Bilateral Buccal Bifurcation Cyst: Case Report and Literature Review

Buccal bifurcation cyst (BBC) is a rare inflammatory odontogenic cyst that typically occurs at the buccal region of the first or second mandibular molars of children. In the current case, a 9-year-old boy complained of an extraoral soft tissue painful swelling. Intraoral examination revealed a partial eruption of the right permanent mandibular first molar with drainage of purulent material and clinical absence of the left mandibular first molar. Panoramic radiographic and computed tomography showed two well-defined areas surrounding the mandibular first molars consistent with cystic lesions. Surgical enucleations were performed and histopathologic analysis revealed inflammatory cysts. Based on the clinical, microscopic, radiographic, and CT images, the diagnosis of bilateral BBC was established. Patient has been under follow-up for about 1 year showing normal bone repair and eruption of the involved teeth. Although BBC is uncommon, it is important to recognize this entity.     

Adenoma-carcinoma sequence in intrahepatic cholangiocarcinoma

IntroductionCholangiocarcinoma is a rare tumor but recent data report a worldwide increase in incidence and mortality. There are several risk factors associated with cholangiocarcinoma, and chronic inflammation of billiary tree seems to be implied in the cholangiocarcinogenesis, but little is known about this process.Presentation of caseWe present a 56-year-old female with a bile duct adenoma incidentally discovered in the follow up of breast cancer that 18 months later progress to intrahepatic cholangiocarcinoma.DiscussionThis is a rare presentation of intrahepatic cholangiocarcinoma that suggests the classic adenoma-carcinoma sequence in cholangiocarcinogenesis. Furthermore this case gives rise to some questions about the possible common ground on intrahepatic cholangiocarcinoma and breast cancer.ConclusionCholangiocarcinogenesis is a complex multi-step mechanism and further investigations are needed to fully understand this process.     

N-acetylglucosaminidase,myeloperoxidase and vascular endothelial growth factor serum levels in breast cancer patients

Inflammatory cells surround breast carcinomas and may act promoting tumor development or stimulating anti-tumor immunity. N-acetylglucosaminidase (NAG) has been employed to detect macrophage accumulation/activation. Myeloperoxidase (MPO) is considered a marker for neutrophils activity/accumulation. Vascular Endothelial Growth Factor (VEGF) is as strong pro-angiogenic cytokine. The aim of this study was to measure the systemic inflammatory response by measuring serum levels of NAG, MPO and VEGF in women diagnosed with breast cancer and associate this response to the peritumoral inflammatory infiltrate and to prognostic factors. Serum samples obtained from women with no evidence of disease (n = 31) and with breast cancer (n = 68) were analyzed for the activities of NAG, MPO and VEGF by enzymatic assay. Serum levels of NAG and VEGF were higher in healthy volunteers (P < 0.0001) and serum levels of MPO were higher in patients with breast cancer (P = 0.002). Serum levels of NAG were positively correlated to serum levels of MPO and VEGF (P < 0.0001 and P = 0.0012, respectively) and MPO and VEGF serum levels had also a positive correlation (P = 0.0018). The inflammatory infiltrate was not associated to serum levels of the inflammatory markers, and higher levels of MPO were associated to lymphovascular invasion negativity (P = 0.0175).     

Single CpG island methylation is not sufficient to maintain the silenced expression of CASPASE-8 apoptosis-related gene among women with epithelial ovarian cancer

Despite impressive research efforts, the biology of epithelial ovarian cancer (EOC) remains poorly understood and alterations in the expression of CASPASE-8 contribute to a worse tumor prognosis. This study assesses the methylation of the CpG island within the CASPASE-8 promoter and CASPASE-8 gene expression both in cystadenoma tumors and in primary and metastatic EOC. DNA and RNA were obtained from women with normal ovarian tissues (n = 18), ovarian serous cystadenoma tumors (n = 11) and EOC (n = 16) using Trizol^®. The methylation frequency of the CpG island in the CASPASE-8 promoter was assessed using the methylation-specific PCR assay after DNA bisulfite conversion. Quantitative PCR was performed to quantify the relative levels of CASPASE-8 in each sample. The differences between samples with each group were evaluated using the Mann-Whitney U and Kruskal-Wallis tests as indicated. Hemimethylation of the CASPASE-8 promoter was found in 11.8% of the normal ovary samples, 20% of the cystadenoma tumors and 20% of the metastatic EOC, while methylation of the CASPASE-8 promoter was absent in the EOC primary tissues (P = 0.047). An increased CASPASE-8 expression level was observed in all tumor groups. Significant differences were observed in the CASPASE-8 expression levels when compared with all ovarian tumor groups (P = 0.0278). Promoter DNA methylation did not associate with expression levels of CASPASE-8, suggesting the presence of other mechanisms in relation to gene expression control in EOC; thus providing a better understanding of this complex disease.     

Balance Deficits are Correlated with Bronchial Obstruction Markers in Subjects with Asthma

[Purpose] Balance deficits are increasingly recognized in chronic obstructive pulmonary disease, but little is known regarding this issue in asthma. Our primary aim was to assess the correlation between postural balance and pulmonary function in adults with asthma. Secondarily, we aimed to correlate balance with functional capacity and body mass index in these subjects. [Methods] A cross-sectional study of 26 adults with asthma was performed in which they were subjected to stabilometry, pulmonary function testing, a 6-minute walking test, and nutritional assessment. [Results] We found significant correlations of forced expiratory volume at one second (ρ=−0.49) and total lung capacity (ρ=0.39) with mediolateral displacement with feet apart/eyes open. Significant correlations were observed between peak expiratory flow and a number of stabilometric parameters. There were several significant correlations between airway-specific conductance and the tasks performed on the force platform, especially one with the feet apart/eyes open. The Berg Balance Scale revealed significant correlations with mediolateral displacement, mediolateral range, and anteroposterior range for feet together/eyes closed (ρ=−0.49). There were no significant correlations between stabilometry, body mass index, and six-minute walking distance. [Conclusion] In adults with asthma, there is an association between balance and the bronchial obstruction markers. This finding may contribute to improvement of rehabilitation programs for these subjects.Key words: Asthma, Respiratory function tests, Postural balance     

Influence of Mechanical Damage under Repeated Loading on the Resistance of Geogrids against Abrasion

Geogrids are building materials widely used for soil reinforcement that can be affected by the action of many degradation agents throughout their service life. The potential negative effect of the degradation agents should be properly estimated and accounted for during the design phase. The main aim of this work was to study the influence of mechanical damage under repeated loading on the resistance of geogrids against abrasion. Three geogrids (one extruded and two woven) were exposed in isolation to mechanical damage under repeated loading and abrasion tests, followed by the successive exposure to both degradation tests. The damage suffered by the geogrids was evaluated by visual inspection and by tensile tests. Based on the changes found in tensile strength, reduction factors were determined. The reduction factors obtained directly from the successive exposure were compared to those resulting from a method in which the reduction factors obtained for the isolated effect of each degradation agent were multiplied. Results indicated that the abrasion process tended to be affected by a previous exposure to mechanical damage under repeated loading and that the multiplication of the reduction factors obtained for the isolated effects of the degradation agents may not correctly represent their combined effect.     

Brazilian guidelines for the management of candidiasis – a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia,Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical

Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.