Focal myositis – A neurogenic phenomenon?

We report four cases of focal myositis. The patients, three men and one woman, had painful muscle hypertrophy, affecting four different sites. MRI confirmed the muscle enlargement and oedema. Electromyography revealed evidence of acute and chronic denervation in all four cases. Muscle biopsy was available in three and confirmed features suggestive of focal myositis. Based on our patient material, we suggest that chronic nerve irritation, such as compression, can lead to muscle hypertrophy which, when prolonged, provokes fibre necrosis and secondary inflammation. Our finding in four patients having hypertrophy involving four different sites, leads us further to suggest that this may be the common mechanism behind focal myositis.     

Granulysin Expression in Lymphocytes that Populate the Peripheral Blood and the Myocardium after an Acute Coronary Event

We aimed to analyse granulysin (GNLY)‐mediated cytotoxicity in the peripheral blood of patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) treated with anti‐ischaemic drug therapy. Thirty‐nine NSTEMI patients with a median age of 70 years and 28 age‐matched healthy subjects were enrolled in this study. On day 7 after MI, the number of GNLY⁺ lymphocytes in the peripheral blood increased approximately six‐fold of that in the healthy subjects, measured by flow cytometry. On day 14, the number of GNLY⁺ cells significantly decreased in T, NKT, and both CD56^+dim and CD56^+bright NK subsets. GNLY⁺ CD3⁺ and GNLY⁺ CD56⁺ cells infiltrated central zone of myocardial infarction (MI). In persons who died in the first week after MI, GNLY⁺ cells were found within accumulation of apoptotic leucocytes and reached the apoptotic cardiomyocytes in border MI zones probably due to the influence of interleukin‐15 in peri‐necrotic cardiomyocytes, as it is was shown by immunohistology. By day 28, the percentage of GNLY⁺ lymphocytes in peripheral blood returned to the levels similar to that of the healthy subjects. Anti‐GNLY mAb decreased apoptosis of K562 targets using peripheral blood NK cells from days 7 and 28 after MI, while in assays using cells from days 1 and 21, both anti‐GNLY and anti‐perforin mAbs were required to significantly decrease apoptosis. Using NK cells from day 14, K562 apoptosis was nearly absent. In conclusion, it seems that GNLY⁺ lymphocytes, probably attracted by IL‐15, not only participate partially in myocardial cell apoptosis, but also hasten resolution of cardiac leucocyte infiltration in patients with NSTEMI.     

Depression with psychotic features in a child with SLE: successful therapy with psychotropic medications—case report

Systemic lupus erythematosus (SLE) is a multisystemic, autoimmune disease of unknown etiology, which affects multiple organ systems, including the central nervous system (CNS). Neuropsychiatric manifestations are seen in 13–75 % of all SLE patients, with equal frequency in children and adults. Despite a high prevalence of psychiatric manifestations, there is no consensus on the proper treatment of such cases. We report here a case of an 11-year-old girl diagnosed with a severe depressive episode with psychotic features, treated successfully with risperidone and sertraline as an adjunct to immunosuppressive therapy.     

Curing characteristics of flowable and sculptable bulk-fill composites

Objectives

The aim of this study was to determine and correlate the degree of conversion (DC) with Vickers hardness (VH) and translucency parameter (TP) with the depth of cure (DoC) of five bulk-fill composites.

Materials and methods

Six specimens per group, consisting of Tetric EvoCeram Bulk Fill (“TEC Bulk,” Ivoclar Vivadent), SonicFill (Kerr), SDR Smart Dentin Replacement (“SDR,” Dentsply), Xenius base (“Xenius,” StickTech; commercialized as EverX Posterior, GC), Filtek Bulk Fill flowable (“Filtek Bulk,” 3M ESPE), and Tetric EvoCeram (“TEC,” control), were prepared for DC and VH: two 2-mm-thick layers, each light-cured for 10 s; one 4-mm bulk-fill, light-cured for 10 or 20 s; and one 6-mm bulk-fill, cured for 20 s. DC was measured using a Fourier-transform infrared spectrometer, VH using a Vickers hardness tester. DoC and TP were measured using an acetone-shaking test and a spectrophotometer, respectively. Data were analyzed using ANOVA and Pearson’s correlation (α = 0.05).

Results

DC and VH ranged between 40–70 % and 30–80 VHN, respectively. TEC Bulk, Xenius, and SonicFill, bulk-filled as 4-mm-thick specimens, showed bottom-to-top hardness ratios above 80 % after 20 s curing. A positive linear correlation was found for bottom DC and VH. An average DC ratio of 0.9 corresponded to a bottom-to-top VH ratio of 0.8.

Conclusions

Sculptable bulk-fills require 20 s, whereas 10 s curing time was sufficient for flowable bulk-fills using a high-intensity LED unit.

Clinical relevance

Clinicians should be aware that longer curing times may be required for sculptable than flowable bulk-fill composites in order to achieve optimal curing characteristics.

     

MRI features of the psoas major muscle in patients with low back pain

Purpose

The purpose was to investigate the changes of the psoas major muscles (PM) cross-sectional area (CSA) and fat infiltration in the PM and to investigate the association between the morphology of the PM and expression of the degenerative changes of lumbar spine in patients with low back pain (LBP).

Methods

T2-weighted scans for measurements of the CSA and analysis of fat infiltration were performed on 42 patients and 49 controls using a 1.5 Tesla MR system. For a quantitative analysis of fat tissue infiltration a 4-grade visual scale was used.

Results

Patients had bigger CSA of the PM than controls at the levels of L3/L4 and L4/L5 intervertebral disc (P < 0.05). Patients with apparent degenerative changes of the lumbar spine had smaller CSA of the PM compared to the patients without apparent changes at the levels of L3/L4 and L4/L5 (P < 0.05). At the levels of L4/L5 and L5/S1 patients with present Modic changes in the lumbar vertebral bodies showed smaller CSA of the PM compared to the patients without Modic changes (P < 0.05). However, CSA of the PM in the patients with degenerative changes of lumbar spine and Modic changes was still bigger than the one of the controls. At all analyzed levels correlation between CSAs of the PM and fat infiltration of the lumbar paraspinal muscles was negative.

Conclusion

Results suggest increased activity of the PM in LBP patients but PM also remains active regardless of the presence of degenerative and Modic changes of the lumbar spine.     

Degree of conversion and microhardness of TPO-containing resin-based composites cured by polywave and monowave LED units

Objectives

To determine the degree of conversion (DC) and Knoop microhardness (KHN) of resin-based composites (RBCs) containing trimethylbenzoyl-diphenylphosphine oxide (TPO) cured by polywave or monowave LED light-curing units (LCUs).

Methods

Three groups (each n = 5) of Tetric EvoCeram (Ivoclar Vivadent), Vit-l-escence (Ultradent) and Herculite XRV Ultra (Kerr) were prepared in Teflon moulds (5 mm in diameter and 2 mm thick) and cured with polywave Bluephase^® G2 (Ivoclar Vivadent), polywave Valo (Ultradent) or monowave Bluephase^® (Ivoclar Vivadent; control) resulting in 9 groups. DC and KHN were determined using micro-Raman spectroscopy and Knoop microhardness, respectively. High-performance liquid chromatography and nuclear magnetic resonance spectroscopy were used to confirm the presence or absence of TPO in the three uncured materials. Data were statistically analysed using two-way and one-way ANOVA and DC and KHN were correlated using Pearson's correlation (α = 0.05).

Results

TPO was confirmed in Tetric EvoCeram and Vit-l-escence but not in Herculite XRV Ultra. All three LCUs produced comparable KHN for Tetric EvoCeram and Herculite XRV Ultra (p > 0.05). Both polywave LCUs resulted in significantly higher KHN for Vit-l-escence and higher DC in Tetric EvoCeram and Vit-l-escence than the monowave Bluephase^® (p < 0.05). Conversely, Bluephase^® showed higher DC than the two polywave LCUs in Herculite XRV Ultra (p < 0.05). Pearson's correlation coefficient was r = 0.818.

Conclusions

Polywave LED LCUs improved monomer to polymer conversion and KHN in the two TPO-containing RBCs, but not in Herculite XRV Ultra. DC and KHN were linearly correlated in all three RBCs. Vit-l-escence showed the highest DC and KHN of the three materials tested.

Clinical significance

The use of polywave LEDs significantly improves both the DC and KHN of materials which contain TPO. This should be taken into account when curing bleached shades of RBCs even if the manufacturers do not indicate the presence of TPO in their materials.     

In vivo animal models for studying brain metastasis: value and limitations

Brain metastasis is associated with a particular poor prognosis. Novel insight into the brain metastatic process is therefore warranted. Several preclinical models of brain tumor metastasis have been developed during the last 60 years, and they have in part revealed some of the mechanisms underlying the metastatic process. This review discusses mechanisms of brain metastasis with a key focus of the development of animal model systems. This includes the use of rodent, syngeneic brain metastasis models (spontaneous, chemically induced and genetically engineered models) and human xenotransplantation models (ectopic inoculation and orthotopic models). Current information indicates that none of these fully reflect tumor development seen in patients with metastatic disease. The various model systems used, however, have provided important insight into specific mechanisms of the metastatic process related to the brain. By combining the knowledge obtained from animal models, new important information on the molecular mechanisms behind metastasis will be obtained, leading to the future development of new therapeutic strategies.     

Functional Adaptation to Loading of a Single Bone Is Neuronally Regulated and Involves Multiple Bones

Regulation of load‐induced bone formation is considered a local phenomenon controlled by osteocytes, although it has also been hypothesized that functional adaptation may be neuronally regulated. The aim of this study was to examine bone formation in multiple bones, in response to loading of a single bone, and to determine whether adaptation may be neuronally regulated. Load‐induced responses in the left and right ulnas and humeri were determined after loading of the right ulna in male Sprague‐Dawley rats (69 ± 16 days of age). After a single period of loading at ?760‐, ?2000‐, or ?3750‐μ? initial peak strain, rats were given calcein to label new bone formation. Bone formation and bone neuropeptide concentrations were determined at 10 days. In one group, temporary neuronal blocking was achieved by perineural anesthesia of the brachial plexus with bupivicaine during loading. We found right ulna loading induces adaptive responses in other bones in both thoracic limbs compared with Sham controls and that neuronal blocking during loading abrogated bone formation in the loaded ulna and other thoracic limb bones. Skeletal adaptation was more evident in distal long bones compared with proximal long bones. We also found that the single period of loading modulated bone neuropeptide concentrations persistently for 10 days. We conclude that functional adaptation to loading of a single bone in young rapidly growing rats is neuronally regulated and involves multiple bones. Persistent changes in bone neuropeptide concentrations after a single loading period suggest that plasticity exists in the innervation of bone.