Symmetrical widening of the periodontal ligament space in a patient with multiple systemic problems

Progressive systemic sclerosis is an uncommon disease that affects the collagen in multiple organ systems. Characteristic oral manifestations that may complicate dental treatment include limited opening, TMJ dysfunction, mucogingival problems, xerostomia, and pathological resorption of the mandible.     

Immune regulation by dendritic cells and T cells--basic science, diagnostic, and clinical application

Dendritic cells (DC) are professional antigen-presenting cells defined by their ability to transport incoming infectious signals from the periphery to T cell areas in lymphoid organs and by their unique properties to induce primary T cell activation. As sentinels of immunity DC play a critical role in the initiation of immune responses. Thus, they are key targets in antigen-specific immunotherapeutic strategies for cancer. However, beside this essential immunostimulatory function in the immune system, DC also play an important role in the maintenance of peripheral tolerance. Dependent on subtype and mode of activation, tissue resident immature DC differentiate into immunostimulatory or immunosuppressive antigen-presenting cells with a strong capacity to activate or to inhibit T cell responses, respectively. This review summarizes our current knowledge about the complex interaction between DC and T cells considering both--immunity and tolerance--as well as the possibilities to use this knowledge for development of novel diagnostic and immunotherapeutic strategies to treat immune-imbalanced human diseases such as cancer, allergy, and autoimmunity.     

A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes

Research findings are particularly important for medication choice for first-episode patients as individual prior medication response to guide treatment decisions is unavailable. We describe the first large-scale double-masked randomized comparison with first-episode patients of aripiprazole and risperidone, 2 commonly used first-episode treatment agents. One hundred ninety-eight participants aged 15–40 years with schizophrenia, schizophreniform disorder, schizoaffective disorder or psychotic disorder Not Otherwise Specified, and who had been treated in their lifetime with antipsychotics for 2 weeks or less were randomly assigned to double-masked aripiprazole (5–30mg/d) or risperidone (1–6mg/d) and followed for 12 weeks. Positive symptom response rates did not differ (62.8% vs 56.8%) nor did time to response. Aripiprazole-treated participants had better negative symptom outcomes but experienced more akathisia. Body mass index change did not differ between treatments but advantages were found for aripiprazole treatment for total and low-density lipoprotein cholesterol, fasting glucose, and prolactin levels. Post hoc analyses suggested advantages for aripiprazole on depressed mood. Overall, if the potential for akathisia is a concern, low-dose risperidone as used in this trial maybe a preferred choice over aripiprazole. Otherwise, aripiprazole would be the preferred choice over risperidone in most situations based upon metabolic outcome advantages and some symptom advantages within the context of similar positive symptom response between medications.Key words: clinical trial, treatment response, negative symptoms, akathisia, metabolic side effects     

DSM-5 Criteria and Its Implications for Diagnosing PTSD in Military Service Members and Veterans

This review addresses how changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 posttraumatic stress disorder (PTSD) criteria has the potential to affect the care and careers of those who have served in the military, where the diagnosis often determines fitness for duty and veterans’ benefits. PTSD criteria changes were intended to integrate new knowledge acquired since previous DSM editions. Many believe the changes will improve diagnosis and treatment, but some worry these could have negative clinical, occupational, and legal consequences. We analyze the changes in classification, trauma definition, symptoms, symptom clusters, and subtypes and possible impacts on the military (e.g., over- and under-diagnosis, “drone” video exposure, subthreshold PTSD, and secondary PTSD). We also discuss critiques and proposals for future changes. Our objectives are to improve the screening, diagnosis, and treatment of those service members who have survived trauma and to improve policies related to the military mental healthcare and disability systems.