Development of low-cost and personalized external silicone breast prosthesis produced by additive manufacturing for women who have undergone mastectomy: A pilot study.

BACKGROUND: The aim of this study was to develop a low-cost and personalized method for external breast prosthesis production. METHODS: The projected light method was used for the acquisition of the 3D geometry of the left breast of a healthy 29-year-old woman, 69 kg and 1.69 m. The 3D modeling software Blender was used to make the prosthesis model and mold with adjustments to the model's mesh, such as smoothing, assigning thickness, and creating the walls of the prosthesis mold. Two counter-molds were created. The pieces were manufactured on the 3D printer Stella Lite 3 using polylactic acid filament. Finally, the silicone was pigmented, and the mold was filled. FINDINGS: Prototype 1 of the prosthesis was produced using a mold without a counter-mold, which resulted in a prosthesis of 495 g, considered heavy compared to traditional prostheses for the same breast size. To solve this issue, a counter-mold with pins was used to produce prototype 2 with a mass of 393 g, 20.6% lighter than prototype 1. Prototype 3 was made with a central-volume counter-mold and presented a mass of 355 g, a reduction of 28.3% compared to prototype 1. The definitive breast prosthesis was made with the pin counter-mold with a different silicone. It has nipple and areola pigmentation and a mass of 294 g, 25.2% lighter than prototype 2. INTERPRETATION: The results suggest that the projected light method and additive manufacturing are potential tools for developing external breast prostheses, which may improve the health conditions and quality of life of mastectomized women.

The effect of bone marrow-derived stem cells associated with platelet-rich plasma on the osseointegration of immediately placed implants.

BACKGROUND: Stem cells associated with growth factors have been shown to improve bone healing and the osseointegration of dental implants. A Brazilian miniature pig model was used to evaluate the effect of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) associated with platelet-rich plasma (PRP) on the osseointegration of immediately placed dental implants. MATERIAL AND METHODS: A total of four male adult miniature pigs were used in this study. BM-MSCs from each pig were isolated from the iliac crest and expanded in vitro. The undifferentiated BM-MSCs were mixed with autologous PRP and implanted in the post-extraction sockets at the experimental sites before implant placement (10 x 106 cells/ socket). The control sites did not receive either BM-MSC or PRP. Each animal received four implants in the control side and 04 on the experimental side, totalizing 32 implants. The specimens were analyzed radiographically and histomorphometrically to determine the implant loss rate (ILR), the bone-implant contact (BIC), and bone density within the threads (BDWT). RESULTS: The ILR, the BIC, and the BDWT for the control and experimental sites were respectively 25.0% and 18.7% (p=0.686); 39.0% and 27.7% (p=0.110); 46.8% and 36.5% (p=0.247). CONCLUSIONS: The use of BM-MSCs + PRP in conjunction with immediately placed implants showed a lower ILR but there was no significant effect on the osseointegration of the dental implants. More preclinical studies, in large animal models, are needed to establish whether BM-MSCs associated with PRP could be used for the enhancement of the osseointegration of dental implants. Key words:Osseointegration, bone marrow-derived mesenchymal stem cells, platelet-rich plasma, dental implants, minipigs.

The interval since first symptoms until diagnosis of squamous cell carcinoma in the head and neck region is still a problem in southern Brazil

BACKGROUND: The aim was to examine the interval since first symptoms until final diagnosis of squamous cell carcinoma (SCC) in the head and neck region in southern Brazil. MATERIAL AND METHODS: The individuals were prospectively selected and underwent anamnesis, physical examination and interview in the first medical consultation at a Cancer Hospital from south of Brazil. RESULTS: From 488 patients who underwent clinical examination, 105 were included in the study with diagnosis of SCC. Patients average interval from first symptoms to final diagnosis was 152 days (median 86; max: 1105; min: 1), the average professional interval was 108 days (median: 97; max: 525; min: 1), and the average total period interval was 258 days (median: 186; max: 1177; min: 45). Factors statistically associated with patient and diagnosis itinerary intervals were smoking and poorly adapted dentures and distance from home to hospital, respectively. CONCLUSIONS: The identification of the itinerary characteristics of this specific population may reflect in more effective public policies, such as primary and secondary prevention programs, aiming to increase the survival of oncological patient. Furthermore, the knowledge of the variables that influence the late diagnosis minimizes patient's journey in search of care to cancer centers through health programs

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Alterações no perfil da microbiota bucal durante permanência na UTI: colonização por patógenos respiratórios potenciais / Changes in the oral microbiota profile during ICU stay: colonization by potential respiratory pathogens / Alteraciones en el perfil de la microbiota bucal durante permanencia en la UTI: colonización por patógenos respiratorios potenciales

Introdução: Pacientes hospitalizados em Unidade de Terapia Intensiva (UTI) geralmente mostram má higiene bucal, o que contribui significativamente para o agravamento da contaminação local, com a presença de patógenos respiratórios potenciais. Objetivo: Caracterizar qualitativamente o perfil da microbiota bucal durante permanência na UTI, além da identificação de alterações bucais e salivares. Materiais e métodos: Foi realizado um estudo prospectivo em pacientes internados na UTI de um hospital oncológico, os quais foram avaliados clínica e microbiologicamente após 24 (T1), 72 (T2) e 120 (T3) horas consecutivas à admissão na UTI. Foram identificados os principais patógenos em cada momento e o perfil da microbiota oral foi comparado. Resultados: A amostra final foi de 30 pacientes, 23 homens e 7 mulheres, com idade média de 61 anos. Em T1, 96,67% dos pacientes apresentaram crescimento de microorganismos patogênicos, sendo identificados 14 tipos diferentes. Em T2 18 tipos de patógenos diferentes e em T3, 21 tipos, dos quais os mais prevalentes nas três coletas foram Staphylococcus não produtor de coagulase e Candida albicans. Clinicamente foram observados presença e progressão do biofilme visível (61%), cálculo (36,89%), condição periodontal deficiente (33,11%). Em relação à condição salivar verificou-se saburra lingual (92,11%), ressecamento labial (86,67%), hipossalivação (36,67%), assialia (52%) e escoamento salivar (8,89%). Conclusão: O biofilme do dorso de língua de pacientes em UTI pode representar um nicho considerável de patógenos respiratórios potenciais, uma vez que microorganismos etiológicos relacionados à pneumonia nosocomial foram isolados já no primeiro dia de internação, com a colonização subsequente por uma variedade de microorganismos predominantemente gram-negativos(AU)

Introduction: Hospitalized patients receiving treatment at Intensive Care Units (ICU) usually show poor oral hygiene, and may have the mouth and oropharingeal region colonized by pathogens involved in nosocomial pneumonia. The presence of these pathogens may increase the risk for respiratory diseases. OBJECTIVES: The aim of this study was to qualitatively characterize the oral microbiota profile of critical patients during ICU stay, besides the identification of oral and salivary alterations. Materials and Methods: A prospective study was carried out on patients admitted to the ICU from a cancer hospital, who were evaluated clinically and microbiologically (tongue-to-mouth swabs) after 24h (T1), 72h (T2) and within 120 consecutive hours (T3) after ICU admission to the ICU. The main pathogens were identified at each moment and the oral microbiota profile was compared. In addition, the major oral and salivary changes were identified. Results: The final sample consisted of 30 patients, 23 men and 7 women, with a mean age of 61 years. The reasons for hospitalization were 30% postoperative of oncological surgeries and 70% of medical emergencies. In T1, 96.67% of the patients presented growth of pathogenic microorganisms, being identified 14 different types. In T2, 18 different pathogen types were identified, and in T3, 21 pathogens, of which the most prevalent Coagulase negative staphylococcus and Candida albicans were the most prevalent in the three collections. It was observed the presence and progression of visible biofilm (61%), calculus (36.89%), poor periodontal condition (33.11%), partial teeth presence (26.67%), total edentulism (23.33%), cavities (10%), presence of residual root (20%). In relation to the salivary condition, there was accumulation of lingual (92.11%), labial dryness (86.67%), hyposalivation (36.67%), asialia (52%) and salivary flow (8.89%). Conclusion: The tongue dorsum biofilm of ICU patients may represent a considerable niche of potential respiratory pathogens, since etiological microorganisms related to nosocomial pneumonia were isolated on the first day of hospitalization, with subsequent colonization by a variety of microorganisms predominantly gram-negatives. The introduction of professional care directed to oral health and biofilm control in this group of patients could represent a significant contribution to the reduction of diseases to the health of the patient in the ICU(AU)

Introducción: Pacientes hospitalizados en UTI generalmente muestran mala higiene bucal, lo que contribuye significativamente al agravamiento de la contaminación local, con la presencia de patógenos respiratorios potenciales. Objetivo: Caracterizar cualitativamente el perfil de la microbiota bucal durante permanencia en la UTI, además de la identificación de alteraciones bucales y salivares. Materiales y métodos: Se realizó un estudio prospectivo en pacientes internados en la UTI de un hospital oncológico, los cuales fueron evaluados clínica y microbiológicamente después de 24 (T1), 72 (T2) y 120 (T3) horas consecutivas a la admisión en la UTI. Se identificaron los principales patógenos en cada momento y el perfil de la microbiota oral fue comparado. Resultados: La muestra final fue de 30 pacientes, 23 hombres y 7 mujeres, con edad media de 61 años. En T1, el 96,67% de los pacientes presentaron crecimiento de microorganismos patógenos, siendo identificados 14 tipos diferentes. En T2 18 tipos de patógenos diferentes y en T3, 21 tipos, de los cuales los más prevalentes en las tres colectas fueron Staphylococcus no productor de coagulasa y Candida albicans. Se observó la presencia y progresión del biofilme visible (61%), cálculo (36,89%), condición periodontal deficiente (33,11%). En cuanto a la condición salivar se verificó saburra lingual (92,11%), resecamiento labial (86,67%), hiposalivación (36,67%), asialia (52%) y flujo salivar (8,89%). Conclusión: El biofilm del dorso de lengua de pacientes en UTI puede representar un nicho considerable de patógenos respiratorios potenciales, ya que microorganismos etiológicos relacionados a la neumonía nosocomial se aislaron ya en el primer día de internación, con la colonización subsecuente por una variedad de microorganismos predominantemente gram-negativa(AU)

Simultaneous Occurrence of Central Giant Cell Granuloma and Odontogenic Keratocyst in Mandible.

Odontogenic keratocysts and central giant cell granulomas are distinct entities of separate origin that may appear simultaneously in the jaw, making them difficult to differentiate. The objectives of this paper are to report a case of a 54-year-old man presenting with a large lesion in the right mandible and to describe the histological characteristics of that lesion. Imaging revealed tumefaction and multilobulation. The case was surgically managed. Histopathological examination revealed that the lesion was a hybrid of an odontogenic keratocyst and a central giant cell granuloma. It remains unclear as to whether this lesion represented a coincidental or related injury. Since both types of lesion involved have a high rate of recurrence, however, long-term follow-up is scheduled.

Bilateral maxillary osteoplasty with esthetic purpose in patient with secondary hyperparathyroidism-related brown tumor: case report

Introduction and Objective: To report a case of a patient with secondary hyperparathyroidism that developed brown tumour in bilateral maxilla surgically managed with bilateral osteoplasty for aesthetic reasons. Case report: A 46 years-old woman patient with chronic kidney disease with complain of a painless bilateral growth on the maxilla, beginning 10 years before that ceased after surgical removal of the parathyroid eight years before. A CT scan showed a diffuse and heterogeneous bone lesion, with lytic areas and increased multilobulated volume on the maxilla, bilaterally. The surgery was an osteoplasty of the maxilla bone and performed under general anaesthesia. At 16-month follow-up, no recurrence was observed and the patient is satisfied with aesthetic and functional results. Conclusion: Secondary hyperparathyroidism related with oral brown tumour is a rare condition that affects function and aesthetic. The case reported in this paper was appropriately managed, achieving patient expectation and improving her life quality.

Tissue repair in osteoradionecrosis using pentoxifylline and tocopherol--report of three cases.

PURPOSE: Osteoradionecrosis is a complication of head and neck radiotherapy, with a difficult resolution and no well-established treatment. The disease progression can cause important loss on patient's quality of life after cancer treatment. The options for treatment are limited and include clinical monitoring, prescription, or surgical procedures. As an alternative for bone necrosis treatment, a combination of drugs, pentoxifylline and tocopherol, can be used. Studies have shown that this combination significantly reduces chronic radiotherapy damage. The article reports successful treatment with this prescription protocol. METHODS: We report three cases of patients referred to the Service of Oral and Maxillofacial Surgery at Erasto Gaertner Hospital, in Curitiba, Brazil. They were submitted to radiotherapy for the treatment of malignant head and neck tumors and later developed osteoradionecrosis. They were treated with the combination pentoxifylline and tocopherol. RESULTS: All patients achieved complete remission in less than 1 year, with complete healing of bone exposure and without clinical symptoms. CONCLUSIONS: This results show that this combination of drugs is beneficial in cases of bone necrosis induced by radiation, avoiding more aggressive treatments and reducing morbidity.

Effect of radiotherapy on osseointegration of dental implants immediately placed in postextraction sites of minipigs mandibles.

INTRODUCTION: The aim of this study was to compare the osseointegration and the survival of dental implants (DIs) immediately placed in postextraction sites, in mandibles of minipigs that underwent radiotherapy (RT). MATERIALS AND METHODS: Twelve Brazilian minipigs were divided into the following groups: A, control; B, implants placement 15 days before RT; C, implants placement 3 months after RT. Implant loss rate (ILR), fibrointegration rate (FIR), bone-implant contact (BIC), and bone density inside the threads (BDIT) were determined in each group 90 days after implantation. RESULTS: ILR was higher in group C (68.7%) than in groups B (28.1%) and A (21.9%), (P = 0.001). FIR was more frequent in group C (30%) than in groups B (21.7%) and A (4%), although not statistically significant. The averages of BIC and BDIT were, respectively, 33.1 and 41.5 in group C; 18.5 and 26.6 in group B; and 11.5 and 16.3 in group A (P = 0.003 for both variables). CONCLUSIONS: RT showed a negative effect in periimplant bone regeneration. The implants placement before RT showed better results compared with the implants performed after RT, suggesting that DIs in head and neck cancer patients must be placed before RT or simultaneously during ablative tumor surgery.

Brazilian minipig as a large-animal model for basic research and stem cell-based tissue engineering. Characterization and in vitro differentiation of bone marrow-derived mesenchymal stem cells.

UNLABELLED: Stem cell-based regenerative medicine is one of the most intensively researched medical issues. Pre-clinical studies in a large-animal model, especially in swine or miniature pigs, are highly relevant to human applications. Mesenchymal stem cells (MSCs) have been isolated and expanded from different sources. OBJECTIVE: This study aimed at isolating and characterizing, for the first time, bone marrow-derived MSCs (BM-MSCs) from a Brazilian minipig (BR1). Also, this aimed to validate a new large-animal model for stem cell-based tissue engineering. MATERIAL AND METHODS: Bone marrow (BM) was aspirated from the posterior iliac crest of twelve adult male BR1 under general anesthesia. MSCs were selected by plastic-adherence as originally described by Friedenstein. Cell morphology, surface marker expression, and cellular differentiation were examined. The immunophenotypic profile was determined by flow cytometry. The differentiation potential was assessed by cytological staining and by RT-PCR. RESULTS: MSCs were present in all minipig BM samples. These cells showed fibroblastic morphology and were positive for the surface markers CD90 (88.6%), CD29 (89.8%), CD44 (86.9%) and negative for CD34 (1.61%), CD45 (1.83%), CD14 (1.77%) and MHC-II (2.69%). MSCs were differentiated into adipocytes, osteoblasts, and chondroblasts as demonstrated by the presence of lipidic-rich vacuoles, the mineralized extracellular matrix, and the great presence of glycosaminoglycans, respectively. The higher gene expression of adipocyte fatty-acid binding protein (AP2), alkaline phosphatase (ALP) and collagen type 2 (COLII) also confirmed the trilineage differentiation (p<0.001, p<0.001, p=0.031; respectively). CONCLUSIONS: The isolation, cultivation, and differentiation of BM-MSCs from BR1 makes this animal eligible as a useful large-animal model for stem cell-based studies in Brazil.

Brazilian minipig as a large-animal model for basic research and stem cell-based tissue engineering. Characterization and in vitro differentiation of bone marrow-derived mesenchymal stem cells

Stem cell-based regenerative medicine is one of the most intensively researched medical issues. Pre-clinical studies in a large-animal model, especially in swine or miniature pigs, are highly relevant to human applications. Mesenchymal stem cells (MSCs) have been isolated and expanded from different sources. Objective: This study aimed at isolating and characterizing, for the first time, bone marrow-derived MSCs (BM-MSCs) from a Brazilian minipig (BR1). Also, this aimed to validate a new large-animal model for stem cell-based tissue engineering. Material and Methods: Bone marrow (BM) was aspirated from the posterior iliac crest of twelve adult male BR1 under general anesthesia. MSCs were selected by plastic-adherence as originally described by Friedenstein. Cell morphology, surface marker expression, and cellular differentiation were examined. The immunophenotypic profile was determined by flow cytometry. The differentiation potential was assessed by cytological staining and by RT-PCR. Results: MSCs were present in all minipig BM samples. These cells showed fibroblastic morphology and were positive for the surface markers CD90 (88.6%), CD29 (89.8%), CD44 (86.9%) and negative for CD34 (1.61%), CD45 (1.83%), CD14 (1.77%) and MHC-II (2.69%). MSCs were differentiated into adipocytes, osteoblasts, and chondroblasts as demonstrated by the presence of lipidic-rich vacuoles, the mineralized extracellular matrix, and the great presence of glycosaminoglycans, respectively. The higher gene expression of adipocyte fatty-acid binding protein (AP2), alkaline phosphatase (ALP) and collagen type 2 (COLII) also confirmed the trilineage differentiation (p<0.001, p<0.001, p=0.031; respectively). Conclusions: The isolation, cultivation, and differentiation of BM-MSCs from BR1 makes this animal eligible as a useful large-animal model for stem cell-based studies in Brazil. .

Oral squamous cell carcinoma in two siblings with Fanconi anemia after allogeneic bone marrow transplantation.

Fanconi Anemia patients are a high risk group for solid and hematologic malignancies. The risk seems to be influenced by age, chronic graft versus host disease and immunosuppressive drug regimens. Reports of oral malignant transformation in Fanconi Anemia after hematopoietic stem cell transplantation (HSCT) are increasing probably because of longer survival rates. This is the report of an 18- and her 28-year old sister who developed a post-HSCT oral squamous cell carcinoma. There were significant differences regarding time to malignant transformation, marrow donor characteristics and graft versus host disease evolution and treatment. The report reinforce the need for a routine head and neck screening for cancer in this particular syndrome and suggest that familial history should also be considered in Fanconi anemia patients at risk for oral malignancy after HSCT.

Effect of fractionated radiotherapy on the parotid gland: an experimental study in brazilian minipigs

INTRODUCTION: Radiotherapy (RT) of head and neck neoplasms often damages the salivary glands. AIM: To examine the pattern of morphologic changes resulting from RT of the head and neck region in minipig parotid glands in a clinical and experimental research setting. METHODS: Twelve 18-month-old male Brazilian minipigs weighing 30-40 kg were selected. Eight minipigs were assigned to the experimental group (group 1) and 4 to the control group (group 2). The RT was performed under general anesthesia at Erasto Gaertner Hospital, Curitiba, Brazil, using an á/â ratio of 2.5. The minipigs from group 1 underwent 3 sessions of irradiation with Cobalt 60 of the head and neck, bilaterally, with 3 exposures of 8 Gy each at 7-day intervals for a total dose of 24 Gy. The animals were sacrificed 12 weeks post-RT. RESULTS: The irradiated parotid glands displayed reductions in the size and number of acini as well as loss of secretory granules. The presence of fibrosis and loss of parenchyma relative to non-irradiated glands were observed, with an average reduction in volume of 54%. CONCLUSIONS: Our results demonstrate that this model for parotid gland damage resulting from an RT regimen appears to be useful for preclinical large animal studies of RT-induced damage and testing novel potential treatment options. Although recent advances in radiation therapy, such as intensity-modulated radiation therapy, have reduced the dose and limited the field of radiation, considerable salivary gland injury still occurs and can greatly impact the patient's quality of life after cancer treatment.

Effect of fractionated radiotherapy on the parotid gland: an experimental study in Brazilian minipigs.

INTRODUCTION: Radiotherapy (RT) of head and neck neoplasms often damages the salivary glands. AIM: To examine the pattern of morphologic changes resulting from RT of the head and neck region in minipig parotid glands in a clinical and experimental research setting. METHODS: Twelve 18-month-old male Brazilian minipigs weighing 30-40 kg were selected. Eight minipigs were assigned to the experimental group (group 1) and 4 to the control group (group 2). The RT was performed under general anesthesia at Erasto Gaertner Hospital, Curitiba, Brazil, using an á/â ratio of 2.5. The minipigs from group 1 underwent 3 sessions of irradiation with Cobalt 60 of the head and neck, bilaterally, with 3 exposures of 8 Gy each at 7-day intervals for a total dose of 24 Gy. The animals were sacrificed 12 weeks post-RT. RESULTS: The irradiated parotid glands displayed reductions in the size and number of acini as well as loss of secretory granules. The presence of fibrosis and loss of parenchyma relative to non-irradiated glands were observed, with an average reduction in volume of 54%. CONCLUSIONS: Our results demonstrate that this model for parotid gland damage resulting from an RT regimen appears to be useful for preclinical large animal studies of RT-induced damage and testing novel potential treatment options. Although recent advances in radiation therapy, such as intensity-modulated radiation therapy, have reduced the dose and limited the field of radiation, considerable salivary gland injury still occurs and can greatly impact the patient's quality of life after cancer treatment.

Lymphoepithelial cysts of oral mucosa: two cases in different regions.

Lymphoepithelial cyst of the oral cavity is a rare cystic lesion that presents as an asymptomatic, well-circumscribed, yellowish small submucosal nodule covered by normal overlying mucosa, usually located in the floor of the mouth or in the ventral or posterolateral surface of the tongue. Histopathological examination reveals a cyst lined by a stratified squamous epithelium surrounded by lymphoid tissue. In this paper, we report two cases of oral lymphoepithelial cyst, one on the anterior floor of the mouth and another on the posterior lateral tongue. In both cases, the patients were women aged approximately 50 years and the lesions were treated by local surgical excision, with no evidence of recurrence after 2 years of follow-up.