Increased adhesion of peripheral blood neutrophils from patients with localized juvenile periodontitis

Adhesion of peripheral blood neutrophils from 5 patients with localized juvenile periodontitis (LJP) and age- and gender-matched healthy controls was measured using a semi-automated 96-well microtiter plate assay method. Both unstimulated and formyl-methionyl-leucyl-phenylalanine (FMLP, 10–1000 nM)-stimulated neutrophils from LJP patients showed in general higher adhesion than did their controls. After 15–60 min incubation with 100 and 1000 nM FMLP the numbers of adherent cells were significantly (p<0.05), 2.1–2.6-fold higher in LJP patients than in controls. Neutrophils from these LJP patients showed also enhanced respiratory burst activity in response to unopsonized zymosan stimulation. To test whether a decrease in intracellular diacylglycerol (DAG) kinase activity could account for the increased neutrophil adhesion of LJP patients normal neutrophils were treated with R59949 (10 μM), a DAG-kinase inhibitor. Both unstimulated and FMLP-stimulated normal neutrophiis showed significantly (p<0.05) enhanced adhesion after R59949-treatment. Taken together, our data indicate that neutrophils from the 5 LJP patients investigated here exhibit 2 parallel hyperactivities, namely increased adhesion and enhanced production of reactive oxygen species. Furthermore, our present and previous (Hurttia et al, J Periodont Res 1997; 32: 401-407) results suggest that the observed neutrophil functional abnormalities in some LJP patients may be associated with decreased cellular DAG-kinase activity. It is proposed that the hyperadherent and -active neutrophils may promote the development of LJP by causing tissue damage in the periodontium.     

Palatal juvenile xanthogranuloma: A case report

A case of palatal juvenile xanthogranuloma in a 1-year-old girl is presented.     

Psychosocial stressors in oral lichen planus

BACKGROUND: Psychosomatic factors and their association with dermatological disorders are well recognized, yet their importance in oral lichen planus (OLP) is still debated. This study was done to determine the importance of psychosocial stressors in patients with OLP. METHODS: An analytical age-sex matched double controlled study. Stratified serial random sampling was done for sample selection. The experimental group consisted of biopsy proven OLP subjects (n = 41), negative control consisted of apparently healthy general Out Patient Department (OPD) patients (n = 73) and positive controls were patients with burning mouth syndrome, atypical facial pain and myofacial pain dysfunction syndrome (n = 36). The General Health Questionnaire-version 28 (GHQ-28) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate psychosocial stressors in terms of stress, anxiety and depression respectively. RESULTS: The OLP patients had significantly higher stress (Z = 4.331; p < 0.05, significant), anxiety (Z = 4.260; p < 0.05, significant) and depression levels (Z = 4.942; p < 0.05, significant) than the negative controls when measured by GHQ and HADS respectively. Similar findings were noted between the two control groups, with higher stress (Z = 5.784; p < 0.05, significant), anxiety (Z = 6.416; p < 0.05, significant), and depression (Z = 4.841; p < 0.05, significant) levels in the positive control group. However, differences in stress (Z = 2.0416; p > 0.05, non-significant), anxiety (Z = 1.681; p > 0.05, non-significant) and depression levels (Z = 0.195; p > 0.05, non-significant) were found to be non-significant between OLP and positive control. CONCLUSION: Significantly higher stress, anxiety and depression levels were found in the OLP and positive control than the general population. No significant difference was noted between the OLP and the positive controls (in which psychosocial stressors are the sole etiology). These suggest that psychological stressors play an important role in the causation of OLP. It may be further hypothesized that these stressors form a starting point for the initiation of various autoimmune reactions, which have been shown to be contributory to the pathogenesis of OLP. Further longitudinal studies need to be done globally before definitive conclusions can be drawn.     

Serum neutralizing activity against Actinobacillus actinomycetemcomitans leukotoxin in juvenile periodontitis

A relatively high incidence of infection by Actinobacillus actionomycetemcomitans can be shown in subgingival plaque samples obtained from patients with juvenile periodontitis. These organisms possess a potent leukotoxin(s) which rapidly destroys isolated human polymorphonuclear leukocytes (PMNs) and monocytes. If such leukotoxins operate in vivo, they could deprive the gingival crevice area of an essential antibacterial defense mechanism. We have found that sera from juvenile periodontitis patients consistently (greater than 90%) contain antibodies which neutralize Actinobacillus actinomycetemcomitans leukotoxin(s). On the other hand, sera from normal individuals or patients with other types of periodontal disease usually amplified rather than inhibited the leukotoxic reaction. Many patients with juvenile periodontitis have demonstrable defects in PMN or monocyte chemotaxis and this may place them at risk to gingival infection by Actinobacillus actinomycetemcomitans. The immune response against these organisms could be a crucial determinant in the course of juvenile periodontitis. While this disease is relatively rare, it does cause immeasurable emotional, physical and economic hardship for patients and their families. The identification of Actinobacillus actinomycetemcomitans as a potential pathogen in this disorder may eventually lead to specific forms of therapy to prevent and eliminate infection by this organism in these patients.     

Cementum hypoplasia in teeth affected by juvenile periodontitis

The cemental surface of teeth affected by juvenile periodontitis was examined using scanning electron microscopy. Molars affected by chronic marginal periodontitis and healthy molars were included as controls. The entire mesial root of teeth affected by juvenile periodontitis showed extensive areas of cementum hypoplasia with exposed dentinal tubules. The hypoplasias were found also on the infracrestal part of the root indicating that they had not been caused by exposure to the oral environment or by any treatment. Cementum hypoplasias were not found in any teeth from the control material. The impaired periodontal attachment in the hypoplasia may facilitate penetration by the special motile bacteria which have been found in plaque from teeth with juvenile periodontitis. Based on the findings in the present study and the hereditary background of juvenile periodontitis it was suggested that development of the disease is initiated by a hereditary developmental disturbance of the cementum.     

Is there a relationship between juvenile idiopathic arthritis and periodontitis?

AIM: The aim was to compare the prevalence of periodontal conditions in patients with juvenile idiopathic arthritis (JIA) (n=78, age 14.4 years) with those revealed in a healthy control group (n=75, age 15.5 years). MATERIAL AND METHODS: In both groups, the approximal plaque index (API), the modified sulcular bleeding index (SBI), and the clinical attachment loss (CAL) were determined. Laboratory parameters for JIA activity included the capsule-reactive protein (CRP) and the immunoglobulins A, G, M. RESULTS: JIA patients had a significantly higher API (64.6%versus 49.9%, p=0.004) and slightly higher mean percentages of sites with CAL>3.5 mm (0.58%versus 0.22%, p=0.041). There was no significant difference in the prevalence of patients and controls who had sites with CAL >3.5 mm (25.6%versus 17.3%, p=0.212). The mean CAL was slightly greater (0.2 mm; p=0.030) in patients with CRP> or =5.0 mg/l compared with patients with CRP<5.0 mg/l. Patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly decreased SBI (26.2%versus 51.1%, p=0.019). CONCLUSION: After adjustment for microbial plaque, JIA is not a risk factor for periodontitis.     

基于“木郁达之”探讨化肝煎之临证运用

“木郁达之”意指肝气郁结当疏泄通达。化肝煎出自明代医学家张景岳的《景岳全书》,由青皮、陈皮、山栀子、牡丹皮、泽泻、芍药、土贝母7味中药组成,可疏肝畅达清热,为治肝郁化火之证的代表方,也是“木郁达之”治法的具体体现。现代临床可用于胃痛、胁痛、腹痛、头痛、烦热、咳吐痰血、妇女月经不调、目赤眼胀等多种病症的治疗。临证之时应抓住肝郁化火之辨证要点,基于“木郁达之”的原则,灵活化裁,以使肝气条畅,气血冲和,病症得除。     

Fatigue,psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review

Transient ischaemic attack (TIA) and minor stroke are characterized by short‐lasting symptoms; however, anecdotal and empirical evidence suggests that these patients experience ongoing cognitive/psychological impairment for which they are not routinely treated. The aims were (i) to investigate the prevalence and time course of fatigue, anxiety, depression, post‐traumatic stress disorder(PTSD) and cognitive impairment following TIA/minor stroke; (ii) to explore the impact on quality of life (QoL), change in emotions and return to work; and (iii) to identify where further research is required and potentially inform an intervention study. A systematic review of MEDLINE, EMBASE, PSYCINFO, CINAHL, the Cochrane libraries and the grey literature between January 1993 and April 2013 was undertaken. Literature was screened and data were extracted by two independent reviewers. Studies were included of adult TIA/minor stroke participants with any of the outcomes of interest: fatigue, anxiety, depression, PTSD, cognitive impairment, QoL, change in emotions and return to work. Random‐effects meta‐analysis pooled outcomes by measurement tool. Searches identified 5976 records, 289 were assessed for eligibility and 31 studies were included. Results suggest high levels of cognitive impairment and depression post‐TIA/minor stroke which decreased over time. However, frequencies varied between studies. Limited information was available on anxiety, PTSD and fatigue. Meta‐analysis revealed that the measurement tool administered influenced the prevalence of cognitive impairment: Mini‐Mental State Examination 17% [95% confidence interval (CI) 7, 26]; neuropsychological test battery 39% (95% CI 28, 50); Montreal Cognitive Assessment 54% (95% CI 43, 66). There is evidence to suggest that TIA/minor stroke patients may experience residual impairments; however, results should be interpreted with caution because of the few high quality studies. Notwithstanding, it is important to raise awareness of potential subtle but meaningful residual impairments.