Interleukin-1 alpha, interleukin-8 and interferon-alpha levels in gingival crevicular fluid

Cytokines play an important role in the pathology associated with chronic inflammatory diseases. We measured the total amounts [picograms (pg)] and concentrations (pg/μl) of interleukin-1 alpha (IL-lα), interleukin-8 (IL-8) and interferonalpha (IFN-α) in 20 s gingival crevicular fluid (GCF) samples obtained from 2 diseased and 2 healthy sites in 20 subjects with periodontitis, and from 2 healthy sites in 20 subjects without disease. Both the mean amount and concentration of IL-lα were significantly higher (p < 0.001) in diseased sites compared to healthy sites in subjects with disease. The results for IL-8 and IFN-α differed depending on the method of reporting. Whereas the amount of IL-8 was significantly higher (p < 0.01) in diseased sites, the mean concentration of IL-8 was lower compared to healthy sites. The mean amount of IFN-α was similar in health and disease; however, the concentration of IFN-alpha was significantly lower in diseased sites (p < 0.001) corresponding to the significant increase in crevicular fluid volume (p < 0.001). There were no significant differences in the amount or concentrations of the 3 cytokines between healthy sites from subjects with disease and healthy sites from healthy controls. The total amounts of both IFN-α and IL-8 were correlated between healthy and diseased sites in subjects. These data suggest that, while the disease status of a site is the major determinant of the levels of these cytokines locally, subjects with high levels of IL-8 and IFN-α in healthy sites also tend to have high levels of these cytokines in diseased sites. Finally, both the concentrations and total amounts of IL-8 and IFN-α were significantly correlated in diseased sites, suggesting that levels of these two cytokines rise or fall in tandem. The combination of decreased IL-8 and decreased IFN-α concentrations at diseased sites may reflect the reduced anti-bacterial host defense activity at that site.     

Osseous resective surgery: long-term case report

This case report evaluated the long-term effects of osseous resective therapy in the treatment of a patient with moderately advanced periodontal disease. In 1984, the patient underwent initial therapy followed by a periodontal surgical phase consisting of osseous recontouring with an apically positioned flap. After 20 years, in 2003, the patient presented with a traumatic complication. An exploratory surgery revealed a fracture on the roof of the pulp chamber on the maxillary left first molar. The buccal roots were resected, preserving the palatal root, and a reevaluation of the long-term outcome of osseous resective surgery was performed. It is suggested that the positive treatment result is the consequence of the reestablishment of tissue morphology favorable for oral hygiene and plaque control by the patient.     

Dry mouth as an initial sign of food-borne botulism: a case report and review of the literature

Botulism is a rare neuroparalytic disease caused by a potent neurotoxin produced by Clostridium botulinum. There are different clinical types of botulism. Early diagnosis of the condition is essential for effective treatment. We report a case of food-borne botulism in identical twins characterized by severe initial oral involvement and a review of the literature about the condition.     

Investigation on the shaping ability of nickel-titanium files when used with a reciprocating motion

Introduction

The introduction of nickel-titanium (NiTi) files into clinical practice has improved the quality of canal shaping, but increasing the curvature of the root canal (or the diameter of the master instrument that prepares the full working length) could result in more transportation, straightening, and aberration of the canal. Nickel-titanium instruments are significantly safer and have an extended cyclic fatigue life when used with a reciprocating movement. The purpose of this study was to compare the shaping ability of FlexMaster NiTi instruments when used in either continuous or reciprocating movements.

Methods

Thirty-two Endo Training Blocks ISO 15, 2% taper, 10-mm radius of curvature, and 70° angle of curvature were prepared, according to the group, with FlexMaster NiTi instruments either in continuous rotation or in reciprocating (60° clockwise, 40° counterclockwise) movement. Preoperative and postoperative images of the simulated canals were taken under standardized conditions. The preoperative and postoperative images were combined exactly. The amount of resin removed was determined both for the inner (convex) and the outer (concave) sides of the curvature at 10 different points.

Results

In the most apical third of the canal, the Continuous group produced the largest enlargement of the canal as compared with the Reciprocating group (P < .05). In the apical third, the Continuous group displayed significantly greater enlargement of the canal at the external side.

Conclusions

The shaping of simulated canals is more centered by using a reciprocating motion when compared with continuous rotation, but the reciprocating motion could be more time-consuming.     

Misperceptions of Facial Emotions Among Youth Aged 9–14 Years Who Present Multiple Antecedents of Schizophrenia

Similar to adults with schizophrenia, youth at high risk for developing schizophrenia present difficulties in recognizing emotions in faces. These difficulties might index vulnerability for schizophrenia and play a role in the development of the illness. Facial emotion recognition (FER) impairments have been implicated in declining social functioning during the prodromal phase of illness and are thus a potential target for early intervention efforts. This study examined 9- to 14-year-old children: 34 children who presented a triad of well-replicated antecedents of schizophrenia (ASz), including motor and/or speech delays, clinically relevant internalizing and/or externalizing problems, and psychotic-like experiences (PLEs), and 34 typically developing (TD) children who presented none of these antecedents. An established FER task (ER40) was used to assess correct recognition of happy, sad, angry, fearful, and neutral expressions, and facial emotion misperception responses were made for each emotion type. Relative to TD children, ASz children presented an overall impairment in FER. Further, ASz children misattributed neutral expressions to face displaying other emotions and also more often mislabeled a neutral expression as sad compared with healthy peers. The inability to accurately discriminate subtle differences in facial emotion and the misinterpretation of neutral expressions as sad may contribute to the initiation and/or persistence of PLEs. Interventions that are effective in teaching adults to recognize emotions in faces could potentially benefit children presenting with antecedents of schizophrenia.Key words: emotion recognition, high risk, child and adolescent psychopathology, social functioning, psychotic-like experiencesPeople with schizophrenia display a marked impairment in recognizing emotions in the faces of others, particularly anger, sadness, and fear, and less difficulty recognizing happy expressions.^1,2 Facial emotion recognition (FER) difficulties are associated with poor social functioning³ and have implications for the development, course, and outcome of the disorder.⁴ Yet, interventions to improve FER performance (eg, Training of Affect Recognition)⁵ can reduce these deficits and elicit generalized improvement in other social cognitive domains.⁶FER impairments are apparent not only among individuals with chronic schizophrenia (for review see Kohler et al 2010)² but also among individuals experiencing a first episode of psychosis^7,8 and among unaffected adolescent (though only for neutral facial expressions)⁹ and adult first-degree relatives of individuals with schizophrenia.¹⁰ Thus, abnormalities in FER are present at illness onset and may also index vulnerabil ity for schizophrenia. Prospective studies following individuals at elevated risk for developing schizophrenia are needed to determine the extent to which impairments of FER precede illness and represent potential targets for early intervention. Among symptomatic, help-seeking individuals meeting ultra-high risk (UHR) criteria for psychosis,^7,8,11–13 evidence for FER impairments is mixed. Two studies reported FER impairments relative to healthy participants,^7,11 while another study indicated specific difficulties in correctly identifying neutral expressions.¹³ A study of a large British birth cohort comprising 5267 children reported no association between FER at 8 years and subclinical psychotic symptoms at 12 years.¹⁴ By contrast, a recent cross-sectional study of 748 children aged 10–13 years indicated that those reporting psychotic-like experiences (PLEs) on questionnaires were poorer at recognizing facial emotional expressions, primarily sadness.¹⁵ Unfortunately, as with many previous FER studies, no information was provided about the nature of the facial emotion misperceptions committed when processing facial expressions. Though PLEs in childhood are significantly associated with later psychotic illness,^16,17 they are also associated with an increased risk of anxiety disorders¹⁶ and other psychiatric disorders including affective disorders, drug use disorders, and personality disorders,¹⁸ albeit to a lesser extent. Thus, PLEs constitute a relatively nonspecific marker of risk for subsequent psychiatric disorders. Further, cross-sectional data from the general population indicate significant comorbidity of PLEs with emotional and behavioral problems,^19,20 implying that the observed relationship between PLEs and FER reported by Roddy et al¹⁵ might reflect the presence of unreported internalizing and/or externalizing psychopathology.To better characterize the nature of FER associated with schizophrenia, several studies have examined facial emotion misperceptions. Relative to healthy adults, individuals with schizophrenia more often mislabel negative emotions to faces displaying no or neutral expressions.^21,22 Adolescent relatives of individuals with schizophrenia, compared with adolescents from healthy families, also more often incorrectly label neutral expressions as displaying negative emotions, predominantly mislabeling them as sad.⁹ Among individuals with schizophrenia, and individuals at high risk for psychosis,²³ functional imaging has revealed hyperactivation of the amygdala during the processing of neutral expressions, which could reflect emotional salience being assigned to neutral stimuli.²⁴ It has been suggested that the tendency to misinterpret neutral facial expressions as displaying emotion may contribute to the development of positive symptoms in schizophrenia.²³ Previous research indicates that facial emotion misperceptions might constitute the cognitive mechanism contributing to the social impairment that characterizes UHR samples¹³ and is a critical component to understanding FER difficulties in samples at risk for schizophrenia.Until recently, there has been no practical method for identifying children who are at elevated risk for schizophrenia. Despite the high heritability of schizophrenia, only approximately one-third of individuals with schizophrenia have a first- or second-degree relative with the illness. Consequently, a positive family history identifies only a subset of children who will develop the illness.²⁵ Prospective investigations of birth cohorts have demonstrated consistently that, by middle childhood, individuals who later developed schizophrenia presented delays in motor and language development; disturbances in social, emotional, and behavioral functioning; and PLEs.¹⁷ Based on this evidence, we developed questionnaires, to be completed by children aged 9–12 years and their primary caregiver, to identify children who present a triad of these replicated antecedents of schizophrenia (ASz).^26,27 We defined ASz to include (1) early speech and/or motor developmental delays/abnormalities; (2) social, emotional, and/or behavioral problems in the clinical range; and (3) PLEs. It is thought that the identification of children who present multiple antecedents of schizophrenia that have been replicated in prospective longitudinal studies will offer greater sensitivity and specificity for later development of schizophrenia than any one antecedent.We are currently following the development of ASz children to determine the specificity and sensitivity of the triad of antecedents for later schizophrenia development. We anticipate that some ASz children will develop schizophrenia and spectrum disorders, some will develop other disorders, and others will remain healthy. In the interim, our investigations have shown that ASz children, compared with typically developing (TD) children who present no antecedents and no family history of schizophrenia or a spectrum disorder, are characterized by features observed among adults with schizophrenia including (1) deficits in performance on standardized intelligence and neuropsychological tests of executive function and memory,²⁸ (2) dyskinetic movement abnormalities,²⁹ (3) reduction in the amplitude of the error-related negativity event-related potential component generated in the anterior cingulate that indexes internal monitoring of behavior,³⁰ and (4) structural brain abnormalities in the superior/middle temporal gyri.³¹ Further, among children aged 9–12 years, two-thirds (69%) of those presenting with the triad of antecedents report distress and/or functional impairment associated with their PLEs.²⁷This study sought to determine whether ASz children present FER difficulties similar to those reported among individuals with schizophrenia and at-risk youth, after accounting for intelligence quotient (IQ) differences between ASz and TD groups,²⁸ which may contribute to FER performance. The study examined overall performance on FER tasks, as well as the specific nature of facial emotion misperceptions. We hypothesized that ASz children would be less accurate than TD children in identifying emotions in facial expressions and that they would more often mislabel neutral faces with other emotion expressions. In particular, we anticipated that ASz children would misidentify neutral expressions as sad, as was reported in a study of youth with family histories of schizophrenia using the same FER task.⁹     

Repetitive transcranial magnetic stimulation transiently reduces punding in Parkinson’s disease: a preliminary study

Amongst the impulse-control disorders (ICDs) associated with dopamine-replacement therapy in patients with Parkinson’s disease (PD) is a repetitive, complex, stereotyped behaviour called punding. Disruption of the reciprocal loops between the striatum and structures in the prefrontal cortex (PFC) following dopamine depletion may predispose patients with PD to these behavioural disorders. The purpose of the present study was to assess the effects of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral PFC (DLPFC) on punding in PD. We used low-frequency (LF) rTMS in four PD patients presenting with punding. Punding was transiently reversed by LF-rTMS over the DLPFC without enhancing motor impairment. The effect was more sustained after right DLPFC rTMS. Therefore, LF-rTMS produced a transient beneficial effect in PD patients with punding, similar to that reported in PD patients with levodopa-induced dyskinesias. rTMS might have therapeutic potential for the treatment of punding and perhaps other ICDs in PD.     

Perioperative Breast MRI Is Not Associated with Lower Locoregional Recurrence Rates in DCIS Patients Treated With or Without Radiation

Introduction

For women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS), the benefit of magnetic resonance imaging (MRI) remains unknown. Here we examine the relationship of MRI and locoregional recurrence (LRR) and contralateral breast cancer (CBC) for DCIS treated with BCS, with and without radiotherapy (RT).

Methods

A total of 2,321 women underwent BCS for DCIS from 1997 to 2010. All underwent mammography, and 596 (26 %) also underwent perioperative MRI; 904 women (39 %) did not receive RT, and 1,391 (61 %) did. Median follow-up was 59 months, and 548 women were followed for ≥8 years. The relationship between MRI and LRR was examined using multivariable analysis.

Results

There were 184 LRR events; 5- and 8-year LRR rates were 8.5 and 14.6 % (MRI), respectively, and 7.2 and 10.2 % (no-MRI), respectively (p = 0.52). LRR was significantly associated with age, menopausal status, margin status, RT, and endocrine therapy. After controlling for these variables and family history, presentation, number of excisions, and time period of surgery, there remained no trend toward association of MRI and lower LRR [hazard ratio (HR) 1.18, 95 % confidence interval (CI) 0.79–1.78, p = 0.42]. Restriction of analysis to the no-RT subgroup showed no association of MRI with lower LRR rates (HR 1.36, 95 % CI 0.78–2.39, p = 0.28). No difference in 5- or 8-year rates of CBC was seen between the MRI (3.5 and 3.5 %) and no-MRI (3.5 and 5.1 %) groups (p = 0.86).

Conclusions

We observed no association between perioperative MRI and lower LRR or CBC rates in patients with DCIS, with or without RT. In the absence of evidence that MRI improves outcomes, the routine perioperative use of MRI for DCIS should be questioned.     

Isolated Tumor Cells in Sentinel Lymph Nodes of Invasive Breast Cancer: Cell Displacement or Metastasis?

The goal of this study was to determine whether the presence of isolated tumoral cells (ITCs) in sentinel lymph nodes (SLNs) after core needle biopsy (CNB) is related to the time interval between CNB and surgery and to histopathologic features of invasive breast cancer. Data from 633 consecutive patients with no micrometastasis or metastasis on both frozen sections and definitive pathologic examination of SLNs were retrieved from a prospective data base. No association was found between ITCs and the time interval between CNB and SLNB. The association was significant with tumor size, the tumor lymphovascular invasion (LVI) and the histologic type of the tumor. This study adds supplementary data to the association between tumoral LVI and ITCs in SLNs, The time interval between CNB procedure and SLNB was not related to affect presence of ITCs, which might not suggest the iatrogenic origin of these cells.