Does the use of panoramic radiography add information in the temporomandibular joint evaluation in Juvenile Idiopathic Arthritis patients? A case control study.

OBJECTIVE: To determine the frequency of radiographic changes in the temporomandibular joint, in a representative population of patients with Juvenile Idiopathic Arthritis (JIA) and to compare with findings in healthy controls matched by sex and age. PATIENTS AND METHODS: One hundred and thirty-seven panoramic radiographies (PR) from JIA patients of a pediatric rheumatology outpatient clinic were prospectively evaluated and compared to 137 PR from healthy individuals. RESULTS: 102 (74.5%) JIA patients and 47 (34.3%) controls showed at least one radiological alteration (p < 0.001). The following radiographic alterations were more frequently observed in JIA patients than in controls: erosion (p < 0.001), altered condylar morphology (p < 0.001), disproportion between condylar process and the coronoid process (p < 0.001) and accentuated curve in the antegonial notch (p = 0.002). Twenty patients (14.6%) presented the four radiographic alterations simultaneously compared to only two controls (1.5%) (p < 0.001). CONCLUSION: Due to the difference in the frequency of findings in the PR of patients and controls, we concluded that PR has value as a screening tool. In the presence of major changes in the mandible head in the PR of patients with a confirmed diagnosis of JIA, MRI should be considered to detect an active inflammatory process in this joint.

Does the use of panoramic radiography add information in the temporomandibular joint evaluation in Juvenile Idiopathic Arthritis patients? A case control study

Abstract Objective To determine the frequency of radiographic changes in the temporomandibular joint, in a representative population of patients with Juvenile Idiopathic Arthritis (JIA) and to compare with findings in healthy controls matched by sex and age. Patients and Methods One hundred and thirty-seven panoramic radiographies (PR) from JIA patients of a pediatric rheumatology outpatient clinic were prospectively evaluated and compared to 137 PR from healthy individuals. Results 102 (74.5%) JIA patients and 47 (34.3%) controls showed at least one radiological alteration (p < 0.001). The following radiographic alterations were more frequently observed in JIA patients than in controls: erosion (p < 0.001), altered condylar morphology (p < 0.001), disproportion between condylar process and the coronoid process (p < 0.001) and accentuated curve in the antegonial notch (p = 0.002). Twenty patients (14.6%) presented the four radiographic alterations simultaneously compared to only two controls (1.5%) (p < 0.001). Conclusion Due to the difference in the frequency of findings in the PR of patients and controls, we concluded that PR has value as a screening tool. In the presence of major changes in the mandible head in the PR of patients with a confirmed diagnosis of JIA, MRI should be considered to detect an active inflammatory process in this joint.

Quantitation of residual D positive red cells in D negative recipients of D positive solid organ transplants.

BACKGROUND: Solid organ transplants (SOT) from D positive donors are potentially sensitising events for D negative recipients. For this reason, it is important to quantify the presence of residual D positive red blood cells (RBCs) in the recipient's circulation and calculate the correct dose of prophylactic anti-D (PAD) required to prevent sensitisation. This is especially important in females of child-bearing potential where the presence of allo anti-D can, at worst, cause the death of the fetus in future pregnancies. OBJECTIVE: This study aimed to identify the patient characteristics of D positive SOT cases referred to Red Cell Immunohaematology, NHSBT for flow cytometry investigation. This information could indicate improvements required in the current testing methodology, as well as to the calculations used to prescribe PAD for this patient group. METHODS: Samples were investigated using a Beckman Coulter Navios Flow Cytometer using BRAD3-FITC (anti-D), AEVZ5.3-FITC (isotype matched negative control) and BIRMA17C-PE (granulocyte exclusion reagent). Mollison's calculation was used to estimate the dose of PAD required to prevent sensitisation in the D negative recipients. The calculation was adapted to consider the presence of organ donor D positive adult RBCs in the circulation of recipients instead of, larger, fetal RBCs. RESULTS: Samples from 20 patients, all female, aged 14-53 years (one 2-year-old outlier) were referred from 2016 to September 2020. The transplants were-liver (n = 6), kidney (n = 6) and lung (n = 8). D positive cell populations were identified in 11 cases (0.1-8.0 ml); and required PAD (500-1500 IU). From these 20 patients, 10 sent a follow-up sample, where 8 required PAD top-up due to the detection of residual D positive cells (0.1-2 ml)-liver (n = 1), kidney (n = 1) and lung transplant (n = 6). CONCLUSION: All patients in the study were D negative females, in which 18 were considered by guidelines to be of childbearing potential (2-42 years old) and 2 were >50 years old. Referrals demonstrate an awareness for the correct calculation of PAD to prevent D sensitisation. The sample size is small, but top up requirement in 8/20 of cases demonstrates accurate quantification is clearly needed to ensure the appropriate dose of PAD is provided.

Frequency and Location of Referred Pain in Patients with Temporomandibular Disorder / Frecuencia y Ubicación del Dolor Referido en Pacientes con Trastornos Temporomandibulares

Based on the survey of records regarding the location and frequency of referred pain in patients with temporomandibular disorder when certain pre-established areas are palpated, we proposed an anatomical-topographical division of the head and neck to allow the standardization and reproducibility of locations of referred pain. Of the 835 charts reviewed, 419 (50.2%) patients had referred pain on palpation of the regions based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and palpation of the cervical regions, as often analyzed by the Cochran Q test. The concordance coefficient of Kendall examined the correlation between regions of referred pain concerning to palpated sites. The new regions were defined preauricular, facial lateral, temporoparietal, posterior head, posterior and lateral cervical, anterior cervical and calvaria. The region palpated that originated more referred pain was corresponding to the masseter muscle followed by the region of the sternocleidomastoid muscle, regardless of the side palpated. On palpation of the regions established by the RDC/TMD, the most frequent area of referred pain was the lateral facial region. On palpation of the neck, were the posterior and lateral cervical regions. The sites that originated more referred pain when palpated were the masseter, temporalis, sternocleidomastoid and trapezius muscles.

Basado en la encuesta de registros relativos a la ubicación y frecuencia de dolor referido en pacientes con trastorno temporomandibular al palpar ciertas áreas preestablecidas, propusimos una division topográfica anatómica de cabeza y cuello para permitir la estandarización y reproducibilidad de los lugares de dolor referido. Al examinar los gráficos de 835 sujetos, 419 un (50,2%) de los pacientes reportaron dolor referido a la palpación de las regiones sobre la base de los Criterios Diagnósticos para la Investigación de Trastornos Temporomandibulares (CDI/TTM) y palpación de la region cervical, con análisis de frecuencia con prueba de Cochran Q. El coeficiente de concordancia de Kendall examinó la correlación entre las regiones de dolor referido en relación a los sitios palpados. Las regiones nuevas fueron definidas como, pre-auricular, facial lateral, temporoparietal, cabeza posterior, posterior y lateral cervical, cervical anterior y bóveda craneal. La región de palpado en la cual se originó el dolor mencionado con mayor frecuencia, corresponde al músculo masetero, seguido por la región del músculo esternocleidomastoideo, independientemente del lado palpado. Durante la palpación de las regiones establecidas por los CDI/TTM, la zona más frecuente de dolor referido fue la región facial lateral. A la palpación del cuello, el dolor referido se reportó en la parte posterior y en las regiones cervicales laterales. Los sitios en los que se originó el mayor dolor referido a la palpación, fueron los músculos maseteros, músculos temporales, esternocleidomastoideo y trapecio.

Effect of nano-sized bioactive glass particles on the angiogenic properties of collagen based composites.

Angiogenesis is essential for tissue regeneration and repair. A growing body of evidence shows that the use of bioactive glasses (BG) in biomaterial-based tissue engineering (TE) strategies may improve angiogenesis and induce increased vascularization in TE constructs. This work investigated the effect of adding nano-sized BG particles (n-BG) on the angiogenic properties of bovine type I collagen/n-BG composites. Nano-sized (20-30 nm) BG particles of nominally 45S5 Bioglass® composition were used to prepare composite films, which were characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The in vivo angiogenic response was evaluated using the quail chorioallantoic membrane (CAM) as an model of angiogenesis. At 24 h post-implantation, 10 wt% n-BG containing collagen films stimulated angiogenesis by increasing by 41 % the number of blood vessels branch points. In contrast, composite films containing 20 wt% n-BG were found to inhibit angiogenesis. This experimental study provides the first evidence that addition of a limited concentration of n-BG (10 wt%) to collagen films induces an early angiogenic response making selected collagen/n-BG composites attractive matrices for tissue engineering and regenerative medicine.

Histomorphometric and microchemical characterization of maturing dental enamel in rats fed a boron-deficient diet.

Few reports are available in the literature on enamel formation under nutritional deficiencies. Thus, we performed a study to determine the effects of boron (B) deficiency on the maturing dental enamel, employing the rat continuously erupting incisor as the experimental model. Male Wistar rats, 21 days old, were used throughout. They were divided into two groups, each containing ten animals: +B (adequate; 3-mg B/kg diet) and -B (boron deficient; 0.07-mg B/kg diet). The animals were maintained on their respective diets for 14 days and then euthanized. The mandibles were resected, fixed, and processed for embedding in paraffin and/or methyl methacrylate. Oriented histological sections of the continuously erupting incisor were obtained at the level of the mesial root of the first molar, allowing access to the maturation zone of the developing enamel. Dietary treatment did not affect food intake and body weight. Histomorphometric evaluation using undecalcified sections showed a reduction in enamel thickness (hypoplasia), whereas microchemical characterization by energy-dispersive X-ray spectrometry did not reveal alterations in enamel mineralization.

Biocompatibility and bone mineralization potential of 45S5 Bioglass-derived glass-ceramic scaffolds in chick embryos.

The aim of the present study was to evaluate the biocompatibility and bone mineralization potential of 45S5 Bioglass-derived glass-ceramic scaffolds using a chick embryo shell-less (ex ovo) culture system. Chick embryos were divided into two groups: control (C) and experimental (E). Scaffolds were placed on the chorioallantoic membrane (CAM) in embryos of group E at 10 days of total incubation. The 45S5 Bioglass-derived glass-ceramic scaffolds proved to be biocompatible in terms of the absence of inflammatory response at the implant site (CAM). Moreover, no alterations in the other end-points assessed, i.e. survival, stage of embryonic development and body weight, were detected. However, body length was greater in group E embryos than in group C embryos (p0.05). A marked reduction (93%) in Ca content in the scaffolds was evidenced by energy-dispersive X-ray analysis at 5 days post-implantation. Calcium release from the scaffold implanted on the CAM might have been responsible for the restoration of the bone-like phenotype in chick embryonic skeleton of group E as detected by Alcian blue-Alizarin red double staining, as well as by histological and microchemical analyses. Conversely, the control embryos exhibited a chondrogenic phenotype.

Proposta de elaboração de uma cartilha para orientação à população que busca serviços de saúde na Unidade Básica de Saúde Rubem Berta

Nosso trabalho está focado na Unidade Básica de Saúde Rubem Berta, diante da busca de informação pelo usuário e a necessidade do profissional de transmití-la, além do desejo deste em melhorar seu local de trabalho. A proposta de elaboração da cartilha pretende contribuir para a uniformização das informações que são fornecidas à população e, consequentemente, diminuir a possibilidade de atritos entre usuários e profissionais do serviço .

Cefalostato virtual – posicionamento inicial para a padronização namarcação de pontos craniométricos em imagens obtidas por tomografia computadorizada, para uso em cefalometria / The Virtual Cephalostat - the preliminar adjustment for standardization of skull orientation in landmarks localization using CT in cephalometric analyses

O desenvolvimento da tecnologia em diagnóstico odontológico por imagem através dos Tomógrafos Computadorizados por Feixe Cônico, tornou possível e acessível a avaliação cefalométrica através de reconstruções volumétricas do crânio. Parâmetros baseados em evidências científicas são necessários para implementar o seu uso. Alguns parâmetros utilizados na cefalometria convencional (bidimensional) deverão ser esquecidos, outros deverão ser adaptados, outros, ainda, deverão ser criados. Propomos aqui a criação de um Cefalostato Virtual para orientação do crânio em TC, com a utilização de pontos intracranianos, que são mais estáveis. Também propomos a criação do ponto TS eda linha TS-Pg em substituição ao ponto S e ao eixo Y de crescimento de Downs,respectivamente. Além disso, propomos a linha Ba-Op como referência para casos de assimetria faciais onde não é possível a utilização do plano Horizontal de Frankfurt, em casos, por exemplo, de síndromes que afetem os pontos de referências mais externos. Métodos: 49 crânios pertencentes ao do Museu de Anatomia – UNIFESP, foram escaneados em um tomógrafo computadorizado por feixe cônico (TCFC), na clínica ISO Orthographic, São Paulo. As pontuações foram realizadas em dois momentos, com espaçamento de uma semana. Foram calculadas estatisticamente medidas-resumo (média, quartis, mínimo, máximo e desvio padrão). Foram calculadas também as correlações intraclasse e correlações de Pearson entre o Eixo Y (S-Gn) e linha entre os pontos TS e Pg...

The development of new technology in dental diagnosis by cone beam CT (CBCT) image, made possible and accessible the realization of cephalometric evaluation through volumetric reconstructions of the skull. Scientific parameters with evidence-based are needed to implement its use. Some parameters used inconventional cephalometry (2D) maybe need to be forgotten, others should be adapted, and others still to be created. In this research we propose to create a Virtual Cephalostat orientation of the skull in CT, with the intracranial landmarks, because they are more stable. We propose the creation of landmark TS (Tubercle Sella) and the TS-Pg line to replace the landmark S (Sella) and the Y-axis of growth (Downs),respectively. Furthermore, we propose to use the Basion-Opistion line as a reference for cases of craniofacial asymmetry where is not possible to use the Frankfurt horizontal plane, as in some cases of syndromes that affects the most external landmarks. Methods: 49 skulls of Anatomy Museum of UNIFESP – Federal University of São Paulo, were scanned in a CBCT. The analyses were performed in 2 stages, within 1-week space. Statistics measurements were calculated (mean,quartiles, minimum, maximum and standard deviation). We also calculated the intraclass correlations (ICC) and the Pearson correlations between the Y axis (S-Gn)and the line between landmarks TS-Pg. Results: Even if there is a low reproducibility in the coordinates for landmarks EC (Ethmoidal Crest), Pg and Gn it was observed ahigh correlation between the angular measures in question...

Anatomic and dynamic aspects of stomatognathic structures in osteogenesis imperfecta: a case report.

The osteogenesis imperfecta congenita (OMIM 166210) type II phenotype can be caused by mutation in either the COL1A1 gene or the COL1A2 gene that encode the chains of type I procollagen, the major protein in bones. Patients can therefore present a combination of features, including multiple long bone fractures and deformities, growth deficiency, joint laxity, hearing loss, blue sclera, and dentinogenesis imperfecta. The purpose of this study is to describe a clinical case of this syndrome, focusing on the anatomy of the temporomandibular joint (TMJ) that was assessed using computed tomography (CT) method. Clinical examination included evaluation of mandibular dynamics and investigation of temporomandibular dysfunction (TMD).

Intrusion of the mandibular condyle into the middle cranial fossa: case report and review of the literature.

OBJECTIVES: To describe a case of mandibular condyle intrusion into the middle cranial fossa in a young child and to systematically review the literature pertaining to this condition. STUDY DESIGN: The diagnostic procedures comprised clinical examination, health history, and both magnetic resonance imaging and computerized tomography. A systematic review of the literature from PubMed, Medline, and Web of Science databases from 1960 to 2005 was made and a total of 55 cases in 51 references were found, of which 36 were described in detail. CONCLUSIONS: Prompt diagnosis of mandibular condyle intrusion into the middle cranial fossa is essential to minimize complications. Advanced imaging modalities of computed tomography and magnetic resonance imaging are indicated.

Fauna de anuros en la ciudad de Salta, Argentina / Anuran fauna from Salta City, Argentina

The loss and transformation of habitat by anthropogenic activities is one of the main causes of biodiversity decrease. Amphibians are declining all over the world and one of the causes of this decline is thought to be habitat reduction. However, there are anuran populations in highly disturbed habitats, like cities. This study presents the ecological baseline needed to understand anuran communities in urban environments, for Salta City, Argentina (ca. 502 000 inhabitants). The sample was stratified by environments defined by infrastructure and geographic location. The species were identified by visual encounter techniques and by auditory transect during the 2002-2003 reproductive period. Three families, seven genera and twelve species were recorded and the species richness decreased from city border to center. Similarity index values among geographic areas was higher East-West (94.7) than South-West (33.3). Bufo arenarum was the only species recorded in all environments. Hyla andina and Odontophrynus americanus had a restricted distribution and are here considered vulnerable. The border effect can explain some distribution pattern in these populations. A map of the potential distribution of recorded species for Salta is provided

La pérdida y transformación del hábitat generado por actividades humanas es una de las principales causas de disminución de biodiversidad. Los anfibios constituyen un grupo en franca declinación a nivel global debido a múltiples motivos, entre ellos la reducción de sus hábitats; sin embargo, se observan poblaciones de anuros en ambientes altamente antropizados como las ciudades. El objetivo del trabajo fue recabar información de base ecológicamente necesaria para comprender la distribución de las comunidades de anuros en estos ambientes. Para ello, se efectuó el inventario de la fauna de anuros del ejido urbano de la Ciudad de Salta, Argentina, con una población estimada en 502 316 habitantes. Se diseñó el muestreo por ambientes, caracterizándolos en función del tipo de infraestructura urbana y su ubicación por zonas geográficas. La identificación de las especies se realizó a partir de técnicas de encuentro visual y transecta auditiva, abarcando la temporada reproductiva 2002-2003. Se detectaron tres familias, siete géneros y doce especies, observando una disminución de la riqueza desde los bordes hacia el centro del ejido urbano. El índice de similitud entre zonas geográficas fue mayor para el par Este-Oeste (94.7), mientras que el menor fue para el par Sur-Oeste (33.3). Bufo arenarum fue la especie presente en todos los ambientes caracterizados, mientras que Hyla andina y Odontophrynus americanus son las especies con distribución más restringida y por lo tanto más vulnerables. Con los datos obtenidos, se generó un mapa de distribución potencial de las especies en la ciudad analizando las posibles causas de las diferencias observadas

[Anuran fauna from Salta city, Argentina]. / Fauna de anuros en la ciudad de Salta, Argentina.

The loss and transformation of habitat by anthropogenic activities is one of the main causes of biodiversity decrease. Amphibians are declining all over the world and one of the causes of this decline is thought to be habitat reduction. However, there are anuran populations in highly disturbed habitats, like cities. This study presents the ecological baseline needed to understand anuran communities in urban environments, for Salta City. Argentina (ca. 502,000 inhabitants). The sample was stratified by environments defined by infrastructure and geographic location. The species were identified by visual encounter techniques and by auditory transect during the 2002-2003 reproductive period. Three families, seven genera and twelve species were recorded and the species richness decreased from city border to center. Similarity index values among geographic areas was higher East-West (94.7) than South-West (33.3). Bufo arenarum was the only species recorded in all environments. Hyla andina and Odontophrynus americanus had a restricted distribution and are here considered vulnerable. The border effect can explain some distribution pattern in these populations. A map of the potential distribution of recorded species for Salta is provided.