Effects of estrogen deficiency during puberty on maxillary and mandibular growth and associated gene expression – an μCT study on rats

Background Estrogen is a well-known and important hormone involved in skeletal homeostasis, which regulates genes involved in bone biology. Some studies support that estrogen is important for craniofacial growth and development. Therefore this in vivo animal study aimed to investigate, whether and in which way low estrogen levels in the prepubertal period affect craniofacial development in the postpubertal stage and to quantify the gene expression of RANK, RANKL and OPG in cranial growth sites in ovariectomized estrogen-deficient rats during puberty. Methods Control (sham-operated, n = 18) and ovariectomy (OVX, n = 18) surgeries were performed on 21-days-old female Wistar rats. Animals euthanized at an age of 45 days (pubertal stage) were used for gene expression analyses (n = 6 per group) and immunohistochemistry of RANK, RANKL and OPG. Animals euthanized at 63 days of age (post-pubertal stage) were used for craniofacial two-dimensional and three-dimensional craniofacial measurements using μCT imaging (n = 12 per group). Results In the μCT analysis of the mandible and maxilla many statistically significant differences between sham-operated and OVX groups were observed, such as increased maxillary and mandibular bone length in OVX animals (p < 0.05). Condylar volume was also significantly different between groups (p < 0.05). The sham-operated group showed a higher level of RANK expression in the midpalatal suture (p = 0.036) and the RANKL:OPG ratio levels were higher in the OVX group (p = 0.015). Conclusions Our results suggest that estrogen deficiency during the prepubertal period is associated with alterations in the maxillary and mandibular bone length and condylar growth

Abordagem clínica e manejo terapêutico pertinentes ao Câncer colorretal: Clinical approach and therapeutic management relevant to coloretal Câncer

O câncer colorretal (CCR) é a malignidade mais comumente identificada e a principal causa de câncer em homens com idade inferior aos 50 anos. Já nas mulheres, o CCR corresponde à segunda maior causa de mortalidade e à quarta maior incidência de neoplasias, ficando atrás apenas do câncer de mama, de tireoide e o melanoma. Nesse cenário, estudos aventam que, apesar da taxa de incidência da afecção venha regredindo em adultos mais velhos, é significativo o aumento da ocorrência e da mortalidade do CCR em pacientes com idades inferiores aos 50 anos. Os componentes de risco modificáveis para o CCR podem ser responsáveis por cerca de até 50% dos casos da doença, sendo possível destacar: dieta ocidental, sobrepeso e obesidade, tabagismo, etilismo exacerbado, consumo elevado de carne vermelha ou processada, sedentarismo e o baixo consumo de fibra dietética, grãos integrais e outros nutrientes. Tais hábitos alteram o microbioma intestinal e, quando em associação ao histórico familiar positivo e às alterações de vias metabólicas e imunológicas, aumentam a chance de desenvolvimento do CCR. Quanto às manifestações clínicas do CCR, sintomas inespecíficos podem fazer-se presentes, sendo eles: alteração do hábito intestinal, anemia ferropriva, dor abdominal, inapetência, perda ponderal e hematoquezia por sangramento retal, fazem parte do quadro da doença. Assim sendo, o diagnóstico do CCR é pautado no rastreio e triagem precoce dos pacientes que contemplam os fatores de risco e possuem idade que justifique a pesquisa. Sobre o método diagnóstico padrão ouro para o rastreio da doença, tem-se a colonoscopia, que além de proporcionar alta sensibilidade e especificidade, permite a resolução da afecção durante o procedimento, por meio da ressecção de lesões neoplásicas e/ou pré-malignas. Ainda, em casos reservados, na qual a ressecção cirúrgica não seja factível, a quimioterapia é uma opção terapêutica adjuvante com excelentes resultados

Adenoma pleomórfico da glândula submandibular: Pleomorphic adenoma of the submandibular gland

Introdução: O Adenoma Pleomórfico é o mais comum dentre os tumores benignos, desenvolvendo-se em áreas de tecido glandular, apesar de ser uma importante patologia glandular salivar, o acometimento da glândula submandibular não é o mais prevalente, e sim o da glândula parótida, o que acaba por negligenciar tal manifestação. Apresentação do Caso: Paciente com 38 anos, sexo feminino, melanoderma, procurou o serviço de otorrinolaringologia devido aparecimento de nódulo em região cervical há cerca de 04 anos, associado à limitação de movimento, com prejuízo estético há 02 meses. Nega dor. Ao exame físico local, evidenciou-se lesão nodular de consistência firme, unilocular.&nbsp; À análise histológica, evidenciou ausência de sinais de malignidade. Discussão: O Adenoma Pleomórfico tem crescimento lento, normalmente, perceptível previamente à consulta médica, de anos a meses, apresentando-se de forma muito semelhante a uma linfonodomegalia cervical, indolor e de consistência firme, podendo se manifestar em todas as idades, com predominância entre os 40 e 50 anos, sendo a excisão cirúrgica com margem de segurança seu tratamento de referência, na maioria das vezes, com um excelente prognóstico e baixo índice de recidivas. Conclusão: A evolução lenta é determinante para a percepção atrasada da lesão em questão, e consequentemente, para a necessidade de excisão cirúrgica, para que se tenha um bom prognóstico, além do aumento nas chances de malignização do tumor, o que torna necessário que haja uma maior exploração do tema ao longo da graduação médica, a fim de repercutir na otimização do diagnóstico e tratamento em níveis de saúde menos avançados e mais acessíveis à população em geral

Síndrome de Stickler: Stickler's Syndrome

INTRODUÇÃO: A Síndrome Stickler é uma colagenopatia, rara, hereditária e caráter autossômica dominante, sua incidência é de 1/7500 nascimentos. APRESENTAÇÃO CASO: GPS, sexo masculino, 5 anos, admitido no Hospital das Clínicas de Goiânia, portador de miopia importante e fissura palatina desde o nascimento, queixava-se de baixa acuidade visual há 3meses. Durante a inspeção, foram evidenciados face plana, maxilar curto, olhos proeminentes e pregas epicantais. DISCUSSÃO: A síndrome é caracterizada por um artro-oftalmopatia, ou seja, anormalidades esqueléticas, anomalias orofaciais, perda auditiva, osteoartrite prematura, perda neuro-sensorial,fenda palatina, miopatia grave e cegueira. É classificada de acordo com a mutação em Tipo I, II e III. CONCLUSÃO: Por se tratar de uma síndrome genética rara, é de difícil diagnóstico, necessita de uma análise fenotípica, um quadro clínico favorável e história familiar. Não existe um tratamento curativo. Portanto, quanto mais precoce seu diagnóstico, a intervenção será mais rápida e melhor será o prognóstico

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Estrogen deficiency affects tooth formation and gene expression in the odontogenic region of female rats

Background: There is some evidence that estrogen regulates the expression of several genes in different cells, including dental cells. Therefore, the aim of this study was to investigate the role of estrogen deficiency during tooth development regarding tooth structure morphology and its impact on the expression of odontogenesis-related genes. Methods: A total of 40 female Wistar rats was divided into OVX (estrogen deficiency) and Sham (control) groups. Bilateral ovariectomy was performed in the OVX group, while Sham surgery was performed in the control group at the age of 21 days. At an age of 56 days, 16 rats were euthanized for gene expression analyses of Bmp4, Smad6, Tgfb1 and Runx2. At the age of 63 days, the remaining rats were euthanized for histological and morphometric analyses of teeth. The mandibles of the rats were submitted to mu CT analysis. Tooth structures (enamel, dentin and dental pulp) were analyzed. T test was used to compare the mean differences between groups (p < 0.05). Results: In the mu CT analysis, enamel and dentin thickness were significantly increased in the control group (p < 0.0001). Pulp dimensions were significantly larger in the OVX group (p < 0.0001). A reduction of tooth structures in the OVX group was confirmed in HE staining. Smad6 was differentially expressed in the OVX group (p = 0.04). Conclusion: Estrogen deficiency affects gene expression in the odontogenic region and tooth structure morphology. (C) 2021 Elsevier GmbH. All rights reserved

The role of postnatal estrogen deficiency on cranium dimensions

Objectives The aim of this study was investigate the cranium dimensions of adult female rats, who suffered estrogen deficiency during the prepubertal stage, to assess the impact of estrogen deficiency on craniofacial morphology. Material and methods Twenty-two female Wistar rats were divided into ovariectomy (OVX) (n = 11) and sham-operated control (n = 11) groups. Bilateral ovariectomy were performed in both groups at 21 days old (prepubertal stage), and rats were euthanized at an age of 63 days (post-pubertal stage). Micro-CT scans were performed with rat skulls, and the cranium morphometric landmark measurements were taken in the dorsal, lateral, and ventral view positions. Differences in measurements between the OVX and sham control groups were assessed using t test with an established alpha error of 5%. Results The measures of the rats' skull showed that the inter-zygomatic arch width and anterior cranial base length were significantly larger in OVX group (p = 0.020 and p = 0.050, respectively), whereas the length of parietal bone was significantly higher in the sham group (p = 0.026). For the remaining measurements no significant differences between groups were detected (p > 0.05). Conclusion This study provides evidence that ovariectomized rats had alterations in cranial bone dimensions, demonstrating that estrogens during puberty are important for skull morphology

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data