Bristow versus Latarjet in high-demand athletes with anterior shoulder instability: a prospective randomized comparison.

BACKGROUND: Traumatic anterior shoulder instability is a common disease, especially in young athletes. The Latarjet and Bristow techniques are nonanatomical surgeries that involve the transfer of the coracoid process to the anterior border of the glenoid and are indicated in cases at a high risk for recurrence and in the presence of associated bone lesions. Studies have evaluated the recurrence and complications associated with these techniques, but they have important differences, and should not be considered synonymous. The objective of this study was to prospectively compare the Bristow and Latarjet techniques in high-demand athletes. Hypothesis: Bristow and Latarjet techniques lead to similar results. PATIENTS AND METHODS: Thirty-seven athletes (41 shoulders; three athletes underwent bilateral surgery) with anterior recurrent dislocation of the shoulder that was surgically treated using the Bristow or Latarjet technique were prospectively analyzed. The follow-up time was 5 years. The mean age was 26.4 years (range: 16-46 years). In 17 cases (41.5%), the dominant side was not affected. RESULTS: Elevation and external rotation (passive and active) decreased in the early postoperative period and achieved values in the final follow-up similar to those found in the preoperative period. The mean postoperative scores at 5 years were as follows: ASES, 79.1 (range: 66-95); ASORS, 77.8 (range: 60-100); WOSI, 52.6 (range: 18-77); and VAS, 1.88 (range: 0-6). All of the results presented statistical significance. There was a complication rate of 9.75% in the follow-up period. There were no new dislocations after the surgery. Most (75%) of the athletes returned to the sport after the surgery, and there was no correlation between poor results and any of the variables studied. There was a statistically significant difference in passive external rotation in favor of the Latarjet technique four weeks after surgery (P = .01). We also found a statistically significant difference in passive elevation in favor of the Latarjet technique eight weeks after the surgery (P = .04). When we compared the Bristow and Latarjet techniques regarding the ASES, ASORS, and WOSI scores, we found no statistically significant difference. In the comparison regarding whether the athletes returned to sports, we found no statistically significant difference. CONCLUSION: The Bristow and Latarjet techniques lead to good results in athletes with no new dislocation episodes and are suitable for treating patients with anterior recurrent dislocation of the shoulder. The Latarjet technique showed better results in some of the variables studied.

Women with temporomandibular disorders: Untargeted proton nuclear magnetic resonance spectroscopy-based metabolomics of saliva and psychological instruments dataset.

This article introduces the first dataset of 1H- nuclear magnetic resonance - based metabolomic spectroscopy of saliva samples from women with temporomandibular disorders (TMD) of muscular origin. Our data generated a metabolomic profile for TMD of muscular origin. The samples were separated in two groups: Experimental Group (EG) represented by women with TMD who were submitted to a conservative treatment compared with a Control group (CG) of women without TMD. These data also include information about time of onset the pain, measures of pain obtained before and after the treatment by the visual analogic scale. Information about some psychological instruments as pain catrastophizing scale, hospital anxiety and depression, and oral health impact profile-14 were also obtained in the CG and in the EG before submitted to the conservative treatment (EG-pre) and at the end of the treatment (EG-post). Those instruments help differentiate the groups, due to the psychosocial impact that TMD has on their lives perpetuating the physiological imbalance of the stomatognathic system. Raw data are available at: https://data.mendeley.com/datasets/wys5xd2vfg/1. It's published on mendeley, the DOI is DOI:10.17632/wys5xd2vfg.1. The data presented in this article are related to the research article entitled "1H-NMR-Based salivary metabolomics from female with temporomandibular disorders - a pilot study" (Lalue Sanches et al. 2020, https://doi.org/10.1016/j.cca.2020.08.006).

1H-NMR-Based salivary metabolomics from females with temporomandibular disorders - A pilot study.

Although temporomandibular disorder (TMD) is the second most common musculoskeletal disorder in the general population, the disease is multifactorial and presents symptoms common to other conditions which misdiagnosis can lead to treatment failure. In this case-control study, we performed, for the first time, a high-resolution 1H-nuclear magnetic resonance spectroscopy metabolomic analysis of the saliva of 26 women with TMD of muscular origin (experimental group [EG]) at the beginning (EG-pre) and at the end (EG-post) of a conservative treatment, and of 27 normal women (control group [CG]) to identify a metabolic signature for TMD. One-way analysis of variance showed changes in the concentration of phenylacetate, dimethylamine, maltose, acetoin, and isovalerate. Partial least-square discriminant analysis showed that metabolite signals did not overlap in CG X EG-pre and EG-pre X EG-post, but overlapped in CG X EG-post. The area under the receiver operating characteristic curve was 1 in CG X EG-pre (95% CI, 1.000-1.000; p < 0.002), 0.993 in EG-pre X EG-post (95% CI, 0.963-1.000), and 0.832 in CG X EG-post (95% CI, 0.699-0.961). These results suggest that the metabolomic profiles of women with and without TMD differ, while after treatment there is a lower distinction and slight tendency towards overlapping between CG and EG-post compared to pre treatment. We also found that phenylacetate, dimethylamine, maltose, acetoin, and isovalerate are potential biomarkers for TMD of muscular origin.

Expression and distribution of kinin B2 receptor in medulla and spinal cord tissues of Rats treated with capsaicin / Expresión y distribución del receptor B2 de cininas en la médula y tejido medular espinal de ratones tratados con capsaicina

Kinins are vasoactive peptides that promote pain and inflammation, yet centrally believed to participate to cardiovascular defensive reflexes produced by noxious stimuli. These peptides signal through the activation of two transmembrane G-protein-coupled receptors named B1 and B2 receptors (B1R and B2R). The B2R is constitutive in healthy tissues and animals. The aim of the study was to measure the gene and protein expression of B2R kinin receptors in central and peripheral tissues isolated from control rats and rats were pre-treated with capsaicin on the second day of life (50 mg/kg, s.c.) or two weeks prior to sacrifice (125 mg/kg over three days, s.c.). The same treatment with saline was made in control animals. Levels of mRNA for B2R were measured by quantitative RT-PCR and Qualitative while receptor binding sites were measured on tissue sections with the radioligands 125I-HPP-Hoe 140 (B2R). B2R was expressed in all studied tissues (hypothalamus, paratrigeminal nucleus, nucleus of solitary tract, spinal cord, aorta and liver) and treatment capsaicin neonates when compared to controls, did not affect its level of expression. Capsaicin had no significant effect on the expression of B2R in some tissues on binding sites. The synthesis of B2R kinin receptor is not associated with sensory C-fibre and tissues showed no significant difference indicating that B2R was regulated by distinct mechanisms.

Las cininas son péptidos vaso activos que participan de mecanismos de dolor e inflamación, con la promoción de reflejos cardiovasculares defensivos producidos por estímulos nocivos. Estos péptidos señalizan por medio de la activación de dos receptores transmembrana acoplados a proteína G llamados receptores B1 y B2 (B1R y B2R). El B2R es constitutivo en tejidos saludables y en animales. El objetivo de este estudio consistió en tomar las medidas de la expresión del gen y la proteína del receptor B2R de cinina en tejidos centrales y periféricos aislados de ratones control y ratones pre tratados con capsaicina en el segundo día de vida (50 mg/kg, s.c.) o con dos semanas antes del sacrificio (125 mg/kg por tres días, s.c.). El mismo tratamiento fue hecho con solución salina en los animales control. Fueron medidos niveles de mRNA para B2R por RT-PCR en forma cuantitativa y cualitativa, en cuanto los sitios de unión del receptor fueron medidos en secciones de tejido con radioligante 125I-HPP-Hoe 140 (B2R). B2R fue expresado en todos los tejidos estudiados (hipotálamo, núcleo paratrigeminal, núcleo del tracto solitario, médula espinal, aorta e hígado). El tratamiento con capsaicina en ratones neonatos comparados con controles no presentaron afectación del nivel de expresión. Por otro lado, la capsaicina no tuvo efecto significante en la expresión de los sitios de unión de B2R en los tejidos. La síntesis del receptor B2R de cininas no está asociado con fibras C sensoriales así como los tejidos no mostraron diferencias significativas indicando que B2R es regulado por mecanismos distintos.

Retinal Biochemistry, Physiology and Cell Biology.

The vitreous, the vasculature of the retina, macular pigments, phototransduction, retinal pigment epithelium, Bruch's membrane and the extracellular matrix, all play an important role in the normal function of the retina as well as in diseases. Understanding the pathophysiology allows us to target treatment. As ocular angiogenesis, immunity and inflammation are covered elsewhere, those subjects will not be discussed in this chapter.

Temporomandibular disorder: prevalence among hemophiliac patients / Trastorno temporomandibular: prevalencia en pacientes hemofílicos

The objective was to investigate the prevalence of temporomandibular dysfunction ­TMD - in severe and moderate hemophiliac A and B patients and healthy men as control group. Hemophilia complication is chronic arthropathy that results from repeated joint bleeding, leading to limited movement. Limitation of jaw movement is present in patients with TMD. Hemophiliac patients were recruited in the Hemophilia outpatient clinic at Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). The control group was composed of voluntary subjects recruited among medical and dental students of UNIFESP. Both groups were screened for TMD symptoms according to the European Academy of Craniomandibular Disorders questionnaire. The Research Diagnostic Criteria further evaluated those considered positive for TMD. The results showed a similar prevalence of TMD in the hemophiliac group compared to the control group (n= 38, n= 79; p= 0.7). There were no significant differences in severity of sign and symptoms between the groups. In conclusion, patients with hemophilia do not have a higher prevalence of temporomandibular disorders, indicating absence of hemorrhage in temporomandibular joint.

El objetivo fue investigar la prevalencia de trastornos temporomandibulares (TTM) entre pacientes hemofílicos A y B severos y moderados, y hombres sanos como grupo de control. Una complicación de la Hemofilia es la artropatía crónica como resultado de una hemorragia articular a repetición, limitando el movimiento en el tiempo. La limitación del movimiento de la mandíbula está presente en pacientes con TTM. Los pacientes hemofílicos fueron reclutados en la clínica de atención ambulatoria de hemofilia en Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). El grupo control estaba compuesto por sujetos voluntarios reclutados entre los estudiantes de Medicina y Odontología de UNIFESP. Ambos grupos fueron evaluados por síntomas de TTM según cuestionario de trastornos craneomandibulares de la Academia Europea. Los criterios de diagnósticos de investigación evaluados se consideraron positivos para TTM. Los resultados mostraron una prevalencia similar de TTM en el grupo de hemofílicos en comparación con el grupo control (n= 38, n= 79; p= 0,7). No se encontraron diferencias significativas en la gravedad de los signos y síntomas entre los grupos. En conclusión, los pacientes con hemofilia no tienen una mayor prevalencia de trastornos temporomandibulares, indicando la ausencia de hemorragia en la articulación temporomandibular.

Effects of early and late adverse experiences on morpho-quantitative characteristics of Sprague-Dawley rat spleen subjected to stress during adulthood.

Morpho-quantitative studies of the spleen indicate that the proportions of the compartments and sub-compartments are stable in normal conditions. However, disorders due to stress can influence the number and function of the immune cells in this organ. The aim of this study was to determine, through the model of altering the early mother-infant bond and altering the late social bond through isolation, the effect on the morpho-quantitative characteristics of the spleen in adult Sprague-Dawley rats subjected to intermittent chronic stress in adulthood. Twenty-five newborn female rats were used, kept under the standardized lactation and feeding conditions. The rats were assigned randomly to 2 control groups (C1 and C2) and 3 experimental groups, exposed to early (E1), late (E2) or early-late (E3) adverse experiences and then subjected to intermittent chronic stress in adulthood (C2, E1, E2 and E3). The spleen of each animal was isolated and its morphometric characteristics were determined: volume density (Vv) of the red pulp, white pulp, marginal zone, splenic lymph nodule, periarterial lymphatic sheath and germinal center; areal number density (Na), surface density (Sv), number density (Nv), diameter (D) and total number of splenic lymph nodules. The mass of each compartment was also determined. A one-way analysis of variance (ANOVA) and Scheffé's post hoc test were used for the statistical analysis. The p values were considered significant when they were less than 0.05 (*) and very significant at less than 0.025 (**). There were significant differences in the Vv of the red pulp, white pulp and their sub-compartments between the control and experimental groups. The white pulp increased significantly (P = 0.000) in E1, E2 and E3 compared to C1 and C2. The average Na and D values of the splenic lymph nodules were also higher in the experimental groups. The ANOVA for the mass of the spleen and the red pulp revealed no differences between the groups. The mass of the white pulp and its subcompartments was greater in the experimental groups. A higher proportion of white pulp in the experimental groups could be associated with an increase in spleen immune activity, with alterations depending on certain cell subsets. The chronic stress produced morpho-quantitative changes in the rat spleen, and these depended on the animal's history of stress, whether it had been previously stressed or not, with further exposure to stress in adulthood.

Shape and Symmetry of Human Condyle and Mandibular Fossa / Forma y Simetría del Cóndilo Humano y Fosa Mandibular

The aim of the study was to determine and classify the shape of the mandibular fossa and the corresponding condyle in different types, relating them to sex and symmetry, in adult human skulls, from lateral, posterior and superior views. The sample included 50 human skulls from 23 to 82 years old, 32 males and 18 females. The condyle and silicone casting molds of the fossa were photographed to assess shape in the three views. Shapes were classified, validated by intra- and inter-rater analysis and frequency, sex distribution and symmetry verified. Shapes were classified as rounded, angled, flattened and mixed types in the lateral and posterior views; and as biconvex, flat-convex, biflattened and mixed in the superior view. Rounded condyle and fossa were more frequent in the lateral (57% and 66% respectively) and posterior (53% and 83%) views. In the superior view, mixed shape presented higher frequency in condyle (59%) while in fossa the biconvex shape (46%) was most common. There was no significant difference in shape distribution by sex. The same shape (symmetry) or otherwise (non-symmetry) in right and left side condyle and fossa were separately assessed and showed various combinations.

El objetivo del estudio fue determinar y clasificar la forma de la fosa mandibular y cóndilo correspondiente en diferentes tipos, relacionándolos con el sexo y la simetría en cráneos humanos adultos en perspectivas laterales, posteriores y superiores. La muestra incluyó 50 cráneos humanos de 32 hombres y 18 mujeres entre 23 a 82 años. Fueron fotografiados el cóndilo y moldes de silicona de la fosa para evaluar la forma en los tres puntos. Se clasificaron las formas, validadas por el análisis intra e inter-evaluador, la frecuencia, distribución por sexo y simetría verificada. Las formas fueron clasificadas como redondeada, en ángulo, aplanada y mixtas en las vistas lateral y posterior; y como biconvexa, convexo-plana, y mixta en la vista superior. En las vistas laterales el cóndilo y la fosa redondeada fueron más frecuentes (57% y 66%, respectivamente), mientras que en la vista posterior (53% y 83%). En la vista superior, la forma mixta presentó mayor frecuencia en el cóndilo (59%), mientras que en la fosa la forma biconvexa (46%) fue más común. No hubo diferencia significativa en la distribución de laforma por sexo. La misma forma (simétrica o no-simétrica) en el cóndilo lateral derecho e izquierdo y la fosa fueron evaluadas por separado, y se observaron varias combinaciones.

Effects of early and late adverse experiences on morphological characteristics of Sprague-Dawley rat liver subjected to stress during adulthood.

The literature indicates that early rupture of the maternal bond and social isolation are variables involved in social and emotional behaviors and in increase in anxiety, particularly in stressful situations. The liver plays a role in the adaptation to stress, yet the possible morphologic changes that its structure can suffer have been studied very little. Therefore, the aim here was to ascertain, through the model of altering the early mother-infant bond and the late social bond through isolation, the effect on the stereologic characteristics of the liver in adult Sprague-Dawley rats subjected to intermittent chronic stress. Twenty-five newborn female rats were used, distributed into 5 groups, under standardized lactation and feeding conditions. The experimental groups were exposed to early (E1), late (E2), and early-late (E3) adverse experiences and then subjected to intermittent chronic stress in adulthood. The liver of each animal was isolated, and the stereologic characteristics of Nv, Vv, and Sv of the hepatocytes were determined. The results from the experimental groups were significantly higher than those obtained in the control groups. The highest values were found in group E3 (Nv = 4.43 ± 0.89 x 10(5)/mm(3), Vv = 68.74 ± 2.01%, Sv = 68.78 ± 3.77 mm(2)/mm(3)). Considering these results, the hepatic morphology can be affected by exposure to chronic stress; however, when the individuals have been subjected to previous adverse experiences, the changes are more evident.

Bronchial tree architecture in mammals of diverse body mass / Arquitectura del árbol bronquial en mamíferos de diferentes masas corporales

The anatomy of mammal's lung air space constitutes the bronchial tree which disposition is associated to air flux dynamics. Casts obtained from human, pig and rat lungs were studied to analyze possible differences of the bronchial tree architecture in mammals with diverse dimensions and posture. Air spaces were filled with polymers through trachea followed by acid corrosion. Tracheal and main bronchial division's diameters were measured to relate with body mass using allometry. The results revealed a dichotomic bronchial branching pattern in the human casts and a monopodial pattern in animals. In allometric relationship trachea was larger in rats, then pigs and lastly in humans, differences were statistically significant, the same occurs in right bronchus, as in the left bronchus there was no difference between rat and pig. The linear relationship between the human tracheal diameters was 1.2 times larger than the pig and 6.7 times larger than the rat; the pig tracheal diameter was 5.6 times larger than the rat. Quadruped position of the pig and rat is linked to a horizontal air way while the erect position, biped in human, correspond to a vertical air way. A big mammal shows less respiratory frequency than small mammals. Mammals with small, medium and high body mass allied to diverse posture and habits was compared revealing morphological differences in the bronchial trees as different allometric correlations between quadruped animals and human biped.

La anatomía de los espacios aéreos en los pulmones de mamíferos constituyen el árbol bronquial cuya disposición es asociada a la dinámica del flujo aéreo. Moldes obtenidos de los pulmones de humanos, cerdos y ratones fueron estudiados para analizar las posibles diferencias de las arquitecturas de los árboles bronquiales en mamíferos de diferentes dimensiones y posturas. Los espacios aéreos fueran llenados con polímeros por la tráquea y posterior corrosión con ácido. Los diámetros de la tráquea y de las principales divisiones de los bronquios fueron medidos y relacionados con las masas corporales por medio de alometría. Los resultados revelaron uno patrón dicotómico en los moldes de humanos y un patrón monopodial en los animales. La relación alométrica determinço que la tráquea es mayor en los ratones, seguidos de los cerdos y por último en los humanos, las diferencias fueran estadísticamente significativas. Lo mismo ocurrió en el bronquio derecho en cambio en el bronquio izquierdo no hubo diferencia entre el cerdo y el ratón. La relación linear entre los diámetros de la tráquea fue 1,2 mayor en el humano comparada con el cerdo y 6,7 mayor que el ratón, el diámetro de la tráquea del cerdo fue 5,6 mayor que el ratón. La posición cuadrúpede del cerdo y del ratón es vinculada a una vía aérea horizontal en cuanto a que la posición erecta en humanos corresponde a una vía aérea vertical. Los grandes mamíferos muestran menor frecuencia respiratoria que los pequeños mamíferos. Mamíferos con masas corporales pequeñas, medias y grandes con diversas posturas y hábitos fueron comparados mostrando diferencias morfológicas en los árboles bronquiales así como diferentes correlaciones alométricas entre animales cuadrúpedos y humanos bípedos.

The enigma of the mental foramen as it relates to plastic surgery.

The mental foramen position changes because of individual characteristics, and the knowledge of its location is paramount in a number of surgical procedures. This study's goal was to assess its position in relation to dentition and its symmetry in a Brazilian population. One hundred ninety-one dried jaws were divided in 3 groups according to the presence or absence of dentition and bone resorption in the foramen region. Standardized measurements of the distance between the foramen and anatomical references were made to establish its position and symmetry. The majority of the specimens studied belonged to white (74%) male (72%) individuals. The foramen most frequent position, using the teeth as reference, was between the premolars for both sexes (males, 41%; females, 60.3%). Most of the mandibles (56%) did not present symmetry between the right and left sides. Accessory foramina were found in 13.6% of jaws. The most frequent position of the mental foramen was between the premolars (position III of Tebo and Telford [Anat Rec 1950;107:61-66]), and they were predominantly asymmetric. The group with no teeth in the mental foramen area showed a reduction of the distance between the alveolar margin of the jaw and the mental foramen.

Expression of claudin, paxillin and FRA-1 in non-nodular breast lesions in association with microcalcifications.

CONTEXT AND OBJECTIVE: The possible role of adhesion molecules in early breast carcinogenesis has been shown in the literature. We aimed to analyze early adhesion imbalances in non-nodular breast lesions and their association with precursor lesions, in order to ascertain whether these alterations exist and contribute towards early carcinogenesis. DESIGN AND SETTING: Retrospective cross-sectional study based on medical records at a private radiological clinic in São Paulo, Brazil. METHODS: We retrospectively reviewed the medical records of all consecutive women attended between August 2006 and July 2007 who presented mammographic evidence of breast microcalcifications classified as Breast Imaging Reporting and Data System Atlas (BI-RADS) type 4. These women underwent stereotaxic biopsy. Clinical, radiological and pathological data were collected, and immunohistochemical assays searched for claudin, paxillin, FRA-1 and HER-2. RESULTS: Over this period, 127 patients were evaluated. Previous BI-RADS diagnoses showed that 69 cases were in category 4A, 47 in 4B and 11 in 4C. Morphological assessment showed benign entities in 86.5%. Most of the benign lesions showed preserved claudin expression, associated with paxillin (P < 0.001). Paxillin and HER-2 expressions were correlated. FRA-1 expression was also strongly associated with HER-2 expression (P < 0.001). CONCLUSIONS: Although already present in smaller amounts, imbalance of adhesion molecules is not necessarily prevalent in non-nodular breast lesions. Since FRA-1 expression reached statistically significant correlations with radiological and morphological diagnoses and HER-2 status, it may have a predictive role in this setting.

Expression of claudin, paxillin and FRA-1 in non-nodular breast lesions in association with microcalcifications / Expressão de claudina, paxilina e FRA-1 em lesões mamárias não nodulares associadas a microcalcificações

CONTEXT AND OBJECTIVE The possible role of adhesion molecules in early breast carcinogenesis has been shown in the literature. We aimed to analyze early adhesion imbalances in non-nodular breast lesions and their association with precursor lesions, in order to ascertain whether these alterations exist and contribute towards early carcinogenesis. DESIGN AND SETTING Retrospective cross-sectional study based on medical records at a private radiological clinic in São Paulo, Brazil. METHODS We retrospectively reviewed the medical records of all consecutive women attended between August 2006 and July 2007 who presented mammographic evidence of breast microcalcifications classified as Breast Imaging Reporting and Data System Atlas (BI-RADS) type 4. These women underwent stereotaxic biopsy. Clinical, radiological and pathological data were collected, and immunohistochemical assays searched for claudin, paxillin, FRA-1 and HER-2. RESULTS Over this period, 127 patients were evaluated. Previous BI-RADS diagnoses showed that 69 cases were in category 4A, 47 in 4B and 11 in 4C. Morphological assessment showed benign entities in 86.5%. Most of the benign lesions showed preserved claudin expression, associated with paxillin (P < 0.001). Paxillin and HER-2 expressions were correlated. FRA-1 expression was also strongly associated with HER-2 expression (P < 0.001). CONCLUSIONS Although already present in smaller amounts, imbalance of adhesion molecules is not necessarily prevalent in non-nodular breast lesions. Since FRA-1 expression reached statistically significant correlations with radiological and morphological diagnoses and HER-2 status, it may have a predictive role in this setting. .

CONTEXTO E OBJETIVO A literatura tem mostrado a importância de moléculas de adesão na carcinogênese precoce de mama. Objetivamos analisar desequilíbrios precoces de adesão em lesões não nodulares da mama e associação com lesões precursoras, a fim de verificar se essas alterações existem e contribuem com a carcinogênese. TIPO DE ESTUDO E LOCAL Estudo retrospectivo baseado em prontuários médicos, numa clínica radiológica privada em São Paulo, Brasil. MÉTODOS Revisamos retrospectivamente prontuários de todas as mulheres consecutivamente atendidas com evidência mamográfica de microcalcificações mamárias, classificadas como tipo 4 do Breast Imaging Reporting and Data System Atlas (BI-RADS) entre agosto de 2006 e julho de 2007. Elas foram submetidas a biópsia estereotáxica. Dados clínicos, radiológicos e histopatológicos foram coletados e ensaios de imunoistoquímica procuraram por claudina, paxilina, HER-2 e FRA-1. RESULTADOS No período, 127 pacientes foram avaliadas. Diagnósticos de BI-RADS anteriores tinham 69 casos na categoria 4A, 47 em 4B, e 11 em 4C. A avaliação morfológica mostrou entidades benignas em 86,5%. A maioria das lesões benignas mostrou expressão preservada de claudina, associada a paxilina (P < 0,001). Expressões de paxilina e HER-2 foram correlacionadas. Expressão de FRA-1 associou-se à de HER-2 (P < 0,001). CONCLUSÕES Embora já presente em menor quantidade, o desequilíbrio de moléculas de adesão não é necessariamente prevalente em lesões mamárias nodulares e talvez a expressão de FRA-1 possa ter um papel preditivo neste cenário, uma vez que atingiu correlações ...

Laryngeal support device enhances the learning of laryngeal anatomy and voice physiology.

Multidisciplinary cooperation in health care requires a solid knowledge in the basic sciences for a common ground of communication. In speech pathology, these fundamentals improve the accuracy of descriptive diagnoses and support the development of new therapeutic techniques and strategies. The aim of this study is to briefly discuss the benefits of hands-on education on laryngeal anatomy and voice physiology in Brazilian graduate programs in speech pathology, as well as to describe a simple prototype that can be used as a useful educational tool for this purpose. The laryngeal anatomic support device was designed to provide a vertical frame to hold human or mammalian larynges with no preservation treatment, with the goal of allowing good visualization of the vocal folds during artificial phonation. The device was designed to provide the user the ability to manipulate the soft and cartilaginous structures of the larynx with near-natural biomechanical properties. The description of the project is detailed to allow the reproduction of this simple and inexpensive device. It may be used as an experimental feature in a variety of settings, from high-school programs to experimental research methods, and may suit a wide array of different educational models.

Asymmetry of human skull base during growth / Asimetría de la base de cráneo durante el crecimiento

Knowledge about human skull asymmetry in normal dry specimens is useful as a parameter for medical and dentistry practice. Skull base was investigated with the objective to validate the method of indirect measurement with digital pictures and to evaluate the degree of asymmetry from human skull base in different ages. We analyzed 176 normal identified human skulls, divided by age in the following groups: Fetuses, newborn, children and adults. Measures were taken from a central point: pharyngeal tubercle and 4 lateral points: foramen ovale, foramen spinosum, carotid canal and stylomastoid foramen using digital biometry after a comparative validation with directed method performed with caliper. Results were presented as asymmetry indexes and data were expressed as percentage. The digital method presented validity in relation to the direct method with caliper. The skulls in all age groups presented asymmetry. The smallest asymmetry index was 2.6 percent and the largest 6.6 percent. In the literature, there are no patterns for defined values of asymmetry in normal skulls. The asymmetry of the foramina related to midline was verified in the whole sample and was considered as normal corresponding to an average asymmetry index of 4 percent. In this study we also observed that in most of the measures there was prevalence of the right side over the left side.

El conocimiento sobre asimetrías craneales a partir de especímenes secos es de gran utilidad en la determinación de parámetros relevantes para las prácticas médica y odontológica. Se estudió la base del cráneo con el objetivo de validar el método de mediciones indirectas con fotografías digitales y evaluar el grado de asimetría en diferentes edades. Se analizaron 176 cráneos humanos identificados, agrupándolos por edad en fetos, recién nacidos, niños y adultos. Las mediciones fueron realizadas a partir de un punto central: el tubérculo faríngeo y de cuatro puntos laterales: foramen oval, foramen espinoso, canal carotideo y foramen estilomastoideo, usando biometría digital, luego de una validación por criterio concurrente respecto de mediciones directas con caliper. Los resultados son presentados como índices de asimetría y los datos son expresados en porcentajes. El método digital evidencia validez concurrente en relación al método directo con caliper. Los cráneos en todos los grupos étareos presentaron asimetrías. El índice de asimetría menor correspondió a 2,6 por ciento, mientras que el mayor a 6,6 por ciento. En la literatura no se reportan parámetros para definir valores de asimetrías en cráneos normales. La asimetría de la foramina respecto de la línea mediana se verificó en toda la muestra y fue considerada como normal, correspondiendo a un índice de asimetría promedio del 4 por ciento. En este estudio se observó también que en la mayoría de las medidas hubo predominancia del lado derecho sobre el lado izquierdo.

Anatomical study of the pterygospinous and pterygoalar bony bridges and foramens in dried crania and its clinical relevance / Estudio anatómico de los puentes óseos y forámenes pterigoespinoso y pterigoalar en cráneos secos y su relevancia clínica

The ossification of the intrinsic ligaments of the sphenoid bone has been reported in the literature. The presence of bony bridges by ossification of the pterygospinous and pterygoalar ligaments has clinical significance in the infratemporal fossa contents. The purpose of this study is to analyze the prevalence of ossification of these ligaments and assess morphometrically the pterygospinous (Civinini's) and pterygoalar (crotaphitico-buccinatorius) foramens. A total of 312 human skulls from the collection of Universidade Federal de São Paulo (UNIFESP) were used to assess the presence of total or partial ossification in pterygospinous (Types I and II) and pterygoalar (Types III and IV) ligaments. Of the sample, 37.18 percent had some degree of ossification; in Type I, ossification was found in 1.6 percent, while Types II, III and IV had 13.14, 3.84, and 22.43 percent, respectively. The pterygospinous foramen presented an average diameter between 10.626ð7.366 mm, whereas for the pterygoalar foramen it was between 5.202ð3.793 mm. The presence of these formations must be considered in the therapeutic procedures that are performed in the infratemporal region, in assessing pain affecting the territory innervated by the mandibular nerve.

La osificación de los ligamentos intrínsecos del hueso esfenoides ha sido reportada en la literatura. La presencia de puentes óseos por osificación de los ligamentos pterigoespinoso y pterigoalar tiene importancia clínica debido a las relaciones que éstas formaciones establecen con el contenido de la fosa infratemporal. El propósito de este estudio fue analizar la prevalencia de la osificación de estos ligamentos y evaluar morfométricamente los forámenes pterigoespinoso (Cinivini's) y pterigoalar (crotaphitico-buccinatorius). Se utilizaron 312 cráneos humanos de la colección de la UNIFESP, se evaluó la presencia de osificación total o parcial de los ligamentos pterigoespinoso (Tipos I y II) y pterigoalar (Tipos III y IV). Un 37,18 por ciento de la muestra presentó algún grado de osificación, el tipo I se encontró en un 1,6 por ciento por ciento, el tipo II en un 13,14 por ciento, el tipo III en un 3,84 por ciento por ciento y el tipo IV en un 22,43 por ciento. El foramen pterigoespinoso presentó un diámetro medio de entre 10,626 ð 7,366 mm, mientras que para el foramen pterigoalar estuvieron entre 5,202 ð 3,793 mm. La presencia de estas formaciones debe ser considerada en los procedimientos terapéuticos que se realicen en la región infratemporal y en la evaluación de cuadros dolorosos que afectan al territorio inervado por el nervio mandibular.

Tomographic analysis of the interalveolar space and thickness of the vestibular cortical bone in the parasymphyseal region of adult human mandibles.

PURPOSE: The aim of this study was to determine by computed tomography (CT) the interalveolar distance on mandible relative to the canine, first and second pre-molar, and the thickness of the cortical bone in the same region. METHODS: A hundred adult cadaveric dentate human hemi-mandibles were examined. A point (P) above the upper margin of the mental foramen was determined, the height at which monocortical screws are inserted to place miniplate according to the technique to treat mandibular fracture. Then, points A, B and C at the same height as point P, referring to the dental units namely canine, first and second pre-molars were marked to determine the CT cut level to measure cortical bone thickness and the interalveolar distance. RESULTS: The figures showed no statistically significant difference between the sides. The thickness of the vestibular cortical bone was less than 3.0 mm in 96% of the samples. In 91% of the samples the interalveolar distance between canine, first and second pre-molars was greater than 2 mm, a potentially safe condition to insert 2.0-mm diameter monocortical screws at the study points. CONCLUSIONS: The individual actual anatomy of the region where screws are to be inserted above the mental foramen is important to perform the technique safely. We believe that the minimal cortical thickness to obtain sufficient screw anchorage should be studied in order to determine the actually safe shortest screw length. It is important to minimize the risk of tooth root damage or nerve injury and the amount of titanium in the human tissues.

Corneal Reconstruction with Tissue-Engineered Cell Sheets Composed of Human Immature Dental Pulp Stem Cells

To determine the outcome of the use of a tissue-engineered cell sheet composed of human undifferentiated immature dental pulp stem cells (hIDPSC) for ocular surface reconstruction in an animal model of total limbal stem cell deficiency (LSCD). LSCD was induced by the application of 0.5 M NaOH to the right eye of rabbits for 25 seconds (mild chemical burn [MCB]) and for 45 seconds (severe chemical burn [SCB]). After 1 month, a superficial keratectomy was performed to remove the fibrovascular pannus that covered the animals' burned corneas. A tissue-engineered hIDPSC sheet was transplanted onto the corneal bed and then covered with deepithelialized human amniotic membrane (AM). In the respective control groups, the denuded cornea was covered with AM only. After 3 months, a detailed analysis of the rabbit eyes was performed with regard to clinical aspect, histology, electron microscopy, and immunohistochemistry. Corneal transparency of the rabbit eyes that underwent hIDPSC transplantation was improved throughout the follow-up, while the control corneas developed total conjunctivalization and opacification. Rabbits from the MCB group showed clearer corneas with less neovascularization. The clinical data were confirmed by histologic analysis that showed healthy uniform corneal epithelium, especially in the MCB group. The presence of hIDPSC was detected using an anti-hIDPSC antibody. The corneal tissue also showed positive immunostaining with anti-human antibodies. In the control corneas, none of these antigens were detected. Overall, these data showed that transplantation of a tissue-engineered hIDPSC sheet was successful for the reconstruction of corneal epithelium in an animal model of LSCD.

Evaluation of the baudoin condylar index diagnostic test for sex determination / Evaluación de la prueba diagnóstica índice condíleo de baudoin para determinación del sexo

This article analyzes the performance of diagnostic tests for sex determination by examining human skulls, using the Baudoin condylar index. For this study, 215 skulls were examined, and the maximum dimensions (length and width) of the right and left occipital condyles, were noted. With these data, we calculated the Baudoin condylar index and determined the level of agreement between the values for the left and the right side, the sensitivity of the method, the accuracy of the tests and the positive predictive value for each sex. The level of agreement in the diagnosis based on both sides was 65.58 percent (of which 83.09 percent were of women, and 63.88 percent were of men). The overall accuracy was 41.39 percent, and a greater sensitivity was seen in women (52.1 percent right side and 64.78 percent left). The positive predictive value was higher in male skulls (77.6 percent right side, left side 76.68 percent). These results question the usefulness of the Baudoin condylar index for the diagnosis of sex and discuss the usefulness of their applicability in forensic and anthropological practice.

El presente artículo analiza el rendimiento de la prueba diagnóstica para la determinación del sexo en cráneos humanos, del índice condíleo de Baudoin, para ello se analizaron 215 cráneos, determinándose las dimensiones máximas (largo y ancho) de los cóndilos occipitales derecho e izquierdo. Con estos datos se calculó el índice de Baudoin y se determinó el nivel de concordancia entre los lados derecho e izquierdo, la sensibilidad del método, su exactitud, el valor predictivo positivo para cada sexo. El nivel de acuerdo en el diagnóstico a ambos lados fue de 65,58 por ciento (mujeres 83,09 por ciento; hombres 63,88 por ciento), estos valores disminuyeron al analizarse sólo los correctamente diagnosticados. La exactitud general fue 41,39 por ciento con una mayor sensibilidad en mujeres (52,1 por ciento lado derecho; y 64,78 por ciento izquierdo). El valor predictivo positivo fue mayor en cráneos de hombres (77,6 por ciento lado derecho; 76,68 por ciento lado izquierdo). Estos resultados cuestionan la utilidad del índice de Baudoin para el diagnóstico del sexo y discuten su aplicabilidad en la práctica forense y antropológica.

Corneal reconstruction with tissue-engineered cell sheets composed of human immature dental pulp stem cells.

PURPOSE: To determine the outcome of the use of a tissue-engineered cell sheet composed of human undifferentiated immature dental pulp stem cells (hIDPSC) for ocular surface reconstruction in an animal model of total limbal stem cell deficiency (LSCD). METHODS: LSCD was induced by the application of 0.5 M NaOH to the right eye of rabbits for 25 seconds (mild chemical burn [MCB]) and for 45 seconds (severe chemical burn [SCB]). After 1 month, a superficial keratectomy was performed to remove the fibrovascular pannus that covered the animals' burned corneas. A tissue-engineered hIDPSC sheet was transplanted onto the corneal bed and then covered with deepithelialized human amniotic membrane (AM). In the respective control groups, the denuded cornea was covered with AM only. After 3 months, a detailed analysis of the rabbit eyes was performed with regard to clinical aspect, histology, electron microscopy, and immunohistochemistry. RESULTS: Corneal transparency of the rabbit eyes that underwent hIDPSC transplantation was improved throughout the follow-up, while the control corneas developed total conjunctivalization and opacification. Rabbits from the MCB group showed clearer corneas with less neovascularization. The clinical data were confirmed by histologic analysis that showed healthy uniform corneal epithelium, especially in the MCB group. The presence of hIDPSC was detected using an anti-hIDPSC antibody. The corneal tissue also showed positive immunostaining with anti-human antibodies. In the control corneas, none of these antigens were detected. CONCLUSIONS: Overall, these data showed that transplantation of a tissue-engineered hIDPSC sheet was successful for the reconstruction of corneal epithelium in an animal model of LSCD.