Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis.

Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other. Methods: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022. Results: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles. Conclusion: PCN appears to be the intervention better tolerated, with less impact on the patient's perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.

Response to the letter to the editor:Osteonecrosis of the jaws in patients under osteoporosis treatment:nine-year experience report.

None.

Aumento do Rebordo Alveolar com Enxerto em Bloco Impresso Personalizado: Relato de Caso / Alveolar ridge augmentation with custom 3D-printed block graft: Case report

A utilização da tecnologia CAD/CAM (computer aided design/computer aided manufacturing) e 3D (tridimensional) para reconstruções alveolares na implantodontia permite o planejamento pré-operatório detalhado, o design do resultado desejado do enxerto e a avaliação virtual do resultado em relação à reconstrução protética. Este trabalho objetiva detalhar a técnica cirúrgica de enxerto ósseo sintético confeccionado por meio dessa tecnologia, seguido da instalação de implantes osseointegráveis e reabilitação protética em um defeito ósseo na mandíbula. Paciente masculino, 22 anos, compareceu à clínica por avulsão dos elementos 32, 31, 41 e 42 com significativa perda óssea vertical de rebordo alveolar. Devido à extensa perda óssea, realizou-se enxerto em bloco prototipado impresso. O escaneamento intraoral e os arquivos de imagem gerados foram enviados ao centro de planejamento virtual. Primeiramente, foi realizada a cirurgia para instalação do enxerto em bloco. Após o período de cicatrização, foi realizada cirurgia para instalação de dois implantes osseointegráveis. Esperado o período de três meses a partir da instalação dos implantes, foi realizada a confecção de próteses provisórias fixas sobre implantes a fim de realizar o condicionamento dos tecidos moles peri-implantares e o carregamento progressivo dos implantes. O aumento do rebordo alveolar através do uso de enxerto em bloco impresso personalizado apresentou-se como uma técnica com inúmeras vantagens, por não necessitar de sítio doador, reduzir tempo cirúrgico e apresentar perfeita adaptação do bloco ao defeito ósseo, resultando em menor morbidade pós-operatória. Essa técnica é uma indicação para casos de defeitos ósseos severos, visando a otimizar o resultado e a propiciar menor desconforto ao paciente.

The use of the technology CAD/CAM (computer aided design/computer aided manufacturing) and 3D (three dimensional) to alveolar reconstructions in implant dentistry allows detailed preoperative planning, the design of the desired grafting result, and the virtual evaluation of the result in relation to the prosthetic reconstruction. This paper aims to details the synthetic bone graft made through this technology, followed by the installation of osseointegrated implants and prosthetic rehabilitation in a bone imperfection in the jaw. A 22-year-old man attended the clinic due to a tooth avulsion of the four lower incisors with significant vertical bone loss of alveolar ridge. Because of the extensive bone loss, it was made a prototyped printed block graft. The intraoral scan and the generated image files were sent to the virtual planning center. First, it was necessary a surgery to install the block graft. After the healing process, it was made a surgery to put two osseointegrated implants. Three months later, temporary fixed prostheses on implants were made to conditioning the peri-implant soft tissues and the progressive loading of the implants. The increase of the alveolar ridge using personalized printed block graft was presented as a technique with numerous advantages, since it does not require a donor site, reduces the surgical time and presents perfect adaptation of the block to the bone imperfection, resulting in a less postoperative morbidity. This technique is indicated to cases of severe bone imperfections, aims to optimize results, and provide less discomfort to the patient.

Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report

ABSTRACT Objective: This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods: The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results: Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusions: The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.

Preservação Tecidual Peri-Implantar em Implante Imediato Posterior com Cicatrizador Personalizado: Relato de Caso / PERI-IMPLANT TISSUE PRESERVATION IN IMMEDIATE POSTERIOR IMPLANT PLACEMENT WITH CUSTOMIZED HEALING ABUTMENT: CLINICAL CASE REPORT

The maintenance of natural dentition under optimal function, health and aesthetics conditions is the main objective of dental treatments, but when therapeutic possibilities are exhausted, dental extractions become necessary. Bone remodeling due to post-extraction alveolar healing may result in volume changes in the region. This topic is common in renowned dentistry scientific publications and several researchers recommend tissue regenerative procedures and seek solutions minimize volume reduction. Among these procedures, the immediate installation of implants in post- extraction sockets without flap elevation is an alternative that guarantees functional and aesthetic benefits in the final result of the rehabilitation. This paper presents a clinical case that shows a practical and viable alternative therapy for adequate alveolar healing. In this clinical case, the use of immediate implants and personalized healing abutments with flowable resin composite reduced alveolar healing remodeling and allowed the preservation of the gingival architecture and to obtain an ideal emergency profile for performing the permanent prosthesis supported by implant.

The WHHERE coactivator complex is required for retinoic acid-dependent regulation of embryonic symmetry.

Bilateral symmetry is a striking feature of the vertebrate body plan organization. Vertebral precursors, called somites, provide one of the best illustrations of embryonic symmetry. Maintenance of somitogenesis symmetry requires retinoic acid (RA) and its coactivator Rere/Atrophin2. Here, using a proteomic approach we identify a protein complex, containing Wdr5, Hdac1, Hdac2 and Rere (named WHHERE), which regulates RA signaling and controls embryonic symmetry. We demonstrate that Wdr5, Hdac1, and Hdac2 are required for RA signaling in vitro and in vivo. Mouse mutants for Wdr5 and Hdac1 exhibit asymmetrical somite formation characteristic of RA-deficiency. We also identify the Rere-binding histone methyltransferase Ehmt2/G9a, as a RA coactivator controlling somite symmetry. Upon RA treatment, WHHERE and Ehmt2 become enriched at RA target genes to promote RNA polymerase II recruitment. Our work identifies a protein complex linking key epigenetic regulators acting in the molecular control of embryonic bilateral symmetry.Retinoic acid (RA) regulates the maintenance of somitogenesis symmetry. Here, the authors use a proteomic approach to identify a protein complex of Wdr5, Hdac1, Hdac2 that act together with RA and coactivator Rere/Atrophin2 and a histone methyltransferase Ehmt2 to regulate embryonic symmetry.

Hemorrhagic adrenal cyst.

The authors present a case of a hemorrhagic adrenal cyst, one of the tumors known in literature as incidentalomas, emphasizing the clinical characteristics, since adrenal cysts or pseudocysts are generally rare and observed by chance during imaging procedures. Traditionally they are classified as pseudocysts, endothelial, epithelial or parasitic cysts. Laparoscopic adrenalectomy has been considered the treatment of choice for benign, functioning or non-functioning adrenal lesions. Small cystic adrenal tumors can be managed conservatively by laparoscopic decortication or marsupialization, but larger cysts should be treated by total or partial adrenalectomy.

The mouse Wnt/PCP protein Vangl2 is necessary for migration of facial branchiomotor neurons, and functions independently of Dishevelled.

During development, facial branchiomotor (FBM) neurons, which innervate muscles in the vertebrate head, migrate caudally and radially within the brainstem to form a motor nucleus at the pial surface. Several components of the Wnt/planar cell polarity (PCP) pathway, including the transmembrane protein Vangl2, regulate caudal migration of FBM neurons in zebrafish, but their roles in neuronal migration in mouse have not been investigated in detail. Therefore, we analyzed FBM neuron migration in mouse looptail (Lp) mutants, in which Vangl2 is inactivated. In Vangl2(Lp/+) and Vangl2(Lp/Lp) embryos, FBM neurons failed to migrate caudally from rhombomere (r) 4 into r6. Although caudal migration was largely blocked, many FBM neurons underwent normal radial migration to the pial surface of the neural tube. In addition, hindbrain patterning and FBM progenitor specification were intact, and FBM neurons did not transfate into other non-migratory neuron types, indicating a specific effect on caudal migration. Since loss-of-function in some zebrafish Wnt/PCP genes does not affect caudal migration of FBM neurons, we tested whether this was also the case in mouse. Embryos null for Ptk7, a regulator of PCP signaling, had severe defects in caudal migration of FBM neurons. However, FBM neurons migrated normally in Dishevelled (Dvl) 1/2 double mutants, and in zebrafish embryos with disrupted Dvl signaling, suggesting that Dvl function is essentially dispensable for FBM neuron caudal migration. Consistent with this, loss of Dvl2 function in Vangl2(Lp/+) embryos did not exacerbate the Vangl2(Lp/+) neuronal migration phenotype. These data indicate that caudal migration of FBM neurons is regulated by multiple components of the Wnt/PCP pathway, but, importantly, may not require Dishevelled function. Interestingly, genetic-interaction experiments suggest that rostral FBM neuron migration, which is normally suppressed, depends upon Dvl function.

Cono extendido, nueva variante técnica en la cirugía de la hernia inguinal / Extended cone a new technical variant in the inguinal hernia surgery

El tratamiento de la hernia inguinal continúa siendo un tema controvertido y no existe un punto común de acción en cuanto a la modalidad terapéutica que se emplea. Con el desarrollo de las técnicas protésicas la controversia continúa a pesar de las demostradas ventajas de estas. El objetivo de este estudio fue evaluar los primeros casos intervenidos quirúrgicamente mediante la técnica del cono extendido, una modificación de las técnicas clásicas de Liechtenstein y Rutkow. Se realizó un estudio prospectivo lineal en 45 pacientes operados mediante una técnica protésica denominada cono extendido. Los pacientes fueron operados en un período de 2 años en la Clínica Multiperfil de Luanda (Angola) y para clasificarlos se utilizó la clasificación de Gilbert modificada. Hubo un predominio del sexo masculino. La localización más frecuente fue la región inguinal derecha. Predominaron los pacientes clasificados de grado III según la clasificación de Gilbert. Hubo 6 complicaciones menores y hasta el momento no han ocurrido recidivas. La técnica del cono extendido es una opción más para el tratamiento de los pacientes que presenten hernias inguinales de grado III y VI de la clasificación de Gilbert(AU)

The treatment of the inguinal hernia remains being a controversial subject and there is not a common point of action as regards the therapeutic modality used. With the development of the prosthetic techniques the controversy remains despite their demonstrated advantages. The objective of present study was to assess the first cases operated on with the extended cone technique a modification of the classic Liechtenstein's and Rutkow's techniques. A linear and prospective study was conducted in 45 patients operated on by a prosthetic technique called extended cone. The patients were operated on in a period of two years in the Multiprofile Clinic of Luanda (Angola) and in classification the modified Gilbert was used. There was predominance of male sex. The more frequent location was the right inguinal region and those patients classified as III degree according to the Gilbert's classification. There were six minor complications and up to present time there were not relapses. The extended cone technique is another option for treatment of patients presenting with III and IV degrees inguinal hernias according to Gilbert's classification(AU)

Cono extendido, nueva variante técnica en la cirugía de la hernia inguinal / Extended cone a new technical variant in the inguinal hernia surgery

El tratamiento de la hernia inguinal continúa siendo un tema controvertido y no existe un punto común de acción en cuanto a la modalidad terapéutica que se emplea. Con el desarrollo de las técnicas protésicas la controversia continúa a pesar de las demostradas ventajas de estas. El objetivo de este estudio fue evaluar los primeros casos intervenidos quirúrgicamente mediante la técnica del cono extendido, una modificación de las técnicas clásicas de Liechtenstein y Rutkow. Se realizó un estudio prospectivo lineal en 45 pacientes operados mediante una técnica protésica denominada cono extendido. Los pacientes fueron operados en un período de 2 años en la Clínica Multiperfil de Luanda (Angola) y para clasificarlos se utilizó la clasificación de Gilbert modificada. Hubo un predominio del sexo masculino. La localización más frecuente fue la región inguinal derecha. Predominaron los pacientes clasificados de grado III según la clasificación de Gilbert. Hubo 6 complicaciones menores y hasta el momento no han ocurrido recidivas. La técnica del cono extendido es una opción más para el tratamiento de los pacientes que presenten hernias inguinales de grado III y VI de la clasificación de Gilbert(AU)

The treatment of the inguinal hernia remains being a controversial subject and there is not a common point of action as regards the therapeutic modality used. With the development of the prosthetic techniques the controversy remains despite their demonstrated advantages. The objective of present study was to assess the first cases operated on with the extended cone technique a modification of the classic Liechtenstein's and Rutkow's techniques. A linear and prospective study was conducted in 45 patients operated on by a prosthetic technique called extended cone. The patients were operated on in a period of two years in the Multiprofile Clinic of Luanda (Angola) and in classification the modified Gilbert was used. There was predominance of male sex. The more frequent location was the right inguinal region and those patients classified as III degree according to the Gilbert's classification. There were six minor complications and up to present time there were not relapses. The extended cone technique is another option for treatment of patients presenting with III and IV degrees inguinal hernias according to Gilbert's classification(AU)

Rere controls retinoic acid signalling and somite bilateral symmetry.

One of the most notable features of the vertebrate body plan organization is its bilateral symmetry, evident at the level of vertebrae and skeletal muscles. Here we show that a mutation in Rere (also known as atrophin2) leads to the formation of asymmetrical somites in mouse embryos, similar to embryos deprived of retinoic acid. Furthermore, we also demonstrate that Rere controls retinoic acid signalling, which is required to maintain somite symmetry by interacting with Fgf8 in the left-right signalling pathway. Rere forms a complex with Nr2f2, p300 (also known as Ep300) and a retinoic acid receptor, which is recruited to the retinoic acid regulatory element of retinoic acid targets, such as the Rarb promoter. Furthermore, the knockdown of Nr2f2 and/or Rere decreases retinoic acid signalling, suggesting that this complex is required to promote transcriptional activation of retinoic acid targets. The asymmetrical expression of Nr2f2 in the presomitic mesoderm overlaps with the asymmetry of the retinoic acid signalling response, supporting its implication in the control of somitic symmetry. Misregulation of this mechanism could be involved in symmetry defects of the human spine, such as those observed in patients with scoliosis.

Oscillations of the snail genes in the presomitic mesoderm coordinate segmental patterning and morphogenesis in vertebrate somitogenesis.

The segmented body plan of vertebrate embryos arises through segmentation of the paraxial mesoderm to form somites. The tight temporal and spatial control underlying this process of somitogenesis is regulated by the segmentation clock and the FGF signaling wavefront. Here, we report the cyclic mRNA expression of Snail 1 and Snail 2 in the mouse and chick presomitic mesoderm (PSM), respectively. Whereas Snail genes' oscillations are independent of NOTCH signaling, we show that they require WNT and FGF signaling. Overexpressing Snail 2 in the chick embryo prevents cyclic Lfng and Meso 1 expression in the PSM and disrupts somite formation. Moreover, cells mis-expressing Snail 2 fail to express Paraxis, remain mesenchymal, and are thereby inhibited from undergoing the epithelialization event that culminates in the formation of the epithelial somite. Thus, Snail genes define a class of cyclic genes that coordinate segmentation and PSM morphogenesis.