Book Reviews

Prevalence of AA amyloid in rheumatoid arthritis (RA) is still unclear. The objective of this retrospective study was whether dedicated re-examination of autopsy tissues from RA patients increases the detection rate of amyloid compared to routine examination. Amyloid was re-examined in tissue samples and detection rate compared with original reports of 369 consecutively autopsied RA patients and 370 non-RA patients matched for sex, age, and year of autopsy between 1952 and 1991. Re-examination of 90% of the 739 cases showed doubling of the prevalence of amyloid compared with the original reports: from 18 to 30% in RA and from 2 to 4% in non-RA patients. In RA patients, cardiac amyloid was as frequent as renal amyloid. In RA patients with amyloid at re-examination, amyloidosis had been diagnosed before autopsy in 37%, and these patients had more inflammation and longer disease duration than RA patients without amyloid. Only 56% of RA patients with renal amyloid were known to have proteinuria. In conclusion, this autopsy study shows that amyloid in RA is a common finding which remains frequently undetected. In patients with active and long-lasting RA, a systematic search for amyloid may enable early diagnosis of amyloidosis, which will require effective suppression of inflammation.     

Timing of developmental stages in permanent mandibular teeth of Finns from birth to age 25

OBJECTIVE: The aim was to provide radiographic data on postnatal development of the 8 mandibular teeth to serve as reference norms in clinical dentistry, forensic dentistry, anthropology, and research. MATERIAL AND METHODS: Developmental stages of teeth were assessed from a total of 2795 radiographs, mostly panoramic, of 1970 Finns (966 M and 1004 F) from birth to age 25. The grading was based on Demirjian's 8 mineralization stages and the crypt stage. RESULTS: Timing of development in individual mandibular teeth is presented in two ways: as age at attainment of each developmental stage and as age of subjects in a developmental stage. Initiation of mineralization was visible in 1st molars at 0.20 years, in central incisors at 0.22 years, lateral incisors at 0.37 years, and canines at 0.56 years of age. Timing was usually earlier in girls than in boys. Differences were greatest in canines, where females were advanced by 1.74 years at the closure of the apex. Root development in 3rd molars showed an opposite trend, where apical closure was 1.19 years earlier in men. In 3rd molars, age at apical closure in females was 21.50 years, among the highest reported. In general, the early developmental stages had the shortest duration and the last stages the longest. CONCLUSION: Timing of postnatal development of individual mandibular teeth in Finns resembled developmental schedules reported for other Caucasian population groups. Any differences were mostly small and inconsequential.     

High cut-off hemodialysis and bortezomib-based therapy to rescue kidneys in myeloma-dependent cast nephropathy

Myeloma-dependent cast nephropathy (MCN) is a medical emergency where prompt medical intervention is essential to rescue the kidneys from irreversible damage and the patient from lifelong dialysis. Evidence of the benefit of plasma exchange in removing serum free light chains (sFLC) has been controversial [1,2]. According to our recent experience, high cut-off hemodialysis (HCOD) with specially designed dialyzers reduces the level of sFLC concentration within hours and improves renal function in MCN in the long term when combined with effective bortezomib-based chemotherapy.     

Dental arch width, overbite, and overjet in a Finnish population with normal occlusion between the ages of 7 and 32 years

The aims of the present study were to provide data on growth changes in the dental arches from age 7 to 32 in Finns with untreated normal Angle Class I occlusions. The material consisted of 33 series of dental casts of 18 women and 15 men. The subjects had been examined and study models taken at the ages of 7, 10, 12, 15, and 32. Dental arch width, overbite, and overjet were measured. Our longitudinal findings show that both the dental arches of young adults are slightly narrowed from adolescence to 32 years of age. All increases in width dimensions took place before 15 years of age. The means of the changes were mostly small, in the order of 0.5 to a few millimetres. Variability in age changes was considerable. In both genders, each variable increased in some subjects and decreased in others during every age interval. Differences between growth changes in the mesial, distal, and gingival intermolar widths indicate that both the maxillary and the mandibular first molars rotate mesiolingually and that the maxillary first molars also become more upright during late occlusal development. We expect the present findings of the changes occurring in the arch dimensions of subjects with untreated normal occlusions to help clinicians in following up occlusal development, choosing an optimal treatment time, and making orthodontic treatment and retention plans. However, because of the wide variability, accurate prediction of future development cannot be made on the individual level.     

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Purpose

We assessed the effects of targeting low-normal or high-normal arterial carbon dioxide tension (PaCO₂) and normoxia or moderate hyperoxia after out-of-hospital cardiac arrest (OHCA) on markers of cerebral and cardiac injury.

Methods

Using a 2³ factorial design, we randomly assigned 123 patients resuscitated from OHCA to low-normal (4.5–4.7 kPa) or high-normal (5.8–6.0 kPa) PaCO₂ and to normoxia (arterial oxygen tension [PaO₂] 10–15 kPa) or moderate hyperoxia (PaO₂ 20–25 kPa) and to low-normal or high-normal mean arterial pressure during the first 36 h in the intensive care unit. Here we report the results of the low-normal vs. high-normal PaCO₂ and normoxia vs. moderate hyperoxia comparisons. The primary endpoint was the serum concentration of neuron-specific enolase (NSE) 48 h after cardiac arrest. Secondary endpoints included S100B protein and cardiac troponin concentrations, continuous electroencephalography (EEG) and near-infrared spectroscopy (NIRS) results and neurologic outcome at 6 months.

Results

In total 120 patients were included in the analyses. There was a clear separation in PaCO₂ (p?<?0.001) and PaO₂ (p?<?0.001) between the groups. The median (interquartile range) NSE concentration at 48 h was 18.8 µg/l (13.9–28.3 µg/l) in the low-normal PaCO₂ group and 22.5 µg/l (14.2–34.9 µg/l) in the high-normal PaCO₂ group, p?=?0.400; and 22.3 µg/l (14.8–27.8 µg/l) in the normoxia group and 20.6 µg/l (14.2–34.9 µg/l) in the moderate hyperoxia group, p?=?0.594). High-normal PaCO₂ and moderate hyperoxia increased NIRS values. There were no differences in other secondary outcomes.

Conclusions

Both high-normal PaCO₂ and moderate hyperoxia increased NIRS values, but the NSE concentration was unaffected.

Registration

ClinicalTrials.gov, NCT02698917. Registered on January 26, 2016.

     

Clinical, radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases

The aim of this study was to investigate the condition of the temporomandibular joint (TMJ) in patients with different rheumatic diseases, and report correlations between the clinical, radiographic and magnetic resonance imaging (MRI) findings. The 67 patients were divided into four groups: 16 with rheumatoid arthritis (RA), 15 with mixed connective tissue disease (MCTD), 18 with ankylosing spondylitis (AS) and 18 with spondyloarthropathy (SPA). They were clinically examined, and panoramic tomography, lateral panoramic radiography and MRI of the TMJ were performed. MRI showed reduced articular cartilage in 25% (4/16) of RA, 0% (0/15) of MCTD, 17% (3/18) of AS and 17% (3/18) of SPA patients. Condylar changes included erosion, osteophytes and abnormal shape. Disc alterations included perforation, abnormal anterior position and decreased movement. These abnormalities were most frequent in RA patients, and least frequent in MCTD and SPA patients. Crepitation and reduced maximum opening of the mouth correlated with abnormalities of the disc and articular cartilage as shown by MRI. Severe condylar erosion in panoramic tomograms significantly correlated with MRI findings of condylar erosion (P<0.01), diminished thickness of condylar cartilage, abnormal condylar shape, and abnormal shape of the temporal surface of the TMJ (P< or =0.001). The presence of crepitation, limited mandibular movement and/or pain on movement of the jaw often indicated structural damage to the TMJ. Panoramic radiographs provide an alternative method to MRI but, to obtain a more detailed anatomic picture, MRI is recommended for patients with acute unexplained pain or as part of preoperative work up. A panoramic recording is not indicated when MRI is planned.     

T-DNA transfer and integration in the ectomycorrhizal fungus Suillus bovinus using hygromycin B as a selectable marker

The T-DNA of Agrobacterium tumefaciens can be transferred to plants, yeasts, fungi and human cells. Using this system, dikaryotic mycelium of the ectomycorrhizal fungus Suillus bovinus was transformed with recombinant hygromycin B phosphotransferase (hph)and enhanced green fluorescent protein (EGFP) genes fused with a heterologous fungal promoter and CaMV35S terminator. Transformation resulted in hygromycin B-resistant clones, which were mitotically stable. Putative transformants were analysed for the presence of hph and EGFP genes by PCR and Southern analysis. The latter analysis proved both multiple- and single-copy integrations of the genes in the S. bovinus genome. A. tumeficiens transformation should make possible the development of tagged mutagenesis and targeted gene disruption technology for S. bovinus.