Correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry in patients with temporomandibular disorders

Recent studies showed that patients with chronic TMD pain also feature increased sensitivity in other craniofacial regions, and even in remote peripheral areas, suggesting that nociceptive processing is centrally facilitated in this patient population. The aim of this study was to investigate the existence of a negative correlation between the levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain in patients with TMD. A total of 20 female patients were evaluated comprising 11 patients diagnosed with myofascial pain (Group I of RDC/TMD) and 9 patients with arthralgia (Group III of RDC/TMD), with both reporting chronic TMD pain for at least 3 months. Patients were tested by the pressure algometry technique, and, in the same visit, clinical diagnosis and levels of non‐specific physical symptoms, including pain‐related issues or not, were obtained. The raw scores were then standardised into a T‐score. The possible correlation between the dependent variable levels of non‐specific physical symptoms and pressure pain thresholds measured by algometry at sites distant from the chief complaint of oro‐facial pain was assessed with Spearman's correlation coefficient. Results were considered statistically significant, which stood a lower than 5% probability of occurring by chance (P < 0·05). A statistically significant (P = 0·02) negative correlation (?0·51) was found to exist between the levels of non‐specific physical symptoms, only if including issues involving pain‐related symptoms, and experimental pressure pain thresholds in patients with painful TMD.     

People with chronic facial pain perform worse than controls at a facial emotion recognition task,but it is not all about the emotion

Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience sample of 19 people (15 females) with chronic facial pain and 19 gender‐matched controls participated. They undertook two tasks; in the first task, they identified the facial emotion presented in a photograph. In the second, they identified whether the person in the image had a facial feature pointed towards their left or right side, a well‐recognised paradigm to induce implicit motor imagery. People with chronic facial pain performed worse than controls at both tasks (Facially Expressed Emotion Labelling (FEEL) task P < 0·001; left/right judgment task P < 0·001). Participants who were more accurate at one task were also more accurate at the other, regardless of group (P < 0·001, r² = 0·523). Participants with chronic facial pain were worse than controls at both the FEEL emotion recognition task and the left/right facial expression task and performance covaried within participants. We propose that disrupted motor processing may underpin or at least contribute to the difficulty that facial pain patients have in emotion recognition and that further research that tests this proposal is warranted.     

Chronic kidney disease–mineral bone disorder: an update on the pathology and cranial manifestations

Chronic kidney disease–mineral bone disorder (CKD‐MBD) is a syndrome encompassing skeletal and extra skeletal changes associated with chronic kidney disease. It progresses silently until an advanced clinical stage when complications impact on the quality of life and survival rates of patients. The maxillofacial manifestations are unique and may play an important role in the early identification of changes which could influence the management of these patients. The goal of this review is to highlight the maxillofacial features, pathology, and principles of management of CKD‐MBD.     

Preoperative assessment for patients with renal impairment

The kidneys play an essential role in homeostasis. They regulate crucial physiological variables including blood pressure, acid-base, fluid and electrolyte balance. With an ageing and increasingly diabetic population, the prevalence of chronic kidney disease is increasing. Acute kidney injury is also very common in hospitalized patients. It is therefore essential to identify patients with renal impairment and assess its impact on a patient's physiology, with aberrancies such as anuria, metabolic acidosis and hyperkalaemia all being potentially life-threatening if untreated. It is these physiological derangements that lead to the observed association of renal impairment with an increased perioperative morbidity and mortality. Prevention, identification and correction of the physiological consequences of renal impairment are vital in improving postoperative outcomes in these patients. This article aims to provide a context and structure for the preoperative assessment of patients with renal impairment irrespective of its cause.     

Phosphorylation of Ribosomal Protein S6 Mediates Mammalian Target of Rapamycin Complex 1–Induced Parathyroid Cell Proliferation in Secondary Hyperparathyroidism

Secondary hyperparathyroidism is characterized by increased serum parathyroid hormone (PTH) level and parathyroid cell proliferation. However, the molecular pathways mediating the increased parathyroid cell proliferation remain undefined. Here, we found that the mTOR pathway was activated in the parathyroid of rats with secondary hyperparathyroidism induced by either chronic hypocalcemia or uremia, which was measured by increased phosphorylation of ribosomal protein S6 (rpS6), a downstream target of the mTOR pathway. This activation correlated with increased parathyroid cell proliferation. Inhibition of mTOR complex 1 by rapamycin decreased or prevented parathyroid cell proliferation in secondary hyperparathyroidism rats and in vitro in uremic rat parathyroid glands in organ culture. Knockin rpS6^p−/− mice, in which rpS6 cannot be phosphorylated because of substitution of all five phosphorylatable serines with alanines, had impaired PTH secretion after experimental uremia- or folic acid–induced AKI. Uremic rpS6^p−/− mice had no increase in parathyroid cell proliferation compared with a marked increase in uremic wild–type mice. These results underscore the importance of mTOR activation and rpS6 phosphorylation for the pathogenesis of secondary hyperparathyroidism and indicate that mTORC1 is a significant regulator of parathyroid cell proliferation through rpS6.     

Pelvic discontinuity: Where are we today?

Pelvic discontinuities in revision total hip arthroplasty remain a challenging problem with an evolving set of treatment options. Discontinuities occur when bone loss of the acetabulum and subsequent unstable movement of the acetabular component result in a fracture between the anterior and posterior columns. These resemble chronic nonunions by the time of revision arthroplasty and are managed differently from the acute fracture type occurring during primary or revision acetabular reconstruction in a previously stable pelvis. We review the treatment options and describe our preferred method of treatment using surgical distraction.     

肝硬化合并结核性胸膜炎1例报告

<正>1病历资料男性患者,25岁,以"腹胀1个月,发热半个月,加重2 d"为主诉,于2011年10月14日至本科住院治疗。患者10余年前体检发现HBsAg阳性,自述当时肝功能正常,未予重视及系统诊治。1个月前自觉腹胀,体检发现"少量腹水",仍未重视及进一步诊治,近半个月出现发热,最高体温38.7℃,无恶寒,无鼻塞流涕,无咳嗽咳痰,在当地诊所予对症治疗后体温下降,未行进一步诊治。2 d前自觉腹胀加重,遂至本院肝病门诊就