Chronic pain disorder manifesting as dental pain: case report

Chronic pain disorder is a challenging presentation for the dental surgeon, and carries considerable impairment for the affected individual. Patients undergo extensive unnecessary investigations and treatments before the correct diagnosis is reached. It is frequently a diagnosis of exclusion. We report the case of a 46-year-old man who experienced persistent severe orofacial pain superimposed upon pain involving other anatomical regions for more than 20 years. He received treatment by eight specialties and at five national centres with increasingly poor outcome.The importance of early recognition of medically unexplained pain will be discussed. Clinical Relevance: Dentists should have a high index of suspicion of pain disorder in those with multiple complaints of chronic pain in order to avoid unnecessary investigation and treatment.     

Assessment of sleep in women with night eating syndrome

STUDY OBJECTIVES: Evaluation of sleep in subjects with night eating syndrome (NES). DESIGN: Polysomnographic and questionnaire comparisons between subjects with NES and controls. SETTING AND PARTICIPANTS: Fifteen women with NES (mean +/- SD = 41 +/- 8 years) and 14 women (comparable age and weight) without NES (39 +/- 10 years) were studied in the laboratory for 3 days. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Subjects with NES did not differ from controls in timing of sleep onset or offset. They had less stage 2 sleep than controls (minutes, p = .012; percentage, p = .016) and less stage 3 sleep (p = .023), which contributed to their having a lower total sleep time (p = .05) and reduced sleep efficiency (p = .03). Subjects with NES did not have more awakenings than controls, but 93.3% of them ate on awakening during all 3 nights, while 92.9% of controls did not eat on any night. Logistic discriminant analyses identified a multiple sleep parameter model associated with increased likelihood of NES that had sensitivity of 84.6% and specificity of 76.9%. Patients with NES were more depressed than controls (p < .001) and reported greater sleep disturbance that included lower sleep quality (p < or = .001), reduced sleep duration (p < or = .001), and increased number of awakenings (p < or = .001). CONCLUSIONS: Patients with NES appear to have sleep maintenance insomnia rather than sleep-related eating disorder or a parasomnia. The maintenance of normal timing for sleep-wake behavior in the presence of a phase delay in the timing of caloric intake suggests this disorder reflects a state of internal circadian desynchrony associated with significant sleep complaints. It remains unknown whether the sleep disturbance precedes the abnormally timed eating.     

Equine estrogen-induced mammary tumors in rats

Long-term hormone replacement therapy is associated with an increased risk of breast, ovarian and endometrial cancers in women. Equine estrogens are a principal component of hormone replacement therapy; however, their tumorigenic potential toward mammary tissue and reproductive organs has not been extensively explored. A pellet containing equilin was inserted under the skin of female ACI rats and the development of mammary tumors was monitored. Histological examination revealed premalignant lesions such as apocrine metaplasia in whole-mount preparations of mammary gland from the equilin-treated rats. ACI rats given 10 mg equilin developed palpable mammary tumors at 13 weeks of treatment, and 37.5% of the rats developed mammary tumors within 15 weeks. For 2.5 mg equilin, palpable tumors were observed in 8.3% of the rats after 8 weeks’ treatment; the frequency was lower than that (42.9%) observed with 2.5 mg E₂. No tumors were observed in the untreated rats. Evidently, equilin is a mammary carcinogen, and this potential may be associated with development of breast and reproductive cancers in women receiving hormone replacement therapy.     

The OPCML tumor suppressor functions as a cell surface repressor-adaptor, negatively regulating receptor tyrosine kinases in epithelial ovarian cancer

Epithelial ovarian cancer is the leading cause of death from gynecologic malignancy, and its molecular basis is poorly understood. We previously demonstrated that opioid binding protein cell adhesion molecule (OPCML) was frequently epigenetically inactivated in epithelial ovarian cancers, with tumor suppressor function in vitro and in vivo. Here, we further show the clinical relevance of OPCML and demonstrate that OPCML functions by a novel mechanism in epithelial ovarian cancer cell lines and normal ovarian surface epithelial cells by regulating a specific repertoire of receptor tyrosine kinases: EPHA2, FGFR1, FGFR3, HER2, and HER4. OPCML negatively regulates receptor tyrosine kinases by binding their extracellular domains, altering trafficking via nonclathrin-dependent endocytosis, and promoting their degradation via a polyubiquitination-associated proteasomal mechanism leading to signaling and growth inhibition. Exogenous recombinant OPCML domain 1-3 protein inhibited the cell growth of epithelial ovarian cancers cell in vitro and in vivo in 2 murine ovarian cancer intraperitoneal models that used an identical mechanism. These findings demonstrate a novel mechanism of OPCML-mediated tumor suppression and provide a proof-of-concept for recombinant OPCML protein therapy in epithelial ovarian cancers. SIGNIFICANCE: The OPCML tumor suppressor negatively regulates a specific spectrum of receptor tyrosine kinases in ovarian cancer cells by binding to their extracellular domain and altering trafficking to a nonclathrin, caveolin-1–associated endosomal pathway that results in receptor tyrosine kinase polyubiquitination and proteasomal degradation. Recombinant OPCML domain 1-3 recapitulates this mechanism and may allow for the implementation of an extracellular tumor-suppressor replacement strategy.     

Electromyographic activity of m. longissimus and the kinematics of the vertebral column during level and downslope treadmill walking in cats

Electromyographic (EMG) burst patterns of m. longissimus and the kinematics of the vertebral column were assessed in cats during treadmill walking for six downslope grades (5 degrees-30 degrees). The EMG bursts during downslope walking were weak between 5 degrees and 20 degrees. At steeper grades (>20 degrees), EMG bursts were large. Bursts at T10 facilitated inward movements, and those at L1 decreased forward movements, while those at L5 decreased backward movements during downslope walking at steeper grades.     

Relationships of categorization on tests and daily tasks in patients with schizophrenia, post-stroke patients and healthy controls

The purpose of this study was to explore the relationships between performance on formal categorization-sorting tests and daily tasks that require sorting skills among individuals with schizophrenia compared with post-stroke and healthy control groups. Furthermore, the relationships among the performances of patients with schizophrenia on the various tests were studied. The study included 70 participants: 37 patients with schizophrenia treated at a community day center, 18 post-stroke patients, and 15 healthy controls. Subjects were evaluated on four different categorization tests (Wisconsin Card Sorting Test (WCST), Short Category Test (SCT), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and Riska Object Classification (ROC); and five different functional daily tasks that require categorization abilities. Results showed significant differences between the performance of patients and control subjects on both tests and daily tasks. Spearman correlations within the schizophrenic group between test scores showed moderate significant correlations, and between tests and daily tasks showed low to moderate significant correlations. These findings suggest that weaker, yet significant relationships were found between performance on cognitive tests and daily tasks than between cognitive tests tapping the same or similar constructs. This type of difference would be expected; however, further research is needed to clarify the underlying components of categorization tests and their relations to daily task performance of individuals with schizophrenia.     

Inosiplex affects the spectra of proton magnetic resonance spectroscopy in subacute sclerosing panencephalitis

In vivo magnetic resonance techniques such as magnetic resonance imaging (MRI) and magnetic resonance spectroscopy have been some of the most useful tools for evaluation of neurologic diseases. In subacute sclerosing panencephalitis, magnetic resonance spectroscopy can be an additional tool for evaluation of disease progression or the efficacy of the treatment, such as interferon or inosiplex, compared with MRI. Inosiplex is one of the effective drugs for subacute sclerosing panencephalitis, but our in vivo and in vitro magnetic resonance spectroscopic study indicated that inosiplex affects the spectra, suggesting a possible failure of neurologic evaluation in a patient with subacute sclerosing panencephalitis treated with inosiplex.     

Rhythm in the speech of a person with right hemisphere damage: Applying the pairwise variability index

Although several aspects of prosody have been studied in speakers with right hemisphere damage (RHD), rhythm remains largely uninvestigated. This study compares the rhythm of an Australian English speaker with right hemisphere damage (due to a stroke, but with no concomitant dysarthria) to that of a neurologically unimpaired individual. The speakers' rhythm is compared using the pairwise variability index (PVI) which allows for an acoustic characterization of rhythm by comparing the duration of successive vocalic and intervocalic intervals. A sample of speech from a structured interview between a speech and language therapist and each participant was analysed. Previous research has shown that speakers with RHD may have difficulties with intonation production, and therefore it was hypothesized that there may also be rhythmic disturbance. Results show that the neurologically normal control uses a similar rhythm to that reported for British English (there are no previous studies available for Australian English), whilst the speaker with RHD produces speech with a less strongly stress-timed rhythm. This finding was statistically significant for the intervocalic intervals measured (t(8) = 4.7, p < .01), and suggests that some aspects of prosody may be right lateralized for this speaker. The findings are discussed in relation to previous findings of dysprosody in RHD populations, and in relation to syllable-timed speech of people with other neurological conditions.