Transgenerational inheritance of methylmercury and vitamin A-induced toxicological effects in a Wistar rats environmental-based model.

Mercury (Hg) and vitamin A (VitA) are two environmental factors with potential health impacts, especially during pregnancy and early childhood. Fish and seafood may present elevated levels of methylmercury (MeHg), the major Hg derivative, and VitA. This study aimed to evaluate the transgenerational effects of exposure to MeHg and/or VitA on epigenetic and toxicological parameters in a Wistar rat model. Our findings revealed persistent toxicological effects in generations F1 and F2 following low/mild doses of MeHg and/or VitA exposure during dams' (F0) gestation and breastfeeding. Toxicological effects observed in F2 included chronic DNA damage, bone marrow toxicity, altered microglial content, reduced neuronal signal, and diminished male longevity. Sex-specific patterns were also observed. Co-exposure to MeHg and VitA showed both synergistic and antagonistic effects. Additionally, the study demonstrated that MeHg and VitA affected histone methylation and caused consistent effects in F2. While MeHg exposure has been associated with transgenerational inheritance effects in other organisms, this study provides the first evidence of transgenerational inheritance of MeHg and VitA-induced toxicological effects in rodents. Although the exact mechanism is not yet fully understood, these findings suggest that MeHg and VitA may perpetuate their impacts across generations. The study highlights the need for remedial policies and interventions to mitigate the potential health problems faced by future generations exposed to MeHg or VitA. Further research is warranted to investigate the transgenerational effects beyond F2 and determine the matrilineal or patrilineal inheritance patterns.

Increased alpha-synuclein and neuroinflammation in the substantia nigra triggered by systemic inflammation are reversed by targeted inhibition of the receptor for advanced glycation end products (RAGE).

The receptor for advanced glycation end products (RAGE) is a protein of the immunoglobulin superfamily capable of regulating inflammation. Considering the role of this receptor in the initiation and establishment of neuroinflammation, and the limited understanding of the function of RAGE in the maintenance of this condition, this study describes the effects of RAGE inhibition in the brain, through an intranasal treatment with the antagonist FPS-ZM1, in an animal model of chronic neuroinflammation induced by acute intraperitoneal injection of lipopolysaccharide (LPS). Seventy days after LPS administration (2 mg/kg, i.p.), Wistar rats received, intranasally, 1.2 mg of FPS-ZM1 over 14 days. On days 88 and 89, the animals were submitted to the open-field test and were killed on day 90 after the intraperitoneal injection of LPS. Our results indicate that blockade of encephalic RAGE attenuates LPS-induced chronic neuroinflammation in different brain regions. Furthermore, we found that intranasal FPS-ZM1 administration reduced levels of gliosis markers, RAGE ligands, and α-synuclein in the substantia nigra pars compacta. Additionally, the treatment also reversed the increase in S100 calcium-binding protein B (RAGE ligand) in the cerebrospinal fluid and the cognitive-behavioral deficits promoted by LPS-less time spent in the central zone of the open-field arena (more time in the lateral zones), decreased total distance traveled, and increased number of freezing episodes. In summary, our study demonstrates the prominent role of RAGE in the maintenance of a chronic neuroinflammatory state triggered by a single episode of systemic inflammation and also points to possible future RAGE-based therapeutic approaches to treat conditions in which chronic neuroinflammation and increased α-synuclein levels could play a relevant role, such as in Parkinson's disease.

Is it all the RAGE? Defining the role of the receptor for advanced glycation end products in Parkinson's disease.

The receptor for advanced glycation end products (RAGE) is a transmembrane receptor that belongs to the immunoglobulin superfamily and is extensively associated with chronic inflammation in non-transmissible diseases. As chronic inflammation is consistently present in neurodegenerative diseases, it was largely assumed that RAGE could act as a critical modulator of neuroinflammation in Parkinson's disease (PD), similar to what was reported for Alzheimer's disease (AD), where RAGE is postulated to mediate pro-inflammatory signaling in microglia by binding to amyloid-ß peptide. However, accumulating evidence from studies of RAGE in PD models suggests a less obvious scenario. Here, we review physiological aspects of RAGE and address the current questions about the potential involvement of this receptor in the cellular events that may be critical for the development and progression of PD, exploring possible mechanisms beyond the classical view of the microglial activation/neuroinflammation/neurodegeneration axis that is widely assumed to be the general mechanism of RAGE action in the adult brain.

Acute Carpal Tunnel Syndrome Secondary to Gout Flare and Outcomes at 18 Months After Open Carpal Tunnel Decompression.

Acute carpal tunnel syndrome is a rare condition that requires immediate surgery. Although numerous causes have been described in the literature, only 7 reports of acute carpal tunnel syndrome secondary to gout have been reported, all with short follow-ups. We report, to our knowledge, the first case of carpal tunnel syndrome presenting with total anesthesia of the fingers innervated by the median nerve and complete recovery of the sensory and motor function after carpal tunnel decompression, with no recurrence at the 18-month follow-up. To prevent irreversible damage to the nerve, treatment should not be delayed.

Effect of handling, time of use and photoactivation on the contamination of dental composite resins

This study evaluated the effect of contamination of composite resins (CRs) handled by undergraduate students during restorative procedures, varying the time (baseline, 30 days and 60 days) and experimental condition (before and after handling, contamination with saliva [positive control] and photoactivation). Eight CR tubes were randomly distributed at the dental clinic and the samples were organized into four groups: CR fragments collected before (GB) and after (GA) the restorative procedure; CR fragments contaminated with saliva (GS) and photoactivated (GP) both collected after the procedure. These 4 groups were evaluated in 3 different times: baseline (after sealing), 30 days and 60 days of use of the CR. Samples that had positive turbidity in Brain HeartInfusion (BHI) broth were sown in BHI and Sabouraud Dextrose (SB) agars for subsequent counting of Colony Forming Units (CFU mL-1). The results showed that the handling was responsible for increasing contamination (p < 0.05) at the baseline (GB [n = 0] and GA [n = 3]), as well as after 30 (GB [n = 1] and GA [n = 6]) and 60 (GB [n = 1] and GA [n = 5]) days of use. Photoactivation was responsible for the reduction for microorganisms in T0 and T60. Additionally, the time use and conservation did not influencethe contamination of CRs. Handling was responsible for the increase of contamination of CR, the photoactivation seems to reduce the number of viable microorganisms and the time of use seems not to potentiate the effect of tube contamination.

Role of toll-like receptor 4 and sex in 6-hydroxydopamine-induced behavioral impairments and neurodegeneration in mice.

Parkinson's disease (PD) is a neurodegenerative disease characterized by progressive loss of the nigrostriatal dopaminergic neurons that are associated with motor alterations and non-motor manifestations (such as depression). Neuroinflammation is a process with a critical role in the pathogenesis of PD. In this regard, toll-like receptor 4 (TLR4) is a central mediator of immune response in PD. Moreover, there are gender-related differences in the incidence, prevalence, and clinical features of PD. Therefore, we aimed to elucidate the role of TLR4 in the sex-dependent response to dopaminergic denervation induced by 6-hydroxydopamine (6-OHDA) in mice. Female and male adult wildtype (WT) and TLR4 knockout (TLR4-/-) mice were administered with unilateral injection of 6-OHDA in the dorsal striatum, and non-motor and motor impairments were evaluated for 30 days, followed by biochemistry analysis in the substantia nigra pars compacta (SNc), dorsal striatum, and dorsoventral cortex. Early non-motor impairments (i.e., depressive-like behavior and spatial learning deficits) induced by 6-OHDA were observed in the male WT mice but not in male TLR4-/- or female mice. Motor alterations were observed after administration of 6-OHDA in both strains, and the lack of TLR4 was also related to motor commitment. Moreover, ablation of TLR4 prevented 6-OHDA-induced dopaminergic denervation and microgliosis in the SNc, selectively in female mice. These results reinforced the existence of sex-biased alterations in PD and indicated TLR4 as a promising therapeutic target for the motor and non-motor symptoms of PD, which will help counteract the neuroinflammatory and neurodegenerative processes.

Intranasal HSP70 administration protects against dopaminergic denervation and modulates neuroinflammatory response in the 6-OHDA rat model.

HSP70 is one of the main molecular chaperones involved in the cellular stress response. Besides its chaperone action, HSP70 also modulates the immune response. Increased susceptibility to toxic insults in intra- and extracellular environments has been associated with insufficient amounts of inducible HSP70 in adult neurons. On the other hand, exogenous HSP70 administration has demonstrated neuroprotective effects in experimental models of age-related disorders. In this regard, this study investigated the effects of exogenous HSP70 in an animal model of dopaminergic denervation of the nigrostriatal axis. After unilateral intrastriatal injection with 6-hydroxydopamine (6-OHDA), the animals received purified recombinant HSP70 through intranasal administration (2 µg/rat/day) for 15 days. Our results indicate a neuroprotective effect of intranasal HSP70 against dopaminergic denervation induced by 6-OHDA. Exogenous HSP70 improved motor impairment and reduced the loss of dopaminergic neurons caused by 6-OHDA. Moreover, HSP70 modulated neuroinflammatory response in the substantia nigra, an important event in Parkinson's disease pathogenesis. Specifically, HSP70 treatment reduced microglial activation and astrogliosis induced by 6-OHDA, as well as IL-1ß mRNA expression in this region. Also, recombinant HSP70 increased the protein content of HSP70 in the substantia nigra of rats that received 6-OHDA. These data suggest the neuroprotection of HSP70 against dopaminergic neurons damage after cellular stress. Finally, our results indicate that HSP70 neuroprotective action against 6-OHDA toxicity is related to inflammatory response modulation.

Neurological impairment caused by Schistosoma mansoni systemic infection exhibits early features of idiopathic neurodegenerative disease.

Schistosomiasis, a neglected tropical disease caused by trematodes of the Schistosoma genus, affects over 250 million people around the world. This disease has been associated with learning and memory deficits in children, whereas reduced attention levels, impaired work capacity, and cognitive deficits have been observed in adults. Strongly correlated with poverty and lack of basic sanitary conditions, this chronic endemic infection is common in Africa, South America, and parts of Asia and contributes to inhibition of social development and low quality of life in affected areas. Nonetheless, studies on the mechanisms involved in the neurological impairment caused by schistosomiasis are scarce. Here, we used a murine model of infection with Schistosoma mansoni in which parasites do not invade the central nervous system to evaluate the consequences of systemic infection on neurologic function. We observed that systemic infection with S. mansoni led to astrocyte and microglia activation, expression of oxidative stress-induced transcription factor Nrf2, oxidative damage, Tau phosphorylation, and amyloid-ß peptide accumulation in the prefrontal cortex of infected animals. We also found impairment in spatial learning and memory as evaluated by the Morris water maze task. Administration of anthelmintic (praziquantel) and antioxidant (N-acetylcysteine plus deferoxamine) treatments was effective in inhibiting most of these phenotypes, and the combination of both treatments had a synergistic effect to prevent such changes. These data demonstrate new perspectives toward the understanding of the pathology and possible therapeutic approaches to counteract long-term effects of systemic schistosomiasis on brain function.

Oral administration of carvacrol/ß-cyclodextrin complex protects against 6-hydroxydopamine-induced dopaminergic denervation.

Carvacrol (CARV) presents valuable biological properties such as anti-inflammatory and antioxidant activities. However, pharmacological uses of CARV are largely limited due to disadvantages related to solubility, bioavailability, preparation and storage processes. The complexation of monoterpenes with ß-cyclodextrin (ß-CD) increases their stability, solubility and oral bioavailability. Here, the protective effect of oral treatment with CARV/ß-CD complex (25 µg/kg/day) against dopaminergic (DA) denervation induced by unilateral intranigral injection of 6-hydroxydopamine (6-OHDA - 10 µg per rat) was analyzed, in order to evaluate a putative application in the development of neuroprotective therapies for Parkinson's disease (PD). Pretreatment with CARV/ß-CD for 15 days prevented the loss of DA neurons induced by 6-OHDA in adult Wistar rats. This effect may occur through CARV anti-inflammatory and antioxidant properties, as the pretreatment with CARV/ß-CD inhibited the release of IL-1ß and TNF-α; besides, CARV prevented the increase of mitochondrial superoxide production induced by 6-OHDA in cultured SH-SY5Y cells. Importantly, hepatotoxicity or alterations in blood cell profile were not observed with oral administration of CARV/ß-CD. Therefore, this study showed a potential pharmacological application of CARV/ß-CD in PD using a non-invasive route of drug delivery, i.e., oral administration.

Systemic Inflammation Changes the Site of RAGE Expression from Endothelial Cells to Neurons in Different Brain Areas.

The receptor for advanced glycation endproducts (RAGE) is a transmembrane, immunoglobulin-like receptor that interacts with a broad repertoire of extracellular ligands. RAGE belongs to a family of cell adhesion molecules and is considered a key receptor in the inflammation axis and a potential contributor to the neurodegeneration. The present study aimed to investigate the content and cell localization of RAGE in the brain of Wistar rats subjected to systemic inflammation induced by a single dose of lipopolysaccharide (LPS, 5 mg/kg, i.p.). Fifteen days after LPS administration, the content of RAGE was analyzed in the prefrontal cortex (PFC), hippocampus (HIPP), cerebellum (CB), and substantia nigra (SN) were investigated. RAGE levels increased in all structures, except HIPP; however, immunohistochemistry analysis demonstrated that the cell site of RAGE expression changed from blood vessel-like structures to neuronal cells in all brain areas. Besides, the highest level of RAGE expression was found in SN. Immunofluorescence analysis in SN confirmed that RAGE expression was mainly co-localized in endothelial cells (RAGE/PECAM-1 co-staining) in untreated animals, while LPS-treated animals had RAGE expression predominantly in dopaminergic neurons (RAGE/TH co-staining). Decreased TH levels, as well as increased pro-inflammatory markers (TNF-α, IL-1ß, Iba-1, GFAP, and phosphorylated ERK1/2) in SN, occurred concomitantly to RAGE stimulation in the same site. These results suggest a role for RAGE in the establishment of a neuroinflammation-neurodegeneration axis that develops as a long-term response to systemic inflammation by LPS.

Nuclear RXRα and RXRß receptors exert distinct and opposite effects on RA-mediated neuroblastoma differentiation.

Retinoic acid (RA) promotes differentiation in multiple neurogenic cell types by promoting gene reprogramming through retinoid receptors and also by inducing cytosolic signaling events. The nuclear RXR receptors are one of the main mediators of RA cellular effects, classically by joining the direct receptors of RA, the nuclear RAR receptors, in RAR/RXR dimers which act as transcription factors. Distinct RXR genes lead to RXRα, RXRß and RXRγ subtypes, but their specific roles in neuronal differentiation remain unclear. We firstly investigated both RXRs and RARs expression profiles during RA-mediated neuronal differentiation of human neuroblastoma cell line SH-SY5Y, and found varying levels of retinoid receptors transcript and protein contents along the process. In order to understand the roles of the expression of distinct RXR subtypes to RA signal transduction, we performed siRNA-mediated silencing of RXRα and RXRß during the first stages of SH-SY5Y differentiation. Our results showed that RXRα is required for RA-induced neuronal differentiation of SH-SY5Y cells, since its silencing compromised cell cycle arrest and prevented the upregulation of neuronal markers and the adoption of neuronal morphology. Besides, silencing of RXRα affected the phosphorylation of ERK1/2. By contrast, silencing of RXRß improved neurite extension and led to increased expression of tau and synaptophysin, suggesting that RXRß may negatively regulate neuronal parameters related to neurite outgrowth and function. Our results indicate distinct functions for RXR subtypes during RA-dependent neuronal differentiation and reveal new perspectives for studying such receptors as clinical targets in therapies aiming at restoring neuronal function.

Arthroscopic treatment of synovial chondromatosis of the ankle / Tratamento artroscópico de condromatose sinovial do tornozelo

ABSTRACT Synovial chondromatosis is a rare proliferative disease, characterized by the occurrence of metaplasia in the synovium of the joints. These lesions become pedunculated; with the evolution of the disease they become detached, leading to intra-articular loose-bodies. It occurs more frequently in males between the third and fifth decades of life, usually affecting large joints such as the knee and hip. Smaller joints, such as the ankle, are less frequently affected. Patients report articular pain, blockage, and limited range of motion caused by the loose fragments. As the disease progresses, the joint undergoes degenerative changes. This report describes a case of synovial chondromatosis of the ankle, treated by arthroscopy. The patient, a 59 year-old male, complained of pain and swelling of the left ankle. Physical evaluation showed limited tibiotarsal mobility (plantar flexion of 20° and dorsiflexion of 5°). After physical and imaging evaluation, the patient underwent ankle arthroscopy due to impingement of the joint, with limitation of mobility. Arthroscopic treatment allowed easy access to the joint, removal of loose bodies, and partial synovectomy, with low morbidity and early rehabilitation. The final prognosis was excellent.

RESUMO A condromatose sinovial é uma doença proliferativa, rara e caracterizada pela ocorrência de metaplasia na sinovial das articulações. Essas lesões tornam-se pediculadas e à medida que a doença evolui, as lesões se soltam, dão origem a corpos livres intra-articulares. A prevalência é maior em homens entre a terceira e quinta décadas de vida, atingindo normalmente grandes articulações como o joelho e o quadril. Articulações menores, como o tornozelo, são afetadas com menos frequência.Os pacientes referem dor articular, bloqueio e limitação da mobilidade causados pelos fragmentos livres. Com o evoluir da doença, a articulação sofre alterações degenerativas. Os autores apresentam um caso clínico de condromatose sinovial do tornozelo, tratado por artroscopia. O doente, do sexo masculino e de 59 anos, referia queixas de dor e edema do tornozelo esquerdo. Ao exame físico, apresentava limitação da mobilidade da tibiotársica (flexão plantar e dorsiflexão de 20° e 5°, respectivamente). Após avaliação clínica e estudo imagiológico, foi proposta artroscopia do tornozelo para tratamento de pinçamento articular com limitação da mobilidade. O tratamento artroscópico permitiu um fácil acesso à articulação, remoção dos corpos livres e sinovectomia parcial, com baixa morbilidade e reabilitação precoce. O prognóstico final foi excelente.

Arthroscopic treatment of synovial chondromatosis of the ankle.

Synovial chondromatosis is a rare proliferative disease, characterized by the occurrence of metaplasia in the synovium of the joints. These lesions become pedunculated; with the evolution of the disease they become detached, leading to intra-articular loose-bodies. It occurs more frequently in males between the third and fifth decades of life, usually affecting large joints such as the knee and hip. Smaller joints, such as the ankle, are less frequently affected. Patients report articular pain, blockage, and limited range of motion caused by the loose fragments. As the disease progresses, the joint undergoes degenerative changes. This report describes a case of synovial chondromatosis of the ankle, treated by arthroscopy. The patient, a 59 year-old male, complained of pain and swelling of the left ankle. Physical evaluation showed limited tibiotarsal mobility (plantar flexion of 20° and dorsiflexion of 5°). After physical and imaging evaluation, the patient underwent ankle arthroscopy due to impingement of the joint, with limitation of mobility. Arthroscopic treatment allowed easy access to the joint, removal of loose bodies, and partial synovectomy, with low morbidity and early rehabilitation. The final prognosis was excellent.

A condromatose sinovial é uma doença proliferativa, rara e caracterizada pela ocorrência de metaplasia na sinovial das articulações. Essas lesões tornam-se pediculadas e à medida que a doença evolui, as lesões se soltam, dão origem a corpos livres intra-articulares. A prevalência é maior em homens entre a terceira e quinta décadas de vida, atingindo normalmente grandes articulações como o joelho e o quadril. Articulações menores, como o tornozelo, são afetadas com menos frequência. Os pacientes referem dor articular, bloqueio e limitação da mobilidade causados pelos fragmentos livres. Com o evoluir da doença, a articulação sofre alterações degenerativas. Os autores apresentam um caso clínico de condromatose sinovial do tornozelo, tratado por artroscopia. O doente, do sexo masculino e de 59 anos, referia queixas de dor e edema do tornozelo esquerdo. Ao exame físico, apresentava limitação da mobilidade da tibiotársica (flexão plantar e dorsiflexão de 20° e 5°, respectivamente). Após avaliação clínica e estudo imagiológico, foi proposta artroscopia do tornozelo para tratamento de pinçamento articular com limitação da mobilidade. O tratamento artroscópico permitiu um fácil acesso à articulação, remoção dos corpos livres e sinovectomia parcial, com baixa morbilidade e reabilitação precoce. O prognóstico final foi excelente.

Stroke as the First Clinical Manifestation of Takayasu's Arteritis.

Takayasu's arteritis is a chronic inflammatory disease, and neurological symptoms occur in 50% of cases, most commonly including headache, dizziness, visual disturbances, convulsive crisis, transient ischemic attack, stroke and posterior reversible encephalopathy syndrome. The aim of this study was to report the case of a young Brazilian female with a focal neurological deficit. She presented with asymmetry of brachial and radial pulses, aphasia, dysarthria and right hemiplegia. Stroke was investigated extensively in this young patient. Only nonspecific inflammatory markers such as velocity of hemosedimentation and C-reactive protein were elevated. During hospitalization, clinical treatment was performed with pulse therapy showing improvement in neurological recuperation on subsequent days. In the chronic phase, the patient was submitted to medicated angioplasty of the brachiocephalic trunk with paclitaxel, with significant improvement of the stenosis. At the 6-month follow-up, the neurological exam presented mild dysarthria, faciobrachial predominant disproportionate hemiparesis, an NIHSS score of 4 and a modified Rankin Scale score of 3 (moderate incapacity). In conclusion, Takayasu's arteritis must be recognized as a potential cause of ischemic stroke in young females.

Heterocontrole da fluoretação da água de abastecimento público do município de Jaguaribara, Ceará, Brasil / External control of fluoridation of public water supplies of the city of Jaguaribara, Ceará, Brazil

Objetivo: Monitorar os teores de flúor (F) nas águas de abastecimento público no município de Jaguaribara, Ceará, Brasil. Métodos: Coletaram-se amostras da água da zona urbana, em três pontos diferentes. As coletas foram realizadas duas vezes ao mês, de agosto de 2010 a julho de 2011. As amostras foram analisadas em triplicata por meio do eletrodo combinado conectado a um medidor, previamente calibrados com padrões contendo de 0,2 a 6,4 ppm F, com Tisab II. Os dados foram analisados por três critérios: I (Brasil, 1975), II (Ramires et al., 2006) e III (Consenso técnico, 2011). Resultados: Em um total de 72 amostras de água foi possível observar uma média de 0,55 (± 0,19) ppm F, mediana de 0,61. No Critério I, foram verificados níveis aceitáveis de flúor em 47,2% das amostras, 44,4% apresentaram-se subfluoretadas (< 0,60 ppm F) e 8,3% superfluoretadas. Para o critério II, observou-se que 36,1% das amostras foram inaceitáveis (<0,55 ppm F) e 63,9% estavam dentro dos limites aceitáveis (0,55 a 0,84 ppm F), não havendo nenhuma amostra superfluoretada. No critério III, verificou-se a presença de 25% das amostras com risco e benefícios insignificantes em relação à fluorose dentária e prevenção de cárie dentária, enquanto 11,1% das amostras apresentaram risco baixo e benefício mínimo e 63,9% apontam risco baixo e benefício máximo. Conclusões: Observaram-se alterações nos teores de flúor nas águas de abastecimento público no período estudado. Sugere-se a necessidade de melhorar o controle operacional e também do heterocontrole da fluoretação das águas de Jaguaribara-CE.

Objective: To monitor the levels of fluoride (F) in public water supplies in the city of Jaguaribara, Ceará, Brazil. Methods: Water samples were collected from the urban area, at three different points. Samples were collected twice a month, from August 2010 to July 2011. The samples were analyzed in triplicate, using the combined electrode connected to a meter, previously calibrated with standards containing 0.2 to 6.4 ppm F, with Tisab II. Data was analyzed by three criteria: I (Brazil, 1975), II (Ramires et al., 2006) and III (Technical Consensus, 2011). results: Among a total of 72 water samples, we observed an average of 0.55 (± 0.19) ppm F, median of 0.61. According to Criterion I, acceptable levels of fluoride were found in 47.2% of samples, while 44,4% were underfluoridated (<0.60 ppm F) and 8,3% were overfluorinated. For criterion II, it was observed that 36.1% of the samples were acceptable (<0.55 ppm F) and 63.9% were into acceptable limits (0.55 and 0.84 ppm F), with no overfluorinated sample (> 0.84 ppm F). Based on criterion III, 25% of samples showed negligible risk and benefits concerning dental fluorosis and prevention of dental caries, while 11.1% of the samples presented low risk and benefit and 63.9% pointed to low risk and maximum benefit. Conclusions: Altered levels of fluoride were observed in public water supplies in the studied period. It is suggested the need to improve operational control and also the external control of water fluoridation in Jaguaribara, Ceará, Brazil.

Aspectos imunológicos e etiopatogênicos das lesões periapicais inflamatórias crônicas / Etiopathogenic and immunologic aspects of chronic inflammatory periapical lesions

Dentre as lesões periapicais inflamatórias crônicas mais comuns, estão os granulomas periapicais (GPs), os cistos radiculares (CRs) e os cistos periapicais residuais (CPRs). Essas lesões se desenvolvem após a necrose e gangrena pulpar, resultante da ação direta dos microrganismos e da resposta imunológica do hospedeiro a estímulos antigênicos oriundos dos canais radiculares. Algumas subpopulações de células atuam diretamente nesse processo como os neutrófilos, macrófagos e linfócitos T e B. Diversas pesquisas vêm tentando esclarecer o perfil das células inflamatórias presentes nestas lesões, no intuito de melhor compreender sua etiopatogenia. Baseado nisso, esta revisão de literatura objetiva descrever aspectos imunológicos e etiopatogênicos das lesões periapicais inflamatórias crônicas, a fim de propiciar mais esclarecimentos sobre essas entidades. O levantamento bibliográfico foi realizado nas bases de dados Medline, PubMed, Science direct, Scielo e Cochrane, utilizando-se os seguintes descritores: ?periapical lesions?, ?radicular cyst?, ?residual cyst?, ?periapical granuloma?, ?pathogenesis?, ?immunology?. Quarenta e sete artigos e 8 livros foram selecionados com base em alguns critérios de inclusão, tais como a disponibilidade do texto integral, publicação nas línguas portuguesa e inglesa e artigos que fizessem referência aos aspectos imunológicos e etiopatogênicos. De fato, ficou claro que as lesões periapicais inflamatórias crônicas são reações imunopatológicas decorrentes da estimulação antigênica advinda dos canais radiculares. Entretanto, há muito a se esclarecer sobre a dinâmica, a nível molecular, dos mecanismos celulares envolvidos nessas lesões, o que justifica a necessidade de mais pesquisas que visem esclarecer os verdadeiros mecanismos celulares na etiopatogenia dessas lesões.

Among the more common chronic inflammatory periapical lesions are the periapical granulomas (PGs), the radicular cysts (RCs) and the residual periapical cysts (RPCs). These lesions develop after pulp necrosis and gangrene, resulting from the microorganisms? direct action and from the host immune response to antigenic stimuli of the root canals. Some cell subpopulations act directly in this process as neutrophils, macrophages and T and B lymphocytes. Some studies have attempted to clarify the inflammatory cells profile present in these lesions in order to better understand its pathogenesis. Based on this, this literature review aims to describe immunological and etiopathogenic aspects of chronic inflammatory periapical lesions, in order to provide further information about these entities. The bibliographic research was conducted in the databases Medline, PubMed, Science Direct, Scielo and Cochrane, using the following keywords: "periapical lesions", "radicular cyst," "residual cyst", "periapical granuloma," "pathogenesis", "immunology". Forty-seven articles and 8 books were selected, based on some inclusion criteria such as the integral text availability, published in Portuguese and English and articles that refer to the immunological and etiopathogenic aspects. In fact, it was clear that the chronic inflammatory periapical lesions are immunopathologic reactions resulting from antigenic stimulation arising from root canals. However, there is much to clarify about the dynamics of cellular mechanisms involved in these lesions at the molecular level, which justifies the need for more research aimed at the pathogenesis of these lesions.

Controle da Dor Pós-Operatória em Cirurgia Oral: Revisão de Literatura / Control of Postoperative Pain in Oral Surgery: Literature Review

Discutir estratégias efetivas de analgesia para ocontrole da dor pós-operatória em cirurgia bucal, a fim desubsidiar a escolha dos medicamentos de forma maisadequada. Material e Métodos: O levantamento bibliográficofoi realizado nas bases de dados Medline, PubMed, Sciencedirect, EBSCO e Cochrane. Foram selecionados 29 artigos,incluindo 13 revisões de literatura convencionais, 05 revisõessistemáticas e 11 ensaios clínicos controlados. Resultados:Os procedimentos cirúrgicos da cavidade oral concentramos procedimentos mais invasivos e com maiores chances decausar dor pós-operatória, exigindo do profissional o empregode estratégias farmacológicas para minimizar o desconfortoproveniente dessas intervenções. Vários medicamentospodem ajudar no controle da dor, como os analgésicos deação central e periféricas, os antiinflamatórios não-esteroidais(AINES), e os antiinflamatórios esteroidais (corticóides). Cadaum apresenta mecanismo de ação específico associado avariados graus de eficiência em determinado estágio doprocesso doloroso. Conclusões: O controle da dor pósoperatóriadeve ser feita de forma individualizada, escolhendoos fármacos de forma correta e sempre levando emconsideração a etiopatogenia da dor, tipo e severidade doprocedimento utilizado e condições sistêmicas do paciente,entre outros fatores. Estratégias com o uso combinado deanalgésicos que atuam nas diferentes vias nociceptivas,tem demonstrado um melhor efeito no controle da dor pósoperatóriaem indivíduos submetidos a cirurgia oral...

To discuss effective analgesic strategies forcontrolling postoperative pain in oral surgery in order tosupport drug choice more appropriately. Material andMethods: The literature review was conducted in thedatabases Medline, PubMed, Science Direct, EBSCO, andCochrane. 29 studies were selected, including 13conventional literature reviews, 05 systematic reviews and11 randomized controlled trials. Results: The surgicalprocedures in the oral cavity were found to be more invasiveand with increased potential to cause postoperative pain,what requires from the professional the use ofpharmacological strategies to minimize discomfort generatedby such interventions. Several drugs might help in controllingpain, like opioids, non-steroidal anti-inflammatory drugs(NSAIDs) and steroidal anti-inflammatory drugs(corticosteroids). Each drug has a specific mechanism ofaction, associated with varying degrees of efficiency at eachstage of the painful process. Conclusions: The control ofpostoperative pain should be made individually, choosing thedrugs correctly and always taking into account the etiologyof pain, type and severity of the procedure performed andpatient’s systemic conditions, among other factors. Strategieswith the combined use of painkillers that act on differentnociceptive pathways have shown a better effect incontrolling postoperative pain in patients undergoing oralsurgery...