André Luis da Silva

Inflammatory events during murine squamous cell carcinoma development

BackgroundSquamous cell carcinoma (SCC) is one of the most common human cancers worldwide. In SCC, tumour development is accompanied by an immune response that leads to massive tumour infiltration by inflammatory cells, and consequently, local and systemic production of cytokines, chemokines and other mediators. Studies in both humans and animal models indicate that imbalances in these inflammatory mediators are associated with cancer development.MethodsWe used a multistage model of SCC to examine the involvement of elastase (ELA), myeloperoxidase (MPO), nitric oxide (NO), cytokines (IL-6, IL-10, IL-13, IL-17, TGF-β and TNF-α), and neutrophils and macrophages in tumour development. ELA and MPO activity and NO, IL-10, IL −17, TNF-α and TGF-β levels were increased in the precancerous microenvironment.ResultsELA and MPO activity and NO, IL-10, IL −17, TNF-α and TGF-β levels were increased in the precancerous microenvironment. Significantly higher levels of IL-6 and lower levels of IL-10 were detected at 4 weeks following 7,12-Dimethylbenz(a)anthracene (DMBA) treatment. Similar levels of IL-13 were detected in the precancerous microenvironment compared with control tissue. We identified significant increases in the number of GR-1+ neutrophils and F4/80+/GR-1- infiltrating cells in tissues at 4 and 8 weeks following treatment and a higher percentage of tumour-associated macrophages (TAM) expressing both GR-1 and F4/80, an activated phenotype, at 16 weeks. We found a significant correlation between levels of IL-10, IL-17, ELA, and activated TAMs and the lesions. Additionally, neutrophil infiltrate was positively correlated with MPO and NO levels in the lesions.ConclusionOur results indicate an imbalance of inflammatory mediators in precancerous SCC caused by neutrophils and macrophages and culminating in pro-tumour local tissue alterations.

Efficacy of Papacarie® in reduction of residual bacteria in deciduous teeth: a randomized, controlled clinical trial

OBJECTIVES: The aim of the present study was to analyze the efficacy of Papacarie® gel compared with the traditional method (low-speed bur) in reducing the counts of total bacteria, Lactobacillus, total Streptococcus and Streptococcus mutans group. METHODS: A randomized, controlled clinical trial with a split-mouth design was performed. The sample comprised 40 deciduous teeth in 20 children (10 males and 10 females) aged four to seven years. The teeth were randomly allocated to two groups: G1, or chemomechanical caries removal with Papacarie Duo®, and G2, or the removal of carious dentin tissue with a low-speed bur. Infected dentin was collected prior to the procedure, and the remaining dentin was collected immediately following the removal of the carious tissue. Initial and final counts of bacterial colonies were performed to determine whether there was a reduction in the number of colony-forming units (CFUs) of each microorganism studied. ClinicalTrials.gov: NCT01811420. RESULTS: Reductions were found in the numbers of total bacteria, total Streptococcus and Streptococcus mutans group following either of the caries removal methods (p<0.05). A reduction was also noted in the number of Lactobacillus CFUs; however, this difference did not achieve statistical significance (p>0.05). CONCLUSION: Papacarie® is an excellent option for the minimally invasive removal of carious tissue, achieving significant reductions in total bacteria, total Streptococcus and S. mutans with the same effectiveness as the traditional caries removal method.

Pain during Removal of Carious Lesions in Children: A Randomized Controlled Clinical Trial

The aim of the present study was to assess pain and the need for anesthesia during chemomechanical caries removal with Papacarie gel and the traditional method (low-speed bur) in pediatric patients. A randomized, controlled, clinical trial with a “split-mouth” design was carried out involving 20 children (10 girls and 10 boys) aged four to seven years. Forty primary teeth (two per child) were randomly allocated to either Group 1 (G1: chemomechanical caries removal with Papacarie gel) or Group 2 (G2: removal of carious dentin with low-speed bur). A face scale was used to classify the sensation of pain during the procedure (1: absence of pain; 2: mild pain; 3: moderate pain; 4: moderately intense pain; 5: intense pain; and 6: extremely intense pain). Statistical analysis of the data was performed using the Wilcoxon-Mann-Whitney (U) test. Pain scores were higher in G2, with statistically significant differences in comparison to G1 (U = 148.0; W = 358.0; P = 0.041). Chemomechanical caries removal with Papacarie provides a lesser degree of pain in comparison to conventional caries removal and does not require the use of local anesthesia. The clinical trial registration number is NCT01811420.

Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel

Objectives Compare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and Methods A randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. Results No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. Conclusion PapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia.

Descompressão orbitária antro-etmoidal na orbitopatia distireoidiana

Purpose: To evaluate the results and complications of a restricted (antral-ethmoidal) orbital decompression in the treatment of dysthyroid orbitopathy. Methods: 14 patients (10 female), with a mean age of 41.7 years, were submitted to 22 orbital decompressions. Three surgeries (2 patients) were performed in the congestive phase of the disease due to severe corneal ulceration. These patients were receiving corticosteroids associated with radiotheraphy and cyclophosphamide and continued these treatments after surgery. Nineteen orbits were operated on during the inactive phase of the ophthalmopathy in order to improve ocular discomfort and for cosmetic reasons. Surgeries were performed by a superior approach, using a conjunctival incision in 19 and a palpebral one in 3. Results: Reduction of proptosis ranged from 1 to 6 mm (average 3.91 mm). Mean reduction was 5.33 ± 0.27 mm in the patients operated on in the acute phase and 3.68 ± 0.25 mm in those operated on in the inactive phase of the ophthalmopathy. None developed diplopia as a result of the surgery. Surgical correction of preexistent strabismus was performed in two patients and temporary blepharorraphy was associated with the decompression in the cases operated on in the acute phase. Six patients were subsequently submitted to surgical correction of preexistent lid retraction. In one, inferior lid retraction worsened as a result of the lid incision. Transient loss of sensitivity in the cheek was common but not permanent. Conclusions: Antral-ethmoidal orbital decompression is efficient in reducing proptosis in patients with Graves ophthalmopathy and is associated with a very low incidence of complications. Combined with other treatment modalities it can be helpful in severe cases in the acute phase and in the cosmetic rehabilitation of patients with residual proptosis.

Assessment of the effects of decontamination and storage methods on the structural integrity of human enamel

Introducao O armazenamento de dentes para utilizacao em pesquisas e uma questao controversia e nao ha consenso sobre o metodo de tratamento mais apropriado para esta finalidade. Objetivo O objetivo deste estudo foi analisar a efetividade e a influencia de diferentes metodos de descontaminacao e armazenamento do esmalte dentario humano, a fim de manter sua integridade. Material e metodo A amostra foi constituida por 124 molares distribuidos aleatoriamente em tres grupos, de acordo com o metodo: controle – agua destilada, solucoes de timol a 0,1% e de azida de sodio a 0,02%. Os testes realizados foram fluorescencia a laser, microdureza de superficie e analise de perfilometria (0, 15 e 30 dias) e teste microbiologico (7, 15 e 30 dias). Os dados foram analisados por meio dos testes ANOVA e Tukey (p<0,05). Resultado No teste de fluorescencia a laser, a solucao de timol a 0,1% demonstrou ser mais viavel na manutencao da integridade do orgao dentario, uma vez que este nao apresentou variacoes significativas nos valores entre os periodos avaliados (p<0,05). A analise de microdureza de superficie evidenciou perda de estrutura dentaria em todos os metodos, sendo que a azida de sodio promoveu menor perda dentaria. Na analise de perfilometria observou-se perda de estrutura em todos os grupos, com maior perda no grupo azida de sodio. Nenhum dos metodos conseguiu inibir o crescimento bacteriano. Conclusao: Dentre os metodos de processamento analisados nenhum foi capaz de aliar a efetividade na descontaminacao ao armazenamento com manutencao da integridade estrutural do esmalte dentario humano.

Ruptura espontânea da cápsula anterior do cristalino em paciente com síndrome de Alport

Trabalho realizado no Hospital das Clínicas da Faculxad dade de Medicina da USP. ,I) Médico Estagiário da Disciplina de Oftalmologia da FMUSP e Médico Assistente do Hospital Universitáxad rio da USP. I Médico Estagiário da Disciplina de Oftalmologia da FMUSP. 1.1 Professor Adjunto da Disciplina de Oftalmologia da FMUSP. Endereço para correspondência: Fernando Betty Cresta R. Professor João de Oliveira Torres, 93. São Paulo (SP)CEP: 03337-010. Fone: 295-9219.e-mail: cresta@usp.br RESUMO