Programming of Dopaminergic Neurons by Early Exposure to Sex Hormones: Effects on Morphine-Induced Accumbens Dopamine Release, Reward, and Locomotor Behavior in Male and Female Rats.

Neonatal programming with sex hormones produces long-term functional changes in various tissues, including the brain. Previously, we demonstrated a higher content of dopamine and an increase in potassium-induced dopamine release in the nucleus accumbens of adult rats exposed to estradiol valerate. On the other hand, sex hormones also affect the opioid system increasing the expression of the µ opioid receptor and ß-endorphins. Here, we investigated if neonatal programming with sex hormones alters the response to morphine during adulthood in rats and predispose them to neurochemical, rewarding and behavioral activating effects. We examined the effects of neonatal exposure to a single dose of estradiol valerate or testosterone propionate on morphine-induced (5 mg/kg, i.v.) dopamine release in the nucleus accumbens and morphine-induced (3 mg/kg, s.c.) locomotor activity and conditioned place preference when these rats were adults. Our results showed a significant increase in morphine-induced dopamine release in the nucleus accumbens of rats that were exposed neonatally to estradiol compared with control rats. This effect was correlated with higher place preference and locomotor activity induced by morphine in adult rats neonatally exposed to estradiol valerate. However, the effect of morphine on dopamine release and behaviors was similar in rats treated with testosterone compared to control rats. Additionally, the expression of mu (µ) opioid receptor, dopamine receptor type 1 (D1) and dopamine receptor type 2 (D2) in the nucleus accumbens of adult rats was not different after treatment with sex hormones. Taken together, our results demonstrated an enhancement of pharmacological effects produced by morphine in rats neonatally programmed with estradiol valerate, suggesting that early exposure to sex hormones could represent a vulnerability factor in the development of addiction to opioid drugs such as morphine and heroin in adulthood.

Reconstrucción de defectos mandibulares: bloque acrílico como mantenedor de contorno de tejidos / Mandibular defects reconstruction: The use of an acrylic block as a space and contour maintainer of the oral tissues

RESUMEN: Introducción: El tratamiento de grandes tumores mandibulares conlleva una alteración anatómica y funcional del paciente. La reconstrucción de estos defectos es un desafío para el cirujano, sin perjuicio que el tratamiento con injertos suele ser la primera opción en la mayoría de los casos, su aplicación podría estar limitada a las consecuencias derivadas de la comunicación del injerto con el medio oral. El presente artículo pretende exponer el uso de acrílico dental como elemento intermediario entre la resección y reconstrucción en situaciones como la descrita. Caso Clínico: Paciente adulta con ameloblastoma mandibular es tratada mediante resección quirúrgica y mantenida con un bloque acrílico en la zona resecada durante 6 meses, con el objeto de permitir el cierre de comunicación de la lesión con el medio oral, reconstruyéndose posteriormente el defecto con injerto libre de cresta ilíaca. Discusión: Las implicancias estético-funcionales de la mandíbula requieren meticulosidad en la reconstrucción de los defectos resultantes a su patología. A través del procedimiento propuesto, se consigue mejorar el pronóstico de la reconstrucción con injerto óseo de un defecto mandibular comunicado al medio oral, obteniéndose buenos resultados morfológicos y funcionales.

ABSTRACT: Introduction: The treatment of large mandibular tumors has anatomic and functional sequelae to the patient. Reconstruction of these defects is a challenge to the surgeon, whereas grafting is the first choice treatment in most cases, its application could be limited by conditions such as a communication with the oral environment. The present article intends to present the use of a methacrylate block as an interim device between resection and reconstruction in situations such as the above described. Case Report: An adult female affected by mandibular ameloblastoma is treated by surgical resection and kept with the aid of a methacrylate block in the resected area for 6 months, allowing closure of the communication between the lesion and the oral environment to be posteriorly treated with a free iliac crest graft. Discussion: Functional and esthetic implications of mandibular resection sequelae mandate a thorough reconstruction of the lasting defects. By the proposed procedure a better prognosis for the reconstruction is achieved when using a bone graft in the setting of a lesion communicated with the oral environment, allowing good morphological and functional results.

Riesgo de hemorragia postquirúrgica en pacientes bajo tratamiento antitrombótico sometidos a cirugía oral: Revisión Sistemática y Metaanálisis / Risk of postsurgical hemorrhage in patients with antitrombotic treatment undergoing oral surgery: A systematic review and Metanalysis

RESUMEN: Introducción: el objetivo de esta revisión fue determinar el riesgo de hemorragia postoperatoria en pacientes con tratamiento anticoagulante oral (TACO) sometidos a cirugía oral que no suspenden su tratamiento comparado con quienes lo modifican o suspenden. Materiales y métodos: se realizó una búsqueda en CENTRAL, Medline y EMBASE, junto con una revisión manual de revistas especializadas y resúmenes de la IADR. Dos revisores realizaron la selección de estudios, evaluación de riesgo de sesgo y extracción de datos de forma independiente. Se seleccionaron los ensayos clínicos aleatorizados que miden la aparición de hemorragias en pacientes sometidos a procedimientos quirúrgicos orales con TACO en comparación con un grupo que interrumpió o modificó su terapia. Resultados: Solo 5 estudios cumplieron los criterios de inclusión (549 pacientes). El metanálisis mostró que el mantenimiento de la TACO no aumenta el riesgo de hemorragia postoperatoria (riesgo relativo: 1,41 [0,93 - 2,16], IC del 95% p = 0,11) en comparación con la interrupción del tratamiento. Conclusión: Aunque se encontró una mayor cantidad de hemorragia postoperatoria en pacientes con TACO comparado con quienes lo interrumpieron o modificaron, esta diferencia no fue estadística ni clínicamente significativa. Por lo tanto, TACO no debe suspenderse en pacientes sometidos a cirugía oral.

ABSTRACT: Introduction: This systematic review aims to determine the postoperative bleeding risk in patients on oral anticoagulant therapy (OAT) undergoing oral surgical procedures when continuing with the treatment, compared with those modifying or discontinuing the treatment. Materials and methods: A search was performed using CENTRAL, Medline and EMBASE, in conjunction with a manual review of indexes of specialized journals and abstracts of the IADR. Study selection, assessments of risk of bias and data extraction were performed independently by 2 reviewers. Randomized clinical trials measuring the occurrence of bleeding in patients on OAT undergoing oral surgical procedures compared with a group discontinuing or modifying their therapy were selected. Results: A total of 5 studies were included based on inclusion criteria (549 patients). The meta-analysis showed that the maintenance of OAT does not increases the risk of postoperative bleeding (relative risk [RR] 1.41 [0.93 - 2.16]; 95% CI p= 0,11) compared with the discontinuation of therapy. Conclusion: Although a larger quantity of oral postoperative bleeding episodes were found in patients continuing with OAT compared with patients discontinuing or modifying their therapy, this difference was neither statistically nor clinically significant. Therefore, OAT should not be discontinued in patients undergoing oral surgery.

Identification and description of controlled clinical trials in Spanish language dental journals.

BACKGROUND: To identify controlled clinical trials (CCTs) published in Spanish and in Latin American dental journals, and provide access to this body of evidence in a single source. METHODS: Handsearching, following Cochrane Collaboration guidelines, of CCTs published in Spanish dental journals from Spain and Latin America. For each eligible trial, we collected the dental specialty, the interventions evaluated, whether and how randomisation was achieved, and the corresponding bibliographic reference. RESULTS: We handsearched 107 journals published in Spain and Latin America in Spanish. Over 17 051 articles, 244 (1.43%) were CCTs. These studies focused mainly on periodontics (70, 29.0%) and oral and maxillofacial surgery (66, 27.0%), assessing mostly pharmacological interventions (112, 46.0%). One hundred fifty-three studies (62.7%) used a random allocation of participants to study arms. CONCLUSIONS: A significant number of dental journals published in Spain and Latin America in Spanish language present original research relevant to inform clinical practice. These journals are not indexed in the major electronic databases. PRACTICAL IMPLICATIONS: References to the identified CCTs are now available in CENTRAL, the Cochrane Collaboration repository for these studies. We call for adherence to the CONSORT statement in dentistry to improve reporting of CCTs in journals published in Spanish language.

Melanoma oral: importancia de un diagnóstico temprano: un caso clínico / Oral melanoma: importance of an early diagnosis: a case report

RESUMEN: Las lesiones pigmentadas malignas en la mucosa oral son de escasa frecuencia, pero de altas tasas de morbilidad y mortalidad, siendo de mal pronóstico a pesar de agresivos tratamientos que pueden combinar grandes resecciones quirúrgicas con quimioterapia y radioterapia. Dado este escenario, la conducta clínica asociada a la pesquisa de lesiones pigmentadas es la biopsia inmediata para la confirmación o descarte de patología maligna y con ello un inicio temprano de tratamiento. Este artículo trata de una paciente recibida en un hospital público aproximadamente seis meses posteriores a las primeras manifestaciones de una lesión pigmentada en mucosa maxilar, que luego de confirmado el diagnóstico de una lesión maligna fue derivada y manejada por un equipo oncológico del mismo centro.

ABSTRACT: Pigmented malignant oral mucosa lesions are infrequent, but with high rates of morbidity and mortality, and have a poor prognosis despite aggressive treatments that can combine large surgical resection with chemotherapy and radiotherapy. Given this scenario, the clinical conduct associated with pigmented lesions is the immediate biopsy to confirm or rule out the disease and thus the early initiation of treatment. This article is about a patient attended in a public hospital about six months after the first signs of an injury to maxillary mucosa, which then confirmed the diagnosis of a malignant lesion, who was referred and treated by a cancer team of the same center.