Massive brown tumors of the jaw: A case report

Brown tumors are non-neoplastic bone lesions caused by an abnormal remodeling of the bone that may occur with primary or secondary hyperparathyroidism. Their radiological aspect: lytic and aggressive can easily be misdiagnosed for a malignant origin hence the importance of knowing that diagnosis is to be considered through both clinical context and radiological semiology, which will be detailed via this case of a 32-year-old female patient with an end-stage kidney disease, admitted for facial disfiguration and palpable masses corresponding to brown tumors affecting the maxilla and the mandibular bone.

Epidemiological profile of arboviruses in two different scenarios: dengue circulation vs. dengue, chikungunya and Zika co-circulation

BACKGROUND

The severity and distribution of dengue virus (DENV) infections have been attributed to a complex interaction among viral, host and environmental factors. Herein, we investigated the influence of chikungunya (CHIKV) and Zika (ZIKV) viruses on the epidemiological profile of dengue cases, using Recife, Pernambuco state, Brazil, as a study model. In addition, we described and compared the epidemiological profile related to each arbovirus (DENV vs. CHIKV vs. ZIKV).

METHODS

All cases of dengue, chikungunya and Zika reported to the Pernambuco Health Department in 2011-2013 (DENV circulation) and 2016-2018 (DENV, CHIKV and ZIKV co-circulation) were included in our study. The cases were classified by sex, age and race/color and their distribution was analyzed by the χ² test. Furthermore, the data were also analyzed for co-infections. Temperature, humidity and rainfall data were analyzed using one-way ANOVA and paired t-test.

RESULTS

During 2011-2013, 15,315 dengue cases were diagnosed, most of them female, brown and 20-29 age group. Between 2016 and 2018, 15,870 dengue cases were described, which presented the same profile described above. In the two triennia, the female/male dengue ratio fluctuated significantly, ranging from 1.07 to 1.52. Regarding chikungunya, 7076 cases were reported, most of them female and brown. The female/male ratio also fluctuated significantly, ranging from 1.62 to 2.1. Two main age groups were observed in chikungunya: ≤ 19 years (minority of diagnoses) and ≥ 20 years (majority of diagnoses). In the same triennium, 266 Zika cases were reported to the Pernambuco Health Department, mainly in females and in the 0-9 and 20-39 age groups. In general, 119 co-infections were identified: 117 DENV-CHIKV, 1 CHIKV-ZIKV and 1 DENV-CHIKV-ZIKV. Concerning climate data, only the humidity in 2011 was significantly different from the other years.

CONCLUSION

The epidemiological profile of dengue cases did not change after the introduction of CHIKV and ZIKV. Females were the most diagnosed with dengue, chikungunya or Zika, however we found important differences in the age profile of these arboviruses, which should be considered by public health policies, as well as investigated in future studies of virus-host interaction.

Conditional gene targeting using UCP1-Cre mice directly targets the central nervous system beyond thermogenic adipose tissues

Objective

Uncoupling protein 1 (UCP1) is a mitochondrial protein critical for adaptive thermogenesis in adipose tissues, and it is typically believed to be restricted to thermogenic adipose tissues. UCP1-Cre transgenic mice are utilized in numerous studies to provide “brown adipose-specific” conditional gene targeting. Here, we examined the distribution of Cre and UCP1 throughout the body in UCP1-Cre reporter mice.

Methods

UCP1-Cre mice crossed to Ai14-tdTomato and Ai9-tdTomato reporter mice were used to explore the tissue distribution of Cre recombinase and Ucp1 mRNA in various tissues. UCP1-Cre mice were independently infected with either a Cre-dependent PHP.eB-tdTomato virus or a Cre-dependent AAV-tdTomato virus to determine whether and where UCP1 is actively expressed in the adult central nervous system. In situ analysis of the deposited single cell RNA sequencing data was used to evaluate Ucp1 expression in the hypothalamus.

Results

As expected, Ucp1 expression was detected in both brown and inguinal adipose tissues. Ucp1 expression was also detected in the kidney, adrenal glands, thymus, and hypothalamus. Consistent with detectable Ucp1 expression, tdTomato expression was also observed in brown adipose tissue, inguinal white adipose tissue, kidney, adrenal glands, and hypothalamus of both male and female UCP1-Cre; Ai14-tdTomato and UCP1-Cre; Ai9-tdTomato mice by fluorescent imaging and qPCR. Critically, expression of tdTomato, and thus UCP1, within the central nervous system was observed in regions of the brain critical for the regulation of energy homeostasis, including the ventromedial hypothalamus (VMH).

Conclusions

TdTomato expression in UCP1-Cre; tdTomato mice is not restricted to thermogenic adipose tissues. TdTomato was also expressed in the kidneys, adrenal glands, and throughout the brain, including brain regions and cell types that are critical for multiple aspects of central regulation of energy homeostasis. Collectively, these data have important implications for the utility of UCP1-Cre mice as genetic tools to investigate gene function specifically in brown adipose tissue.

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UCP1-Cre transgenic mice express Cre in tissues beyond thermogenic adipose tissues.

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UCP1-Cre; tdTomato reporter mice show that Cre is also expressed throughout the brain, kidney, and adrenal glands.

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Ucp1 mRNA is actively expressed in the central nervous system of adult mice.

Brown/Beige adipose tissues and the emerging role of their secretory factors in improving metabolic health: The batokines

Brown and beige adipose tissues are the primary sites for adaptive non-shivering thermogenesis. Although they have been known principally for their thermogenic effects, in recent years, it has emerged that, just like white adipose tissue (WAT), brown and beige adipose tissues also play an important role in the regulation of metabolic health through secretion of various brown adipokines (batokines) in response to various physiological cues. These secreted batokines target distant organs and tissues such as the liver, heart, skeletal muscles, brain, WAT, and perform various local and systemic functions in an autocrine, paracrine, or endocrine manner. Brown and beige adipose tissues are therefore now receiving increasing levels of attention with respect to their effects on various other organs and tissues. Identification of novel secreted factors by these tissues may help in the discovery of drug candidates for the treatment of various metabolic disorders such as obesity, type-2 diabetes, skeletal deformities, cardiovascular diseases, dyslipidemia. In this review, we comprehensively describe the emerging secretory role of brown/beige adipose tissues and the metabolic effects of various brown/beige adipose tissues secreted factors on other organs and tissues in endocrine/paracrine manners, and as well as on brown/beige adipose tissue itself in an autocrine manner. This will provide insights into understanding the potential secretory role of brown/beige adipose tissues in improving metabolic health.

An Eltrombopag Red (Plasma) Alert

Eltrombopag is a thrombopoietin receptor agonist frequently used to manage immune thrombocytopenia and aplastic anemia. At the high doses used for aplastic anemia, but not the doses used for immune thrombocytopenia, eltrombopag can cause reddish-brown discoloration of plasma, which can interfere with bilirubin measurement and cause false clinical alarm. This case report and clinical image describes a patient with aplastic anemia managed with eltrombopag who developed reddish-brown plasma initially concerning for possible hemolysis or rhabdomyolysis.

Uncovering the Role of p38 Family Members in Adipose Tissue Physiology

The complex functions of adipose tissue have been a focus of research interest over the past twenty years. Adipose tissue is not only the main energy storage depot, but also one of the largest endocrine organs in the body and carries out crucial metabolic functions. Moreover, brown and beige adipose depots are major sites of energy expenditure through the activation of adaptive, non-shivering thermogenesis. In recent years, numerous signaling molecules and pathways have emerged as critical regulators of adipose tissue, in both homeostasis and obesity-related disease. Among the best characterized are members of the p38 kinase family. The activity of these kinases has emerged as a key contributor to the biology of the white and brown adipose tissues, and their modulation could provide new therapeutic approaches against obesity. Here, we give an overview of the roles of the distinct p38 family members in adipose tissue, focusing on their actions in adipogenesis, thermogenic activity, and secretory function.

Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa

Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.

Role of ABC transporters White, Scarlet and Brown in brown planthopper eye pigmentation

The brown planthopper ATP-binding cassette (ABC) proteins White (W), Scarlet (St) and Brown (Bw) belong to the ABC transporter superfamily and are responsible for the transportation of guanine and tryptophan precursors of eye pigments. In the present study, the brown planthopper White (NlW), S t(NlSt) and Bw (NlBw) genes were cloned, and subsequent phylogenetic analysis showed that these genes are clustered with their respective homologues, with a genetic relationship observed between NlW and its Bemisia tabaci homologue having the highest similarity. Sequence alignments showed that these three proteins have a highly conserved Walker A domain, an ABC "signature sequence" and a Walker B domain. QRT-PCR demonstrated that W, St and Bw are highly expressed in the head of long-winged males and are highly expressed in both egg and male. Adult eye colour was altered after the downregulation of NlW, NlSt and NlBw in the 1st to 3rd instar nymph. The eye colours of emerged adults became white, dark and red after injection of dsNlW, dsNlSt and dsNlBw, respectively. The eye pigment content assay revealed that xanthommatin and pteridine were significantly decreased after the injection of dsRNAs, and the range of variation was inversely correlated with nymph age. The present study provides a theoretical basis for understanding the function of ABC transporters at the molecular and biochemical levels.

Lessons from Cre-Mice and Indicator Mice

The adult human adipose tissue is predominantly composed of white adipocytes. However, within certain depots, adipose tissue contains thermogenically active brown-like adipocytes, which have been evolutionarily conserved in mammals. This chapter will give a brief overview on the methods used to genetically target and trace both white and brown adipocytes using techniques such as bacterial artificial chromosome (BAC) cloning to create transgenic mouse models and the tools with which genetic recombination is mediated in vivo (e.g., Cre-loxP, CreERT, and Tet-On). The chapter furthermore critically discusses the strength and limitation of the various systems used to target mature white and brown adipocytes (ap2-Cre, Adipoq-Cre, and Ucp1-Cre). Based on these systems, it is evident that our knowledge of mature adipocyte categorization into brown, white, brite, or beige adipocytes is strongly influenced by the use of the various genetic mouse models described in this chapter. Our evaluation of different studies using the aforementioned systems focuses on key genes, which have been reported to maintain adipocyte's function (insulin receptor, Raptor, or Atgl).

Addressing health disparities: Brown University School of Public Health

Health disparities are a public health concern in Rhode Island and around the world. Faculty members and students in the Brown University School of Public Health are working to understand, address, and ultimately eliminate disparities in health and health care affecting diverse populations. Our educational offerings and research efforts are directed toward understanding and addressing the social, cultural, and environmental factors that contribute to these health disparities. Research methods to carry out this work include implementing interdisciplinary, community-based, quantitative and qualitative research with the goal of preventing, reducing, and eliminating health disparities. This article focuses on some of the School's work with vulnerable communities confronting issues around the following: HIV/AIDS, obesity, nutrition, physical activity and delivery of health services.

MiR-27 orchestrates the transcriptional regulation of brown adipogenesis

OBJECTIVE

Brown adipose tissue (BAT) produces heat using chemical energy of lipids and glucose, a function induced by cold exposure or diet. The brown adipogenesis is tightly controlled in a coordinated interplay between several transcriptional factors. It is not known what enables and coordinates this robust program of concerted cooperation between the transcriptional factors and co-regulators necessary for the brown adipogenesis.

MATERIALS/METHODS

A. In vivo studies--we investigated the expression levels of miR-27a and b in mice after cold exposure. B. Using gene expression and functional studies together with high throughput imaging in primary preadipocytes, and cell culture models, we investigated the role of miR-27 in beige and brown adipogenesis. C. Using gene silencing and rescue experiments we dissected the molecular mechanisms of the miR-27 action.

RESULTS

After cold exposure, miR-27 is downregulated in BAT and subcutaneous white adipose tissue (SAT). MiR-27 is also downregulated during brown adipogenesis of primary preadipocytes in vitro, and it directly targets and negatively regulates the essential components of the brown transcriptional network: Prdm16, Pparα, Creb, and in part Pgc1β. Together with its direct effect on Pparγ, and indirect on Pgc1α, mir-27 decreases brown differentiation of cultured cells and of primary SAT preadipocytes.

CONCLUSIONS

Our results point to miR-27 as a central upstream regulator of the transcriptional network involved in beige and brown adipogenesis after cold exposure, and suggest miR-27 inhibition as a novel therapeutic approach for metabolic diseases aiming at increasing the beige/brown fat mass.

Creating the future: Brown University's Executive Master of Healthcare Leadership

The Affordable Care Act is ushering in a new paradigm for all aspects of the healthcare industry - from hospitals to insurers, from IT companies to physician practice groups. Brown's new executive master's degree in healthcare leadership provides the knowledge healthcare leaders need to navigate this new world. The 16-month program mixes online learning and short campus-based sessions to accommodate the working professional.

The Brown School of Public Health

The nation's newest school of public health boasts research excellence in aging, obesity, addictions, health care services and policy research, and more. The Brown School of Public Health is home to a variety of master's and doctoral programs, in addition to one of the oldest undergraduate concentrations in community health. The School plays a key role in the development of public policy at the state and national level and implements programs that benefits Rhode Island physicians and their patients.