Artificial Saliva in the Management of Patients Suffering from Xerostomia

Hyposalivation results in the sensation of a dry mouth “subjective xerostomia.” Besides the sensation of a dry mouth in serious conditions, distressing clinical symptoms are observed, e.g. difficulties in oral functioning, mucositis, progressive dental caries and nocturnal oral discomfort. A mucin-containing artificial saliva to relieve patients'complaints from xerostomia has been developed. Its chemical and physical properties are demonstrated. In a 3-year retrospective study the efficacy of this substitute and a CMC-containing saliva has been evaluated for a total of 137 patients. Patients were free in choosing a mucin- or CMC preparation. Ninety-six patients reported a considerable relief of their complaints with mucin-saliva, one patient wished to continue using the CMC product. To increase efficacy of the saliva substitute on intra-oral saliva reservoir has been developed for dentate and edentulous persons.     

Manifestations of Peripheral Autonomic Insufficiency in Patients Suffering from Acute Inflammatory Demyelinating Neuropathies

We tried to characterize the frequency and significance of manifestations of peripheral autonomic insufficiency (PAI) in clinical cases of acute inflammatory demyelinating neuropathies (AIDN). Forty patients with the above diagnosis (21 men and 19 women, 16 to 72 years old) were examined. To detect symptoms attributable to PAI, we used Birkmayer–Vein tables; these data were compared with the results of electroneuromyographic (ENMG) examinations. In 38 and 2 cases, clinical manifestations of AIDN corresponded to the Guillain–Barre and Miller–Fisher syndromes, respectively. According to ENMG data, changes in the peripheral nerves and neuromuscular junctions corresponded to axonopathy, myelinopathy, and a mixed damage (myelinoaxonopathy) in 18 (45%), 14 (35%), and 8 (20%) patients, respectively. The following disturbances in the sphere of autonomic control were observed: orthostatic hypotension, in 28 cases (70%); tachycardia in the resting state, in 24 cases (60%); hypertension in the reclining position, in 16 cases (40%); hypohydrosis of the skin on the limbs, in 18 cases (45%); dyspepsia, in 8 cases (20%), and enuresis, in 3 cases (7.5%). Manifestations of PAI began to be observed in the earliest stage of the disease and were preserved within the period of recovery of the motor functions; they were more intensive in the cases of a severe clinical course of polyneuropathies. The severity of autonomic disorders strictly correlated with the level of axonal degeneration (characterized according to the ENMG data). The treatment used (i.v. injections of immunoglobulin, plasmapheresis, use of vasoactive and neurometabolic drugs) not only improved the state of the motor sphere but also decreased the intensity of PAI symptoms. Thus, in the cases of AIDN not only thick myelinated fibers of the peripheral nerves but also a significant proportion of thin fibers responsible for the control of automatic functions are subjected to damage. PAI is rather frequently observed in patients suffering from AIDN, and the level of its manifestation reflects the severity of the disease and intensity of damage to the peripheral nerves.     

Arterial Stiffness and Pulse Wave Reflection Are Increased in Patients Suffering from Severe Periodontitis

Aim

This single blind cross-sectional study compared the vascular health of subjects suffering from severe chronic periodontitis, severe aggressive periodontitis and periodontal healthy controls by evaluating pulse wave velocity (PWV), augmentation index (AIx) and pulse pressure amplification (PPA).

Material and Methods

In a total of 158 subjects, 92 suffering from severe periodontitis and 66 matched periodontal healthy controls, PWV, AIx, central and peripheral blood pressure were recorded using an oscillometric device (Arteriograph).

Results

Subjects suffering from severe chronic or aggressive periodontitis exhibited significantly higher PWV (p = 0.00004), higher AIx (p = 0.0049) and lower PPA (p = 0.028) than matched periodontal healthy controls.

Conclusions

The results of this study confirm the association between periodontal inflammation and increased cardiovascular risk shown by impaired vascular health in case of severe periodontitis. As impaired vascular health is a common finding in patients suffering from severe periodontal disease a concomitant routine cardiovascular evaluation may be advised.     

Presence of C1-Inhibitor Polymers in a Subset of Patients Suffering from Hereditary Angioedema

Hereditary angioedema (HAE) is a potentially life-threatening disease caused by mutations in the gene encoding the serine protease inhibitor (serpin) C1 inhibitor (C1-inh). The mutations cause decreased functional plasma levels of C1-inh, which triggers unpredictable recurrent edema attacks. Subjects suffering from HAE have been classified in type I patients with decreased functional and antigenic levels of C1-inh, and type II patients with decreased functional but normal antigenic C1-inh levels. However, a few reports have demonstrated that some mutations cause C1-inh polymerization in vitro, and it is speculated that C1-inh polymers may exist in patient plasma, challenging the current classification of HAE patients. To investigate the presence of C1-inh polymers in patient plasma samples, we developed an immunological method, where monoclonal antibodies produced against polymerized C1-inh were applied in native PAGE western blotting. Using this approach we analyzed genuine plasma samples from 31 Danish HAE families, and found that plasma samples from three genotypically distinct HAE type I families (classified upon C1-inh plasma concentrations) contained C1-inh polymers. Identical C1-inh polymerization phenotypes were observed in four affected family members from one of these families. Genotyping of the families revealed that the polymerogenic mutations of two families were located in proximity to the reactive center loop insertion site in C1-inh (p.Ile271Thr and p.Ser258_Pro260del),and one mutation affected helix C (p.Thr167Asn). In conclusion, we demonstrate that C1-inh polymers are present in the plasma of a subgroup of HAE type I patients.     

Neuron-Specific Enolase Is Correlated to Compromised Cerebral Metabolism in Patients Suffering from Acute Bacterial Meningitis; An Observational Cohort Study

Introduction

Patients suffering from acute bacterial meningitis (ABM) with a decreased level of consciousness have been shown to have an improved clinical outcome if treated with an intracranial pressure (ICP) guided therapy. By using intracranial microdialysis (MD) to monitor cerebral metabolism in combination with serum samples of biomarkers indicating brain tissue injury, S100B and Neuron Specific Enolase (NSE), additional information might be provided. The aim of this study was to evaluate biomarkers in serum and MD parameters in patients with ABM.

Methods

From a prior study on patients (n = 52) with a confirmed ABM and impaired consciousness (GCS ≤ 9, or GCS = 10 combined with lumbar spinal opening pressure > 400 mmH₂O), a subgroup of patients (n = 21) monitored with intracerebral MD and biomarkers was included in the present study. All patients were treated in the NICU with intracranial pressure (ICP) guided therapy. Serum biomarkers were obtained at admission and every 12 hours. The MD parameters glucose, lactate, pyruvate and glycerol were analyzed. Outcome was assessed at 12–55 months after discharge from hospital. Mann-Whitney U-Test and Wilcoxon matched-pairs signed rank test were applied.

Results

The included patients had a mean GCS of 8 (range, 3–10) on admission and increased ICP (>20 mmHg) was observed in 62% (n = 13/21) of the patients. Patients with a lactate:pyruvate ratio (LPR) >40 (n = 9/21, 43%) had significantly higher peak levels of serum NSE (p = 0.03), with similar, although non-significant observations made in patients with high levels of glycerol (>500 μmol/L, p = 0.11) and those with a metabolic crisis (Glucose <0.8 mmol/L, LPR >25, p = 0.09). No associations between serum S100B and MD parameters were found. Furthermore, median MD glucose levels decreased significantly between day 1 (0–24h) and day 3 (48–72h) after admission to the NICU (p = 0.0001). No correlation between MD parameters or biomarkers and outcome was found.

Conclusion

In this observational cohort study, we were able to show that cerebral metabolism is frequently affected in patients with ABM. Furthermore, patients with high LPR (LPR>40) had significantly higher levels of NSE, suggesting ongoing deterioration in compromised cerebral tissue. However, the potential clinical impact of MD and biomarker monitoring in ABM patients will need to be further elaborated in larger clinical trials.     

Infrared Spectroscopy of Blood Serum from Patients with Oncohematological Diseases

Biophysics - A comparative analysis of the secondary structure of blood serum proteins was carried out in patients with multiple myeloma, chronic lymphocytic leukemia and in healthy donors. The...     

肝硬化与肝癌患者血浆游离氨基酸水平分析

采用高效液相色谱法分析了２５例肝硬化和１５例肝癌患者空腹血浆游离氨基酸水平的变化。结果表明,二者支链氨基酸（ＢＣＡＡ）如Ｖａｌ、Ｉｌｅ呈下降趋势,而芳香族氨基酸（ＡＡＡ）如Ｔｙｒ、Ｐｈｅ则呈上升趋势,ＢＣＡＡ／ＡＡＡ分子比值下降。丙氨酸（Ａｌａ）、蛋氨酸（Ｍｅｔ）、谷氨酰胺（Ｇｌｎ）及天门冬氨酸（Ａｓｐ）明显上升。其变化趋势二者存在差别。     

A Screening Test for Wilson's Disease and its Application to Psychiatric Patients

Varied modes of onset make the early diagnosis of Wilson''s disease difficult. A deficiency of serum ceruloplasmin, usually characteristic of the disease, was used as the basis for a screening test. Simple test materials and provision for handling about 50 plasma samples simultaneously made this test feasible for large-scale screening.The screening test was applied to 336 persons hospitalized for psychiatric disorders, to detect patients with Wilson''s disease before the classical symptoms appeared. Two patients with ceruloplasmin levels below the normal limits were detected but did not have Wilson''s disease. Further application of the screening test to relatives of patients known to have Wilson''s disease and to individuals with any symptoms of the disease (hepatic disease, extrapyramidal dysfunction, psychiatric disorders, behaviour problems in children) would aid in early diagnosis and more effective treatment.     

Effect of Electromagnetic Stimulation on Patients Suffering from Non-Union. A Retrospective Study with a Control Group

In this study we have reviewed a group of patients suffering from non-union treated at the same hospitals by the same surgeons. Twenty six patients (control group) received an orthopaedic treatment aimed at promoting bone healing, fourty one patients (experimental group) were stimulated with an electromagnetic field generator without any further change in the orthopaedic management of the non-union. Eighteen patients healed in the control group and thirty six in the experimental group. The average healing time was shorter among patients stimulated. No difference was observed in the success rate between the 2 groups of patients for non infected non-unions. Infection proved to be detrimental for the success of the treatment in the control group, while it did not negatively influence the outcome of stimulation. Provided that the orthopaedic treatment of the non-union is considered satisfactory, electromagnetic stimulation is a valid option in the treatment of non-unions.     

某些内科系统疾病患者血浆游离氨基酸的变化及意义

为了解某些内科系统疾病的血氨基酸代谢特点。测定１７０例９种内科系统急慢性疾病患者血浆游离氨基酸浓度,并分别与５８例健康人血浆氨基酸浓度作对比分析。９种疾病的血浆胱氨基酸浓度不同程度升高,以尿毒症病人最为显著,炎症性病人血浆苯丙、蛋、赖氨酸和苯丙／酪比值显著升高,丙、组、精、脯氨酸和支／芳比值显著降低;糖尿病和甲亢病人血浆总游离氨基酸、谷、丙、酪、赖和支链氨酸显著升高;糠尿病病人支／芳比值显著升高,表明不同疾病的血氨基酸浓度有特征性变化,炎症是导致血氨基酸代谢紊乱的重要因素     

ASXL1 but Not TET2 Mutations Adversely Impact Overall Survival of Patients Suffering Systemic Mastocytosis with Associated Clonal Hematologic Non-Mast-Cell Diseases

Systemic mastocytosis with associated hematologic clonal non-mast cell disease (SM-AHNMD) is a rare and heterogeneous subtype of SM and few studies on this specific entity have been reported. Sixty two patients with Systemic mastocytosis with associated hematologic clonal non-mast cell disease (SM-AHNMD) were presented. Myeloid AHNMD was the most frequent (82%) cases. This subset of patients were older, had more cutaneous lesions, splenomegaly, liver enlargement, ascites; lower bone mineral density and hemoglobin levels and higher tryptase level than lymphoid AHNMD. Defects in KIT, TET2, ASXL1 and CBL were positive in 87%, 27%, 14%, and 11% of cases respectively. The overall survival of patients with SM-AHNMD was 85.2 months. Within the myeloid group, SM-MPN fared better than SM-MDS or SM-AML (p = 0.044,). In univariate analysis, the presence of C-findings, the AHNMD subtypes (SM-MDS/CMML/AML versus SM-MPN/hypereosinophilia) (p = 0.044), Neutropenia (p = 0.015), high monocyte level (p = 0.015) and the presence of ASXL1 mutation had detrimental effects on OS (p = 0.007). In multivariate analysis and penalized Cox model, only the presence of ASXL1 mutation remained an independent prognostic factor that negatively affected OS (p = 0.035). SM-AHNMD is heterogeneous with variable prognosis according to the type of the AHNMD. ASXL1 is mutated in a subset of myeloid AHNMD and adversely impact on OS.