Assessment of bone metabolism biomarkers in serum and saliva of cirrhotic patients.

OBJECTIVE: To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs. MATERIALS AND METHODS: Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1ß, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used. RESULTS: Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 ß (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI. CONCLUSION: RANKL, OPG, IL-1ß, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI. CLINICAL RELEVANCE: This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

Differentiation of periapical granuloma from radicular cyst using cone beam computed tomography images texture analysis.

OBJECTIVE: This study aimed to investigate the use of texture analysis for characterization of radicular cysts and periapical granulomas and to assess its efficacy to differentiate between both lesions with histological diagnosis. METHODS: Cone beam computed tomography (CBCT) images were obtained from 19 patients with 25 periapical lesions (14 radicular cysts and 11 periapical granulomas) confirmed by biopsy. Regions of interest were created in the lesions from which 11 texture parameters were calculated. Spearman's correlation analysis was performed and adjusted with Benjamini-Hochberg false discovery rate procedure (FDR <0.005). RESULTS: The texture parameters used to differentiate the lesions were assessed by using a receiver operating characteristic analysis. Five texture parameters were predictive of lesion differentiation for eight positions: angular second moment; sum of squares; sum of average; contrast; correlation. CONCLUSION: Texture analysis of CBCT scans distinguishes radicular cysts from periapical granulomas and can be a promising diagnostic tool for periapical lesions. CLINICAL SIGNIFICANCE: Texture analysis can be used in diagnostic and treatment monitoring to provide supplementary information.

Primary intra-osseous Hybrid Schwannoma-Perineurioma in the mandible.

Benign nerve sheath tumours include perineuriomas, schwannomas and neurofibromas. Hybrid schwannoma-perineurioma represents a cutaneous, subcutaneous or occasionally intra-osseous tumour with schwannian cytomorphology and perineurioma-like architecture consisting of a mixture of both types of cells. These tumours can develop at any age and there is no gender-predilection. Tongue is the most frequently affected site, followed by palate, mouth floor, jugal mucosa, lips and, more rarely, mandible. We present a case of hybrid tumour with schwannoma-perineurioma morphology located on the right mandibular body (intra-osseous) of a 54-year-old female patient. The tumour was symptomatic and evolving for six months. Microscopically, it was encapsulated and highly cellularised, presenting fascicular aspect and exhibiting scant mitotic activity. The tumour consisted of distinct cellular populations involving fusiform cells, cells with wavy and hyperchromatic nucleus or even epithelioid cells. Positive immunostaining for S-100 and epithelial membrane antigen (EMA) was observed. The lesion was completely removed under general anaesthesia, with the patient showing no clinical or radiographic sign of relapse after two-year follow-up. Despite the limited knowledge on the pathogenesis of Hybrid Schwannoma-Perineurioma, these tumours seem to present a non-aggressive biological behaviour. Conservative surgery provides adequate solution without recurrence, even after a long-term follow-up. Key words:Nerve sheath tumours, Schwannoma, Perineurioma, Immunohistochemistry.

Presence of langerhans cells, regulatory T cells (Treg) and mast cells in asymptomatic apical periodontitis.

Asymptomatic Apical Periodontitis is essentially an inflammatory disease of microbial aetiology. Association and function of the cell components involved, or specific inductive factors and growth mediators associated with development, maintenance and resolution of the periapical lesions are still unknown. The objective of this study was to evaluate the concentration of Regulatory T cells (FoxP3+; Treg), Langerhans cells (CD1a+; LC) and mast cells in asymptomatic apical periodontitis. 73 cases were selected: 30 periapical granulomas, 29 radicular cysts and 14 residual cysts. All groups were submitted to morphological analysis for classification of inflammatory infiltrate and thickness of the epithelial lining as well as to immunohistochemical analysis for detection of LC and Treg cells. Toluidine blue staining was used for detecting mast cells. Analysis showed higher mean numbers of LC (8.2 cells/0.2mm2), and Treg cells in radicular cysts (5.910 cells/0.2mm2). As for mast cells, it was found that radicular cysts had a higher mean number of these cells compared to other periapical lesions (12.68 cells/0.2mm2). The association between thickness of the epithelial lining and inflammatory cells showed that the presence of hypertrophic epithelium in radicular cysts presented higher density of LC. The number of LC and Treg cells play an important role in the control of the inflammatory micro-environment in periapical granulomas and radicular cysts, respectively. The presence of mast cells in radicular cysts may be associated with progression of the lesion. Knowledge regarding the inflammatory cell profile is therefore essential for a better understanding of the pathogenesis of asymptomatic periapical periodontitis.

A distinct fibro-osseous lesion of the jaws affecting the maxilla.

The differential diagnosis of fibro-osseous lesions (FOL) presents oral clinician stomatologists with a challenging task because of their similar clinical, radiographic and histopathological behavior that will also hinder the therapeutic planning. Presentation of case to describe the clinical, radiographic and histopathological features of an unusual case of FOL presented by the patient, a Black woman, and the results obtained with the conservative surgical treatment and 3-month follow-up. The presence of cementum in the histopathological analysis of cemento-osseous dysplasias, according to the current literature, is an important factor for the diagnosis of this lesion. Considering the characteristics presented by this particular case, we could suggest another entity that could be named a benign cemento-osseous lesion with adult onset. Some occurrences, as in the present case, do not fit properly into the current World Health Organization classification, thereby generating some doubts concerning the correct management of these patients. Conservative surgical treatment is the first choice in the management of these lesions due to their self-limiting nature, which show a behavior of clinical involution.

Presence of langerhans cells, regulatory T cells (Treg) and mast cells in asymptomatic apical periodontitis

Abstract Asymptomatic Apical Periodontitis is essentially an inflammatory disease of microbial aetiology. Association and function of the cell components involved, or specific inductive factors and growth mediators associated with development, maintenance and resolution of the periapical lesions are still unknown. The objective of this study was to evaluate the concentration of Regulatory T cells (FoxP3+; Treg), Langerhans cells (CD1a+; LC) and mast cells in asymptomatic apical periodontitis. 73 cases were selected: 30 periapical granulomas, 29 radicular cysts and 14 residual cysts. All groups were submitted to morphological analysis for classification of inflammatory infiltrate and thickness of the epithelial lining as well as to immunohistochemical analysis for detection of LC and Treg cells. Toluidine blue staining was used for detecting mast cells. Analysis showed higher mean numbers of LC (8.2 cells/0.2mm2), and Treg cells in radicular cysts (5.910 cells/0.2mm2). As for mast cells, it was found that radicular cysts had a higher mean number of these cells compared to other periapical lesions (12.68 cells/0.2mm2). The association between thickness of the epithelial lining and inflammatory cells showed that the presence of hypertrophic epithelium in radicular cysts presented higher density of LC. The number of LC and Treg cells play an important role in the control of the inflammatory micro-environment in periapical granulomas and radicular cysts, respectively. The presence of mast cells in radicular cysts may be associated with progression of the lesion. Knowledge regarding the inflammatory cell profile is therefore essential for a better understanding of the pathogenesis of asymptomatic periapical periodontitis.

Inflammatory profile of chronic apical periodontitis: a literature review.

Apical periodontitis caused by root canal infection is the most frequent pathological lesion in the jaws, mainly manifested as periapical granulomas and cysts. Understanding of the formation and progression of apical periodontitis as well as the identification of inflammatory biomarkers can help increase the knowledge of pathogenic mechanisms, improve the diagnosis and provide support for different therapeutic strategies. The objective of the present article is to review inflammatory biomarkers such as cytokines, chemokines, inflammatory cells, neuropeptides, RANK/RANKL/OPG system and other inflammatory markers and to relate these systems to the development and progression of pathological conditions related to apical periodontitis.

Hyperbaric Oxygen therapy effects on bone regeneration in Type 1 diabetes mellitus in rats.

PURPOSE: The aim of this study was evaluate the effect of HBO on diabetic rats. MATERIALS AND METHODS: Twenty rats were distributed into four groups (n = 5): Control (C); Control + HBO (CH); Diabetes (D) and Diabetes + HBO (DH). Diabetes was induced by streptozotocin, and bone defects were created in both femurs in all animals. HBO therapy began immediately after surgery and was performed daily in the CH and DH groups. After 7 days, the animals were euthanized. The femurs were removed, demineralized, embedded in paraffin, and histologic images were analyzed. RESULTS: Qualitative histologic analyses showed more advanced stage bone regeneration in control groups (C and CH) compared with diabetic groups (D and DH). Histomorphometric analysis showed significantly increased bone neoformation in CH compared with the other groups (p < 0.001). Diabetic Group (D) showed decreased bone neoformation compared with non-diabetic groups (C and CH) (p < 0.001); however DH did not differ from C Group (p > 0.05). The mast cell population increased in CH compared with the other groups (C, D, and DH) (p < 0.05). The mast cell population did not differ between D and DH Groups. CONCLUSIONS: This study showed that HBO therapy improved early bone regeneration in diabetic rats and increased the mast cell population only in non-diabetic animals. HBO was shown to be important treatment for minimizing deleterious effects of diabetes on bone regeneration.

Análise da concentração de células dendríticas, linfócitos T reguladores e mastócitos em lesões periapicais crônicas / Analysis of Dendritic Cells, T Regulatory Lymphocytes and Mastocytes Concentration in Chronic Apical Periodontitis

As lesões periapicais crônicas estão entre as mais frequentes do complexo maxilofacial, porém o perfil inflamatório dessas lesões é pouco compreendido, tanto do ponto de vista da caracterização celular como da expressão de citocinas. Cistos e granulomas periapicais compõem dois terços dessas lesões inflamatórias em região de mandíbula, onde são mais frequentes. O presente estudo propôs-se a estudar e avaliar a expressão imuno-histoquímica de CD1a+ (marcador de células dendríticas imaturas) e de FoxP3+ (marcador de linfócitos T reguladores) e verificar a presença de mastócitos em granulomas periapicais, cistos radiculares e residuais. Foram selecionados 73 casos, sendo 30 de granulomas periapicais, 29 de cistos radiculares e 14 de cistos residuais, dos arquivos do Serviço de Patologia Cirúrgica Oral e Maxilofacial do Departamento de Estomatologia da Faculdade de Odontologia da Universidade de São Paulo. Todos os grupos foram submetidos a análise morfológica, para classificação do infiltrado inflamatório e espessura epitelial, análise imuno-histoquímica, para detecção e contagem de células dendríticas e linfócitos T reguladores e coloração com azul de toluidina para contagem de mastócitos nas lesões periapicais crônicas. A análise morfológica revelou que a presença de infiltrado inflamatório grau I foi mais comum nos cistos periapicais. A gradação II e III foi mais comumente encontrada em cistos radiculares e granulomas periapicais. A avaliação da espessura epitelial mostrou que os epitélios atrófico e hipertrófico se apresentaram majoritariamente em cistos radiculares. Não houve diferenças estatisticamente significantes em relação ao infiltrado inflamatório e espessura epitelial nas lesões periapicais crônicas estudadas (p>0,05). A avaliação da contagem do número de células dendríticas (CD1a+) apresentou um valor médio maior em cistos radiculares (8,16 células/0,2mm2) (p<0,001) e o número médio de linfócitos T reguladores (FoxP3+) também foi maior em cistos radiculares (5,910 células/0,2mm2) (p<0,05). Na avaliação do número de mastócitos, os cistos radiculares apresentaram maior número médio dessas células do que as outras lesões periapicais (12.68 células/0,2mm2) (p<0,001). A avaliação da correlação entre infiltrado inflamatório e imunomarcação mostrou que houve diferença estatisticamente significante na correlação entre infiltrado inflamatório e células CD1a+ em granulomas periapicais (p<0,001). A medida que a gradação do infiltrado inflamatório aumentou, o número células CD1a+ diminuiu. E a correlação entre espessura epitelial e imunomarcação das células mostrou que a presença de epitélio hipertrófico em cistos radiculares apresentou maior densidade de células CD1a+. Não houve correlação estatisticamente significante da presença de linfócitos Treg e a gradação do infiltrado inflamatório nem da espessura epitelial. Todos esses resultados foram estatisticamente significativos (p<0,05). A concentração de células dendríticas imaturas e linfócitos T reguladores desempenham um papel importante no controle do microambiente inflamatório nos granulomas periapicais e cistos radiculares, respectivamente. A presença de mastócitos nos cistos radiculares pode estar associada à progressão, expansão da lesão e reabsorção óssea.