Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence

Effect of photobiomodulation on the viability of osteoblasts and fibroblasts submitted to alendronate sodium or zoledronic acid: an in vitro study

O objetivo deste estudo é avaliar o efeito da terapia de fotobiomodulação (TFBM) na viabilidade de osteoblastos e cultura de fibroblastos em diferentes concentrações de alendronato ou ácido zoledrônico. Duas linhagens celulares – células de camundongos semelhantes a osteoblastos (OSTEO 1) e fibroblastos de mucosa bucal humana (FMM1) – foram utilizadas. As células foram submetidas a diferentes concentrações de bisfosfonatos (1 μM, 10 μM e 100 μM de alendronato de sódio e 3 μM, 5 μM e 10 μM de ácido zoledrônico) por 24 horas. Em seguida, as culturas receberam TFBM. As irradiações foram aplicadas com laser de diodo (InGaAIP, 660 nm, 30 mW, spot 0,028 cm2) em modo contínuo, pontual e de contato, em duas densidades de energia: 5 J/cm2 (4,5 s) ou 10 J/cm2 (9s) com intervalos de 6 horas. A viabilidade celular foi determinada pelo ensaio de atividade mitocondrial (MTT) 24 h após a última irradiação. Os dados foram comparados pelo ANOVA One-Way, complementado pelo teste de Tukey (p < 0,05). O alendronato de sódio nas concentrações de 100 μM e 10 μM e o ácido zoledrônico na concentração de 10 μM apresentaram maior toxicidade a longo prazo. A viabilidade celular do grupo tratado com TFBM foi significativamente maior que a do grupo de controle negativo. O mesmo ocorreu com os osteoblastos tratados com as maiores concentrações do fármaco (5 e 10 μM), apesar de não atingir a viabilidade celular do grupo de controle positivo, apresentou maior viabilidade do que o controle negativo no qual as células não foram irradiadas. Nos grupos submetidos ao ácido zoledrônico, controles positivos apresentaram maior viabilidade celular. Concluímos que sob os parâmetros aplicados neste estudo, a TFBM, com uma densidade de energia de 5 J/cm2, foi capaz de reverter a toxicidade do alendronato sódico aplicado nas concentrações mais altas em ambos os tipos celulares, enquanto a toxicidade do ácido zoledrônico, independentemente de suas concentrações, foi não influenciada pela TFBM.The goal of this study is to evaluate the effect of photobiomodulation therapy (PBMT) on the viability of osteoblasts and cultured fibroblasts in different concentrations of alendronate or zoledronic acid. Two cell lines: osteoblast-like mouse cells (OSTEO 1) and human buccal mucosa fibroblast (FMM1) were used. Cells were submitted to different concentrations of bisphosphonates (1 μM, 10 μM, and 100 μM sodium alendronate and 3 μM, 5 μM and 10 μM zoledronic acid) for 24 hours. Next, the cultures received PBMT. The irradiations were applied with a diode laser (InGaAIP, 660 nm, 30 mW, spot 0.028 cm2) in continuous, punctual and contact mode at two energy densities: 5 J/cm2 (4.5 s) or 10 Jcm2 (9s) with 6 hours-intervals. Cell viability was determined by mitochondrial activity assay (MTT) 24 h after the last irradiation. The data were compared by the one way- ANOVA, complemented by the Tukey’s test (p < 0.05). Sodium alendronate at concentrations of 100 μM and 10 μM and zoledronic acid at 10 μM concentration showed higher long-term toxicity. The cellular viability of the PBMT treated group was significantly higher than that of the negative control group. The same occurred with the osteoblasts treated with the highest concentrations of the drug (5 and 10 μM), despite not reaching the cell viability of the positive control group, it presented greater viability than the negative control where the cells were not irradiated. In the groups submitted to zoledronic acid, positive controls presented greater cell viability. We concluded that under the parameters applied in this study, PBMT at an energy density of 5 J/cm2 was able to revert the toxicity of sodium alendronate applied at the higher concentrations in both cell types, whereas zoledronic acid toxicity, regardless of its concentrations, was not influenced by PBMT

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Terapias adjuvantes fotodinâmicas e fotobiomoduladoras antimicrobianas para osteonecrose maxilar relacionada a medicamentos – Relato de dois casos com acompanhamento de longo prazo

A osteonecrose maxilar associada a medicamentos (OMAM) é uma doença relativamente rara com alta morbidade. Nesse estudo, relatamos o tratamento de dois casos recalcitrantes de OMAM nas mandíbulas de duas idosas cujo tratamento para osteoporose foi feito com alendronato. Ambas as pacientes receberam sequestrectomia combinada com terapia fotodinâmica antimicrobiana (TFA) e fotobiomodulação (FBM). Durante o perioperatório e em atendimentos semanais pós-operatórios TFA tratou três pontos anatômicos através de um laser de diodo emitindo uma onda contínua de arseneto de gálio-alumínio a 660 nm (laser vermelho), 0,028 cm2, 0,1 W, 3,57 W/cm2 por 90 s por ponto, 9 J por ponto, 321 J/cm2 e uma energia total de 27 J. O tratamento com FBM foi aplicado em sessões pós-operatórias semanais, consistindo em ondas com 808 nm de comprimento e os demais parâmetros idênticos. Ambas as pacientes foram acompanhadas por dois anos e não relataram a recorrência de OMAM. Logo, TFA e FBM podem ser consideradas terapias adjuvantes não-invasivas para OMAM sem efeitos adversos.Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare condition with high morbidity. In this study, we report the management of two recalcitrant cases of MRONJ in the mandibles of two older women who received treatment with alendronate for osteoporosis. Sequestrectomies, combined with antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBMT), were performed in both patients. During perioperative and weekly postoperative aPDT sessions, a diode laser treated three anatomical points by emitting a continuous gallium-aluminum-arsenide wave at 660 nm (red laser), 0.028 cm2, 0.1 W, 3.57 W/cm2 for 90 s per point, 9 J per point, 321 J/cm2, and a total energy of 27 J. PBMT was applied weekly after surgery at 808 nm wavelength (other parameters being equal) for wound healing and pain relief. Both patients were followed-up for two years without any report of recurrence. Thus, aPDT and PBMT can be considered non-invasive adjuvant therapies for MRONJ without any adverse effects

Qualidade microbiológica de queijo mussarela em peça e fatiado

The aim of this study was to verify the microbiological quality of mozzarella cheese sold in retail markets of Pelotas, Rio Grande do Sul, Brazil. Forty samples of mozzarella cheese were analyzed, comprising 20 samples of block cheese and 20 of sliced cheese. The cheese samples were analyzed for thermotolerant coliform counts and coagulase positive staphylococci counts, and presence of Salmonella spp and Listeria monocytogenes. The percentage of 12,5% and 5% of the sliced and block cheese samples analyzed, respectively, exceeded the microbiological standards accepted by Brazilian legislation. These results indicate the need for a better product monitoring and more concern with hygiene and sanitary practices during industrial process.O objetivo deste trabalho foi verificar o padrão microbiológico de queijo mussarela comercializado em estabelecimentos varejistas de Pelotas, Rio Grande do Sul. Foram analisadas 40 amostras de queijo mussarela, compreendendo 20 de queijo em peça e 20 de queijo fatiado, as quais foram submetidas a contagem de coliformes termotolerantes e de estafilococos coagulase positiva, e a pesquisa de Salmonella spp. e de Listeria monocytogenes. Observou-se que 12,5% das amostras de queijo fatiado e 5% de queijo em peça estavam em desacordo com os padrões estabelecidos pela legislação brasileira. Estes resultados indicam a necessidade de maior monitoramento desses produtos e maior cuidado higiênico-sanitário durante o processamento por parte das indústrias

Osteonecrose maxilar associada ao uso de bisfosfonatos Bisphosphonate-related osteonecrosis of the jaw

Os bisfosfonatos (BFs) têm sido indicados para o tratamento de doenças do metabolismo ósseo. Atualmente, seu emprego terapêutico aumentou e, com ele, os efeitos adversos, dos quais um dos mais importantes é a indução da osteonecrose dos maxilares, uma complicação de difíceis tratamento e solução. Até o presente, não se sabe ao certo qual é o mecanismo de desenvolvimento da osteonecrose dos maxilares induzida por bisfosfonatos (ONMB), nem qual deve ser o tratamento estabelecido perante essa manifestação. Apesar de a literatura apresentar formas variadas de tratamento, não existe um protocolo definido. Apresentamos uma revisão sobre a ONMB, enfocando sua etiopatogenia e as formas reportadas de tratamento.<br>Bisphosphonates (BPs) have been used for the management of bone metabolic diseases. Currently their therapeutic use has increased, as also have their adverse effects, one of the most important being the bisphosphonate-related osteonecrosis of the jaw (BRONJ), a complication of difficult treatment and solution. Until now, the physiopathology of BRONJ remains unclear, and its treatment is uncertain. Although the literature provides several treatment options, there is no defined protocol. We present a review about BRONJ, focusing on its pathogenesis and its reported forms of treatment