Craniofacial radiographic patterns of multiple myeloma in patients treated with bisphosphonates

Orientadores: Alan Roger dos Santos Silva, Mario Fernando de GoesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Esta tese de doutoramento avaliou a frequência e os padrões de manifestação radiográfica do mieloma múltiplo (MM) nos ossos craniofaciais por meio de investigações clinicopatológicas de natureza retrospectiva. Os resultados da consecução desta tese estão apresentados em 2 artigos. No primeiro capítulo (artigo 1), comparou-se uma série de 88 pacientes diagnosticados com MM que receberam bisfosfonatos administrados por via endovenosa (BFs e.v.) (grupo estudo) com a uma série de 100 pacientes diagnosticados com MM que não utilizaram BFs e.v. (grupo controle). Radiografias panorâmicas digitais foram estudadas em ambos os grupos para avaliação da presença (ou ausência) dos seguintes critérios: imagens osteolíticas solitárias, imagens osteolíticas múltiplas, osteoporose difusa, esclerose difusa, anormalidades de lâmina dura, alvéolo pós-extração não cicatrizado e sequestro ósseo. A análise dos dados revelou que múltiplas lesões osteolíticas (p=0.001), osteoporose difusa (p=0.001) e esclerose difusa (p=0.0036) foram mais frequentemente observadas em mandíbula do que em maxila em ambos os grupos estudados. A presença de lesão osteolítica solitária foi observada com menor frequência no grupo que recebeu BFs e.v. (p=0.0078, OR=0.1994, CI95%=0.057-0.696). As anormalidades de lâmina dura (p=0.0006, OR=2.447, CI95%=1.47-4.08) e alvéolo ósseo persistente (p=0.0021, OR=20.23, CI95%=1.158-353.3) também estavam associados ao tratamento com BFs e.v. Concluiu-se que o tratamento com BFs e.v. altera os padrões radiográficos de manifestação do MM em mandíbula e maxila. O segundo capítulo (artigo 2) comparou a frequência da detecção radiográfica de imagens osteolíticas do MM nos ossos craniofaciais de uma série de 155 pacientes por meio de três técnicas digitais (radiografia panorâmica, radiografia frontal e radiografia lateral de crânio). Radiografias panorâmicas detectaram imagens osteolíticas em 137 (88,3%) casos, radiografia frontal de crânio em 141 (91%) casos e radiografia lateral de crânio em 144 (93%) casos. Apenas 18 (11,61%) casos se manifestaram exclusivamente no crânio e 6 (3,87%) exclusivamente em mandíbula e maxila; entretanto, 129 (83,23%) pacientes apresentaram imagens osteolíticas sincrônicas em crânio, mandíbula e maxila. Concluiu-se que apesar da radiografia lateral de crânio ter apresentado maior frequência de detecção de imagens osteolíticas do MM, as três técnicas radiográficas utilizadas neste estudo demonstraram altas frequências de detecção de imagens osteolíticas relacionadas ao MM nos ossos craniofaciaisAbstract: This thesis evaluated the frequency and radiographic patterns of multiple myeloma (MM) in craniofacial bones through clinical, pathological and radiographic investigations in a retrospective approach. The results are presented in two papers. The first chapter (manuscript 1) compared a series of 88 patients diagnosed with MM who received intravenous bisphosphonates (i.v. BPs) (study group) with a series of 100 MM patients naive to i.v. BPs (group control).Digital panoramic radiographs were analized in both groups to evaluate the presence (or absence) of the following criteria: solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, abnormalities of the lamina dura, non-healing alveolar sockets and bone sequestration. Data analysis revealed multiple osteolytic lesions (p=0.001), diffuse osteoporosis (p=0.001) and diffuse sclerosis (p=0.0036) were more often observed in the mandible than in the maxilla in both studied groups. The presence of solitary osteolytic lesions showed to be reduced in the BPs group (p=0.0078, OR=0.1994, CI95%=0.057-0.696). Abnormalities of the lamina dura (p=0.0006, OR=2.447, CI95%=1.47-4.08) and non-healing alveolar sockets (p=0.0021, OR=20.23, CI95%=1.158-353.3) were also associated with BPs treatment. I.v. BPs therapy changes the typical radiographic patterns of MM in the jawbones. The second chapter (manuscript 2) compared the frequency of radiographic detection of osteolytic MM lesions in craniofacial bones of a series of 155 patients, using three digital techniques (panoramic radiograph, frontal radiograph and lateral radiograph of the skull). Panoramic radiographs detected osteolytic images in 137 (88.3%) cases, frontal radiograph of skull in 141 (91%) cases and lateral radiograph of skull in 144 (93%) cases. Eighteen (11.61%) cases showed images affecting exclusively the skull and 6 (3.87%) cases only affected mandible and maxilla; however, 129 (83.23%) patients presented MM osteolytic images synchronously affecting skull and jawbones. It was concluded that although the lateral radiograph of skull presented increased rates of osteolytic MM lesions detection, all studied radiographic techniques were effective in detecting osteolytic images related to MM in craniofacial bonesDoutoradoEstomatologiaDoutora em EstomatopatologiaCAPE

Radiation-related superficial oral mucoceles : an under-recognized acute toxicity in head and neck cancer patients

Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy

Panoramic and skull imaging may aid in the identification of multiple myeloma lesions

The purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients. One hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques. MM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately. All investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions

Postradiation Matrix Metalloproteinase-20 Expression and Its Impact on Dental Micromorphology and Radiation-Related Caries

Recent evidence suggests that head-and-neck radiotherapy (HNRT) increases active forms of matrix metalloproteinase-20 (MMP-20) in human tooth crowns, degrading the dentin-enamel junction (DEJ) and leading to enamel delamination, which is a pivotal step in the formation of radiation-related caries (RRC). Additional participation of enzymatic degradation of organic matrix components in caries progression was attributed to MMP-20 in dentin. Therefore, the current study tested the hypothesis that MMP-20 is overexpressed in the DEJ, dentin-pulp complex components, and carious dentin of post-HNRT patients, leading to detectable micromorphological changes to the enamel and dentin. Thirty-six teeth were studied, including 19 post-HNRT specimens and 17 nonirradiated controls. Optical light microscopy was used to investigate the micromorphological components of the DEJ, dentin-pulp complex components, and carious dentin. The samples were divided into 2 subgroups: nondemineralized ground sections (n = 20) and demineralized histological sections (n = 16). In addition, immunohistochemical analysis using the immunoperoxidase technique was conducted to semiquantitatively assess MMP-20 expression in the DEJ, dentin-pulp complex components, and carious dentin. No apparent damage to the DEJ microstructure or other dentin-pulp complex components was observed and no statistically significant differences were detected in MMP-20 expression (p > 0.05) between the irradiated and control groups. This study rejected the hypothesis that MMP-20 is overexpressed in the DEJ, dentin-pulp complex components, and carious dentin of post-HNRT patients, leading to detectable micromorphological changes. Hence, direct effects of radiation may not be regarded as an independent factor to explain aggressive clinical patterns of RRC. (C) 2017 S. Karger AG, BaselPeer reviewe

Dentin-pulp complex reactions in conventional and radiation-related caries : a comparative study

Radiation-related caries (RRC) is one of the most significant oral toxicities of head and neck radiotherapy (HNRT); however, the potential of radiation to directly cause harmful dentin and pulpal effects and impair response to caries progression is controversial. Therefore, the aim of this study was to characterize the reactions of the dentin-pulp complex in teeth affected by RRC. Patients and methods: Twenty-two carious teeth extracted from 22 head and neck cancer (HNC) patients were divided into control (conventional caries; n=11) and irradiated (RRC; n=11) groups and paired matched by dental homology, clinical patterns of caries progression following the Post-Radiation Dental Index (PRDI) and microscopic depth of carious invasion. Histopathological characteristics based on morphological hierarchy, cell populations of dental pulp, blood vessels, neural elements, extracellular matrix components, inflammation, patterns of carious invasion and reactionary dentin presence were evaluated by optical light microscopy and histomorphometry. Mean PRDI scores were 3.2 for the control group and 3.8 for the irradiated group. Dentin demineralization patterns were also similar between the groups and the mean depths of demineralization were 1,158.58µm and 1,056.89µm for the control and irradiated groups, respectively. Pulp histopathological changes and dentin reaction patterns were similar between groups and varied according to the PRDI scores and carious lesions depth. Dentin and pulp reactions are highly preserved in RRC teeth

Management of intraoral stents for radiotherapy during COVID-19 pandemic

Radiotherapy is being performed in many situations as a curative approach for head and neck cancer instead of surgery due to the current novel coronavirus disease (COVID-19) pandemic. A recent publication reported that even hypofractionation was being conducted in order to reduce the daily exposure of both patients and the medical staff involved in cancer therapies. As a result, dental teams may be requested more frequently than usual to fabricate intraoral stents (IOS). Given that IOS may be a potential source of COVID-19 contagion, the main purpose of the present correspondence is to offer a guide on how health professionals may be safely presented in the room, on the management of the IOS and also how to sanitize the stents. 

Uso de telas pela população pediátrica e seus impactos oftalmológicos a curto e a longo prazo: uma revisão sistemática : Use of screens by the pediatric population and its short and long-term ophthalmological impacts: a systematic review

Ao se discorrer sobre a formação e formatação da nossa sociedade, pode-se notar que cada vez mais esta está permeada pela tecnologia e pelos sistemas integrativos, processo esse benéfico para comunicação, gestão e tomada de decisões para além de ser uma ferramenta de trabalho e entretenimento, porém, com a progressiva quantidade de horas que ficamos expostos a este tipo de tecnologia também podem acarretar prejuízos a acuidade visual dos usuários. Juntamente a isso, nota-se que as crianças estão tendo cada vez mais precocemente acesso os equipamentos eletrônicos e deixando de lado as brincadeiras, desta forma a partir de uma pesquisa qualitativa, feita a partir de um levantamento bibliográfico, pode-se dispor que esta busca compreender quais são os sintomas e efeitos do uso excessivo deste tipo de ferramenta e algumas formas de tratamento e profilaxia que podem ser dispostas sobre o tema, com enfoque na população pediátrica

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio