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Non-secretory multiple myeloma (NSMM) is a rare cancer of plasma cells characterized by the absence of detectable monoclonal M protein in the blood or urine. A 57-year-old woman presented with mandibular pain but without intraoral swelling. Imaging studies revealed multiple osteolytic lesions in her mandible and pronounced root resorption of the left mandibular second molar. Biopsy results showed atypical plasmacytoid cells positive for anti-kappa, CD138, MUM1, and CD79a antibodies, but negative for anti-lambda and CD20. These results were indicative of a malignant plasma cell neoplasm. No abnormalities were revealed by free light chain assay or by serum or urine protein electrophoresis, leading to a diagnosis of NSMM. The patient began chemotherapy in conjunction with bisphosphonate therapy and achieved remission following treatment. This case underscores the critical role of dentists in the early detection and prevention of NSMM complications, as the disease can initially present in the oral cavity.
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Background: To evaluate the influence of chemotherapy on the prevalence of trismus in irradiated head and neck cancer patients. Material and Methods: This systematic review guided by PRISMA-2020 and registered in PROSPERO (CRD42021255377) screened 963 articles in 7 scientific-databases (PubMed, Lilacs, Livivo, Scopus, Embase, Web of Science, EBSCO) and 3 grey-literature databases (Open Grey, Google Scholar, ProQuest) and eight articles were included for qualitative synthesis, meta-analysis (combined odds ratio, inverse variance method plus random effects), heterogeneity analysis (I² and Tau²), one-of-out evaluation and publication bias analysis (Eggs' and Begg's tests) (RevMan®, p<0.05). The Newcastle-Ottawa Quality Assessment Scale Cohort Studies was used to assess the risk of bias (RoB). The classification assessment, development, and recommendations (GRADE) approach was used to assess the certainty of evidence. Results: The eight articles evaluated 1474 patients treated with chemoradiotherapy and 858 patients treated with radiotherapy. Five articles had low RoB, and three had high RoB. Chemoradiotherapy significantly (p=0.0003) increased the prevalence of trismus (OR=2.55, 95% CI = 1.53-4.23) compared to radiotherapy, with significant (p=0.010) but low heterogeneity (I²=59%;Tau²=0.29). There was no significant risk of publication bias, one-out analysis showed no significant difference between studies, and GRADE showed a moderate level of evidence. Trismus was directly associated to worse quality of life. Conclusions: The incidence of trismus increases when chemotherapy is combined with radiotherapy for head and neck cancer, which negatively impacts the quality of life. Key words:Radiotherapy, Chemoradiotherapy, Head and Neck Neoplasms, Trismus, Quality of Life.
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BACKGROUND: To evaluate the presence of myofibroblasts (MFs) in the development of lip carcinogenesis, through the correlation of clinical, histomorphometric and immunohistochemical parameters, in actinic cheilitis (ACs) and lower lip squamous cell carcinomas (LLSCCs). METHODS: Samples of ACs, LLSCCs, and control group (CG) were prepared by tissue microarray (TMA) for immunohistochemical TGF-ß, α-SMA, and Ki-67 and histochemical hematoxylin and eosin, picrosirius red, and verhoeff van gieson reactions. Clinical and microscopic data were associated using the Mann-Whitney, Kruskal-Wallis/Dunn, and Spearman correlation tests (SPSS, p < 0.05). RESULTS: ACs showed higher number of α-SMA+ MFs when compared to CG (p = 0.034), and these cells were associated with the vertical expansion of solar elastosis (SE) itself (p = 0.027). Areas of SE had lower deposits of collagen (p < 0.001), immunostaining for TGF-ß (p < 0.001), and higher density of elastic fibers (p < 0.05) when compared to areas without SE. A positive correlation was observed between high-risk epithelial dysplasia (ED) and the proximity of SE to the dysplastic epithelium (p = 0.027). LLSCCs showed a higher number of α-SMA+ MFs about CG (p = 0.034), as well as a reduction in the deposition of total collagen (p = 0.009) in relation to ACs and CG. There was also a negative correlation between the amount of α-SMA+ cells and the accumulation of total collagen (p = 0.041). Collagen and elastic density loss was higher in larger tumors (p = 0.045) with nodal invasion (p = 0.047). CONCLUSIONS: Our findings show the possible role of MFs, collagen fibers, and elastosis areas in the lip carcinogenesis process.
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Carcinoma de Células Escamosas , Queilite , Matriz Extracelular , Neoplasias Labiais , Miofibroblastos , Humanos , Queilite/patologia , Queilite/metabolismo , Neoplasias Labiais/patologia , Neoplasias Labiais/metabolismo , Miofibroblastos/patologia , Carcinoma de Células Escamosas/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Matriz Extracelular/patologia , Idoso , Fator de Crescimento Transformador beta , Adulto , Actinas , Imuno-Histoquímica , Antígeno Ki-67 , Colágeno , Tecido Elástico/patologiaRESUMO
This study aimed to investigate the anti-inflammatory and wound healing effects of the polysaccharide extract from Opuntia ficus-indica cladodes (TPL-Ofi) using a rat cutaneous wound model. After anaesthesia, four 7-mm-diameter dorsal wounds per animal (n = 6/group for each experimental day of evaluation) were created in female Wistar rats using a surgical punch. The animals were treated topically twice daily with TPL-Ofi (0.01-1%; treated group) or sterile saline (control group) for a period of 21 days. Ulcerated tissue was collected for analysis of histological parameters (inflammation score, number of polymorphonuclear, mononuclear, fibroblast/myofibroblasts and blood vessels), immunohistochemical (fibroblast growth factor 2 [FGF-2]) and oxidative stress markers (myeloperoxidase [MPO] and glutathione [GSH]). After 21 days of treatment, body weight, net organ weight and plasma biochemical levels were measured. TPL-Ofi, containing a total carbohydrate content of 65.5% and uronic acid at 2.8%, reduced oedema on the second day and increased the nociceptive threshold on the second and third days. TPL-Ofi reduced mononuclear infiltrate on the second and MPO activity on the fifth day. TPL-Ofi increased GSH levels on the second day, as well as fibroblast/myofibroblasts counts, neoangiogenesis and FGF-2 levels on the fifth and seventh days. No changes were observed in body weight, net organ weight or toxicology assessment. Topical application of TPL-Ofi exhibited anti-inflammatory and antinociceptive effects, ultimately improving wound healing in cutaneous wounds.
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Opuntia , Ratos , Feminino , Animais , Ratos Wistar , Opuntia/química , Fator 2 de Crescimento de Fibroblastos/farmacologia , Cicatrização , Anti-Inflamatórios/farmacologia , Peso Corporal , Extratos Vegetais/farmacologiaRESUMO
INTRODUCTION: Bisphosphonate (BF) therapy is strongly related to the occurrence of medication-related osteonecrosis of the jaw (ONJ). However, no previous study has evaluated if there are sex-related differences on the ONJ establishment together with bone biomechanical alterations, and if they could have a synergy with the ZA treatment. MATERIALS AND METHODS: This study aimed to analyze the physicochemical properties of mineralized tissues in a zoledronate (ZA)-related osteonecrosis mouse model, by a 2 × 2-factorial design, considering sex (female/male) and treatment (ZA/Saline) factors (n = 8/group). After three ZA (1.0 mg/kg) or saline administrations (days 0, 7, 14), the lower left second molar was extracted (day 42). Further ZA administration (day 49) and euthanasia (day 70) were conducted. After confirmation of ZA-induced jaw necrosis (histologic and microtomographic analysis), spectroscopic and mechanical parameters were assessed. RESULTS: ZA-treated groups presented lower bone density due to impaired healing of tooth extraction socket. Sex-related alterations were also observed, with lower bone density in females. Regarding biomechanical parameters, sex and treatment exerted independent influences. ZA, although decreasing flexural modulus and yield stress, increases stiffness mainly due to a higher bone volume. Females show less resistance to higher loads compared to males (considering dimension-independent parameters). Additionally, ZA increases crystallinity in bone and dental structure (p < 0.05). In summary, although strongly related to osteonecrosis occurrence, ZA modifies bone and dental mineral matrix, improving bone mechanical properties. CONCLUSION: Despite sex-dependent differences in bone biomechanics and density, osteonecrosis was established with no sex influence. No synergistic association between sex and treatment factors was observed in this study.
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Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Camundongos , Animais , Masculino , Feminino , Ácido Zoledrônico/farmacologia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Difosfonatos/efeitos adversos , Alvéolo Dental , Densidade Óssea , Conservadores da Densidade Óssea/efeitos adversosRESUMO
OBJECTIVE: To evaluate the healing potential of Nile tilapia skin collagen using a rat model with experimentally induced traumatic oral ulcers. DESIGN: Male Wistar rats were segregated into three experimental groups (n = 8/group/euthanasia day). Ulcers were induced using a dermatological punch on the left buccal mucosa. The rats were then euthanized on days 1, 5, 10, 15, and 20 (ntotal=120 rats). Each group received topical treatment, 2x/day, with 1 % Nile tilapia skin collagen orabase (experimental group), only orabase (negative control), or Oncilom-A® orabase (positive control). Ulcer area, closure percentage, and body mass variation were measured. Slides were prepared for histological analysis, which included Picrosirius red staining (collagen analysis), and immunohistochemistry (platelet endothelial cell adhesion molecule, alpha-smooth muscle actin, and transforming growth factor-beta). RESULTS: On day 15, the experimental and positive control groups displayed smaller ulcer areas, a higher percentage of closure, complete re-epithelialization, superior histological repair scores, and a reduced count of polymorphonuclear cells in comparison to the negative control group (p < 0.05). Additionally, the experimental group exhibited an increased number of blood vessels, total collagen (types I and III) and expression of platelet endothelial cell adhesion molecule, alpha-smooth muscle actin, and transforming growth factor-beta relative to the negative and positive control groups (p < 0.05). By day 20, the experimental group showed a more significant weight gain compared to the other groups (p < 0.0001). CONCLUSIONS: Nile tilapia skin collagen orabase optimizes the healing of traumatic ulcers by stimulating re-epithelialization, angiogenesis, and collagenesis. Transforming growth factor-beta plays a significant role in this process.
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Ciclídeos , Úlceras Orais , Ratos , Masculino , Animais , Cicatrização/fisiologia , Úlcera/metabolismo , Úlceras Orais/tratamento farmacológico , Ratos Wistar , Actinas/metabolismo , Pele , Colágeno/metabolismo , Fatores de Crescimento Transformadores/metabolismo , Moléculas de Adesão Celular/metabolismoRESUMO
BACKGROUND: Opioids are the most effective drugs currently available for cancer pain management. The administration of morphine, in addition to its analgesic effect, can alter tumor development. OBJECTIVE: To characterize the immunoexpression of opioid receptors µ and κ in oropharyngeal squamous cell carcinoma, and correlate it with prognostic factors, proliferation markers, and cell death. MATERIALS AND METHODS: A retrospective, cross-sectional observational study was carried out with 50 patients diagnosed at Haroldo Juaçaba Hospital. Sociodemographic, clinicopathological, and overall survival data were collected, and excisional biopsies were taken for immunohistochemistry using tissue microarrays for opioid receptors µ and κ, Ki-67, and caspase-3. Immunolabeling was evaluated and correlated with other variables using Mann-Whitney, Kruskal-Wallis, Spearman correlation, log-rank (Mantel-Cox), and Cox regression tests. RESULTS: Immunoexpression of opioid receptors µ and κ, Ki-67, and caspase-3 was significantly higher in p16+ and p16- primary tumors and lymph node metastases than in surgical resection margins. The overall survival of patients with p16- tumors was 57.53 ± 8.43 months and that of patients with p16+ tumors was slightly higher at 75.92 ± 11.14 months. Multivariate analysis showed that the expression of opioid receptors µ and κ in the nucleus was directly associated with a lower and higher risk of death, respectively. CONCLUSION: We found increased expression of opioid receptors µ and κ in tumor tissues. The nuclear expression of opioid receptors µ and κ influences overall survival and may be a prognostic factor of oropharyngeal squamous cell carcinoma.
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Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Humanos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Receptores Opioides kappa/metabolismo , Caspase 3 , Carcinoma de Células Escamosas/diagnóstico , Estudos Retrospectivos , Antígeno Ki-67/metabolismo , Estudos Transversais , Neoplasias Orofaríngeas/diagnóstico , PrognósticoRESUMO
O estudo investigou aspectos da evasão e avaliou a satisfação de calouros no curso de Odontologia de uma instituição de ensino superior pública, além de relatar intervenções de combate ao abandono acadêmico desenvolvidas neste período. Trata-se de um estudo com uma fase observacional, transversal, descritiva, quanti-qualitativa, com aplicação de questionários; e outra intervencionista, com atividades voltadas ao combate à evasão. Foram entrevistados 74 alunos, matriculados no primeiro ano do curso, com idade entre 15 e 30 anos. Os dados foram expressos em frequências absoluta e percentual e analisados pelos testes exato de Fisher ou qui-quadrado de Pearson (p ≤0,05). Variáveis com associação significativa foram submetidas ao modelo de regressão logística multinomial (RLM). Observou-se que o grau de insatisfação com o curso foi maior entre os alunos com menor faixa etária (entre 15 e 20 anos) e menor renda familiar (até 2 salários mínimos). Além disso, cerca de 66% dos possíveis desistentes ainda não haviam vivenciado nenhum tipo de experiência prática odontológica, enquanto 69% dos que pretendem completar o curso já passaram por algum contato com vivências clínicas. A RLM revelou que a Odontologia não ser a primeira opção aumenta em 7,96 vezes a probabilidade de desistência do curso, independente do semestre. Observou-se, ainda, redução nos índices de evasão a medida em que intervenções (cerimônia do jaleco, visita clínica guiada e apadrinhamento de alunos calouros) foram realizadas. Conclui-se que asações implementadas para o combate de evasão no curso de Odontologia impactaram positivamente nos índices de abandono do curso nos semestres analisados (AU).
El estudio investigó aspectos de la evasión y evaluó la satisfacción de los estudiantes de primer año de la carrera de Odontología de una institución de enseñanza superior pública, además de relatar las intervenciones para combatir la deserción académica desarrolladas en ese período. Se trata de un estudio con fase observacional, transversal, descriptivo, cuantitativo y cualitativo, con aplicación de cuestionarios; y otra intervencionista, con actividades encaminadas a combatir la evasión. Fueron entrevistados 74 estudiantes, matriculados en el primer año de la carrera, con edades entre 15 y 30 años. Los datos se expresaron como frecuencias absolutas y porcentuales y se analizaron mediante la prueba exacta de Fisher o la prueba de chi-cuadrado de Pearson (p ≤0,05). Las variables con asociación significativa fueron sometidas al modelo de regresión logística multinomial (RLM). Se observóque el grado de insatisfacción con el curso fue mayor entre los estudiantes de menor franja etaria (entre 15 y 20 años) y menor renta familiar (hasta 2 salarios mínimos). Además, alrededor del 66% de los posibles desertores aún no habían tenido ningún tipo de experiencia práctica en odontología, mientras que el 69% de los que pretendían completar el curso ya habían tenido algúncontacto con experiencias clínicas. El RLM reveló que el hecho de no ser Odontología la primera opción aumenta en 7,96 veces la probabilidad de deserción de la carrera, independientemente del semestre. También hubo una reducción en las tasas de deserción a medida que se realizaron intervenciones (ceremonia de bata de laboratorio, visita clínica guiada y patrocinio de estudiantes de primer año). Se concluye que las acciones implementadas para combatir la deserción en la carrera de Odontología incidieron positivamente en las tasas de deserción de la carrera en los semestres analizados (AU).
The study investigated aspects of evasion and evaluated the satisfaction of freshmen in the Dentistry course at a public higher education institution, in addition to reporting interventions to combat academic dropout developed during this period. This is astudy with an observational, cross-sectional, descriptive, quantitative and qualitative phase, with the application of questionnaires; and another interventionist, with activities aimed at combating evasion. 74 students were interviewed, enrolled in the first year of the course, aged between 15 and 30 years old. Data were expressed as absolute and percentage frequencies and analyzed using Fisher's exact test or Pearson's chi-square test (p ≤0.05). Variables with significant association were submitted to the multinomial logistic regression model (RLM). It was observed that the degree of dissatisfaction with the course was higher among students with a lower age group (between 15 and 20 years old) and lower family income (up to 2 minimum wages). In addition, around 66% of possible dropouts had not yet had any kind of practical dental experience, while 69% of those intending to complete the course had already had some contact with clinical experiences. The RLM revealed that Dentistry not being the first option increases the probability of dropping out of the course by 7.96 times, regardless of the semester. There was also a reduction in dropout rates as interventions were carried out (lab coat ceremony, guided clinical visit and sponsorship of freshman students)were performed. It is concluded that the actions implemented to combat dropout in the Dentistry course had a positive impact on the dropout rates of the course in the analyzed semesters (AU).
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Humanos , Masculino , Feminino , Adolescente , Adulto , Satisfação Pessoal , Fatores Socioeconômicos , Evasão Escolar/estatística & dados numéricos , Estudantes de Odontologia , Universidades , Distribuição de Qui-Quadrado , Estudos Transversais/métodos , Inquéritos e Questionários , Educação em Odontologia , Estudo ObservacionalRESUMO
We performed a systematic review on literature associated with meta-analyses to elucidate whether (I) low-level laser therapy (C) compared to placebo accelerates (O) bone neoformation in the region of the midpalatal suture in (P) patients undergoing transverse maxillary expansion. Two reviewers blindly performed targeted searches using the selection criteria (PICOS) in seven major databases and three grey literature databases, employing specific terms and their entrenchments. The RevMan® software (Review Manager, version 5.3, Cochrane Collaboration) was used to adapt the RoB summary illustration to the Cochrane 2.0 tool questions. Meta-analysis was performed using standardized mean difference (SMD) and Cohen's d calculation on random effects, tests for heterogeneity (I2 ) and publication bias (Egger and Begg), and one-of-out sensitivity analysis. GRADE (Grading of Recommendations Assessment, Development and Evaluation) was used for evidence quality analysis. Among the five studies included in the qualitative synthesis, three were included in the meta-analysis. All analysed studies were prospective randomized clinical trials. The risk of bias was such that the Egger (P = .1991) and Begg (P = .024) tests showed no significant risk of publication bias. The meta-analysis showed high heterogeneity (I2 = 81%, P < .00001), and 3 months after the operation, there was no significant difference between the photobiomodulation (PBMT) group and control group (P = .850) or between the subgroups of the periods evaluated after 3 months (P = 0.490). GRADE showed an SMD of 0.62. Photobiomodulation as an adjuvant therapy in patients undergoing transverse maxillary expansion has few benefits and is limited in shape, as it contributes to bone healing in the midpalatal suture region after a period of 3 months.
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Terapia com Luz de Baixa Intensidade , Técnica de Expansão Palatina , Humanos , Estudos ProspectivosRESUMO
Pods of Caesalpinia ferrea, popularly used to treat inflammatory processes, were collected to obtain the polysaccharide-rich extract, presenting anti-inflammatory and antinociceptive effects in acute inflammation models. This study aimed to evaluate the anti-inflammatory, antinociceptive and healing activities of the polysaccharide-rich extract from Caesalpinia ferrea pods (PEp-Cf) in the rat model of cutaneous excisional wound. PEp-Cf (0.025-0.1%) or 0.9% NaCl was topically applied in the wounds at dorsal thoracic region (2×/day) during 21 days for measurement of clinical signs (hyperemia, inflammatory exudate, edema, nociception), wound size, histopathological/histomorphometric, oxidative/inflammatory markers and systemic toxicity. PEp-Cf at 0.1% reduced wound area and increased ulcer contraction [days 2 and 10 (21-78%)]. PEp-Cf reduced clinical signs [days 2 and 5 (2.2-2.8×)] and modulated the healing inflammatory phase via stimulation of epithelialization (days 10 and 14), and inhibition of polymorphonuclears [days 2 and 5 (71-74%)], protein leakage [days 2 and 5 (28-41%)], nitrate [days 2 and 5 (2.2-6×)] and malondialdehyde [days 2 and 5 (46-49%)]. PEp-Cf increased the number of blood vessels [days 5 and 7 (3.1-9.6×)], fibroblasts [days 5 and 7 (2.1-6.4×)] and collagen [days 5 to 14 (1.5-1.8×)]. In conclusion, the topical application of PEp-Cf at 0.1% accelerates the healing process of rat cutaneous wounds via modulation of the inflammatory and proliferative phases, being devoid of systemic alterations.