molar direito. Imagens axial, coronal e sagital demonstraram lesão expansiva hipodensa na sínfise e na linha média mandibular. Fez-se a remoção parcial da lesão, o que levou ao diagnóstico de TOE. A paciente não apresentou recidiva durante quatro anos e dois meses de acompanhamento.

Neuroplastic Effects of Transcranial Direct Current Stimulation on Painful Symptoms Reduction in Chronic Hepatitis C: A Phase II Randomized, Double Blind, Sham Controlled Trial.

INTRODUCTION: Pegylated Interferon Alpha (Peg-IFN) in combination with other drugs is the standard treatment for chronic hepatitis C infection (HCV) and is related to severe painful symptoms. The aim of this study was access the efficacy of transcranial direct current stimulation (tDCS) in controlling the painful symptoms related to Peg-IFN side effects. MATERIALS AND METHODS: In this phase II double-blind trial, twenty eight (n = 28) HCV subjects were randomized to receive either 5 consecutive days of active tDCS (n = 14) or sham (n = 14) during 5 consecutive days with anodal stimulation over the primary motor cortex region using 2 mA for 20 min. The primary outcomes were visual analogue scale (VAS) pain and brain-derived neurotrophic factor (BDNF) serum levels. Secondary outcomes were the pressure-pain threshold (PPT), the Brazilian Profile of Chronic Pain: Screen (B-PCP:S), and drug analgesics use. RESULTS: tDCS reduced the VAS scores (P < 0.003), with a mean pain drop of 56% (p < 0.001). Furthermore, tDCS was able to enhance BDNF levels (p < 0.01). The mean increase was 37.48% in the active group. Finally, tDCS raised PPT (p < 0.001) and reduced the B-PCP:S scores and analgesic use (p < 0.05). CONCLUSIONS: Five sessions of tDCS were effective in reducing the painful symptoms in HCV patients undergoing Peg-IFN treatment. These findings support the efficacy of tDCS as a promising therapeutic tool to improve the tolerance of the side effects related to the use of Peg-IFN. Future larger studies (phase III and IV trials) are needed to confirm the clinical use of the therapeutic effects of tDCS in such condition. TRIAL REGISTRATION: Brazilian Human Health Regulator for Research with the approval number CAAE 07802012.0.0000.5327.

Human identification by oral prosthesis analysis with probability rates higher than DNA analysis.

Several techniques are used to perform an appropriate and reliable human identification. Forensic dentistry has achieved great relevance over the past years. The aim of this article is to report the method used for the identification of a male body found in the colliquative stage of putrefaction. The identification of the victim was succeeded confronting the dental findings found in the corpse with the data present on dental records provided by his dentist. The major elements for the identity's recognition were a metal core and a prosthetic crown that were being fabricated. These elements associated with the dental records were compelling for the elucidation of the case, and a positive body identification was achieved with high levels of probability. In the present case, cadaveric analysis of stomatognathic system structures achieved a probability value higher than DNA identification techniques, emphasizing the importance of forensic dentistry.

Expression of laminin-5 γ2 chain in cutaneous pseudocarcinomatous hyperplasia.

BACKGROUND: Since the use of laminin-5 as a marker of invasiveness has been proposed by several authors, our objective was to compare the expression of this protein in pseudocarcinomatous hyperplasia and squamous cell carcinoma (SCC). METHODS: Sixty-four paraffin-embedded skin biopsy samples with diagnosis of epidermal hyperplasia (non-pseudocarcinomatous), pseudocarcinomatous hyperplasia, actinic keratosis/carcinoma in situ, microinvasive and frankly invasive SCC were obtained for immunohistochemical study. RESULTS: Adjacent normal epithelium and epidermal hyperplasia (non-pseudocarcinomatous) showed no staining. In pseudocarcinomatous hyperplasia, laminin-5 was positive, at least focally, in 14 of 16 (87.5%) samples and was concentrated in peripheral cells of elongated rete pegs and in migrating cells in dermis. In samples of microinvasive carcinoma (n = 7), the expression was observed in all cases and was concentrated in the leading edge of the tumor. All cases (n = 21) of frankly invasive SCC showed cells expressing laminin-5, at least focally. Well-differentiated areas of the tumor presented a pattern of expression in peripheral cells of tumor nests while a diffuse pattern of expression was observed in less differentiated areas. CONCLUSION: We showed that cytoplasmic laminin-5 expression should not be used as a criterion of malignancy and is not useful in distinguishing pseudocarcinomatous hyperplasia from microinvasive and well-differentiated SCC.

Status da saúde bucal em pacientes com demência senil / Oral health status in patients with elderly dementia

Objetivos: Verificar o impacto da demência senil sobre alguns aspectos relacionados à saúde bucal, por meio de avaliação odontológica de idosos demenciados em comparação com idosos não demenciados. Material e método: Realizou-se estudo transversal com coleta de dados por meio de entrevista, avaliação dos hábitos de higiene e dieta, exame físico extra e intraoral, análise das condições protéticas e levantamento do índice de CPOD. Resultados: A média de idade no grupo de estudo e no grupo controle foi 75.6 e 69.08 respectivamente. Mais de 80% dos idosos portadores de síndromes demenciais necessita de auxílio para higiene bucal, embora apenas 19% dos cuidadores o façam. O CPOD médio foi de 29,8; e a prevalência de edentulismo total foi de 48%. Suas principais queixas foram dor e dificuldade na mastigação. Cerca de 40% dos idosos demenciados apresentaram dieta pastosa. As principais alterações extraorais, em ambos os grupos, foram queilite angular e ressecamento labial. No entanto, a presença de candidose foi maior no grupo dos pacientes demenciados. Conclusão: O empobrecimento da saúde bucal e da qualidade de vida dos idosos portadores de quadros demenciais é visível, e provavelmente têm múltiplas causas, como falta de acesso aos serviços de saúde e baixa escolaridade, aliados aos déficits cognitivos e motores e à necessidade de orientação familiar para auxílio direcionado a higiene bucal.

Aim: To verify the impact of elderly dementia on some aspects related to oral health through dental evaluation of demented compared with non-demented subjects. Material and Methods: A cross-sectional study was performed with data collection through interviews, evaluation of hygiene and diet, physical examination and intra-oral prosthetic and analysis of the conditions survey index DMFT. Results: The mean age in the study group and control group was 75.6 and 69.08, respectively. More than 80% of elderly patients with dementia required help for oral hygiene, although only 19% of caregivers do it. The mean DMFT was 29.8 and the prevalence of total edentulism about 48%. The main complaints were pain and difficulty in chewing. About 40% of the demented had pasty diet. Angular cheilitis and lip dryness were the most common extra-oral findings in both groups. However, the presence of candidiasis was higher among demented patients. Conclusion: The poor oral health and quality of life of people with elderly dementia is evident and probably has multiple causes, including lack of access to health services, low educational level, cognitive and motor deficits and the need for family counseling assistance directed to oral hygiene.