Neutrophil N1 and N2 Subsets and Their Possible Association with Periodontitis: A Scoping Review.

Periodontitis is a chronic non-communicable disease caused by dysbiotic changes that affect the subgingival microbiota. During periodontitis, neutrophils play a central role in the initial recognition of bacteria, and their number increases with the appearance of the first signs of periodontal inflammation. Recent evidence has led to the proposition that neutrophils can also functionally polarize, determining selective activity patterns related to different diseases. Two well-defined neutrophil phenotypes have been described, the pro-inflammatory N1 subset and the suppressor N2 subset. To date, it has not been established whether these different neutrophil subtypes play a role in the pathogenesis of periodontitis. Thus, this scoping review aimed to determine whether there was evidence to suggest that the neutrophils present in periodontal tissues can be associated with certain phenotypes. The research question, population, concept, and context sought to identify original articles, in humans, that detected the presence of neutrophils in the periodontal tissues of people affected by periodontitis. Based on the search strategy, we found 3658 studies. After removing the papers with abstracts not related to the outcome measures and eligibility criteria, 16 articles were included for qualitative analysis. Several studies identified the presence of different neutrophil subsets, specifically, the naive, pro- and para-inflammatory, hyper-reactive and hyper-active, and high- and low-responder phenotypes. The existing evidence demonstrates the presence of pro-inflammatory, hyper-reactive and high-responder neutrophils in periodontal tissues affected with periodontitis. There is no evidence demonstrating the presence of the N1 or N2 phenotypes in periodontal tissues during periodontitis. However, the existence of pro-inflammatory phenotypes, which increase NETosis and degranulation, and increase the production of pro-inflammatory cytokines, could be suggestive of the N1 phenotypes.

Gingival crevicular fluid as Biomarker's source for alzheimer's disease / Fluido crevicular gingival como biomarcador de enfermedad de Alzheimer

Abstract Periodontitis is a low-grade inflammatory disease caused by a subgingival dysbiotic microbiota. Multiple studies have determined the higher prevalence of tooth loss and poor oral hygiene in patients with Alzheimer's disease (AD). However, the periodontal diagnosis, periodontal bacteria or mediators has not been measured to date. Aim: To determine the periodontal status, the pro-inflammatory mediators, Porphyromonas gingivalis load, and Apoliporpotein E (ApoE) in patients with AD. A complete dental examination was performed on 30 patients, and cognitive status was determined by the Montreal Cognitive Assessment (MoCA). Subgingival microbiota and GCF samples were then taken from all patients from the deepest sites. Total DNA was isolated from the microbiota samples for the quantification of the 16S ribosomal subunit. Pro-inflammatory mediators and ApoE were quantified from the gingival crevicular fluid (GCF). Patients with AD had periodontitis stage III-IV in 80%, a higher concentration of pro-inflammatory and ApoE mediators, and a higher P. gingivalis load compared to healthy subjects. The pro-inflammatory mediators, P. gingivalis load had a negative correlation with the MoCA test scores. Finally, a ROC curve was performed to assess the specificity and sensitivity of ApoE levels, detecting an area of 84.9%. In AD patients, we found a more severe periodontitis, a higher levels of pro-inflammatory mediators, and higher bacterial load. In addition, there is an increase in ApoE that allows to clearly determine patients with health, periodontitis and periodontitis and AD.

Resumen La periodontitis es una enfermedad crónica no transmisible que se caracteriza por generar una inflamación sistémica de bajo grado causada por una microbiota disbiótica subgingival. Múltiples estudios han determinado la mayor prevalencia de pérdida de dientes y mala higiene bucal en pacientes con enfermedad de Alzheimer (EA). Sin embargo, el diagnóstico periodontal, bacterias periodontales o mediadores pro-inflamatorio no se ha medido hasta la fecha. Determinar el estado periodontal, los mediadores pro-inflamatorios, la carga de Porphyromonas gingivalis y la apoliporpoteína E (ApoE) en pacientes con EA. Se realizó un examen odontológico completo en 30 pacientes y el estado cognitivo se determinó mediante la Evaluación Cognitiva de Montreal (MoCA). Luego, se tomaron muestras de microbiota subgingival y FCG de todos los pacientes de los sitios más profundos. Se aisló el DNA total de las muestras de microbiota para la cuantificación de la subunidad ribosómica 16S. Los mediadores pro-inflamatorios y la ApoE se cuantificaron a partir del líquido crevicular gingival (GCF). Los pacientes con EA tenían periodontitis en estadio III-IV en 80%, una mayor concentración de mediadores pro-inflamatorios y ApoE, y una mayor carga de P. gingivalis en comparación con los sujetos sanos. Los mediadores pro-inflamatorios y la carga de P. gingivalis tuvieron una correlación negativa con las puntuaciones de la prueba MoCA. Finalmente, se realizó una curva ROC para evaluar la especificidad y sensibilidad de los niveles de ApoE, detectando un área del 84,9%. En los pacientes con EA encontramos una periodontitis más severa, mayores niveles de mediadores pro-inflamatorios y mayor carga bacteriana. Además, un aumento de ApoE que permite determinar claramente a los pacientes con salud, periodontitis y periodontitis y EA.

Oral-Gut-Brain Axis in Experimental Models of Periodontitis: Associating Gut Dysbiosis With Neurodegenerative Diseases.

Periodontitis is considered a non-communicable chronic disease caused by a dysbiotic microbiota, which generates a low-grade systemic inflammation that chronically damages the organism. Several studies have associated periodontitis with other chronic non-communicable diseases, such as cardiovascular or neurodegenerative diseases. Besides, the oral bacteria considered a keystone pathogen, Porphyromonas gingivalis, has been detected in the hippocampus and brain cortex. Likewise, gut microbiota dysbiosis triggers a low-grade systemic inflammation, which also favors the risk for both cardiovascular and neurodegenerative diseases. Recently, the existence of an axis of Oral-Gut communication has been proposed, whose possible involvement in the development of neurodegenerative diseases has not been uncovered yet. The present review aims to compile evidence that the dysbiosis of the oral microbiota triggers changes in the gut microbiota, which creates a higher predisposition for the development of neuroinflammatory or neurodegenerative diseases.The Oral-Gut-Brain axis could be defined based on anatomical communications, where the mouth and the intestine are in constant communication. The oral-brain axis is mainly established from the trigeminal nerve and the gut-brain axis from the vagus nerve. The oral-gut communication is defined from an anatomical relation and the constant swallowing of oral bacteria. The gut-brain communication is more complex and due to bacteria-cells, immune and nervous system interactions. Thus, the gut-brain and oral-brain axis are in a bi-directional relationship. Through the qualitative analysis of the selected papers, we conclude that experimental periodontitis could produce both neurodegenerative pathologies and intestinal dysbiosis, and that periodontitis is likely to induce both conditions simultaneously. The severity of the neurodegenerative disease could depend, at least in part, on the effects of periodontitis in the gut microbiota, which could strengthen the immune response and create an injurious inflammatory and dysbiotic cycle. Thus, dementias would have their onset in dysbiotic phenomena that affect the oral cavity or the intestine. The selected studies allow us to speculate that oral-gut-brain communication exists, and bacteria probably get to the brain via trigeminal and vagus nerves.

Cuantificación de la quimiocina CCL5 en pacientes con diabetes mellitus tipo 2 y/o periodontitis cronica: Estudio preliminar

l propósito del presente estudio fue cuantificar la presencia de la quimiocina CCL5 (RANTES) en Líquido Crevicular Gingival (LCG) de pacientes con Periodontitis Crónica (PC) y/o Diabetes Mellitus tipo 2 (DM2). Se realizó un estudio comparativo, transversal en 40 pacientes. Se tomó LCG de bolsas periodontales y surcos gingivales de 4 grupos de pacientes (10 por grupo de estudio), se excluyó a los pacientes que recibieron tratamiento periodontal, antibiótico y antiinflamatorio 6 meses anteriores al estudio o cursaron con alguna enfermedad sistémica distinta a DM2. Las concentraciones de CCL5 se determinaron mediante ensayos LUMINEX de selección magnética. Se realizó estadística descriptiva, prueba ANOVA de una vía, T de student y correlación de Pearson. La cuantificación de CCL5 fue mayor en los pacientes que presentaron ambas enfermedades, seguidos del grupo con solo PC, los sanos y el grupo con solo DM2. No se encontró diferencia significativa entre los grupos y no hubo correlación entre las cuantificaciones y los indicadores glicémicos. A pesar de que las diferencias no fueron significativas, el grupo de pacientes con ambas enfermedades presentó la mayor cuantificación de CCL5. La expresión de CCL5 en LGC debe considerarse un potencial inductor de destrucción periodontal, su determinación podría ser útil para monitoreo de la salud/enfermedad de los tejidos periodontales.

he purpose of the present study was to quantify the presence of chemokine CCL5 (RANTES) in gingival crevicular fluid (LCG) in patients with chronic periodontitis (PC) and / or type 2 diabetes mellitus (DM2). A comparative cross-sectional study was conducted in 40 patients. LCG was taken from periodontal pockets and gingival grooves from 4 patient groups (10 per study group); patients who received periodontal, antibiotic and anti-inflammatory treatment 6 months prior to the study or who had systemic disease other than DM2 were excluded. Concentrations of CCL5 were determined by LUMINEX® assays. Descriptive statistics, one-way ANOVA, Student's T, and Pearson's correlation were performed. The quantification of CCL5 was higher in the patients who presented both diseases, followed by the group with only PC, healthy and the group with only DM2. No significant difference was found between groups and there was no correlation between quantifications and glycemic indicators. Although the differences were not significant, the group of patients with both diseases had the highest CCL5 quantification. The expression of CCL5 in LGC should be considered as a potential inducer of periodontal destruction, its determination could be useful for monitoring the health/disease of periodontal tissues.

Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis: 30 Patients at a Minimum Follow-Up of 10 Years.

To evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up. Outcomes and knee arthritis severity were evaluated at final follow-up. Mean follow-up was 11.2 ± 1.2. At final follow-up, 85 and 57% of tibial and femoral tunnels, respectively, developed some degree of enlargement. Frontal tibial angle (mean) was 72°, sagittal tibial angle 63°, frontal femoral angle 47°, sagittal femoral angle 20°, and tunnels divergence angle 36°. Preoperatively, KT-1000 30L and Lachman test scores were 5.52 and 5.79 respectively. In the last follow-up, 30L and manual Lachman test scores were 0.97 and 1.13, respectively (p < 0.001). In IKDC scale, pivot shift and Jerk tests showed 83 and 84% grade A results, respectively (p < 0.0001). In Fairbank scale, 23% worsened one grade and 27% worsened more than one grade (p < 0.005). Tibial tunnels widened more than femoral tunnels and further dilatation was found between intermediate and final follow-up. Higher incidence of tibial tunnel widening was observed in patients with tunnel verticalization. Tibial tunnel dilation was associated with long-term degenerative changes but not with final knee instability.

Nonbilayer Phospholipid Arrangements Are Toll-Like Receptor-2/6 and TLR-4 Agonists and Trigger Inflammation in a Mouse Model Resembling Human Lupus.

Systemic lupus erythematosus is characterized by dysregulated activation of T and B cells and autoantibodies to nuclear antigens and, in some cases, lipid antigens. Liposomes with nonbilayer phospholipid arrangements induce a disease resembling human lupus in mice, including IgM and IgG antibodies against nonbilayer phospholipid arrangements. As the effect of these liposomes on the innate immune response is unknown and innate immune system activation is necessary for efficient antibody formation, we evaluated the effect of these liposomes on Toll-like receptor (TLR) signaling, cytokine production, proinflammatory gene expression, and T, NKT, dendritic, and B cells. Liposomes induce TLR-4- and, to a lesser extent, TLR-2/TLR-6-dependent signaling in TLR-expressing human embryonic kidney (HEK) cells and bone marrow-derived macrophages. Mice with the lupus-like disease had increased serum concentrations of proinflammatory cytokines, C3a and C5a; they also had more TLR-4-expressing splenocytes, a higher expression of genes associated with TRIF-dependent TLR-4-signaling and complement activation, and a lower expression of apoptosis-related genes, compared to healthy mice. The percentage of NKT and the percentage and activation of dendritic and B2 cells were also increased. Thus, TLR-4 and TLR-2/TLR-6 activation by nonbilayer phospholipid arrangements triggers an inflammatory response that could contribute to autoantibody production and the generation of a lupus-like disease in mice.

Actualización en las lesiones del ligamento cruzado anterior. Análisis de los resultados mediante TAC y escalas clínicas / Current status of the ACL repair. Clinical scales and TAC results

Se realizó una revisión bibliográfica sobre el estado actual de las ligamentoplastias del LCA, incluyendo bases anatómicas, funcionales y tratamiento quirúrgico, así como un estudio retrospectivo de las ligamentoplastias del LCA mediante técnica SAC con más de 10 años de evolución. En dicho estudio se valoran parámetros clínicos y radiológicos mediante escalas clínicas y TAC, estableciendo relaciones entre la posición y ensanchamiento de los túneles con los resultados clínicos a largo plazo.

We performed a literature review on the current status of the ACL repair, including anatomical basis, functional and surgical treatment, as well as a retrospective study of the ACL repair by SAC technique with over 10 years of evolution. This study evaluated clinical and radiological parameters, clinical scales and TAC by establishing relationships between the position and broadening of the tunnels with long-term clinical results.

A case report of semitendinosus tendon autograft for reconstruction of the meniscal wall supporting a collagen implant.

PURPOSE: Describe the evolution of the reconstruction of meniscal rim with semitendinosus tendon in a patient with knee pain after a subtotal meniscectomy and absence of meniscal wall. METHOD: 32 years old male with a six-month history of the left knee pain after a subtotal meniscectomy. The MRI indicated a small internal meniscal remainder without posterior horn attachment. Taking this absence as a relative contraindication for implant and meniscal transplantation, the reconstruction of a new meniscal wall with semitendinosus tendon autograft was considered. A collagen meniscal implant was attached to the new wall five months later. RESULTS: After two years the patient referred only non specific discomfort with full pain relief in the medial compartment. The MRI revealed integration of implants without significant degenerative changes compared to previous images. CONCLUSIONS: This staged technique was designed to restore medial meniscus-like biologic tissue in a symptomatic patient following arthroscopic subtotal meniscectomy with a significant loss of the peripheral meniscus rim. Symptomatic improvement was obtained at two years follow-up.

Lipodystrophy syndromes.

Lipodystrophy syndromes comprise a group of rare, heterogeneous disorders characterized by progressive loss of fat tissue, mainly from subcutaneous compartment and occasionally affecting visceral fat. Lipoatrophy may be partial, localized, or generalized. The latter cases are usually accompanied by metabolic-related disorders, including insulin resistance, diabetes mellitus, hyperlipemia, progressive hepatic disease and anabolic state. Treatment for lipodystrophy has increased interest in recent years because a new lipoatrophic population-patients who have HIV-associated lipodystrophy--is much more numerous than the whole number of patients affected by classic lipodystrophy entities.

Quiste branquial / Brachial cyst

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Vitíligo segmentario asociado a traumatismo quirúrgico / Segmental vitiligo associated with surgical trauma

El vitíligo segmentario es una dermatosis infrecuente caracterizada por una distribución metamérica. Se presenta el caso de un varón de 20 años de edad con un vitíligo segmentario, que se inició tras una intervención quirúrgica en las proximidades del área metamérica afectada (AU)

Pénfigo foliáceo inducido por haloperidol / Haloperidol induced pemphigus foliaceus

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Reconstrucción de la región ciliar mediante colgajo de deslizamiento en V-T / V-T Advancement flap for eyebrown reconstruction

La región ciliar y supraciliar son áreas de frecuente asiento de lesiones tumorales cuya corrección quirúrgica puede ser problemática. La reconstrucción tras la excisión del tumor debe realizarse sin distorsión anatómica, intentando evitar la elevación de la ceja, la asimetría respecto a la región frontal contralateral y, en lo posible, la pérdida de folículos pilosos. Presentamos el caso de una mujer de 72 años con un carcinoma epidermoide de mediano tamaño, localizado en ceja y región supraciliar izquierda. Tras la excisión se empleó un colgajo de deslizamiento en V-T para la corrección del defecto resultante, con un resultado funcional y estético satisfactorio. En este trabajo realizamos la descripción de esta técnica y revisamos las diferentes posibilidades reconstructivas tras cirugía oncológica en la región ciliar. (AU)

Osteoma miliar de la cara / Multiple miliary osteoma of the face

Se trata de una mujer de 40 años, sin antecedentes de acné juvenil, que notó la aparición a los 37 años de múltiples pápulas asintomáticas, duras, en ambas mejillas. El estudio histopatológico mostró que se trataba de osteomas. (AU)

Púrpura fulminans asociada a sepsis meningocócica. Presentación de un caso en una paciente adulta / Meningococcal sepsis-associated purpura fulminans. Report of a case in an adult female

Púrpura fulminans es una rara entidad caracterizada por el desarrollo rápido de grandes áreas purpúricas con bordes geográficos, frecuentemente necróticas, asociada con hiperpirexia, hipotensión y coagulopatía de consumo. El examen histopatológico revela la presencia de trombos en los capilares y vénulas cutáneos, junto con hemorragia intersticial y diversos grados de necrosis cutánea.Presentamos un caso de púrpura fulminans asociada a sepsis meningocócica en una paciente adulta previamente sana. (AU)

Empleo del colgajo axial frontonasal en cirugía reconstructiva de punta nasal / The use of axial fronto-nasal flap in reconstructive surgery of the nasal tip

La corrección de defectos de gran tamaño localizados en el dorso y la punta nasales tras la extirpación de lesiones tumorales debe realizarse mediante colgajos locales o a distancia. Éstos aportan un tejido de gran similitud en textura, color y grosor superior al proporcionado por los injertos de piel. El colgajo frontonasal descrito por Marchac es una variante del colgajo pannasal de Rieger que incorpora una excelente vascularización axial a través de la arteria angular. Esta modificación aumenta la movilidad, permitiendo un amplio descenso y rotación para la cobertura de defectos en la punta nasal. Aportamos el caso de una mujer de 80 años que presentaba un carcinoma basocelular de gran tamaño localizado en tercio distal del dorso y la punta nasales. Tras la extirpación se empleó un colgajo axial frontonasal para la corrección del defecto resultante, obteniéndose un excelente resultado cosmético. Describimos la técnica y comentamos las ventajas que aporta en cirugía reconstructiva nasal (AU)