Association of clinical findings of temporomandibular disorders (TMD) with self-reported musculoskeletal pains

Background and aims: Temporomandibular disorders (TMD) can be related to self‐reported musculoskeletal pains. The aim of the study was to investigate the association of clinical findings of TMD with self‐reported pain in other parts of the body, and to discriminate pain clusters according to definite profiles of pain conditions including TMD among subjects in general population. Methods: A nationally representative Health 2000 Survey was carried out in 2000–2001 in Finland. The data were obtained from 6227 subjects aged ≥30 years. Information about pain in different parts of the body was collected from a questionnaire. The associations between clinically assessed TMD findings and pain in other areas were analyzed using chi‐square test and logistic regression analyses. Latent class analysis (LCA) was used to form natural clusters, i.e., groups in which the individuals had similar profiles of pain conditions. Results: Masticatory muscle pain on palpation associated with back, neck and shoulder pain and pain in joints. Temporomandibular joint (TMJ) pain on palpation associated with back, neck, shoulder and other joint pain. These associations did not change essentially after adjustment for confounders. After clustering of the study population with the LCA, 5.8% of the study population showed a multiple pain condition linked with TMD findings. Female gender, intermediate/poor self‐reported health and presence of a longstanding illness increased the probability to belong to this cluster. Conclusions: TMD findings associate with pain in several locations. Female gender and presence of impaired health were particularly related to occurrence of multiple pain conditions.     

颞下颌关节急慢性操作的(牙合)间矫治

目的:进一步阐明间矫治颞下颌关节急慢性损伤的作用机制,以扩展其应用范围,提高医疗质量。方法:对与颅颌系统间解剖生理关系的复习;对颞下颌关节急慢性损伤病因病变情况分析,对扩展应用病种治疗作用的临床观察及对多项间矫治作用机制实验研究结果的综合分析。结果:间矫治具有较恒定的调整下颌骨与颅骨间的三维关系的作用,从而减轻关节区应力和缓解肌张力,使颌部双侧肌力与关节运动平衡协调,增加其活动度,促进其生理性改建,避免其病理性继发损伤。结论:间矫治是治疗颞下颌关节急慢性损伤不可缺少的重要措施之一,特别是因其无创而又效果肯定,其应用范围尚能进一步开拓与发展。     

伴有颞下颌关节紊乱病的女性开骀患者的[牙合]干扰特征分析

目的探讨伴有颞下颌关节紊乱病（temporomandibulardisorders,TMD）的开[牙合]患者的[牙合][牙合]干扰特征。方法169例女性开[牙合]患者根据有无TMD分为伴有颞下颌关节紊乱病组（TMD（＋）组）和无颞下颌关节紊乱病组（TMD（一）组）,对两组患者治疗前的模型进行研究,来比较两组患者的早接触等[牙合]干扰特点。结果TMD（＋）组开骀患者中,57．8％的患者存在着正中颌位的[牙合]干扰,明显高于TMD（-）组（P〈0．05）。终末位置上的不稳定和由于磨牙的早接触引起的下颌前方偏移是伴有TMD的开[牙合]患者常见的两种咬合特征。结论本研究提示开[牙合]患者中早接触等功能性因素和颞下颌关节病的发病有关。     

咀嚼肌疼痛患者的定量感觉功能研究

目的 采用定量感觉测试分析咀嚼肌疼痛患者咬肌区的感觉功能特征。方法 选择初次就诊的单侧咬肌疼痛患者以及健康志愿者各20名,测量双侧咬肌区及患侧手背部的冷感觉阈值（cold detection thresholds,CDT）、热感觉阈值（warm detection thresholds,WDT）、冷痛觉阈值（cold pain thresholds,CPT）、热痛觉阈值（hot pain thresholds,HPT）和压力疼痛阈值（pressure pain threshold,PPT）,采用独立样本t检验进行统计分析。结果 两组受试者手背部的CDT/WDT/CPT/HPT/PPT均无明显差异。两组受试者咬肌区温度感觉阈值CDT及WDT无明显统计学差异。患者双侧温度痛觉阈值HPT及CPT较正常人敏感。患者患侧咬肌区PPT显著低于正常人对应侧（P=0.001）,患者患侧咬肌区PPT低于健侧咬肌区。结论 咀嚼肌疼痛患者对温度痛觉和机械疼痛较为敏感。     

Treatment of obstructive sleep apnea syndrome in patients from a teaching hospital in Brazil: is it possible?

Objective  The aim of this study was to evaluate the efficacy of a cost-effective intra-oral appliance for obstructive sleep apnea syndrome built into a large teaching hospital. Materials and methods  Out of 20 evaluated and treated patients, 14 concluded the study: eight men and six women, with a mean age of 42–46 (mean + SD) years and mean body mass index of 27.66. Inclusion criteria were mild or moderate apnea–hypopnea index (AHI) according to a polysomnographic study. All patients were treated with the monobloco intra-oral appliance. They were then submitted to a follow-up polysomnographic study after 60 days using the appliance. An orofacial clinical evaluation was carried out with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire and with clinical evaluation questionnaire devised by the Orofacial Pain Team before and 60 days after fitting the intra-oral appliance. Results  The AHI showed a statistically meaningful (p = 0.002) reduction from 15.53 to 7.82 events per hour, a non-statistically significant oxygen saturation increase from 83.36 to 84.86 (p = 0.09), and Epworth’s sleepiness scale reduction from 9.14 to 6.36 (p = 0.001). Three patients did not show any improvement. The most common side effect during the use of the appliance/device was pain and facial discomfort (28.57%), without myofascial or temporomandibular joint pain as evaluated by the RDC/TMD questionnaire. Conclusions  The intra-oral device produced a significant reduction of the apnea–hypopnea index during the study period with the use of the monobloco intra-oral appliance. Patients did not show prior myofascial pain or 60 days after use of the intra-oral appliance. Support FAPESP, process number 2007/06792-5.     

Energy metabolism in the masseter muscle: A comparison of normal subjects and TMD patients using31P-MRS

³¹P-MRS (Magnetic Resonance Spectroscopy) is the only noninvasive technique capable of measuring high-energy phosphate compounds in muscle tissue. In this study, we used³¹P-MRS to analyze the energy metabolism at rest in the masseter muscle of TMD patients who showed clinical symptoms in the masseter muscles. The subjects were 10 TMD patients who had complaints of pain and contracture in the masseter muscles, and 10 normal subjects.

Role of the C-terminus and the long cytoplasmic loop in reduced folate carrier expression and function

The reduced folate carrier (RFC1), a member of the major facilitative superfamily, generates uphill transport of folates into cells through an exchange mechanism with intracellular organic anions. RFC1 has twelve transmembrane domains with N- and C-termini, and the long loop connecting the 6th and 7th transmembrane domains, directed to the cytoplasm. To elucidate the role of the C-terminus and the long cytoplasmic loop in carrier function, mutants with deletion of the entire C-terminus or with progressive deletions of the loop region were constructed and stably transfected into the murine MTX(r)A cell line, which lacks functional RFC1. While expression of the C-terminus-deleted RFC1 protein could not be detected in the cell lysate, the RFC1 mutant lacking 57 of 66 amino acid residues of the long cytoplasmic loop appeared to be inserted into the cytoplasmic membrane but was not functional. In cell lines in which 17 or 31 amino acids were deleted from the carboxyl half of the loop, there was partial preservation of methotrexate, 5-formyltetrahydrofolate, and 5-methyltetrahydrofolate transport. The loss of 5-formyltetrahydrofolate transport activity in the delta31 and delta17 mutants was due primarily to a decrease in substrate binding to the carrier. Mutants with partially truncated internal loops demonstrated an anion responsiveness similar to that of wild-type RFC1, indicating that this region of the carrier does not contain a site(s) that plays a role in anion exchange. This is the first study to describe the important role of the long cytoplasmic loop in substrate binding and the crucial role of the C-terminus in maintaining stability of RFC1.     

颞下颌关节病的颈部伴随症状及其治疗的临床研究

目的：调查颞下颌关节病的颈背部伴随症状的临床发生情况及特性，探讨其治疗方法及疗效。方法：随机调查100例患者颈部伴随症状的发生情况。并和无关节病症状的对照组进行比较，对颞下颌关节病患者进行常规治疗，对有颈部症状的患者侧重进行修复，He垫和综合治疗并对治疗效果进行评价。结果：颞下颌关节病患者中伴随颈部症状的患者比例高于对照组，另外，前者的下颌偏斜比例及咬合异常比例均高于对照组，患者组中有明显咬合异常或下颌位不稳定的人，治疗开始一年后显效或有效率较高，而对有原发性椎病的人和可能伴有其它心理精神因素的人疗效较差。结论：颞下颌关节病和颈部状有一定的关联，下颌位置改变有可能引起部关节及肌系统的改变，进而影响颈部功能。     

The current agonists and positive allosteric modulators of α7 nAChR for CNS indications in clinical trials

The alpha-7 nicotinic acetylcholine receptor (α7 nAChR), consisting of homomeric α7 subunits, is a ligand-gated Ca²⁺-permeable ion channel implicated in cognition and neuropsychiatric disorders. Enhancement of α7 nAChR function is considered to be a potential therapeutic strategy aiming at ameliorating cognitive deficits of neuropsychiatric disorders such as Alzheimer's disease (AD) and schizophrenia. Currently, a number of α7 nAChR modulators have been reported and several of them have advanced into clinical trials. In this brief review, we outline recent progress made in understanding the role of the α7 nAChR in multiple neuropsychiatric disorders and the pharmacological effects of α7 nAChR modulators used in clinical trials.     

三种方法治疗颞下颌关节紊乱病的疗效比较

目的　比较关节灌洗、关节镜和关节开放手术 3种方法治疗颞下颌关节紊乱病的临床效果。方法　应用 3种方法治疗颞下颌关节紊乱病 :关节灌洗术治疗 35例 (42侧关节 ) ,关节镜术治疗 4 2例 (5 0侧关节 ) ,关节开放手术治疗 2 8例 (2 9侧关节 ) ,并对 3种方法的疗效进行比较。结果　关节灌洗组随访 2 4～ 5 2个月 ,术后张口度平均增加 (8.1± 3.9)mm ,健侧侧向运动增加 (3.8± 1.4 )mm ,85 .7%患者疼痛缓解 ,72 .2 %杂音消失 ,总有效率为 82 .9%。关节镜组随访 2 4～ 5 6个月 ,张口度平均增加 (7.5± 3.8)mm ,健侧侧向运动增加 (4.1± 1.8)mm ,88.1%患者疼痛缓解 ,79.2 %杂音消失 ,总有效率为 85 .7%。关节开放手术组 ,随访 2 4～ 5 5个月 ,术后张口度平均增加 (8.0± 5 .1)mm ,健侧侧向运动增加 (3.7± 2 .3)mm ,92 .9%患者疼痛缓解 ,总有效率为 89 3%。 3组比较 ,张口度、侧向运动改善及疼痛缓解率均无显著差异。结论　关节灌洗术、关节镜术和关节开放手术治疗颞下颌关节紊乱病均有效 ,但关节灌洗术方法简单、损伤小 ,易于推广应用。首先应选择手术创伤小的治疗方法 ,最后才选择开放手术。