Position paper from the IBRA Symposium on Surgery of the Head - The 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012

Background: This is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades.Methods: Using a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used.Results: The consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (> 12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children.Conclusions: The experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Shell beds from the Low Head Member (Polonez Cove Formation, early Oligocene) at King George Island, west Antarctica: new insights on facies analysis, taphonomy and environmental significance

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Necrose Asséptica da cabeça do fêmur

Legg-Calvé-Perthes disease is a non-inflammatory aseptic necrosis of the head of the femur that is found in both young animals and humans before the gap in the femur head closes. In the fields of both human and veterinary medicine the cause of this condition is not known for certain. Various factors have been put forward in the literature as being responsible for the incidence of this condition such as: abnormalities in coagulation, changes in blood flow in the arteries, a septic obstruction in the draining of the epiphysis or the upper parts of the femur, trauma, growth cycle, hyperactivity in a child, genetic influences and dietary factors. Case histories in dogs show that the first stages of the condition progress slowly but that limping or putting weight on the limb worsens at 6 to 8 weeks. Some owners talk about a sharp onset in clinical lameness. Other clinical symptoms may include irritability, loss of appetite and knawing at the hair surrounding the affected hip. In the course of physical examination manipulating the hip joint will cause pain to the animal. The advanced stages of the disease may result in restricted amplitude of movement, muscular atrophy and fracturing. In humans the clinical signs are similar, although progression of the disease is slower so that it can be diagnosed at an earlier stage. In veterinary medicine the diagnosis is, in the main, based on case history, clinical symptoms, physical examination and certain related procedures such as radiography. The various diagnoses include physical trauma and dislocation of the medial patella. In human medicine many people have been correctly diagnosed. Whatsmore, there is a range of related procedures that are virtually not available to veterinary medicine such as magnetic nuclear resonance, that show up necroses with great clarity before radiography and cintilography do, and is considered... (Complete abstract click electronic access below)

Análise de variáveis eletromiográficas e cinemáticas em protocolo incremental de corrida na esteira

Muscle fatigue is described as a cause of injuries among the many related to the running practice. Therefore, the purpose of this study was to analyze the behavior of the amplitude (RMS) and median frequency (MF) of EMG signal of the iliocostalis (CI), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM) biceps femoris (long head) (BFCL), tibialis anterior (TA) and gastrocnemius (lateral) (LNG) from the right lower limb, and the behavior of the parameters of amplitude (AP) and frequency (PF) spent in different percentages of the maximum speed during incremental protocol of treadmill running. 10 volunteers participated in this study, athletes, male, aged between 18 and 30 years with no history of injury in lower limbs and similar anthropometry. The protocol consisted of a treadmill test with initial velocity of 10 km.h-¹ and increments of 1 km.h-¹ each three minutes until volitional exhaustion, without rest interval. Synchronized collections were made of electromyographic and kinematic data. The signals were obtained through an acquisition module of biological signals (Telemyo 900 - Noraxon - USA) and software (Myoresearch - Noraxon - USA) calibrated with a sampling frequency of 1000 Hz, gain 2000 times. The raw data were filtered with a 60Hz notch filter, high pass and low pass 20Hz to 500Hz. To capture the image was used a digital video recorder (model NV-GS320, PANASONIC brand), and for image scanning and kinematic data collection was used the software Peak Motus 9.0 (ViconPeak). To obtain the values of RMS and FM analyzed the last ten passes of each speed through a specific routine (Matlab). To obtain these variables AP (m) and FP (stride I min) were analyzed for the last ten past each speed, using specific software (Peak Motus 9.0). After verification of data normality (Shapiro-Wilk) and homogeneity of the data (Levene), the comparison ...(Complete abstract click electronic access below)

Salivary and serum proteomics in head and neck carcinomas before and after surgery and radiotherapy

Several body fluids have been evaluated as new sources for cancer biomarker discovery. In this context, salivary and serum proteomics seem promising diagnostic and predictive tools for head and neck diseases. In the present study, we performed a proteomic analysis of saliva and serum from patients presenting head and neck squamous cell carcinoma (HNSCC) and compared the results before and after therapy. In saliva of cancer patients, we observed an altered protein profile, including over-expression of PLUNC and zinc-alpha-2-glycoprotein. Both proteins may contribute to control tumor growth and, therefore, represent targets for new analysis. We also detected serotransferrin and a modified transthyretin form with altered levels in serum from patients. Comparing preoperative and postreatment samples, the results showed that the protein profile after treatment reverted to a pattern closer to those observed for controls. These results add information on the role of secreted proteins in the cancer process and emphasize the potential of saliva and serum analysis for diagnosis and monitoring of HNSCC.

Cardiovascular and autonomic alterations in rats with parkinsonism induced by 6-OHDA and treated with L-DOPA

Evaluate the effects caused by L-DOPA on cardiovascular and autonomic parameters in an animal model of Parkinsonism induced by 6-hydroxydopamine (6-OHDA).Adult male Wistar rats were subjected to bilateral microinfusion of 6-OHDA or saline (sham group) in the substantia nigra, and treated by gavage with L-DOPA or water for 7days after surgery. On the 6th day the rats were subjected to femoral artery catheterization for cardiovascular recording. Mean arterial pressure (MAP) and heart rate (HR) were evaluated at baseline and during head up tilt (HUT) protocol. Spectral analysis of cardiovascular variability was performed using the V2.4 CardioSeries software v2.4. The lesion was quantified by dopamine levels in the striatum.Dopamine levels in the striatum were decreased in 6-OHDA rats (sham: 4.79±0.49ng/mg; 6-OHDA: 1.99±0.68ng/mg) and were not recovered by Prolopa treatment. Baseline values of MAP and HR were not different between groups. HUT induced an increase in MAP and HR (ΔMAP: 17±1mmHg, ΔHR: 39±4bpm) that were attenuated in 6-OHDA and in Prolopa treated animals. At baseline, the systolic arterial pressure (SAP) variance was lower in the 6-OHDA and sham Prolopa groups. Spontaneous baroreflex sensitivity was higher at baseline in the 6-OHDA group as compared to all studied groups.Our data suggest that treatment with Prolopa did not interfere with cardiovascular variables at baseline. However, during HUT, the 6-OHDA and Prolopa control animals presented a lower cardiovascular compensation, suggesting a possible autonomic impairment in Parkinsonism induced by 6-OHDA.

PHF21B as a candidate tumor suppressor gene in head and neck squamous cell carcinomas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The effect of simvastatin treatment on bone repair of femoral fracture in animal model

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Interação entre as vias de sinalização de receptores serotoninérgicos e Β-adrenérgicos em artéria femoral de ratos

Fundamento: A doença coronária tem sido amplamente estudada em pesquisas cardiovasculares. No entanto, pacientes com doença arterial periférica (DAP) têm piores resultados em comparação àqueles com doença arterial coronariana. Portanto, os estudos farmacológicos com artéria femoral são altamente relevantes para a melhor compreensão das respostas clínicas e fisiopatológicas da DAP. Objetivo: Avaliar as propriedades farmacológicas dos agentes contráteis e relaxantes na artéria femoral de ratos. Métodos: As curvas de resposta de concentração à fenilefrina contrátil (FC) e à serotonina (5-HT) e os agentes relaxantes isoproterenol (ISO) e forskolina foram obtidos na artéria femoral de ratos isolada. Para as respostas ao relaxamento, os tecidos foram contraídos com FC ou 5-HT. Resultados: A potência de classificação na artéria femoral foi de 5-HT > FC para as respostas contráteis. Em tecidos contraídos com 5-HT, as respostas de relaxamento ao isoproterenol foram praticamente abolidas em comparação aos tecidos contraídos com FC. A forskolina, um estimulante da adenilil ciclase, restaurou parcialmente a resposta de relaxamento ao ISO em tecidos contraídos com 5-HT. Conclusão: Ocorre uma interação entre as vias de sinalização dos receptores β-adrenérgicos e serotoninérgicos na artéria femoral. Além disso, esta pesquisa fornece um novo modelo para estudar as vias de sinalização serotoninérgicas em condições normais e patológicas que podem ajudar a compreender os resultados clínicos na DAP.

Evaluation of the cervical vertebrae maturation index in lateral cephalograms taken in different head positions

The aim of this study was to evaluate if upward or downward head inclination might interfere with determination of the growth stage, using cervical vertebrae maturation index (CVMI), in order to verify the accuracy of such diagnosis when radiographs are taken with errors. Forty-nine patients, 26 females and 23 males, aged 9 to 15 years, were submitted to 3 lateral cephalograms: normal (NHP), with 15° upward head inclination (NHP-Up), and with 15° downward head inclination (NHP-Down). Three examiners evaluated the CVMI on the 147 cephalograms. The agreement among examiners was higher in the evaluation of cephalograms taken in NHP. The weighted Kappa test revealed moderate to substantial agreement between NHP and NHP-Up and between NHP and NHP-Down. There was greater agreement between NHP-Up and NHP-Down. It may be concluded that the evaluation of the CVMI on cephalograms in NHP is different as compared with radiographs taken with inclinations. Both NHP-Up and NHP-Down exhibited greater disagreement in the interpretation among examiners, since the evaluation method was not designed for cephalograms with positioning errors.

Relationship between head and neck cancer therapy and some genetic endpoints

Head and neck cancer (HNC) is the sixth most common human malignancy worldwide. The main forms of treatment for HNC are surgery, radiotherapy (RT) and chemotherapy (CT). However, the choice of therapy depends on the tumor staging and approaches, which are aimed at organ preservation. Because of systemic RT and CT genotoxicity, one of the important side effects is a secondary cancer that can result from the activity of radiation and antineoplastic drugs on healthy cells. Ionizing radiation can affect the DNA, causing single and double-strand breaks, DNA-protein crosslinks and oxidative damage. The severity of radiotoxicity can be directly associated with the radiation dosimetry and the dose-volume differences. Regarding CT, cisplatin is still the standard protocol for the treatment of squamous cell carcinoma, the most common cancer located in the oral cavity. However, simultaneous treatment with cisplatin, bleomycin and 5-fluorouracil or treatment with paclitaxel and cisplatin are also used. These drugs can interact with the DNA, causing DNA crosslinks, double and single-strand breaks and changes in gene expression. Currently, the late effects of therapy have become a recurring problem, mainly due to the increased survival of HNC patients. Herein, we present an update of the systemic activity of RT and CT for HNC, with a focus on their toxicogenetic and toxicogenomic effects.

Norepinephrine responses in rat renal and femoral veins are reinforced by vasoconstrictor prostanoids

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Opportunistic microorganisms in patients with head and neck trauma

The use of antimicrobial agents has facilitated the dissemination of multi-resistant microorganisms, compromising dental and medical treatment. The aim of this study was to evaluate the distribution of different opportunistic microbial species in patients who suffered head and neck trauma, under temporary maintenance in nosocomial environment, particularly intensive care units, on the occurrence of such microorganisms in the oral cavity of the patients. It was selected 38 patients subjected to head and neck traumas. After emergency surgical procedures, clinical samples of saliva, sub and supragingival biofilms and mucosal surfaces were collected at two different moments: just after stabilization of the patient and soon after patients’ release from medical units. The presence of opportunistic and superinfecting microorganisms was evaluated by culture on selective and non-selective media, and the presence of the family Enterobacteriaceae, as well as genera Enterococcus, Pseudomonas, and Staphylococcus was assessed by PCR. It was found that the use of antimicrobials, even for short periods of time was sufficient to facilitate colonization by microorganisms of the families Enterobacteriaceae and Pseudomonadaceae, as well as yeasts and enterococci. These results support the concept that medical and dental teams should make a periodically change of antimicrobials used in treatment protocols in hospital for head and neck trauma patients, in order to minimize dissemination of opportunistic or superinfecting microorganisms.

Femoral Biomechanic and microtomography from male rats submitted to dietary restricition supplemented with sucrose

Food restriction reduces body weight and influence bone mass and also is correlated with bone mineral density (BMD). Mechanisms have been proposed for the loss of BMD after body weight reduction, including reduced energy intake. Growing 8 wk-old Wistar male rats were randomly divided into Control and Calorie restriction associated with sucrose 30% (CRS). These animals were subjected to intermittent food restriction during 8 weeks and had free access to tap water and sucrose30% in distilled water. The rats were euthanized at the end of week 8, blood collected from abdominal aorta artery, femurs cleaned of adherent soft tissues, scanned using dual energy X-ray absorptiometry, structural and material properties determined by three-point bending testing in the mid-diaphyseal region, bone surface tested in a microhardness tester and microstructure was assessed in a microcomputer tomography. In CRS animals body weight decreased significantly relative to the Control animals. There was a clear option for high-sucrose beverage in CRS animals. No difference was observed in biochemical, densitometric and biomechanical analyzes. Results from micro CT showed only significant difference in connectivity of trabecular bone. It has been suggested that rats submitted to food restriction consumed sugar not because of its inherent palatability, but in order to alter their macronutrient balance and animals need to meet energy demands in high-sucrose.