Mammary neoplasms in female dogs: Clinical, diagnostic and therapeutic aspects.

With the increase in the life expectancy of domestic animals and their increasingly affectionate relationship with their owners, it is possible to observe an increase in cases of neoplasms in these animals. Mammary neoplasia mainly affects older females who have not been castrated, due to hormonal dependence for the development of the tumour. The main form of treatment is surgery. This study aims to carry out an updated review on mammary neoplasms in female dogs covering the anatomy, physiology, prevalence, causes, diagnoses, treatments, prevention and prognosis, based on scientific articles by renowned researchers.

Investigating the Incidence of Dyslipidemia among Brazilian Children and Adolescents Diagnosed with Type 1 Diabetes Mellitus: A Cross-Sectional Study.

The treatment of Type 1 Diabetes Mellitus (T1DM) has always been a challenge for health professionals in relation to glycemic control. Increased body fat has been related to a worsening of the lipid profile and increased prevalence of dyslipidemia in this population, leading to negative repercussions on the control of cardiovascular risk. We aimed to investigate the distribution of lipid levels and the presence of dyslipidemia in children and adolescents with T1DM. A cross-sectional observational study was conducted with 81 individuals of both sexes (4-19 years) diagnosed with T1DM. Anthropometric and biochemical data were collected, in addition to data on physical activity level, sexual maturation stage, and insulin administration regimen. Lipid levels were categorized as normal, borderline, and elevated, and the presence of dyslipidemia was diagnosed by the presence of one or more altered lipid parameter. We noted a prevalence of dyslipidemia in 65.4% of the participants when considering borderline lipid values. Of those, 23.5% had one altered lipid level, and 42.0% had two or more. The main altered lipid levels were total cholesterol and triglycerides, followed by non-HDL-c. The main factor associated with the worsening of lipid levels was the increase in HbA1c. Sex had a significant effect on the levels of TC, HDL-c, and ApoA-I. The results of this study reinforce the need to monitor lipid profile in children and adolescents with T1DM, as well as the importance of early intervention in treating dyslipidemia, especially in patients with poor glycemic control.

New Trends to Treat Muscular Atrophy: A Systematic Review of Epicatechin.

Epicatechin is a polyphenol compound that promotes skeletal muscle differentiation and counteracts the pathways that participate in the degradation of proteins. Several studies present contradictory results of treatment protocols and therapeutic effects. Therefore, the objective of this systematic review was to investigate the current literature showing the molecular mechanism and clinical protocol of epicatechin in muscle atrophy in humans, animals, and myoblast cell-line. The search was conducted in Embase, PubMed/MEDLINE, Cochrane Library, and Web of Science. The qualitative analysis demonstrated that there is a commonness of epicatechin inhibitory action in myostatin expression and atrogenes MAFbx, FOXO, and MuRF1. Epicatechin showed positive effects on follistatin and on the stimulation of factors related to the myogenic actions (MyoD, Myf5, and myogenin). Furthermore, the literature also showed that epicatechin can interfere with mitochondrias' biosynthesis in muscle fibers, stimulation of the signaling pathways of AKT/mTOR protein production, and amelioration of skeletal musculature performance, particularly when combined with physical exercise. Epicatechin can, for these reasons, exhibit clinical applicability due to the beneficial results under conditions that negatively affect the skeletal musculature. However, there is no protocol standardization or enough clinical evidence to draw more specific conclusions on its therapeutic implementation.

The Influence of Body Fat and Lean Mass on HbA1c and Lipid Profile in Children and Adolescents with Type 1 Diabetes Mellitus.

Glycated hemoglobin (HbA1c) is used to assess glycemic control in Type 1 diabetes (DM1) patients. Apolipoproteins play an essential role in DM1 pathophysiology and may be associated with complications and HbA1c. This cross-sectional observational study of 81 children and adolescents of both sexes diagnosed with DM1 investigated the relationship between body fat distribution and lean mass with HbA1C and apolipoprotein values, analyzing biochemical and body composition measurements. A Shapiro-Wilk test with Lilliefors correction, a non-parametric Mann-Whitney test, and others were used with a significance level of 5%. The sample had a diagnosis time of 4.32 years and high blood glucose levels (mean 178.19 mg/dL) and HbA1c (mean 8.57%). Subjects also had a moderate level of adiposity, as indicated by arm and thigh fat areas. The study also found significant differences in the distribution of patients concerning levels of apolipoproteins A and B, with a smaller proportion of patients having undesirable levels. Finally, the study found a significant difference in the distribution of patients with estimated cardiovascular risk based on the ApoB/ApoA-I ratio. Conclusively, visceral fat in children and adolescents with DM1 may increase the risk of DM1 long-term complications owing to its association with elevated HbA1C and apolipoprotein values.

Radiological and Functional Pulmonary Evolution in Post-COVID-19 Patients: An Observational Study.

COVID-19 has generated a scenario for global health with multiple systemic impairments. This retrospective study evaluated the clinical, radiological, and pulmonary functional evolution in 302 post-COVID-19 patients. Regarding post-COVID-19 pulmonary symptoms, dry cough, dyspnea, and chest pain were the most frequent. Of the associated comorbidities, asthma was more frequent (23.5%). Chest tomography (CT) initially showed a mean pulmonary involvement of 69.7%, and evaluation in the subsequent months showed improvement in the evolutionary image. With less than six months post-pathology, there was a commitment of 37.7% from six to twelve months it was 20%, and after 12 months it was 9.9%. As for most of the sample, 50.3% of the patients presented CT normalization less than six months after infection, 23% were normalized between six and twelve months, and 5.2% presented with normalized images after twelve months, with one remaining. A percentage of 17.3% maintained post-COVID-19 pulmonary residual sequelae. Regarding spirometry, less than six months after pathology, 59.3% of the patients presented regular exam results, 12.3% had their function normalized within six to twelve months, and 6.3% had normal exam results twelve months after their post-pathology evaluation. Only 3.6% of the patients still showed some alteration during this period.

Organokines in COVID-19: A Systematic Review.

Coronavirus disease 2019 (COVID-19) is a viral infection caused by SARS-CoV-2 that induces a generalized inflammatory state. Organokines (adipokines, osteokines, myokines, hepatokines, and cardiokines) can produce beneficial or harmful effects in this condition. This study aimed to systematically review the role of organokines on COVID-19. PubMed, Embase, Google Scholar, and Cochrane databases were searched, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and 37 studies were selected, comprising more than 2700 individuals infected with the virus. Among COVID-19 patients, organokines have been associated with endothelial dysfunction and multiple organ failure due to augmented cytokines and increased SARS-CoV-2 viremia. Changes in the pattern of organokines secretion can directly or indirectly contribute to aggravating the infection, promoting immune response alterations, and predicting the disease progression. These molecules have the potential to be used as adjuvant biomarkers to predict the severity of the illness and severe outcomes.

Estimated Worldwide Prevalence of the PI*ZZ Alpha-1 Antitrypsin Genotype in Subjects With Chronic Obstructive Pulmonary Disease

Introduction: The prevalence of α1-antitrypsin PI*ZZ genotypes in patients with COPD is only partially known. We aimed to estimate this prevalence worldwide. Method: A systematic review of the literature was conducted for studies investigating the prevalence of COPD and the prevalence of severe alpha-1-antitrypsin deficiency (AATD) PI*ZZ genotype. Results are shown in tables and on a whole world interpolation map. Results: Studies from 48 countries with available data (21 from Europe, 9 from the Americas, 5 from Africa, 11 from Asia and 2 from Australasia) were selected. About 235,000 individuals with PI*ZZ genotypes were accounted: 50% in Europe, 37% in America, 9% in Asia, 3% in Australasia and 1% in Africa. The estimated crude prevalence of COPD in adults older than 40 years was 12.45% in Europe, 13.51% in America, 13.22% in Africa, 11.70% in Asia and 11.86% in Australasia. The highest PI*ZZ weighted average prevalence among COPD subjects (expressed as 1/x [95% confidence intervals]) were found in Northern Europe (395 [252–576]) followed by Western (797 [538–1165]), Southern (944 [600–1475]) and Central Europe (1096 [687–1738]). Outside Europe, high values were found in Australia–New Zealand (1007 [684–1509]), Saudi Arabia (1276 [563–2961]), United States (1298 [1094–1540]), Canada (1482 [1057–2083]) and Thailand (1807 [717–4692]). In the rest of the world, prevalence was significantly lower, especially in vast regions of Asia and Africa where the PI*Z gene is practically non-existent. Conclusions: Severe AATD is associated with a significant number of cases of COPD, especially in Europe, USA, Canada, New Zealand and Australia. (AU)

Estimated Worldwide Prevalence of the PI*ZZ Alpha-1 Antitrypsin Genotype in Subjects With Chronic Obstructive Pulmonary Disease.

INTRODUCTION: The prevalence of α1-antitrypsin PI*ZZ genotypes in patients with COPD is only partially known. We aimed to estimate this prevalence worldwide. METHOD: A systematic review of the literature was conducted for studies investigating the prevalence of COPD and the prevalence of severe alpha-1-antitrypsin deficiency (AATD) PI*ZZ genotype. Results are shown in tables and on a whole world interpolation map. RESULTS: Studies from 48 countries with available data (21 from Europe, 9 from the Americas, 5 from Africa, 11 from Asia and 2 from Australasia) were selected. About 235,000 individuals with PI*ZZ genotypes were accounted: 50% in Europe, 37% in America, 9% in Asia, 3% in Australasia and 1% in Africa. The estimated crude prevalence of COPD in adults older than 40 years was 12.45% in Europe, 13.51% in America, 13.22% in Africa, 11.70% in Asia and 11.86% in Australasia. The highest PI*ZZ weighted average prevalence among COPD subjects (expressed as 1/x [95% confidence intervals]) were found in Northern Europe (395 [252-576]) followed by Western (797 [538-1165]), Southern (944 [600-1475]) and Central Europe (1096 [687-1738]). Outside Europe, high values were found in Australia-New Zealand (1007 [684-1509]), Saudi Arabia (1276 [563-2961]), United States (1298 [1094-1540]), Canada (1482 [1057-2083]) and Thailand (1807 [717-4692]). In the rest of the world, prevalence was significantly lower, especially in vast regions of Asia and Africa where the PI*Z gene is practically non-existent. CONCLUSIONS: Severe AATD is associated with a significant number of cases of COPD, especially in Europe, USA, Canada, New Zealand and Australia.

Insights into Pathogenesis, Nutritional and Drug Approach in Sarcopenia: A Systematic Review.

Sarcopenia is a multifactorial condition related to the loss of muscle mass and strength due to aging, eating habits, physical inactivity, or even caused by another disease. Affected individuals have a higher risk of falls and may be associated with heart disease, respiratory diseases, cognitive impairment, and consequently an increased risk of hospitalization, in addition to causing an economic impact due to the high cost of care during the stay in hospitals. The standardization of appropriate treatment for patients with sarcopenia that could help reduce pathology-related morbidity is necessary. For these reasons, this study aimed to perform a systematic review of the role of nutrition and drugs that could ameliorate the health and quality of life of sarcopenic patients and PRISMA guidelines were followed. Lifestyle interventions have shown a profound impact on sarcopenia treatment but using supplements and different drugs can also impact skeletal muscle maintenance. Creatine, leucine, branched-chain amino acids, omega 3, and vitamin D can show benefits. Although with controversial results, medications such as Metformin, GLP-1, losartan, statin, growth hormone, and dipeptidyl peptidase 4 inhibitors have also been considered and can alter the sarcopenic's metabolic parameters, protect against cardiovascular diseases and outcomes, while protecting muscles.

Influence of the surface modification of granular-activated carbon synthesized from macauba on heavy metal sorption.

Adsorption on activated carbon is a promising technique for the treatment of low-concentration heavy metal pollutants in water with high efficiency and simple operation. However, commercial-activated carbon is often associated with high costs. Therefore, much attention has been given to activated carbon derived from low-cost agricultural and residual biomass. In this work, adsorption of Zn, Cd, and Pb ions in aqueous solutions was conducted using granular-activated carbon obtained from macauba palm, biomass waste of biofuel production, after surface modification using different methods. The adsorbents were obtained in granular form which facilitates all steps of the use, recovery, and reuse of the material, differently from the powdered-activated carbon normally used. The materials were characterized by using XPS, elemental analysis, N2 sorption (BET method), and zeta potential measurements. Such techniques allowed observation of the functionalization of the carbon surface. The materials presented high adsorption capacities when compared to other works in the literature, with a capacity of approximately 7.69, 8.42, and 1.63 mmol g-1 for Zn2+, Cd2+, and Pb2+, respectively. In addition, the materials showed a high capacity to be reused, removing 75% of Pb and 99% of both Cd and Zn after 4 cycles.

Bite Force, Masticatory Performance, and Nutritional Status of Adult Individuals With Treacher Collins Syndrome.

OBJECTIVE: To characterize the stomatognathic system of individuals with Treacher Collins syndrome (TCS) by assessing bite force (BF) and masticatory performance (MP) and to evaluate the nutritional status (NS) of this population through anthropometric measurements. DESIGN: Cross-sectional study. SETTING: A public tertiary care hospital. PATIENTS: Forty-one individuals were divided into 2 groups: (1) Control (CON): 20 control adults with class I skeletal pattern and (2) TCS: 21 adults with TCS. INTERVENTIONS: BF measurement was assessed using a gnathodynamometer (IDDK Kratos). MP assessment was done using Image J-NIH software, by calculating the particles size of food submitted to standard chewing cycles ). NS was assessed based on body mass index (BMI). MAIN OUTCOME MEASURES: Based on the craniofacial dysmorphology, it is our hypothesis that this population present a dysfunctional masticatory system, which can negatively impact NS. RESULTS: Means BF values for the TCS were significantly reduced when compared with the CON group and corresponded to 170.9 ± 109.4N and 431.6 ± 134.1N (right molar [RM]) and 171.2 ± 93.9N and 427.4 ± 147.8N (left molar [LM]), respectively (P < .05). Although no significant differences were observed, the mean particle size of the TCS was greater when compared with the CON group and corresponded to 1.58 ± 1.93 mm2 and 0.66 ± 0.52 mm2, respectively. Although statistically similar mean values of BMIs were observed on both groups (CON = 23.4 ± 4.7/TCS = 23.4 ± 6.1), underweight and overweight individuals were found in 48% of the individuals with TCS and in 15% of the CON group participants. CONCLUSION: Individuals with TCS showed a significant BF reduction, but no differences were observed in MP and NS when compared with the control individuals.

The Effects of Probiotics, Prebiotics and Synbiotics in Non-Alcoholic Fat Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): A Systematic Review.

Modifications in the microbiota caused by environmental and genetic reasons can unbalance the intestinal homeostasis, deregulating the host's metabolism and immune system, intensifying the risk factors for the development and aggravation of non-alcoholic fat liver disease (NAFLD). The use of probiotics, prebiotics and synbiotics have been considered a potential and promising strategy to regulate the gut microbiota and produce beneficial effects in patients with liver conditions. For this reason, this review aimed to evaluate the effectiveness of probiotics, prebiotics, and symbiotics in patients with NAFLD and NASH. Pubmed, Embase, and Cochrane databases were consulted, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed. The clinical trials used in this study demonstrated that gut microbiota interventions could improve a wide range of markers of inflammation, glycemia, insulin resistance, dyslipidemia, obesity, liver injury (decrease of hepatic enzymes and steatosis and fibrosis). Although microbiota modulators do not play a healing role, they can work as an important adjunct therapy in pathological processes involving NAFLD and its spectrums, either by improving the intestinal barrier or by preventing the formation of toxic metabolites for the liver or by acting on the immune system.

Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: State of the Art and Perspectives.

Diagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk.

Organokines in Rheumatoid Arthritis: A Critical Review.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily affects the joints. Organokines can produce beneficial or harmful effects in this condition. Among RA patients, organokines have been associated with increased inflammation and cartilage degradation due to augmented cytokines and metalloproteinases production, respectively. This study aimed to perform a review to investigate the role of adipokines, osteokines, myokines, and hepatokines on RA progression. PubMed, Embase, Google Scholar, and Cochrane were searched, and 18 studies were selected, comprising more than 17,000 RA patients. Changes in the pattern of organokines secretion were identified, and these could directly or indirectly contribute to aggravating RA, promoting articular alterations, and predicting the disease activity. In addition, organokines have been implicated in higher radiographic damage, immune dysregulation, and angiogenesis. These can also act as RA potent regulators of cells proliferation, differentiation, and apoptosis, controlling osteoclasts, chondrocytes, and fibroblasts as well as immune cells chemotaxis to RA sites. Although much is already known, much more is still unknown, principally about the roles of organokines in the occurrence of RA extra-articular manifestations.

Ginkgo biloba in the Aging Process: A Narrative Review.

Neurodegenerative diseases, cardiovascular disease (CVD), hypertension, insulin resistance, cancer, and other degenerative processes commonly appear with aging. Ginkgo biloba (GB) is associated with several health benefits, including memory and cognitive improvement, in Alzheimer's disease (AD), Parkinson's disease (PD), and cancer. Its antiapoptotic, antioxidant, and anti-inflammatory actions have effects on cognition and other conditions associated with aging-related processes, such as insulin resistance, hypertension, and cardiovascular conditions. The aim of this study was to perform a narrative review of the effects of GB in some age-related conditions, such as neurodegenerative diseases, CVD, and cancer. PubMed, Cochrane, and Embase databases were searched, and the PRISMA guidelines were applied. Fourteen clinical trials were selected; the studies showed that GB can improve memory, cognition, memory scores, psychopathology, and the quality of life of patients. Moreover, it can improve cerebral blood flow supply, executive function, attention/concentration, non-verbal memory, and mood, and decrease stress, fasting serum glucose, glycated hemoglobin, insulin levels, body mass index, waist circumference, biomarkers of oxidative stress, the stability and progression of atherosclerotic plaques, and inflammation. Therefore, it is possible to conclude that the use of GB can provide benefits in the prevention and treatment of aging-related conditions.

Brote de enfermedad aguda de Chagas adquirida oralmente en Sucre, 2019-2020 / Outbreak of orally acquired acute Chagas disease in Sucre, 2019-2020

Introducción: En las dos últimas décadas, varios países de América Latina han experimentado múltiples brotes de la enfermedad de Chagas oral. El estudio: Estudio retrospectivo que analiza un brote de enfermedad de Chagas oral aguda en Sucre, Colombia durante diciembre-enero de 2020. Los casos fueron confirmados por diferentes métodos diagnósticos. Hallazgos: Durante dos semanas se confirmaron 16 casos, donde la edad media fue de 14 años. Del total, 14 pacientes fueron hospitalizados y 2 fallecieron. Las manifestaciones clínicas incluyeron: fiebre, edema facial, hepatoesplenomegalia. En 13 de los pacientes se observaron tripomastigotes de Trypanosoma cruzi en los frotis fino y grueso. La transmisión oral se estableció como la vía más probable. Conclusiones: La enfermedad de Chagas aguda transmitida por vía oral puede poner en peligro la vida o incluso ser mortal, por tanto, es urgente mejorar las medidas de control epidemiológico a nivel nacional y en otros países de América Latina.

Background:In the last two decades, several Latin Americancountrieshaveexperiencedmultiple outbreaksoforalChagasdisease.Thestudy: Retrospective study analyzing an outbreak of acute oralChagasdiseaseinSucre,Colombiaduring December-January 2020. The cases were confirmed by different diagnostic methods. During two Finding:weeks, 16 cases were confirmed, where the mean age was 14 years and 12 were male. Of the total, 14 patientswerehospitalizedand2died.Clinical manifestationsinclude:fever,facialedema, hepatosplenomegaly,In13ofthepatients Trypanosoma cruzi trypomastigotes were observed in thethinandthicksmears.Oraltransmissionis established as the most likely route in 14 of the patients. Acute orally transmitted Conclusions: Chagas disease can be life-threatening or even fatal, therefore, it is urgent to improve epidemiological control measures at the national level and in other Latin American countries.

Estimated Prevalence and Number of PiMZ Genotypes of Alpha-1 Antitrypsin in Seventy-Four Countries Worldwide.

BACKGROUND: The α-1 antitrypsin (AAT) protease inhibitor PiMZ is a moderately deficient genotype, until recently considered of little or negligible risk. However, a growing number of studies show that MZ carriers have an increased risk of developing lung and liver diseases, if exposed to smoking or other airborne or industrial pollutants, and hepatotoxic substances. METHODS: We used the epidemiological studies performed to determine the frequencies of PiM and PiZ worldwide, based on the following criteria: 1) samples representative of the general population; 2) AAT phenotyping or genotyping characterized by adequate methods, including isoelectric focusing and polymerase chain reaction; and 3) studies with reliable results assessed with a coefficient of variation calculated from the sample size and 95% confidence intervals, to measure the precision of the results in terms of dispersion of the data around the mean. RESULTS: The present review reveals an impressive number of MZs of more than 35 million in 74 countries of the world with available data. Seventy-five percent of them are people of Caucasian European heritage, mostly living in Europe, America, Australia and New Zealand. Twenty percent of the remaining MZs live in Asia, with the highest concentrations in the Middle East, Eastern¸ Southern, and South-eastern regions of the Asian continent. The remaining five percent are Africans residing in Western and Eastern Africa. CONCLUSION: Considering the high rate of smoking, the outdoor and the indoor air pollution from solid fuels used in cooking and heating, and the exposure to industrial dusts and chemicals in many of these countries, these figures are very worrying, and hence the importance of adequately assessing MZ subjects, recommending them rigorous preventive measures based on the adoption of healthy lifestyles, including avoidance of smoking and alcohol.

The Effects of Curcumin on Diabetes Mellitus: A Systematic Review.

Diabetes mellitus (DM) is an ensemble of metabolic conditions that have reached pandemic proportions worldwide. Pathology's multifactorial nature makes patient management, including lifelong drug therapy and lifestyle modification, extremely challenging. Currently, there is growing evidence about the effectiveness of using herbal supplements in preventing and controlling DM. Curcumin is a bioactive component found Curcuma longa, which exhibits several physiological and pharmacological properties such as antioxidant, anti-inflammatory, anticancer, neuroprotective, and anti-diabetic activities. For these reasons, our objective is to systematically review the effects of Curcuma longa or curcumin on DM. Databases such as PUBMED and EMBASE were searched, and the final selection included sixteen studies that fulfilled the inclusion criteria. The results showed that curcumin's anti-diabetic activity might be due to its capacity to suppress oxidative stress and inflammatory process. Also, it significantly reduces fasting blood glucose, glycated hemoglobin, and body mass index. Nanocurcumin is also associated with a significant reduction in triglycerides, VLDL-c, total cholesterol, LDL-c, HDL-c, serum C reactive protein, and plasma malonaldehyde. Therefore, it can be considered in the therapeutic approach of patients with DM.

Adipokines, Myokines, and Hepatokines: Crosstalk and Metabolic Repercussions.

Adipose, skeletal, and hepatic muscle tissues are the main endocrine organs that produce adipokines, myokines, and hepatokines. These biomarkers can be harmful or beneficial to an organism and still perform crosstalk, acting through the endocrine, paracrine, and autocrine pathways. This study aims to review the crosstalk between adipokines, myokines, and hepatokines. Far beyond understanding the actions of each biomarker alone, it is important to underline that these cytokines act together in the body, resulting in a complex network of actions in different tissues, which may have beneficial or non-beneficial effects on the genesis of various physiological disorders and their respective outcomes, such as type 2 diabetes mellitus (DM2), obesity, metabolic syndrome, and cardiovascular diseases (CVD). Overweight individuals secrete more pro-inflammatory adipokines than those of a healthy weight, leading to an impaired immune response and greater susceptibility to inflammatory and infectious diseases. Myostatin is elevated in pro-inflammatory environments, sharing space with pro-inflammatory organokines, such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), resistin, and chemerin. Fibroblast growth factor FGF21 acts as a beta-oxidation regulator and decreases lipogenesis in the liver. The crosstalk mentioned above can interfere with homeostatic disorders and can play a role as a potential therapeutic target that can assist in the methods of diagnosing metabolic syndrome and CVD.

The role of double-step advancement genioplasty and bilateral coronoidectomy in Nager Syndrome: A case report.

AIM: To report the surgical management of bilateral mandibular coronoid processes hyperplasia and mandibular retrognathism associated with trismus and convex facial profile in an individual diagnosed with Nager syndrome (NS). CASE REPORT: A 21 years old female was referred to the Department of Oral and Maxillofacial Surgery, presenting limited mouth opening and an unpleasant convex facial profile. The tomography exhibited hyperplasia of mandibular coronoid processes with no evidence of intracapsular ankylosis of the temporomandibular joint. The treatment objectives were to increase mouth opening through a bilateral coronoidectomy and gain chin projection using the double-step advancement genioplasty technique. The 9-month postoperative follow-up revealed a 22.22% (6 mm) gain in jaw opening, improved masticatory function, and facial profile. CONCLUSIONS: The NS is a complex craniofacial anomaly due to its clinical heterogeneity. Thus, treatment planning must be done individually, considering the patients' main complaints and respecting the limitations regarding anatomy and availability of proper surgical materials. In the present case, a bilateral coronoidectomy associated with immediate physiotherapy improved the patient's mouth opening, and the double-step genioplasty promoted a much more significant chin advancement than would be obtained with the single-step traditional osteotomy.