Análise da imuno expressão das proteínas IL-17, IL-23 E RORγt na patogenia da doença periodontal

Periodontal disease is a chronic inflammatory condition primarily caused by bacteria in dental biofilm, which interact with the host, thus determining the nature of the resulting disease. Despite the wide knowledge about the pathogenesis of these diseases, the exact composition of the T cell profile during the active phase of the disease (Th1, Th2 or Th17) remains unknown. This study aimed to evaluate by immunohistochemical expression, the presence of the markers (IL-17, IL-23 and RORγt), involved in Th17 response in clinically healthy gingiva cases (n = 32), biofilm-induced gingivitis (n = 30), chronic periodontitis (n = 32) and aggressive periodontitis (n = 25), in order to analyze if the expression and/or distribution of these molecules in lymphocytes and macrophages, present in the inflammatory infiltrate of periodontal tissue, influences the tissue destruction observed in these diseases. The morphological analysis of cases was performed which assessed the intensity of the inflammatory infiltrate in mild, moderate and intense. For each case, in the area with the most representative immunostaining, 5 fields were chosen and analyzed, both for the intensity of the inflammatory infiltrate as for the quantity of immunostained cells, based on predetermined scores: score 0 (absence of inflammatory infiltrate/immunostaining), score 1 (the infiltrate/immunostaining covered less than 25% of the field area), score 2 (the infiltrate/immunostaining occupied between 25 and 50%) and score 3 (infiltrate/immunostaining present in over 50% of the field area). From this, a median was generated representing each case. The intensity of the inflammatory infiltrate correlated with the disease progression, in other words, it was crescent from clinically healthy gingiva to aggressive periodontitis (P <0.001). It was detected the presence of IL-17, IL-23 and RORγt in most of the evaluated cases and the number of immunostained cells correlated with the intensity of the inflammatory infiltrate (P <0.001) and with the clinical parameters analyzed (P <0.001), showing a positive correlation, mainly moderate. Aggressive periodontitis showed a higher percentage of immunostaining for all markers in relation to other clinical conditions assessed, suggesting a possible association of these markers with the progression of this disease, in which the higher the loss of periodontal support, the greater the amount of inflammatory infiltrate and larger the number of immunostained cells.

Epítese gengival removível: alternativa estética e de rápida resolução para repor tecidos periodontais anteriores

The gingiva, part of the masticatory mucosa tissue that covers the alveolar process and surrounds the cervical portion of teeth, has a definitive shape and texture associated with the eruption of teeth. Therefore, it must be included in rehabilitative planning, as the absence of papillae induces problems with esthetics, phonetics and food-impaction. The purpose of the present study was to approach the indications, limitations and techniques for making a removable artificial gingiva made of acrylic resin, by reporting on a clinical case. The patient, a 29-year-old woman, with the sequelae of periodontal disease, presented loss of interdental papilla causing “black holes”. She was dissatisfied with the esthetic appearance of her teeth, and also complained of long teeth and air escaping when she spoke. As treatment, prosthetic reconstruction was proposed, by means of a removable artificial gingiva (gingival epithesis) to simulate the presence of interdental papillae, providing better esthetics and phonetics. Gingival epithesis is an easily made, inserted and hygienically cleaned appliance that provides a simple and safe alternative solution for cases in which surgical techniques are limited.

Epítese gengival removível: alternativa estética e de rápida resolução para repor tecidos periodontais anteriores

The gingiva, part of the masticatory mucosa tissue that covers the alveolar process and surrounds the cervical portion of teeth, has a definitive shape and texture associated with the eruption of teeth. Therefore, it must be included in rehabilitative planning, as the absence of papillae induces problems with esthetics, phonetics and food-impaction. The purpose of the present study was to approach the indications, limitations and techniques for making a removable artificial gingiva made of acrylic resin, by reporting on a clinical case. The patient, a 29-year-old woman, with the sequelae of periodontal disease, presented loss of interdental papilla causing “black holes”. She was dissatisfied with the esthetic appearance of her teeth, and also complained of long teeth and air escaping when she spoke. As treatment, prosthetic reconstruction was proposed, by means of a removable artificial gingiva (gingival epithesis) to simulate the presence of interdental papillae, providing better esthetics and phonetics. Gingival epithesis is an easily made, inserted and hygienically cleaned appliance that provides a simple and safe alternative solution for cases in which surgical techniques are limited.

Estudo imunoistoquímico do CD34 e podoplanina na doença periodontal

Angiogenesis and lymphangiogenesis are changes that occur due to gingival inflammation caused by microorganisms present in the biofilm, as well as the migration of immune cells and secretion of mediators in the aggressed site. This study aimed to research angiogenesis and lymphangiogenesis in 90 specimens of clinically healthy, with gingivitis and chronic periodontitis gingival tissue biopsies. The histological sections were evaluated by hematoxylin and eosin and the immunohistochemical technique through immunostaining for CD34 and podoplanin. To evaluate the angiogenic and lymphangiogenic indexes we performed a microvessel counting technique. The results showed that there is a correlation between the indexes (p = 0.030), however, we observed that periodontitis showed less lymphatic vessels than clinically healthy gingival tissue (p = 0.016). Podoplanin showed positive staining in the basal layers of the epithelium, and we observed a relationship between immunostaining intensity and the intensity of inflammatory infiltrate, with more intense staining in the presence of severe inflammatory infiltrate (p = 0.033). For this study, we concluded that there are fewer blood vessels in periodontitis compared with clinically healthy gingiva. The signaling present in the inflammatory process and the actual role of gingival blood and lymphatic vasculature are not fully understood, with further studies on angiogenesis and lymphangiogenesis being suggested.

Estudo imunoistoquímico do CD34 e podoplanina na doença periodontal

Angiogenesis and lymphangiogenesis are changes that occur due to gingival inflammation caused by microorganisms present in the biofilm, as well as the migration of immune cells and secretion of mediators in the aggressed site. This study aimed to research angiogenesis and lymphangiogenesis in 90 specimens of clinically healthy, with gingivitis and chronic periodontitis gingival tissue biopsies. The histological sections were evaluated by hematoxylin and eosin and the immunohistochemical technique through immunostaining for CD34 and podoplanin. To evaluate the angiogenic and lymphangiogenic indexes we performed a microvessel counting technique. The results showed that there is a correlation between the indexes (p = 0.030), however, we observed that periodontitis showed less lymphatic vessels than clinically healthy gingival tissue (p = 0.016). Podoplanin showed positive staining in the basal layers of the epithelium, and we observed a relationship between immunostaining intensity and the intensity of inflammatory infiltrate, with more intense staining in the presence of severe inflammatory infiltrate (p = 0.033). For this study, we concluded that there are fewer blood vessels in periodontitis compared with clinically healthy gingiva. The signaling present in the inflammatory process and the actual role of gingival blood and lymphatic vasculature are not fully understood, with further studies on angiogenesis and lymphangiogenesis being suggested.

Association of the XPD and XRCC3 gene polymorphisms with oral squamous cell carcinoma in a Northeastern Brazilian population: A pilot study

Objective to evaluate the association between XPD and XRCC3 polymorphisms and oral squamous cell carcinoma (OSCC). Design the sample consisted of 54 cases of OSCC and 40 cases of inflammatory fibrous hyperplasia (IFH). Genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results XPD-Lys/Gln was more common in IFH (n = 28; 70%) than in OSCC (n = 24; 44.4%) (OR: 0.3; p < 0.05). XPD-Gln was more frequent in high-grade lesions (0.48) than in low-grade lesions (0.21) (OR: 3.4; p < 0.05). The Gln/Gln genotype was associated with III and IV clinical stages (OR: 0.07; p < 0.05). XRCC3-Met was more frequent in OSCC (0.49) than in IFH (0.35) (OR: 2.6; p < 0.05). The Met/Met genotype was associated with the presence of metastases (OR: 8.1; p < 0.05) and with III and IV clinical stages (OR: 0.07; p < 0.05). Conclusions in this sample, the frequency of XPD-Gln in IFH suggests that this variant may protect against OSCC. The presence of the XRCC3-Met allele seems to contribute to the development of OSCC, metastases and more advanced stages in these lesions.

Association of the XPD and XRCC3 gene polymorphisms with oral squamous cell carcinoma in a Northeastern Brazilian population: A pilot study

Objective to evaluate the association between XPD and XRCC3 polymorphisms and oral squamous cell carcinoma (OSCC). Design the sample consisted of 54 cases of OSCC and 40 cases of inflammatory fibrous hyperplasia (IFH). Genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results XPD-Lys/Gln was more common in IFH (n = 28; 70%) than in OSCC (n = 24; 44.4%) (OR: 0.3; p < 0.05). XPD-Gln was more frequent in high-grade lesions (0.48) than in low-grade lesions (0.21) (OR: 3.4; p < 0.05). The Gln/Gln genotype was associated with III and IV clinical stages (OR: 0.07; p < 0.05). XRCC3-Met was more frequent in OSCC (0.49) than in IFH (0.35) (OR: 2.6; p < 0.05). The Met/Met genotype was associated with the presence of metastases (OR: 8.1; p < 0.05) and with III and IV clinical stages (OR: 0.07; p < 0.05). Conclusions in this sample, the frequency of XPD-Gln in IFH suggests that this variant may protect against OSCC. The presence of the XRCC3-Met allele seems to contribute to the development of OSCC, metastases and more advanced stages in these lesions.

Cardiomyopathy in Offspring of Pregestational Diabetic Mouse Pregnancy

PURPOSE: To investigate cardiomyopathy in offspring in a mouse model of pregestational type 1 diabetic pregnancy.

METHODS: Pregestational diabetes was induced with STZ administration in female C57BL6/J mice that were subsequently mated with healthy C57BL6/J males. Offspring were sacrificed at embryonic day 18.5 and 6-week adolescent and 12-week adult stages. The size and number of cardiomyocyte nuclei and also the extent of collagen deposition within the hearts of diabetic and control offspring were assessed following cardiac tissue staining with either haematoxylin and eosin or Picrosirius red and subsequently quantified using automated digital image analysis.

RESULTS: Offspring from diabetic mice at embryonic day 18.5 had a significantly higher number of cardiomyocyte nuclei present compared to controls. These nuclei were also significantly smaller than controls. Collagen deposition was shown to be significantly increased in the hearts of diabetic offspring at the same age. No significant differences were found between the groups at 6 and 12 weeks.

CONCLUSIONS: Our results from offspring of type 1 diabetic mice show increased myocardial collagen deposition in late gestation and have increased myocardial nuclear counts (hyperplasia) as opposed to increased myocardial nuclear size (hypertrophy) in late gestation. These changes normalize postpartum after removal from the maternal intrauterine environment.

Role of NleH, a type III secreted effector from attaching and effacing pathogens, in colonization of the bovine, ovine, and murine gut

The human pathogen enterohemorrhagic Escherichia coli (EHEC) O157:H7 colonizes human and animal gut via formation of attaching and effacing lesions. EHEC strains use a type III secretion system to translocate a battery of effector proteins into the mammalian host cell, which subvert diverse signal transduction pathways implicated in actin dynamics, phagocytosis, and innate immunity. The genomes of sequenced EHEC O157:H7 strains contain two copies of the effector protein gene nleH, which share 49% sequence similarity with the gene for the Shigella effector OspG, recently implicated in inhibition of migration of the transcriptional regulator NF-kappaB to the nucleus. In this study we investigated the role of NleH during EHEC O157:H7 infection of calves and lambs. We found that while EHEC DeltanleH colonized the bovine gut more efficiently than the wild-type strain, in lambs the wild-type strain exhibited a competitive advantage over the mutant during mixed infection. Using the mouse pathogen Citrobacter rodentium, which shares many virulence factors with EHEC O157:H7, including NleH, we observed that the wild-type strain exhibited a competitive advantage over the mutant during mixed infection. We found no measurable differences in T-cell infiltration or hyperplasia in colons of mice inoculated with the wild-type or the nleH mutant strain. Using NF-kappaB reporter mice carrying a transgene containing a luciferase reporter driven by three NF-kappaB response elements, we found that NleH causes an increase in NF-kappaB activity in the colonic mucosa. Consistent with this, we found that the nleH mutant triggered a significantly lower tumor necrosis factor alpha response than the wild-type strain.

Effects of Purified Saccharomyces cerevisiae (1→3)-β-Glucan on Venous Ulcer Healing

Water-insoluble glucan was isolated from the baker’s yeast Saccharomyces cerevisiae. The yeast cells were treated with alkali and the residue then with acid. Chemical and NMR (1D and 2D) analyses showed that a linear (1→3)-β-glucan was purified that was not contaminated with other carbohydrates, proteins or phenolic compounds. The effects of the glucan on wound healing were assessed in human venous ulcers by histopathological analysis after 30 days of topical treatment. (1→3)-β-glucan enhanced ulcer healing and increased epithelial hyperplasia, as well as increased inflammatory cells, angiogenesis and fibroblast proliferation. In one patient who had an ulcer that would not heal for over 15 years, glucan treatment caused a 67.8% decrease in the area of the ulcer. This is the first study to investigate the effects of (1→3)-β-glucan on venous ulcer healing in humans; our findings suggest that this glucan is a potential natural biological response modifier in wound healing

Effects of Purified Saccharomyces cerevisiae (1→3)-β-Glucan on Venous Ulcer Healing

Water-insoluble glucan was isolated from the baker’s yeast Saccharomyces cerevisiae. The yeast cells were treated with alkali and the residue then with acid. Chemical and NMR (1D and 2D) analyses showed that a linear (1→3)-β-glucan was purified that was not contaminated with other carbohydrates, proteins or phenolic compounds. The effects of the glucan on wound healing were assessed in human venous ulcers by histopathological analysis after 30 days of topical treatment. (1→3)-β-glucan enhanced ulcer healing and increased epithelial hyperplasia, as well as increased inflammatory cells, angiogenesis and fibroblast proliferation. In one patient who had an ulcer that would not heal for over 15 years, glucan treatment caused a 67.8% decrease in the area of the ulcer. This is the first study to investigate the effects of (1→3)-β-glucan on venous ulcer healing in humans; our findings suggest that this glucan is a potential natural biological response modifier in wound healing

Sinusite maxilar odontogénica

O seio maxilar é o seio paranasal mais susceptível a invasões bacterianas, tanto pelo óstio nasal, como pela cavidade oral. As sinusites maxilares têm como causas mais frequentes, as infecções víricas, rinites alérgicas ou não alérgicas, variações anatómicas, diabetes mellitus, fumar, nadar, mergulhar, escalar a altas atitudes, e as infecções e tratamentos dentários. A pesquisa bibliográfica, foi realizada sem quaisquer limitações temporais, com restrição linguística a Português, Espanhol e Inglês, sendo excluídos os artigos de outros idiomas; em vários livros e revistas, assim como artigos científicos obtidos, entre Maio e Julho de 2015, nos motores de busca Pubmed, ScienceDirect, Scielo, Elsevier e B-on. A sinusite maxilar odontogénica é uma doença infecto-inflamatória, habitualmente associada à ruptura da membrana de Schneider e a processos infecciosos dentários crónicos. Causa hiperplasia e hipertrofia da mucosa, o que origina sinais e sintomas próprios, assim como mudanças radiográficas perceptíveis. Existem diferentes etiologias de causa odontogénica: cárie, doença periodontal, quistos odontogénicos e iatrogenia – tratamento endodôntico não cirúrgico, cirurgia endodôntica, comunicações oro-antrais, implantes dentários, elevação do seio maxilar, cirurgia pré-protética e cirurgia ortognática – sendo que a iatrogenia é a mais comum (cerca de 56%). Esta patologia afecta com mais frequência indivíduos dos 42,7 aos 51, 7 anos, e preferencialmente a região molar, seguida dos pré-molares e em alguns casos, caninos. Os organismos que dominam na fase aguda e crónica, são sensivelmente os mesmos, mas em número diferente, e existe uma conexão entre a flora comensal periapical e a flora patogénica em caso de sinusite maxilar odontogénica. O diagnóstico é essencialmente clínico, no entanto existem diferentes exames complementares para confirmarem ou formarem o diagnóstico. Pela grande acessibilidade ao método radiográfico, torna-se fundamental que o médico dentista saiba diferencial as diversas patologias que afectam o seio maxilar. O tratamento abrange a eliminação da causa dentária e o tratamento farmacológico, da infecção, essencialmente à base de antibióticos, e da dor se esta existir. E o tratamento cirúrgico, que contempla a punção-lavagem sinusal, antrostomia intranasal, técnica de Caldwell-Luc e cirurgia sinusal endoscópica. Concluindo, o médico dentista deve ter um amplo conhecimento sobre esta patologia para que a possa reconhecer, tratar ou preveni-la.

Masson’s tumor: a soft tissue tumor simulating a tendon cyst. Case report

Introduction. Intravascular papillary endothelial hyperplasia (Masson's hemangioma or Masson’s tumor) is a benign vascular disease with an exuberant endothelial proliferation in normal blood vessels. Although relatively uncommon, its correct diagnosis is important because it can clinically be like both benign lesions and malignant neoplasms. We present a case of intravascular proliferative endothelial hyperplasia simulating a tendon cyst both clinically and on ultrasound. Case report. A 74-year old Caucasian female presented with a 4-month history of soreness and swelling in the fourth finger of the right hand. Ultrasound showed an oval mass with fluid content, referred to a tendon cyst. A wide surgical excision was subsequently performed. The final histological diagnosis was Masson’s tumor. Discussion. The pathogenesis of intravascular papillary endothelial hyperplasia is still unclear but the exuberant endothelial cell proliferation might be stimulated by an autocrine loop of endothelial basic fibroblast growth factor (bFGF) secretion. There are three types of papillary endothelial hyperplasia: primary, or intravascular; secondary, or mixed; and extravascular. The main differential diagnosis is against pyogenic granuloma, Kaposi sarcoma, hemangioma, and angiosarcoma. Conclusions. Masson's tumor can be like both benign lesions and malignant neoplasms clinically and on ultrasound. For this reason, the right diagnosis can be made only by histology, which reveals a papillary growth composed of hyperplastic endothelial cells supported by delicate fibrous stalks entirely confined within the vascular lumen.

A aplicação de plasma rico em plaquetas na regeneração dos tecidos periodontais

O periodonto é uma unidade biológica e funcional, constituída pela gengiva, pelo cemento, pelo ligamento periodontal e pelo osso alveolar. O seu processo de cicatrização envolve mecanismos fisiológicos complexos que requerem a ação dos fatores de crescimento, péptidos oriundos da desgranulação das plaquetas. Neste sentido surge o Plasma Rico em Plaquetas como um produto autólogo, obtido a partir da centrifugação do sangue do próprio paciente e que visa melhorar a cicatrização dos tecidos após procedimentos enquadrados na Medicina Dentária. Esta revisão bibliográfica baseou-se numa pesquisa realizada na base de dados MEDLINE, via pubmed. Foram utilizadas as palavras-chave “plasma rich in growth factors”, “platelet-rich plasma”, “oral surgery”, “dental implants”, “sinus lift”, “third molar surgery” e “bone regeneration”. Após leitura de 40 artigos, foram descartados 9 pela sua pouca relevância no contexto. O objetivo é avaliar a efetividade da aplicação de plasma rico em plaquetas na regeneração dos tecidos periodontais em situações clínicas como alvéolos pós-extracionais, cirurgias de implantes, cirurgias de elevação do seio maxilar e na regeneração óssea. A efetividade em tecidos moles parece ser consensual. A efetividade no tecido ósseo é alvo de contradição entre os diversos autores, concluindo-se que há necessidade de mais estudos randomizados e controlados para que se possa responder à questão com evidência científica suficiente.

Ectopic thyroid carcinoma. Case report

Introduction. Ectopic thyroid tissue can be found in many sites, including the tongue, thyroglossal duct, mediastinum, trachea, lung, aorta and abdomen. Ectopic thyroid tissue may also be involved in the same processes as normal, orthotopic thyroid gland. These processes include tumors, inflammation and hyperplasia. The appearance of such tissue in rare locations may lead to diagnostic and therapeutic dilemmas. Case report. We report a rare case of ectopic thyroglossal thyroid carcinoma in a 63-year-old Caucasian male with a normal orthotopic thyroid gland. Conclusion. Although 99% of thyroid cancers develop within the thyroid itself, in rare cases a carcinoma can arise in ectopic thyroid tissue located in the neck or in other areas of the body. Though rare, the possibility of an ectopic thyroid carcinoma must always be considered by the surgeon in cases of a pathological mass in the neck.