Soluble CD14 and toll-like receptor-2 are potential salivary biomarkers for oral lichen planus and burning mouth syndrome

Oral lichen planus (OLP) and burning mouth syndrome (BMS) are chronic conditions affecting the oral mucosa characterized by pain and burning sensation. Saliva plays a significant role in the maintenance of physical and functional integrity of normal oral mucosa. Identification of potential "salivary biomarkers" for early diagnosis and/or monitoring of human diseases is being explored. We investigated the soluble forms of innate immune associated proteins CD14 and toll-like receptor-2 in unstimulated whole saliva (UWS) as potential biomarkers for OLP and BMS. Our results suggest that the levels of sCD14 and sTLR-2 in UWS were upregulated in OLP and BMS respectively. In addition, oral epithelial cells in the saliva of patients with OLP and BMS exhibited elevated levels of CD14 mRNA and decreased levels of TLR-2 mRNA. Interestingly, presence of co-existent oral candidiasis nullified these changes.     

Temporomandibular Disorders in Burning Mouth Syndrome Patients: An Observational Study

BACKGROUND: Burning Mouth Syndrome (BMS) is a chronic disease characterized by absence of any lesions and burning of the oral mucosa associated to a sensation of dry mouth and/or taste alterations. The purpose of our study is to estimate signs and symptoms of Temporomandibular Disorders (TMD) in patients with BMS and to investigate for the existence of an association between BMS and TMD.MATERIALS AND METHODS: Forty-four BMS patients were enrolled; BMS subtype was established according to the classification of Lamey. After a gnathological evaluation, according to the protocol of the European Academy of Craniomandibular Disorders, patients were classified by RDC/TMD criteria. The data were compared and analyzed using a chi-square test to describe the existence of an association between BMS and TMD.RESULTS: 65.9% the BMS patients showed disorders classified as primary signs and symptoms of TMD according to RDC / TMD criteria, and 72.7% showed parafunctional habits. The chi-square test revealed a statistically significant association (p = 0.035) between BMS and TMD.CONCLUSION: The data suggest that there is a possible relationship not yet well understood between BMS and TMD, may be for neurophatic alterations assumed for BMS that could be also engaged in TMD pathogenesis.     

灼口综合征患者心理健康状况研究

灼口综合征 (BurningMouthSyndrome ,BMS)又名舌痛症 ,其病因不清 ,治疗极棘手。目前对BMS的病因研究涉及局部因素、全身疾病、心理因素等 ,其中心理因素占有重要地位[1,2 ] 。本研究调查了BMS患者的近期社会生活应激性事件、心因性躯体症状以及焦虑、抑郁状况 ,旨在探索心理因素与BMS的相互关系。1　对象与方法以 2 0 0 2年 3月至 11月中南大学湘雅医院、湘雅二医院口腔粘膜病专科门诊诊断的 87例BMS患者为研究对象。纳入标准 :以舌部或其它口腔粘膜部位的烧灼样疼痛为主要症状 ,可伴有口腔干燥 ,味觉障碍 ,感觉异常及其它口腔不适…     

A Psychotherapeutic Case Illustrating a Psychogenic Factor in Burning Mouth Syndrome (BMS)

Burning Mouth Syndrome (BMS) is described as a burning sensation of the oral mucosa, tongue, palate, lips and pharynx. The case material presented in this paper illustrates a strong psychogenic element in the aetiology of BMS. Conclusions are drawn on the basis that the patient's material suggests that the recovery of memories played a part in the resolution of her symptoms. The importance this has for psychotherapists is that it allows a reappraisal of the value of using psychoanalytic constructs as a means of understanding the mental representation, symbolisation and psychopathology of conditions of a psychogenic nature.     

灼口综合征患者心理健康状况及相关因素分析

目的:探讨灼口综合征患者心理健康状况及相关因素。方法:采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、艾森克人格问卷简式量表中国版(EPQ-RSC)以及医学应对方式问卷(MCMQ)对60例灼口综合征患者和对照组进行测评。结果:灼口综合征患者抑郁、焦虑情绪明显高于对照组,"回避"和"屈服"应对方式与抑郁情绪呈正相关;精神质、神经质和掩饰性人格与抑郁、焦虑情绪呈正相关。结论:灼口综合征患者并发较高程度的抑郁、焦虑症状,同时不同人格类型与应对方式对其焦虑、抑郁有较大影响。     

A new therapeutic candidate for oral aphthous ulcer: Allicin

Recurrent aphthous ulcer (RAU) is the most common ulcer of oral non-keratinized mucosa, but the treatment is always limited at present. Considering the multifactorial etiology of RAU, a novel therapeutic agent with multi-bioactivties should be presented. Garlic has been recognized as a favorable natural medicine against a large number of pathologic conditions. The major component of garlic is allicin, which could effectively decrease inflammatory factors secretion, reduce the migration of neutrophils, inhibit bacterium and virus, antagonize oxidation and regulate immunity. By these bioactivities of anti-inflammation, anti-microbial activity, anti-oxidation and immunomodulation, the allicin may be an effective therapeutic candidate to control the pain, promote ulcer healing and prevent the recurrence of RAU.     

灼口综合征患者的心理分析及心理综合疗法研究

目的 应用以森田疗法为核心的心理综合治疗方案治疗灼口综合征，评价其临床效果。方法 对纳入于本院首诊的灼口综合征患者46例施行以森田疗法为核心的心理综合治疗方案，在治疗前及治疗后第2、4、6、8周分别对患者进行精神卫生自评量表（SCL-90）和Hamilton抑郁量表分析。结果 根据SCL-90量表，46例灼口综合征患者可分为强迫症型（7例，占15．2％）、疑病型（7例，占15．2％）、恐惧症型（4例，占8．7％）及混合型（28例，占60．9％）。治疗后SCL-90和HAMD评分较治疗前显著下降，临床治愈率30．4％，显效率47．8％。结论 应用以森田疗法为核心的心理综合治疗方案治疗灼口综合征有较好疗效。     

Substrate mobilization: A new hypothesis for the aetiology of the idiopathic respiratory distress syndrome

This hypothesis for the aetiology of the idiopathic respiratory distress syndrome of the newborn (IRDS) proposes that, althouth the aetiology is multifactorial, the factor of prime importance is the mobilization of substrate for surfactant synthesis. All factors known to influence the incidence, treatment, and prognosis of the IRDS can be shown to be associated with the mobilization of substrate and thereafter its continued availability for the synthesis of adequate surfactant. Thus factors which promote an antenatal increase in the breakdown of energy stores will be associated with a reduced incidence of the IRDS. On the other hand, despite adequate mobilization, factors associated with a lack of substrate secondary to poor transport of substrate, a reduction in pulmonary circulation or an alteration in fetal or neonatal metabolism which involves an increased utilization of substrate to provide energy, will be associated with an increased incidence of the IRDS.     

The prognostic significance of facial lymphoedema in HIV-seropositive subjects with Kaposi sarcoma

Background

Kaposi Sarcoma (KS) is a multifocal angioproliferative neoplasm characterized by inflammation, oedema, neoangiogenesis and spindle cell proliferation. The pathogenesis of human immunodeficiency virus (HIV)-associated KS (HIV-KS) is multifactorial. HHV-8 is an essential factor but not in itself sufficient to cause HIV-KS, the development of which is influenced by HIV, by increased production of cytokines and by growth factors. Whether HIV-KS is a true malignancy or a reactive hyperplastic inflammatory condition is debatable.

Results and Conclusion

Oedema of the face, legs and hands is a prominent feature of HIV-KS and is probably caused by lymphoedema related to the HIV-KS lesions. The cases of two HIV-seropositive subjects with KS-associated facial lymphoedema are reported. Extensive oral HIV-KS in association with facial oedema in the absence of anti-retroviral treatment appears to be an indication of a poor prognosis.     

Liver biopsies from psoriatics related to methotrexate therapy. 2. Findings before and after methotexate therapy in 88 patients. A blind study.

Eightyeight patients with severe, recalcitrant psoriasis had liver biopsies performed before and after Methotrexate (MTX) therapy. MTX was given for an average of 26 months as a single, weekly, oral dose of 25 mg maximum. The mean cumulative dose was 1733 mg (range 175-4590 mg). A statistically significant increase in the number of pathological post-MTX liver biopsies was found (p less than 0.0001). Of the 88 patients 6 developed cirrhosis and another 5 developed fibrosis, in all 12.5 per cent, during MTX therapy (95 per cent confidence limits for cirrhosis: 3-14 per cent). There was no statistically significant correlation between the number of pathological post-MTX liver biopsy findings in the 88 patients and the following variables one by one: cumulative dose of MTX, duration of MTX therapy and admitted alcoholic intake during MTX therapy. Cirrhosis and fibrosis did not develop statistically more frequently from pathological than normal pre-MTX liver histology (p = 0.062). The liver damage appeared to be due to a multifactorial interaction of straining factors on the liver during MTX therapy. A multifactorial index comprising: cumulative dose of MTX, admitted alcoholic intake during MTX therapy, age, obesity and, if available, pre-MTX liver histology gave an estimate of the probability of developing cirrhosis or fibrosis during treatment of psoriasis with weekly, oral doses of MTX. For use of MTX therapy in psoriasis the following precautions are suggested: MTX therapy should be used only in disabling cases; a pre-MTX liver biopsy and repeat liver biopsies at regular intervals of 1/2-1 year should be performed, alcohol should be prohibited and frequent inquiries should be made about the patient's alcoholic intake; and strong reliance should not be placed on the SGOT as an indicator of abnormal liver histology.     

Surgery for severe rhinosinusitis

Sinusitis is one of the most common reasons patients visit their primary care physician. The etiology of sinusitis is multifactorial in most cases. However, the final common pathway of disruption is usually made with a thorough history. The physical examination is often unremarkable. Complaints of nasal obstruction, mucopuluent nasal drainage, and facial pain/pressure are most diagnostic chronic sinusitis. Isolated headache is an uncommon presenting symptom. Computed tomography scans are the gold standard for diagnostic imaging. They can be used both for diagnosis and surgical treatment. All chronic sinusitis patients, being considered for endoscopic sinus surgery, should have failed a trial of maximal medical therapy. This includes a 4–6 wk course of oral antibiotics, nasal steroids, topical nasal decongestants, and oral prednisone if possible. Patients who fail maximal medical therapy have persistent symptoms that significantly effect their daily activities, have chronic abnormalities on computet tomography scan, and are candidates for endoscopic sinus surgery. Appropriate patient selection and preoperative counseling are key factors in patient satisfaction. Most patients with symptoms that significantly impact their daily activities will receive marked improvement in symptoms after sinus surgery. Endoscopic sinus surgery has undergone radical changes in the last 15 yr. Minimally invasive techniques, combined with advances in instrumentation and computers have reduced postoperative discomfort and improved patient satisfaction.     

A Comprehensive Review of the Treatment of Atopic Eczema

Atopic eczema (AE) is a chronic, inflammatory skin disorder which usually develops in early childhood. In spite of intensive investigations, the causes of AE remain unclear, but are likely to be multifactorial in nature. Environmental factors or genetic-environmental interactions seem to play a key role in disease progression. Among various measures of AE managment, cutaneous hydration, which improves barrier function and relieve itchiness, may be helpful to reduce the need for topical steroid use and therefore should be used as a basic treatment. Avoiding aggravating factors is also a basic treatment of AE. Standard medical treatment with a pharmacologic approach may be necessary if basic treatment fails to control symptoms satisfactorily. Recently, more attention is given to a proactive therapeutic by regular intermittent application of low potency steroids or topical calcineurin inhibitors to prevent new flares. Furthermore, various targeted biologics are being introduced for AE control and are proposed as promising therapies. This paper provides a summary of the recent literature on the manangement of AE and a treatment guideline.     

Glossodynia and coeliac disease

Coeliac disease is an immune-mediated chronic inflammatory disorder of the small bowel caused by irritant gluten and, possibly, other environmental cofactors, in genetically prone people. Coeliac disease is characterized by no (or elusive or varied) symptoms. Oral clinical settings include aphthous stomatitis and dental enamel defects. Association with other signs in the oral mucosa (such as, for example, soreness, a burning sensation, erythema or atrophy) is much less common and, often, not considered by clinicians. We report on a 72-year-old woman with a four months history of oral burning sensation as a single clinical manifestation of coeliac disease. Clinical presentation and symptomatology are discussed in relation to the differential diagnosis of oral glossodynia. This case history highlights the importance of considering coeliac disease in managing cases of idiopathic glossodynia.     

Glossodynia and coeliac disease

Coeliac disease is an immune-mediated chronic inflammatory disorder of the small bowel caused by irritant gluten and, possibly, other environmental cofactors, in genetically prone people. Coeliac disease is characterized by no (or elusive or varied) symptoms. Oral clinical settings include aphthous stomatitis and dental enamel defects. Association with other signs in the oral mucosa (such as, for example, soreness, a burning sensation, erythema or atrophy) is much less common and, often, not considered by clinicians. We report on a 72-year-old woman with a four months history of oral burning sensation as a single clinical manifestation of coeliac disease. Clinical presentation and symptomatology are discussed in relation to the differential diagnosis of oral glossodynia. This case history highlights the importance of considering coeliac disease in managing cases of idiopathic glossodynia.     

Maize BMS cultured cell lines survive with massive plastid gene loss

As part of developing an ex planta model system for the study of maize plastid and mitochondrial gene expression, a series of established Black Mexican Sweet (BMS) suspension cell lines was characterized. Although the initial assumption was that their organelle biochemistry would be similar enough to normal in planta cells to facilitate future work, each of the three lines was found to have plastid DNA (ptDNA) differing from control maize plants, in one case lacking as much as 70% of the genome. The other two BMS lines possessed either near-wild-type ptDNA or displayed an intermediate state of gene loss, suggesting that these clonal lines are rapidly evolving. Gene expression profiles of BMS cells varied dramatically from those in maize leaf chloroplasts, but resembled those of albino plants lacking plastid ribosomes. In spite of lacking most plastid gene expression and apparently mature rRNAs, BMS cells appear to import proteins from the cytoplasm in a normal manner. The regions retained in BMS ptDNAs point to a set of tRNA genes universally preserved among even highly reduced plastid genomes, whereas the other preserved regions may illuminate which plastid genes are truly indispensable for plant cell survival.Communicated by F.-A. Wollman     

Cancer pain management: basic information for the young pain physicians

Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.     

Pathological features of in-stent restenosis after sirolimus-eluting stent versus bare metal stent placement

A 70-year-old man developed diffuse restenosis in the right coronary artery, in which a bare metal stent (BMS) and two sirolimus-eluting stents (SES) were deployed sequentially. He underwent directional coronary atherectomy (DCA) for in-stent restenosis (ISR) lesions 13 months after both BMS and SES stenting. Further 4 months later, that is, 17 months after stent implantation, however, ISR recurred just at the SES site alone. Then we performed second DCA for the ISR lesion at SES site. The tissue materials obtained from debulking were compared histologically. In the first DCA specimen, accumulation of inflammatory cells such as T lymphocytes and macrophages was observed densely in ISR lesions at SES site but not in those at BMS site, and endothelial coverage was absent in ISR lesions at SES site but present in those at BMS site. In the second DCA specimen, ISR lesions at SES site showed less inflammatory cells, compared with first DCA specimen. ISR lesions after drug-eluting stenting showed persistent signs of delayed or incomplete wound healing and relapsed inflammation, compared with BMS. Thus, the mechanism of restenosis after drug-eluting stenting may be different from that after BMS placement.     

Risk factors in osteoporosis

Osteoporosis is caused by a reduction in bone mass, but the cause of osteoporotic fractures is multifactorial because fractures arise following various degrees of trauma. There are therefore several different categories of risk factors for osteoporotic fracture. They may be related to the determinants of bone mineral density, capture the risk of falls, be related to skeletal fragility independently of bone mineral density or a combination of these. The identification of strong risk factors permits the identification of patients in whom further assessment and treatment can be offered in case finding strategies.     

Both long and brief maternal separation produces persistent changes in tissue levels of brain monoamines in middle-aged female rats

Adverse experiences early in life are associated with an increased incidence of later psychopathology including depression. Based on evidence that dysfunction of central monoaminergic systems is involved in the pathophysiology of depression, we hypothesize that early adversity could negatively affect these systems. To test this we have investigated the effects of maternal separation, which has been suggested to model early-life stress and the development of a depression-like syndrome in the rat, on brain monoaminergic systems. Since depression is more common in women and the risk of developing this disorder appears to increase with age, we have studied such effects in middle-aged female rats. Rat pups were separated for 180 min (long maternal separation; LMS) or 15 min (brief maternal separation; BMS, often referred to as neonatal handling) twice daily for 2 weeks postpartum. An animal facility-reared (AFR) group was also included. At 15 months of age tissue levels of monoamines and their metabolites in several different brain regions were analyzed. In the LMS females tissue levels of both 5-HT and 5-hydroxyindole acetic acid (5-HIAA) were significantly increased in the dorsal raphe nucleus, and 5-HIAA and homovanillic acid levels were also elevated in the nucleus accumbens as compared with AFR and BMS rats. In the cingulate cortex both LMS and BMS decreased noradrenaline (NA) levels, although this effect was more pronounced in the LMS rats. On the other hand, BMS decreased 5-HT, 5-HIAA, dopamine (DA) as well as NA levels in the amygdala and produced an increase in DA levels in response to acute stress in the hypothalamus, an effect not seen in AFR rats. Our results demonstrate that LMS produced persistent alterations in both serotonergic, noradrenergic and dopaminergic systems in brain regions that have been suggested to be implicated in the pathophysiology of depression. In addition, BMS affected brain monoaminergic levels mainly in the amygdala.     

The menopause and oral health

Objectives

To review the literature about oral symptoms and signs at the menopause with an emphasis on hormone replacement therapy (HRT). To give practical guidelines for women and their physicians in menopause-related oral health problems.

Methods

The PubMed and Cochrane databases was searched until mid January 2009 with key words such as “menopause”, “menopausal complaints”, “postmenopausal complaints” and “oral diseases”, “oral discomfort”, “dental health”, “dental diseases”, “saliva”, “burning mouth syndrome”, “dry mouth”, “xerostomia”. Because of a scarcity of controlled studies no systematic review could be conducted.

Results

Oral discomfort is found in many menopausal women in addition to more general climacteric complaints. The principal peri- and postmenopausal symptoms are dry mouth and burning mouth (glossodynia) which, in turn, may increase the occurrence of oral mucosal and dental diseases, such as candidiasis. The mechanisms of hormone-related oral symptoms and signs are not known although oestrogen receptors, for example, have been detected in the oral mucosa and salivary glands. In principle, the histology of oral and vaginal mucosa is very similar and thus their symptoms might share a common cause. Yet, hormone replacement therapy use does not necessarily prevent or help women with oral symptoms.

Conclusion

Properly controlled long-term randomized studies are needed to assess the effect of HRT on oral discomfort. Future gene profiling could identify women who may or may not benefit from HRT with regard to oral symptoms.