Einfluss der CMD auf die mechanische Schmerzschwelle außerhalb der Kopf-Gesichts-Region

Background and objective

There is currently no evidence of changes in pressure sensitivity of myofascial trigger points (MTrPs) in extra-trigeminal regions in patients with craniomandibular dysfunction (CMD). The purpose of this study was to evaluate whether pressure sensitivity of MTrPs in patients with CMD increases in trigeminal and extra-trigeminal regions compared to a healthy control group. Furthermore, the extent to which MTrPs can be used as diagnostic markers for hyperalgesia in patients with CMD was investigated.

Subjects and methods

In this study 34 patients with CMD (15–64 years old) and 30 healthy control subjects (22–65 years old) were included. The pressure pain threshold of MTrPs in trigeminal and extra-trigeminal regions was measured and compared. Additionally, the most suitable diagnostic marker of hyperalgesia in patients with CMD was investigated using ROC curve analysis.

Results

Pressure sensitivity of all MTrPs was significantly increased in the CMD group. Even after correction for multiple testing, most of the effects continued to be significant. The trapezius muscle was the most suitable among all MTrPs for the classification of hyperalgesia in patients with CMD. Assuming a false positive rate of below 5?%, 42?% of patients with CMD were classified as hyperalgetic.

Discussion

The significant differences in pressure sensitivity of MTrPs in trigeminal and extra-trigeminal regions indicate that hyperalgesia is present in patients with CMD. The trapezius muscle might be a marker for diagnosing hyperalgesia. Further studies are required in order to identify gender and age-specific indicators.     

Changes in Pneumococcal Serotypes and Antimicrobial Resistance after Introduction of the 13-Valent Conjugate Vaccine in the United States

Ongoing surveillance for Streptococcus pneumoniae is needed to assess the impact of the pneumococcal conjugate vaccine introduced in 2010 (PCV13). Forty-two U.S. centers submitted S. pneumoniae isolates between 1 October 2012 and 31 March 2013. Susceptibility testing was performed by use of a broth dilution method as recommended by the Clinical and Laboratory Standards Institute. Serotyping was performed by multiplex PCR and the Quellung reaction. Multidrug resistance (MDR) was defined as nonsusceptibility to penicillin (PNSP; MIC ≥ 0.12 μg/ml) combined with resistance to ≥2 non-β-lactam antimicrobials. Penicillin-resistant S. pneumoniae (PRSP) was defined as a penicillin MIC of ≥2 μg/ml. For the 1,498 isolates collected during 2012-13, the PRSP and MDR rates were 14.2 and 21.0%, respectively. These percentages were lower than rates obtained in a surveillance study conducted 4 years earlier in 2008-09 (17.0 and 26.6%, respectively). The most common serotypes identified in 2012-13 were 3, 35B, and 19A, each representing 9 to 10% of all isolates. The largest percentage of PNSP in 2012-13 were found in serotypes 35B (24.8%), 19A (23.5%), and 15A (10.3%). Predominant PRSP serotypes were 19A (54.5%), 35B (28.2%), and 19F (7.0%). Major MDR serotypes were 19A (38.5%), 15A (16.9%), 6C (8.3%), and 35B (6.4%). The change in prevalence of PCV13 serotypes (43.4 to 27.1%) was primarily due to a decrease in serotype 19A strains, i.e., 22% of all strains in 2008-09 to 10% of all strains in 2012-13. Among the PNSP subset, serotypes showing a proportional increase were 35B, 15B, and 23B. Among MDR strains, the largest proportional increases were observed in serotypes 35B, 15B, and 23A.     

Crack Propagation in As-Extruded and Heat-Treated Mg-Dy-Nd-Zn-Zr Alloy Explained by the Effect of LPSO Structures and Their Micro- and Nanohardness

The investigation of the crack propagation in as-extruded and heat-treated Mg-Dy-Nd-Zn-Zr alloy with a focus on the interaction of long-period stacking-ordered (LPSO) structures is the aim of this study. Solution heat treatment on a hot extruded Mg-Dy-Nd-Zn-Zr (RESOLOY^®) was done to change the initial fine-grained microstructure, consisting of grain boundary blocky LPSO and lamellar LPSO structures within the matrix, into coarser grains of less lamellar and blocky LPSO phases. C-ring compression tests in Ringer solution were used to cause a fracture. Crack initiation and propagation is influenced by twin boundaries and LPSO lamellae. The blocky LPSO phases also clearly hinder crack growth, by increasing the energy to pass either through the phase or along its interface. The microstructural features were characterized by micro- and nanohardness as well as the amount and location of LPSO phases in dependence on the heat treatment condition. By applying nanoindentation, blocky LPSO phases show a higher hardness than the grains with or without lamellar LPSO phases and their hardness decreases with heat treatment time. On the other hand, the matrix increases in hardness by solid solution strengthening. The microstructure consisting of a good balance of grain size, matrix and blocky LPSO phases and twins shows the highest fracture energy.     

An unusual presentation of a common infection

A 40-year-old Ghanaian woman presented with fever and exanthema. She had anemia, leukopenia, increased erythrocyte sedimentation rate (ESR), creatinin kinase, lactate dehydrogenase (LDH), and liver enzymes. She was diagnosed with schistosomiasis and was cured with praziquantel. During the following years, she developed polymyositis, chronic nephritis, and life-threatening perimyocarditis. High numbers of Epstein–Barr virus (EBV)-encoded RNA copies were demonstrated in CD8+ T-lymphocytes from endomyocardial biopsies. There was no evidence of any underlying immunosuppression or an EBV-related malignancy. Chronic active EBV infection was diagnosed, a clinical picture not described in an adult African previously. Interestingly, among all therapy attempts, only rituximab was effective at stabilizing the disease.     

Immune parameters in male atheletes after a lacto-ovo vegetarian diet and a mixed Western diet

The influence of a lacto-ovo vegetarian diet versus a meat-rich Western diet on in vitro measures of immune function was studied in eight male endurance athletes. Subjects consumed two different diets for 2 x 6 wk, separated by 4 wk on an ad libitum diet, in a cross-over design. Both diets consisted of 57 energy % (E%) carbohydrates, 14 E% protein and 29 E% fat. One diet was a mixed meat-rich diet (M) prepared with 69% animal protein sources, whereas the other diet (V) was a lacto-ovo vegetarian diet prepared with 82% vegetable protein sources. Blood for determination of leukocyte subpopulations and in vitro function was collected at the end of each diet period 36 h after the last training bout. Fiber content and P/S ratio of fatty acids were twice as high on the V diet as on the M diet. Training volume was similar on the two diets, and maximal aerobic capacity did not change during diet periods. The number of CD3+ (pan T-cells), CD8+ (mainly T suppressor cells), CD4+ (mainly T helper cells), CD16+ (natural killer cells), and CD14+ (monocytes) was similar after the two different diets. Similarly, proliferations of mononuclear cells after stimulation with interleukin-2 (IL-2), phytohemagglutinin, and purified derivative of tuberculin (PPD), as well as activity of natural killer cells in the unstimulated state and after stimulation with IL-2, indomethacin, and interferon-alpha (IFN-alpha), were identical after the two diet periods.(ABSTRACT TRUNCATED AT 250 WORDS)     

4 years' experience with a balloon-expandable endoprosthesis. Experimental and clinical application]

During a 4-year period of clinical application of the balloon-expandable Palmaz stent, a randomized trial comparing stent implantation and traditional balloon angioplasty of iliac arteries in arterial occlusive disease was started. The first long-term results, recorded after 2 years, indicate statistically significant differences in the complication rate (after stenting 2/62 and after angioplasty 5/69) and patency (greater than or equal to 70% of original lumen size upon stent implantation or balloon inflation: 95% after stenting and 72% after angioplasty). Clinical improvement after 2 years was 89% after stenting and 70% after angioplasty. Parallel to the clinical trials, experimental canine artery stenting was performed to evaluate differences in the long-term patency of stents exposed to restricted flow. Significant differences in neointimal healing were found between normally perfused stents and stents with artificially reduced flow: during the total observation period of 6 months the neointimal height was up to 200% higher in flow-restricted stents, while the histological composition of the neointima was the same as with normally perfused stents.     

Direct radiographic magnification in bone infections

An experimental model of bacterial osteomyelitis was used to investigate the correlation of direct radiographic magnification and histopathologic changes in the femora of rabbits. The histopathologic changes demonstrated a severe chronic state of osteomyelitis. The extent of radiographic changes was more clearly recognizable with direct radiological enlargement (up to 15-fold) than on normal radiographs: this applied to destruction of marrow and cortical bone, formation of sequestra, and (frequently) extraosseous extension. Histopathologic findings were in agreement with the changes revealed by direct radiographic enlargement.