Age estimation through the development of third molars in a case of multiple dismemberment / Estimación de la edad mediante el desarrollo de terceros molares en un caso de desmembramiento múltiple

El crimen organizado se ha convertido en un flagelo a nivel internacional conformado por grupos al margen de la ley que realizan todo tipo de actividades que involucran desde tráfico de personas, secuestros, extorsiones, narcotráfico y muchos otros delitos. Producto de este fenómeno, la desaparición y ejecución de personas es cada día más frecuente, en muchos casos los cuerpos son quemados o desmembrados para impedir o hacer más difícil la identificación. La odontología forense se ha convertido en una disciplina transcendental en la identificación de cadáveres y restos óseos, además de contar con múltiples métodos para estimar la edad aproximada de una persona. Se presenta el caso de un descuartizamiento múltiple de tres individuos masculinos donde era indispensable identificar si alguno correspondía a una persona menor de 18 años.

Organized crime has become an international scourge made up of outlaw groups that carry out all kinds of activities ranging from human trafficking, kidnapping, extortion, drug trafficking and many more. As a result of this phenomenon, the disappearance and execution of people is becoming more frequent every day, in many cases the bodies are burned or dismembered to prevent or make identification more difficult. Forensic odontology has become a transcendental discipline in the identification of corpses and skeletal remains, in addition to having multiple methods to estimate the approximate age of a person. The case of a multiple dismemberment of three male individuals is presented, where it was essential to identify a person under 18 years of age.

Primer reporte en Argentina de variante patógena en DMP1 asociada a raquitismo hipofosfatémico autosómico recesivo / First report in Argentina of a pathogenic DMP1 variant associated with autosomal recessive hypophosphatemic rickets

El raquitismo hipofosfatémico hereditario es una condición genética asociada con una mineralización ósea alterada causada por la deficiencia de fosfato. Produce deformidad esquelética y retraso del crecimiento en la infancia. Se describen diferentes patrones de herencia según el locus involucrado. Dado el solapamiento de los fenotipos y la dificultad en analizar genealogías reducidas, los estudios moleculares son importantes para establecer la causa genética y realizar el abordaje familiar. La forma recesiva del raquitismo hipofosfatémico (ARHR, OMIM #241520) es una condición extremadamente poco frecuente reportada en familias de origen europeo y de Oriente Medio. Las mutaciones con pérdida de función del gen DMP1 (dentin matrix acidic phosphoprotein 1) se asocian al raquitismo hipofosfatémico hereditario tipo 1. En este artículo presentamos el primer reporte de una familia argentina con raquitismo hipofosfatémico hereditario por mutación en DMP1

Hereditary hypophosphatemic rickets is a genetic condition associated with impaired bone mineralization caused by phosphate deficiency. It results in skeletal deformity and growth retardation in early childhood. Different inheritance patterns have been described according to the locus involved. Given the phenotypic overlapping and the difficulty in analyzing reduced genealogies, molecular studies are important to establish the genetic cause and implement a family-centered approach. The autosomal recessive form of hypophosphatemic rickets (ARHR, OMIM 241520) is an extremely rare condition reported in families of European and Middle Eastern descent. Loss-of-function mutations in the DMP1 (dentin matrix acidic phosphoprotein 1) gene are associated with hereditary hypophosphatemic rickets type 1. In this article, we describe the first report of an Argentine family with hereditary hypophosphatemic rickets due to a mutation in the DMP1 gene.

Particle size of oyster shell meal and calcium: phosphorus ratios in broiler diets / Efeito do tamanho de partícula da farinha de ostras e relações cálcio: fósforo em dietas para frangos de corte

The effects of Ca:P total ratio and particle size of oyster shell meal (OSM) were evaluated in broiler diets. In Experiment 1, 800 broilers (22-42 days old) were distributed in a 2×2 factorial design, with two Ca:P ratios (1.7 and 2.0:1) and two OSM particle sizes (coarse = 1,354 µm and fine = 428 µm), totaling four treatments with 10 repetitions with 20 broilers. Feed intake, weight gain, and feed conversion ratio were calculated. In Experiment 2, 1,280 broilers were distributed in a 2×2×2 factorial design (1.7 and 2.0:1 Ca:P ratios; coarse and fine OSM; male and female broilers), with eight treatments and 16 repetitions with 10 broilers. Apparent metabolizability of dry matter, Ca, P, and apparent metabolizable energy (AME), as well as bone resistance, bone weight, ash, Ca, and P content in the tibia were assessed. Growth performance was not affected (P > 0.05). Coarse OSM increased tibia Ca content in male broilers (P < 0.001), and higher Ca:P ratio improved bone ash and bone resistance in both sexes (P < 0.001), but reduced P content in male broilers (P < 0.05); male broilers displayed heavier bones with higher ash content than females (P < 0.05). Metabolizability of Ca was improved with coarse OSM (P < 0.05); whereas metabolizability of DM, P, and AME was not affected (P > 0.05). In conclusion, diets with a Ca:P total ratio of 2.0:1 containing coarser OSM improved bone mineral composition, particularly in male broilers, and coarse OSM improved the metabolizability of Ca in broilers regardless of the Ca:P total ratio or broiler sex.

Dois experimentos foram conduzidos para avaliar os efeitos do tamanho de partícula da farinha de ostras (FO) e relação Ca:P total em dietas para frangos de corte. No primeiro experimento, 800 frangos (22 a 42 dias) foram distribuídos em um delineamento fatorial 2x2: 2 relações Ca:P (1,7 e 2,0:1) e dois tamanhos de partícula da FO (grossa = 1354 µm e fina = 428 µm), totalizando quatro tratamentos com 10 repetições de 20 aves. O consumo de ração, o ganho de peso e a conversão alimentar foram calculados. No segundo experimento, 1.280 frangos foram distribuídos em um fatorial 2x2x2 (relações Ca:P 1,7 e 2,0:1; FO grossa e fina; aves machos e fêmeas) com oito tratamentos e 16 repetições de 10 aves. Foram avaliados: metabolizabilidade aparente da matéria seca, Ca e P, energia metabolizável aparente (EMA), peso e resistência óssea, conteúdo de cinzas, Ca e P na tíbia. As variáveis de desempenho não foram afetadas (P > 0,05). O uso de FO grossa aumentou o conteúdo de Ca na tíbia de frangos machos (P < 0,001), e a relação Ca:P de 2,0:1 aumentou o conteúdo de cinzas e aprimorou resistência óssea em ambos os sexos (P < 0,001), porém reduziu P na tíbia dos machos (P < 0,05); frangos machos também tiveram ossos mais pesados e maior conteúdo de cinzas do que fêmeas (P < 0,05). A metabolizabilidade de Ca foi melhorada com FO grossa, enquanto a metabolizabilidade da matéria seca, P, e EMA não foram afetadas (P > 0,05). Conclui-se que as dietas com relação Ca:P de 2,0:1 e com FO grossa resultaram em melhor composição mineral óssea - particularmente em frangos machos - e a FO grossa melhorou a metabolizabilidade de Ca independentemente da relação Ca:P ou do gênero das aves.

Bazo estrellado. A propósito de un caso / Stellate spleen. A case report

Las lesiones esplénicas pueden pasar desapercibidas en los estudios imagenológicos solicitados con otros fines. Las calcificaciones esplénicas representan un amplio espectro de lesiones que pueden originarse secundarias a diversos procesos patológicos subyacentes. La autoesplenectomía es una entidad extremadamente rara con algunos casos descritos en la literatura asociados a enfermedades autoinmunes. Se presenta el caso de una paciente de 46 años de edad con lupus eritematoso sistémico (LES) en quien se encuentra el bazo calcificado y atrófico como hallazgo incidental en una tomografía axial computarizada (TAC) de tórax.

Splenic lesions may go unnoticed in imaging studies requested for other purposes. Splenic calcifications represent a wide spectrum of lesions that can arise secondary to various underlying pathological processes. Autosplenectomy is an extremely rare entity with some cases described in the literature associated to autoimmune diseases. The case of a 46-year-old patient with Systemic Lupus Erythematosus (SLE) is presented, in whom the calcified and atrophic spleen is found as an incidental finding in a Chest tomography.

Citotoxicidade e efeito indutor de mineralização de flavonoides sobre células osteoblásticas / Cytotoxicity and inducing effect of mineralization of flavonoids on osteoblastic cells

A perda óssea dentária e a formação de lesões periapicais surgem como uma consequênc ia do desequilíbrio da homeostase óssea. Os osteoblastos, juntamente com os osteoclastos e osteócitos, atuam na formação e na reabsorção óssea. Vários marcadores de formação óssea são produzidos por osteoblastos ativos e refletem diferentes aspectos da dif erenciação osteoblástica e da remodelação óssea. Com isso, muitos autores têm explorado o uso de fitoterápicos, visando obter novos compostos que apresentem propriedades terapêuticas, como os flavonoides, e que estimulem a neoformação óssea e o reparo da r egião periapical. O objetivo deste estudo foi avaliar in vitro a citotoxicidade e efeito indutor de mineralização de flavonoides sobre células osteoblásticas humanas. Para isso, células osteoblásticas da linhagem Saos expostas aos seguintes flavono2 foram ides: quercetina, miricetina e seus derivados taxifolina, isoquercitrina, rutina, ampelopsina e EGCG, além de pinocembrina, crisina e canferol, de forma isolada e combinada. Foi avaliado o efeito citotóxico, a atividade de fosfatase alcalina e indução de n mé todo de Shapiroódulos de mineralização. Os resultados foram analisados p elo Wilk, e as variáveis foram submetidas à análise de ANOVA seguida pelo teste de Tukey para comparar entre os grupos e/ou concentrações ou teste de Dunnett para comparar entre cada grupo e o controle, com nível de significância de 5%. A viabilidade da cultura de osteoblastos não teve uma redução estatisticamente significativa na presença da maioria dos compostos, exceto crisina a 100µM. Taxifolina, isoquercitrina, rutina, ampelopsina e EGCG foram os compostos que estimularam significativamente a atividade da fosfatase alcalina, juntamente com as combinações taxifolina+isoquercitrina, taxifolina+ampelopsina e taxifolina+rutina a 25/25 µM. Quanto a formação de nódulos de mine ralização, ampelopsina, isoquercitrina, rutina, pinocembrina e miricetina isolados e taxifolina+isoquercitrina, taxifolina+ampelopsina e taxifolina+rutina combinados obtiveram os melhores resultados, variando de acordo com as concentrações. Concluise que a taxifolina, isoquercitrina, rutina e ampelopsina e combinações de taxifolina com esses flavonoides são citocompatíveis e apresentam efeito indutor de mineralização em osteoblastos Saos-2(AU)

Dental bone loss and the formation of periapical lesions arise as a consequence of imbalance of bone homeostasis. Osteoblasts, together with osteoclasts and osteocytes, act in bone formation and resorption. Several markers of bone formation are produced by active osteoblasts and reflect different aspects of osteoblastic differentiation and bone remodeling. Thus, many authors have explored the use of phytotherapics in order to obtain new compounds with therapeutic properties, such as flavonoids, and also stimulate bone neoformation and periapical region repair. The objective of this study was to evaluate in vitro the cytotoxicity and inducing effect of flavonoid mineralization on human osteoblastic cells. For this, osteoblastic cells of the Saos-2 lineage were exposed to the following flavonoids: quercetin, myricetin and its derivatives taxifoline, isoquercitrin, rutin, ampelopsin and EGCG, in addition to pinocembrin, chrysin and kaempferol, in an isolated and combined manner. The cytotoxic effect, the activity of alkaline phosphatase and the induction of mineralization nodules were evaluated. The results were analyzed using the Shapiro-Wilk method, and the variables were submitted to ANOVA analysis followed by the Tukey test to compare between groups and/or concentrations or Dunnett's test to compare between each group and the control, with a level of 5% significance. The viability of the osteoblast culture did not have a statistically significant reduction in the presence of most compounds, except 100 µM chrysin. Taxifoline, isoquercitrin, rutin, ampelopsin and EGCG were the compounds that significantly stimulated the activity of alkaline phosphatase, together with the combinations taxifoline+isoquercitrin, taxifoline+ampelopsin and taxifoline+rutin at 25/25 µM. As for the formation of mineralization nodules, ampelopsin, isoquercitrin, rutin, pinocembrin and myricetin alone and taxifoline+isoquercitrin, taxifoline+ampelopsin and taxifoline+rutin combined obtained the best results, varying according to the concentrations. It is concluded that taxifoline, isoquercitrin, rutin and ampelopsin and combinations of taxifolin with these flavonoids are cytocompatible and have a mineralization-inducing effect on Saos-2 osteoblasts(AU)

Reparo periimplantar em ratos diabéticos tipo 2, tratados pela combinação da terapia fotodinâmica antimicrobiana e compostos polifenóis: caracterização biomecânica, histométrica, microtomográfica e molecular / Periimplant bone repair in type 2 diabetics rats treated with the combination of antimicrobial photodynamic therapy and polyphenol compounds: biomechanical, histometric, microtomographic and molecular characterization

Caracterizar as respostas reparacionais do tecido ósseo após a instalação de implantes em ratos diabéticos tipo 2 tratados sistemicamente com resveratrol e com o uso local da aPDT, por meio das análises biomecânica e molecular. Foram utilizados 128 ratos divididos em quatro grandes grupos: 1- NG: ratos normoglicêmicos; 2- NGrvt: ratos normoglicêmicos tratados com resveratrol oral; 3- T2D: ratos diabéticos tipo 2; e 4- T2Drvt: ratos diabéticos tipo 2 tratados com resveratrol oral. Dentro de cada grupo existem quatro subgrupos: ST- Sem terapia local (n=8), a loja cirúrgica não recebeu terapia local adicional; AM- Azul de metileno (n=8), aplicação tópica de azul de metileno por 60 segundos; FBM- fotobiomodulação (n=8), irradiação com laser em baixa intensidade por 60 segundos; aPDT- Terapia fotodinâmica antimicrobiana (n=8), associação da aplicação de azul de metileno com irradiação com laser em baixa intensidade. A indução do T2D foi feita pela associação de dieta de cafeteria com uma única aplicação de Estreptozotocina (35mg.kg). Após a comprovação do diabetes tipo 2, foi dado início ao tratamento com resveratrol e passadas duas semanas os animais foram submetidos à cirurgia de exodontia dos primeiros molares superiores e instalação dos implantes. Neste momento foram realizadas as terapias locais de acordo com os grupos. Passados 28 dias, foi realizada a eutanasiados animais e realizadas as análises biomecânica (torque de remoção) e molecular de RT-PCR (IBSP, OCN, TRAP OPG e RANK-L). Os dados quantitativos foram submetidos ao teste de normalidade Shapiro Wilk para confirmar a distribuição normal das amostras. Na sequência, foram aplicados os testes de ANOVA um fator ou dois fatores, seguidos de pós teste de Tukey, com nível de significância de 5%. Os resultados da análise biomecânica revelaram que em animais normoglicêmicos tratados ou não por resveratrol tiveram uma diminuição do torque de remoção dos implantes quando empregado o uso de terapias locais. A presença da interferência sistêmica e o uso de terapias locais auxiliaram no aumento nos valores de contra-torque, especialmente no grupo T2Drvt com o uso da aPDT. A análise molecular de RT-PCT aos 28 dias sugere que no grupo NG a expressão de IBSP foi semelhante com a presença ou não das terapias locais, entretanto houve uma diminuição dos genes de OCN e um aumento de TRAP com o uso das terapias. Em NGrvt, houve um aumento na expressão de IBSP na ausência de terapias locais, uma diminuição de OCN e TRAP quando utilizadas as terapias e um aumento expressivo de OPG com ausência de RANK-L com o uso sistêmico de resveratrol sem tratamentos locais. O grupo T2D expressou um aumento de IBSP com o uso da terapia de FBM e a terapia com aPDT elevou a expressão de OCN e diminuiu TRAP e RANK-L. O uso de resveratrol em T2Drvt e sua associação com a aPDT aumentaram a expressão de IBSP e OCN, e além disso diminuíram a expressão de TRAP e RANK-L. A análise conjunta dos resultados permite-nos concluir que o uso sistêmico de resveratrol e a sua associação com a aPDT promoveram uma melhora no reparo periimplantar de ratos diabéticos tipo 2, aumentando a expressão de genes relacionados a mineralização da matriz óssea e diminuindo a expressão de genes relacionados a reabsorção óssea que resultaram em uma melhora da biomecânica óssea(AU)

The aim of this study is to characterize bone tissue repair responses after the installation of implants in type 2 diabetic rats treated systemically with resveratrol and with local use of aPDT, through biomechanical and molecular analysis. One hundred and twenty-eight rats were used, divided into four groups: 1- NG: normoglycemic rats; 2- NGrvt: normoglycemic rats treated with oral resveratrol; 3- T2D: type 2 diabetic rats; and 4- T2Drvt: type 2 diabetic rats treated with oral resveratrol. Within each group, are four subgroups: ST- No local therapy (n=8), the surgical store received no additional local therapy; MB- Methylene blue (n=8), topical application of methylene blue for 60 seconds; FBM- Photobiomodulation (n=8), low intensity laser irradiation for 60 seconds; aPDT- Antimicrobial photodynamic therapy (n=8), association of methylene blue application with low intensity laser irradiation. T2D induction was made by the association of cafeteria diet with a single application of Streptozotocin (35mg.kg). After type 2 diabetes confirmation, resveratrol treatment was started and after two weeks the animals were submitted to upper first molars extraction and implants installation. At this moment the local therapies were performed according to the groups. After 28 days, the animals were euthanized and the biomechanical (removal torque) and molecular analysis of RT-PCR (IBSP, OCN, TRAP OPG and RANK-L) were performed. The quantitative data were submitted to the Shapiro Wilk normality test to confirm the normal distribution of the samples. In the sequence, the ANOVA tests were applied one or two factors, followed by Tukey's post-test, with a significance level of 5%. The results of biomechanical analysis showed that in normoglycemic animals treated or not by resveratrol had a decrease in the implants removal torque when local therapies were applied. The presence of systemic interference and the use of local therapies helped to increase biomechanical values, especially in the T2Drvt group with the use of aPDT. The molecular analysis of RT-PCT at 28 days suggests that in the NG group the expression of IBSP was similar with the presence or not of local therapies, however there was a decrease in OCN genes and an increase in TRAP with the use of therapies. In NGrvt, there was an increase in IBSP expression in the absence of local therapies, a decrease in OCN and TRAP when using therapies and a significant increase in OPG without RANK-L with the systemic use of resveratrol without local treatments. T2D group expressed an increase of IBSP with the use of PBM therapy, aPDT raised the expression of OCN and decreased TRAP and RANKL. The use of resveratrol on T2Drvt and its association with aPDT increased the expression of IBSP and OCN, and also decreased TRAP and RANK-L expression. The overall analysis of the results allows us to conclude that the systemic use of resveratrol and its association with aPDT promoted an improvement in periimplant repair of type 2 diabetic rats, increasing the expression of genes related to bone matrix mineralization and decreasing the expression of genes related to bone resorption that resulted in an improvement of bone biomechanics(AU)

Clinical observation of accordion technique in promoting bone transport and prolonging newborn bone mineralization / 中国骨伤

OBJECTIVE@#To analyze effect of accordion technique on bone mineralization of extended bone segment in treating tibial bone defect with bone transport.@*METHODS@#From May 2017 to October 2019, 22 patients with tibial bone defects were treated with Ilizarov bone-transport technique, and divided into two groups after bone-transport was completed, 11 patients in each group. In observation group, there were 9 males and 2 females aged from 20 to 60 years old with an average of (42.6± 13.3) years old;the length of bone defect ranged from 3 to 13 cm with an average of(6.4±2.6) cm;2 patients were suffered from upper tibial bone defects, 3 patients were middle and 6 patients were lower;patients were treated with accordion technique for 35 days. In control group, there were 10 males and 1 female aged from 41 to 60 years old with an average of (51.6±6.4) years old;the length of bone defect ranged from 3 to 10.7 cm with an average of (6.6±2.5) cm;1 patient was suffered from upper tibial bone defects, 3 patients were middle and 7 patients were lower;patients were treated with lock external fixator to waiting bone mineralization. The content of hydroxyapatite (HAP) extended bone segment was measured after bone-transport completed immediately, 35, 65 and 95 days after bone-transport was completed, respectively, then the mineralization time and healing time were compared between two groups, and the therapeutic effect of bone defect was evaluated by using Paley scoring criteria.@*RESULTS@#Twenty-two patients were followed up from 18 to 36 months with an average of (27.0±6.3) months. The wounds on the bone defects healed spontaneously during bone transport, and there were no wound complications such as skin infection or skin necrosis occurred. There were statisticaldifference in the content of HAP of the extended bone segments at 35, 65 and 95 days after bone-transport between two groups (@*CONCLUSION@#Accordion technique and locking external fixator mineralization in prolonging bone segment healing after bone-transport have the equal clinical effect, while the accordion technique could significantly accelerate the growth rate of HAP and shorten the mineralization time and healing time.

Masa ósea y tratamiento esteroideo en pacientes con hiperplasia suprarrenal congénita / Bone mass and steroid treatment in patients with congenital adrenal hyperplasia

Introducción: La terapia de reemplazo con glucocorticoides sigue siendo el paradigma de tratamiento en las formas clásicas de la hiperplasia suprarrenal congénita. Sus efectos sobre la mineralización ósea no están totalmente claros. Objetivo: Describir las variables relacionadas con la masa ósea en pacientes con HSC que reciben tratamiento esteroideo sustitutivo. Método: Se realizó un estudio descriptivo transversal que exploró variables clínicas, bioquímicas, hormonales y de mineralización óseaen 25 pacientes con hiperplasia suprarrenal congénita por déficit de 21OHasa y tratamiento esteroideo. Resultados: 21 (84,0 por ciento) femeninas, el mayor grupo correspondió a los adolescentes entre 10 y 19 años (52 por ciento). Predominaron las formas clásicas con 22 pacientes (88,0 por ciento), de ellas 13 (52 por ciento) fueron perdedoras de sal, 9 virilizantes simples (36,0 por ciento) y solo 3 (12,0 por ciento) formas no clásicas. El esteroide más utilizado fue la hidrocortisona en 16 pacientes (64 por ciento), a una dosis media de 22,10±12,00 mg diarios, correspondiendo con 17,09±5,71 mg/m2sc/día y como promedio llevaban 14,02±6,57 años de terapéutica sustitutiva. No se detectaron alteraciones del metabolismo fosfocálcico. La densidad y el contenido mineral óseo en columna y en fémur mostraron valores superiores en las formas no clásicas de la enfermedad, seguidos de la virilizante simple y finalmente los pacientes perdedores de sal, en ninguno de los casos con significación estadística. Conclusiones: Los pacientes con hiperplasia suprarrenal congénita del presente estudio mostraron en su mayoría una masa ósea conservada(AU)

Introduction: Glucocorticoid replacement therapy is still the treatment´s paradigm in the classic forms of congenital adrenal hyperplasia. Its effects on bone mineralization are not entirely clear. Objective: Describe bone mass-related variables in congenital adrenal hyperplasia patients receiving substitute steroid treatment. Method: A cross-sectional descriptive study was conducted exploring clinical, biochemical, hormonal and bone mineralization variables in 25 patients with congenital adrenal hyperplasia caused by 21OHase deficiency and steroid treatments. Results: 21 women (84.0 percent); the largest group was of adolescents between the age of 10 and 19 years (52 percent).Classical forms predominated with 22 patients (88.0 percent), including 13 of them (52 percent) that were salt losers, 9 simple virilizers (36.0 percent) and only 3 (12.0 percent) of non-classical forms. The most commonly used steroid was hydrocortisone in 16 patients (64 percent), at an average dose of 22.10±12.00 mg daily, corresponding to 17.09±5.71 mg/m2sc/day and on average carried 14.02±6.57 years of substitute therapy. No alterations in the phosphocalcic metabolism were detected. Density and bone mineral content in the spinal column and femur showed higher values in non-classical forms of the disease, followed by simple virilizing and finally the salt loser patients, in none of the cases with statistical significance. Conclusions: Patients with congenital adrenal hyperplasia in this study showed mostly preserved bone mass(AU)

Pulmonary alveolar microlithiasis: Incidental finding - should we Ignore?

Pulmonary alveolar microlithiasis (PAM) is a rare entity, presenting mostly as an incidental finding. This disease has an autosomal recessive inheritance with inactivating mutations in the gene "solute carrier family 34 member 2". The present study was conducted to bring attention to this rare though preventable disease. The study was a cross-sectional descriptive study, conducted at the Department of Pathology, of a tertiary care hospital in New Dehli-India. PAMs were incidentally seen in two patients diagnosed with micronodular hepatic cirrhosis leading to reanalysis of 212 autopsies, retrospectively. Statistical analysis was done using Stata 14.0. We observed three forms (Type A, B and C) of round hyaline bodies measuring in diameter with thin delicate, radiating fibrils. These bodies were PAS positive, showed black discolouration of the pigment with von Kossa stain and birefringence on polarized microscopy using Congo red stain, however the refringence was light green as compared to apple green birefringence seen with amyloid deposition. PAM has a slow progressive course leading to a high rate of incidental detection. Drugs known to inhibit the micro-crystal growth of hydroxyapatite may slow the disease progression. The family members of patients with PAM may also be kept on follow up with regular imaging. Key messages: It is important to bring out the incidental finding as, seemingly innocuous observations may provide valuable insight into incurable diseases, especially rare diseases.

Prevalence of calcified triticeous cartilage-compatible images on 2500 digital panoramic radiographs of a Brazilian population sample / Prevalência de imagens compatíveis com calcificação da cartilagem tritícea em 2500 radiografias panorâmicas de uma amostra populacional brasileira

Objective: To investigate the prevalence of calcified triticeous cartilage (CTC)-compatible images on digital panoramic radiographs of a significant Brazilian population sample. Methods: In this retrospective study, 2500 digital panoramic radiographs were analyzed by a trained examiner using contrast and brightness adjustments of the Adobe® Photoshop® CC 2015 software. Data were collected and exported for statistical analysis (p-value <0.05 was considered statistically significant). Results: The prevalence of CTC-compatible images was 4.5% (61.1% in women and 38.9% in men). The most prevalent age ranged between 51 and 60 years (32.7%), and bilateral occurrence had a higher prevalence (46.9%). Women between the ages of 61 and 70 years showed a significantly higher prevalence of CTC-compatible images (p=0.027). Conclusion: This study showed a low prevalence of CTC-compatible images, which mainly occurred in women close to 70 years of age.

Objetivo: Investigar a prevalência de imagens compatíveis com calcificação da cartilagem tritícea (CCT) em radiografias panorâmicas digitais de uma significante amostra populacional brasileira. Métodos: Neste estudo retrospectivo, 2500 radiografias panorâmicas digitais foram analisadas por um examinador treinado utilizando ajustes de contraste e brilho através do software Adobe® Photoshop® CC 2015. Os dados foram coletados e exportados para análise estatística (p<0,05 foi considerado como valor estatisticamente significante). Resultados: A prevalência de imagens compatíveis com CCT foi de 4,5% (61.1% em mulheres e 38.9% em homens). A idade mais prevalente variou entre 51 e 60 anos (32,7%), sendo a ocorrência bilateral a mais comum (46,9%). Mulheres com idade entre 61 e 70 anos apresentaram prevalência significativamente maior de imagens compatíveis com CCT (p=0,027). Conclusão: O presente estudo evidenciou uma baixa prevalência de imagens compatíveis com CCT, que ocorreram, principalmente, em mulheres com idade próxima aos 70 anos.

MicroRNA-10b Plays a Role in Bone Formation by Suppressing Interleukin-22 in Ankylosing Spondylitis

OBJECTIVE: The microRNA (miR)-10b is the T helper (Th) 17 cell specific in patients with ankylosing spondylitis (AS). The interleukin (IL)-22, which is closely related to Th17 cells, has been implicated in the regulation of new bone formation in experimental models. Therefore, the aim of this study was to evaluate whether miR-10b affects bone formation via the IL-22 pathway in AS.METHODS: Primary CD4+ T cells from AS were purified and transfected with miR-10b, anti-miR-10b, or scramble. Cell-surface markers and cytokine expression were analyzed by flow cytometry and enzyme-linked immunosorbent assay. Primary bone-derived cells (BdCs) from the facet joints of the spine were isolated, then osteogenic differentiation of primary BdCs was performed. We assessed alkaline phosphatase (ALP) activity and staining of BdCs at early time points. Alizarin red S staining of BdCs was performed at late time points.RESULTS: Overexpression of miR-10b reduced both IL-22 producing cell frequencies and cytokine production in T cells from the patients with AS. The IL-22 significantly increased ALP staining and bone mineralization. The ALP promotor activity of AS-BdCs was notably higher for the IL-22 concentration. The supernatants of the miR-10b overexpression group suppressed ALP activity on osteogenic progenitor cells from the facet joints of the spine in patients with AS.CONCLUSION: Our data suggest that miR-10b suppresses IL-22 production, which was involved in osteogenic proliferation in AS. Therefore, miR-10b might be a potential therapeutic candidate for regulation of new bone formation in patients with AS.

Plasma Fibroblast Growth Factor 23 Concentration Is Associated with Intracranial Cerebral Atherosclerosis in Acute Ischemic Stroke Patients

Osteomalacia. Diagnóstico y tratamiento / Osteomalacia. Diagnosis and treatment

Introducción: la osteomalacia se caracteriza por la falta de mineralización de la sustancia osteoide, que afecta al hueso cortical y al hueso esponjoso maduro. Es una enfermedad que se presenta en adultos y niños, aunque la causa es diferente en cada uno. Objetivo: exponer la generalidad de la osteomalacia por ser una enfermedad que produce serias afectaciones a la población que la padece, especialmente a los niños. Se enfatiza en el diagnóstico y su tratamiento. Desarrollo: a fin de resumir los elementos esenciales para establecer el diagnóstico de osteomalacia hay que plantear en primer lugar, la presencia de un trastorno de la mineralización ósea, de ahí que además de tener en cuenta las causas de la enfermedad, su curso clínico y la sintomatología. Conclusiones: una recomendación importante es no tener en cuenta la posibilidad de complicaciones en el curso de la enfermedad, como las fracturas, que, aunque sean parte del cuadro clínico, al producirse pueden ocasionar graves problemas, como el caso de las que aparecen en las costillas, que si se desplazan pueden interesar órganos vitales, de modo que en este tipo de pacientes no debe excluirse la posibilidad de emergencias o de urgencias reumatológicas tanto en los adultos como en los niños(AU)

Introduction: osteomalacia is characterized by the lack of mineralization of the osteoid substance, which affects cortical bone and mature cancellous bone. It is a disease that occurs in adults and children, although the cause is different in each. Objective: to expose the generality of osteomalacia for being a disease that causes serious affectations to the population that suffers it, especially to children. Emphasis is placed on the diagnosis and its treatment. Development: in order to summarize the essential elements to establish the diagnosis of osteomalacia, we must first consider the presence of a bone mineralization disorder, hence, in addition to taking into account the causes of the disease, its clinical course and the symptomatology. Conclusions: an important recommendation is not to take into account the possibility of complications in the course of the disease, such as fractures, which, although they are part of the clinical picture, can cause serious problems when they occur, as in the case of those that appear in the ribs, which if they move may involve vital organs, so that in this type of patients should not exclude the possibility of emergencies or rheumatological emergencies in both adults and children(AU)

Costilla o dedo (falange) pélvico: una serie de casos / Pelvic Rib or Pelvic Digit: A Series of Cases

El dedo (falange) pélvico es una alteración benigna resultante de una anomalía en el desarrollo óseo, donde se encuentra una estructura ósea con apariencia radiológica característica en los tejidos blandos, especialmente en relación con la articulación coxofemoral, aunque puede tener otras localizaciones. Se trata de una entidad benigna que usualmente es asintomática y se encuentra como hallazgo incidental. Conocer su origen y características imaginológicas es de gran importancia para poderla diferenciar de otras lesiones como osificaciones postraumáticas o lesiones por avulsión, que son frecuentes en esta misma localización. Se presentan seis casos con hallazgo incidental de dedo pélvico en diferentes modalidades diagnósticas

The pelvic digit is a benign entity resulting from an abnormality in bone development, where a bony structure with a characteristic radiological appearance is found in the soft tissues, especially in relation to the hip joint, although it may be found at other locations. It is usually asymptomatic and is found as an incidental finding. Knowing its origin and imaging characteristics is of great importance to differentiate it from other injuries such as post-traumatic ossification or avulsion injuries, which are frequent in this same location. Six cases, from the institution, with incidental finding of pelvic digit in different diagnostic modalities are presented.

Stanozolol promotes osteogenic gene expression and apposition of bone mineral in vitro

Abstract Stanozolol (ST) is a synthetic androgen with high anabolic potential. Although it is known that androgens play a positive role in bone metabolism, ST action on bone cells has not been sufficiently tested to support its clinical use for bone augmentation procedures. Objective: This study aimed to assess the effects of ST on osteogenic activity and gene expression in SaOS-2 cells. Material and Methods: SaOS-2 deposition of mineralizing matrix in response to increasing doses of ST (0-1000 nM) was evaluated through Alizarin Red S and Calcein Green staining techniques at 6, 12 and 24 days. Gene expression of runt-related transcription factor 2 (RUNX2), vitamin D receptor (VDR), osteopontin (SPP1) and osteonectin (ON) was analyzed by RT-PCR. Results: ST significantly influenced SaOS-2 osteogenic activity: stainings showed the presence of rounded calcified nodules, which increased both in number and in size over time and depending on ST dose. RT-PCR highlighted ST modulation of genes related to osteogenic differentiation. Conclusions: This study provided encouraging results, showing ST promoted the osteogenic commitment of SaOS-2 cells. Further studies are required to validate these data in primary osteoblasts and to investigate ST molecular pathway of action.

Losartan improves alveolar bone dynamics in normotensive rats but not in hypertensive rats

Abstract Hypertension is one of the main causes of premature death in the world; also, it is associated with several bone alterations. Preclinical studies have demonstrated delayed alveolar bone healing in hypertensive rats. However, losartan has been favorable for consolidation of bone grafts and reduction in active periodontitis. Therefore, losartan is suggested to be effective in bone formation stages, as well as in the synthesis of matrix proteins and mineralization. Objectives: To evaluate the alveolar bone dynamics in hypertensive rats treated with losartan by laser confocal microscopy and histological analysis. Methodology: Thirty-two rats, 16 spontaneously hypertensive rats (SHR) and 16 Wistar albinus rats, treated or not with losartan (30 mg/kg/day) were used. Calcein fluorochrome at 21 days and alizarin red fluorochrome at 49 days were injected in rats (both 20 mg/kg). The animals were submitted to euthanasia 67 days after treatment, and then the right maxilla was removed for laser confocal microscopy analysis and the left maxilla for histological analysis. Results: This study showed a greater calcium marking in normotensive animals treated with losartan in relation to the other groups. Laser confocal microscopy parameters showed higher values of bone volume formed, mineralized surface, active surface of mineralization and bone formation rate in normotensive animals treated with losartan. However, a smaller mineralized surface was observed in all hypertensive animals. Conclusion: Losartan can improve bone mineralization parameters under normal physiological conditions, but the same anabolic effect does not occur under hypertension.

Síndrome de eagle: reporte de caso / Eagle syndrome: case report / Síndrome de eagle: relato de caso

Resumen El síndrome de Eagle se considera como la elongación del proceso estiloides con osificación del ligamento estilohioideo o sin él, que se extiende entre el hueso temporal y el hioides. El diagnóstico puede ser realizado principalmente con tomograña computarizada (TC) o radiografía panorámica, por su puesto sin dejar de lado la variedad de signos y síntomas, como dolor cervical, sensación de cuerpo extraño en la faringe, limitaciones en la apertura bucal, dificultad para la fonación, disfagia, otalgia, tinnitus, trismo y movilidad reducida del cuello. Ya identificada la elongación, el paciente podrá recibir un tratamiento conservador o quirúrgico dependiendo de la severidad de los síntomas. El manejo conservador incluye fisioterapia, infiltración con anestésicos locales o corticosteroides y el tratamiento con fármacos antiinflamatorios, anticonvulsivos o antidepresivos. El manejo quirúrgico consiste en fracturar el proceso estiloides bajo anestesia general, a través de abordajes transorales o transcervicales. A continuación, expondremos información pertinente sobre el síndrome de Eagle y posteriormente presentaremos un caso clínico de una paciente con dicho síndrome del servicio de Cirugía Oral y Maxilofacial del Hospital Militar Central.

Abstract Eagle syndrome is considered as the elongation of the styloid process with or without ossification of the stylohyoid ligament, which extends between the temporal bone and the hyoid. The diagnosis can be made mainly with computed tomography (CT) or panoramic radiography, of course without neglecting the variety of signs and symptoms, such as cervical pain, foreign body sensation in the pharynx, limitations in oral opening, difficulty in phonation, dysphagia, otalgia, tinnitus, trismus and reduced neck mobility. Once the elongation has been identified, the patient may receive conservative or surgical treatment depending on the severity of the symptoms. Conservative management includes physiotherapy, infiltration with local anesthetics or corticosteroids and treatment with anti-inflammatory, anticonvul sant or antidepressant drugs. Surgical management consists in fracturing the styloid process under general anesthesia, through transoral or transcervical approaches. Next, we will present pertinent information about the Eagle syndrome and then we will present a clinical case of a patient with said syndrome of the Oral and Maxillofacial Surgery service of the Hospital Militar Central.

Resumo A síndrome de Eagle considera-se como o alongamento do processo estiloide com ossificação do ligamento estilo-hioideo ou sem ele, que se estende entre o osso temporal e os hioides. O diagnóstico pode ser realizado principalmente com tomografia computadorizada (TC) ou radiografia panorâmica, obviamente sem deixar de lado a variedade de sinais e sintomas, como dor cervical, sensação de corpo estranho na faringe, limitações na abertura bucal, dificuldade para a fonação, disfagia, otalgia, zumbido, trismo e mobilidade reduzida do pescoço. Já identificado o alongamento, o paciente poderá receber um tratamento conservador ou cirúrgico dependendo da gravidade dos sintomas. O tratamento conservador inclui fisioterapia, infiltração com anestésicos locais ou corticosteroides e o tratamento com fármacos anti-inflamatórios, anticonvulsivos ou antidepressivos. O tratamento cirúrgico consiste em fraturar o processo estiloide sob anestesia geral, por meio de abordagens intraorais ou transcervicais. A seguir, exporemos informação pertinente sobre a síndrome de Eagle e, posteriormente, apresentaremos um caso clínico de uma paciente com essa síndrome do serviço de Cirurgia Oral e Maxilofacial do Hospital Militar Central.

Analysis of lifestyle and bone mineralization in a population of Spanish young adults / Análisis de los estilos de vida y la mineralización ósea en una población de adultos jóvenes españoles

Abstract Objective: To analyze the environmental factors (nutritional status, levels of physical activity and nutritional habits) and their possible association with bone mass in a population of young adults. Methods: The study population consisted of 200 subjects (117 women and 83 men) aged between 18 and 25 years (mean age 20.4 years ±2.2 years). Body composition parameters were measured by an electronic balance (TANITA BC-418MA), nutritional habits were estimated by 72-h dietary recall, level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and bone mass was measured by ultrasonography at the calcaneus. Results: There were significant differences in bone mass values ​​according to gender (p= 0.013). Despite the fact that 70% of the subjects had a body mass index (BMI) within the normal range, 20% had overweight or obesity. 49% of the individuals had a moderate level of physical activity, although women had lower levels of physical activity than men (17.9% vs 8.4%). Most diets among young adults were hyperprotic, hyperlipidic and low-carbohydrates, with low-calcium and fiber intakes and high-phosphorus. Analysis of bone mass according to BMI showed higher values ​​as the weight category rises, with significant differences in women. Higher values ​​of bone mass were shown as the level of physical activity was higher, showing significant differences in males. Conclusion: Our results show that BMI and level of physical activity are significantly associated with bone health in a population of young adults, suggesting the relevance of promoting healthy lifestyles as a strategy for the early prevention of osteoporosis.

Resumen Objetivo: Analizar los factores ambientales (estado nutricional, nivel de actividad física y hábitos nutricionales) y su posible relación con los niveles de masa ósea en una población de adultos jóvenes. Métodos: La población de estudio estuvo constituida por 200 sujetos (117 mujeres y 83 hombres) de edades comprendidas entre 18 y 25 años (edad media 20.4 años ± 2.2 años). La composición corporal se evaluó con balanza electrónica (TANITA BC-418MA), la valoración de los hábitos nutricionales mediante Recordatorio de 72 h, el nivel de actividad física a través del Cuestionario Internacional de Actividad Física (IPAQ) y la masa ósea mediante ultrasonografía en el calcáneo. Resultados: Existen diferencias estadísticamente significativas en los valores de masa ósea en función del sexo (p= 0.013). A pesar de que el 70% de los sujetos presentaron un índice de masa corporal (IMC) dentro de los límites de la normalidad, un 20% padece sobrepeso y obesidad. El 49% de los individuos tenian un nivel moderado de actividad física, aunque las mujeres presentaron niveles más bajos de actividad física que lo varones (17.9% vs 8.4%). Las dietas mayoritarias entre los adultos jóvenes son hiperprotéicas, hiperlipídicas y bajas en hidratos de carbono, observándose una ingesta baja de calcio y fibra y alta en fósforo. El análisis de la masa ósea en función de IMC mostró valores mayores conforme asciende la categoría ponderal, existiendo diferencias significativas en mujeres. Igualmente, se muestran valores más altos de masa ósea conforme mayor es el nivel de actividad física, evidenciando diferencias significativas en los varones. Conclusión: Nuestros resultados muestran que el índice de masa corporal y el nivel de actividad física se asocian significativamente con la salud ósea en una población de adultos jóvenes, evidenciando la importancia del fomento de estilos de vida saludables como estrategia para la prevención temprana de la osteoporosis.

Multiple Sequential Physeal Injuries with Vitamin D Deficiency / 대한정형외과학회잡지

Vitamin D plays a major role in bone metabolism, and its deficiency has an impact on fracture risk and healing. Low vitamin D levels are a cause of poor bone mineralization and have been associated with a significantly higher risk of physeal injury in children. This paper presents a case of a 13-year-old boy with a vitamin D deficiency, who sustained multiple sequential epiphyseal injuries at various areas. This report suggests that vitamin D deficiency is not only a significant cause of the clinical disease itself, but also an important factor affecting the successful recovery of injuries.