Pulp sensibility test in elderly patients

doi: 10.1111/j.1741‐2358.2012.00623.x
Pulp sensibility test in elderly patients Background: The ageing process transforms the histological composition of the dental pulp and may affect the response to pulp sensibility tests. Objectives: The aim of this study was to assess the influence of age on pulp response time and on pain intensity. Material and methods: Fifty elderly patients and 50 young patients were selected. Different classes of teeth were evaluated. The pulp sensibility test was performed with a refrigerant spray. The pulp response time was measured in seconds and the pain intensity was assessed by visual analogue scale. Results: The Spearman coefficient was calculated and detect a positive correlation between age and pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). On the contrary, there was a negative correlation between age and pain intensity for maxillary incisors, mandibular incisors, and mean (p < 0.05). Also, the results of elderly and young groups were compared by Mann–Whitney test. Significant difference was noted regarding the pulp response time for maxillary incisors, premolars, mandibular incisors, and mean (p < 0.05). Significant difference was detected regarding the pain intensity for mandibular incisors only (p < 0.05). Conclusions: Pulp response time increases when people get older while pain intensity decreases. There were variations among the classes of teeth.     

Laser-evoked brain potentials in patients with dissociated loss of pain and temperature sensibility

Brief heat stimuli, elicited by a CO₂ laser (10.6 μm wave length), activate the most superficial cutaneous nerve terminals of the thin myelinated Aδ and unmyelinated C fibres which mediate heat and pain sensations. This paper investigates late cerebral potentials (SEPs) in response to laser pulses in comparison with those to conventional electrical stimulation in 18 patients with a dissociated sensory deficit (intact mechanosensibility and disturbed temperature and pain sensation). Patients were stimulated in the most disturbed limb (affected area) and in a corresponding control area.In all 18 patients the SEPs elicited by laser stimuli were able to identify the body site with heaviest disturbances in pain and thermosensibility: the SEPs from the affected area were reduced or delayed, compared to the control area. In contrast, no alterations in SEPs could be observed after conventional electrical nerve stimulation, in agreement with the normal mechanosensibility. However, the degree of SEP modulation in response to cutaneous heat stimuli did not correspond to the severity of the subjectively reported sensory deficit. Highest correlations between sensory deficits and abnormal SEPs were found in all those patients in whom computer tomography or MR imaging documented a localized destructive process in the CNS. All patients with the smallest SEP modulations despite a considerable sensory deficit had an inflammatory aetiology. Preliminary criteria to define a laser-evoked SEP as pathological are discussed.     

A case of otocephaly with anencephaly and meningomyelocele

A case of otocephaly with anencephaly and meningomyelocele: Otocephaly is a rare lethal syndrome with microstomia, aglossia, agnathia, and synotia as major clinical features due to arrest in development of the first branchial arch. Some associated anomalies may be present as cyclopia, holoprosencephaly, cerebellar hypoplasia, situs inversus, and other visceral anomalies. We describe a case of fetus, spontaneously aborted in the 14th week of gestation with otocephaly complex (agnathia, synotia, microstomia) and associated anencephaly and meningomyelocele.     

Circulating interleukin-18 and osteopontin are useful to evaluate disease activity in patients with tuberculosis

BACKGROUND: T helper type 1 (Th1) responses have been implicated in the protective immunity, pathophysiology and development of tuberculosis. However, it is still unclear which molecule(s) reflect disease activity in patients with tuberculosis. METHODS: By specific enzyme immunoassays, circulating interferon-gamma. (IFN-gamma), interleukin-12 (IL-12), IL-18 and osteopontin (OPN) were measured in 47 patients with pulmonary tuberculosis and 7 patients with miliary tuberculosis before anti-tuberculosis therapy, and also measured in 19 patients with tuberculosis before and after anti-tuberculosis therapy. RESULTS: Circulating IFN-gamma, IL-18 and OPN levels were significantly higher in patients with pulmonary tuberculosis than in healthy controls, while there was no significant difference in levels of circulating IL-12 between tuberculosis patients and controls. Circulating IFN-gamma, IL-12, IL-18 and OPN paralleled the extent of lung lesions, and circulating IFN-gamma, IL-18 and OPN paralleled the magnitude of fever in patients with pulmonary tuberculosis. Patients with miliary tuberculosis had extremely high levels of circulating OPN, IFN-gamma and IL-18. Circulating IL-18 and OPN were significantly decreased with anti-tuberculosis therapy, whereas circulating IL-12 and IFN-gamma were not. CONCLUSIONS: Among Th1 response associated molecules, circulating levels of IL-18 and OPN, but not IFN-gamma or IL-12, reflect disease activity in patients with tuberculosis.     

A suspensory jacket permitting long-term sitting in paraplegic patients

A thoracic suspensory jacket has been used in four patients with recurring ischial pressure sores to transfer the site of skin pressure from the insensate ischial area to the sensory area over the rib cage. This modality is not an alternative to surgery, but rather an adjunct to prevent an early recurrence after an ischial pressure sore has been repaired with a proper surgical procedure.     

Changes in fatigue,autonomic functions,and blood biomarkers due to sitting isometric yoga in patients with chronic fatigue syndrome

Background

In a previous randomized controlled trial, we found that sitting isometric yoga improves fatigue in patients with chronic fatigue syndrome (CFS) who are resistant to conventional therapy. The aim of this study was to investigate possible mechanisms behind this finding, focusing on the short-term fatigue-relieving effect, by comparing autonomic nervous function and blood biomarkers before and after a session of isometric yoga.

Methods

Fifteen patients with CFS who remained symptomatic despite at least 6 months of conventional therapy practiced sitting isometric yoga (biweekly 20 min practice with a yoga instructor and daily home practice) for eight weeks. Acute effects of sitting isometric yoga on fatigue, autonomic function, and blood biomarkers were investigated after the final session with an instructor. The effect of a single session of sitting isometric yoga on fatigue was assessed by the Profile of Mood Status (POMS) questionnaire immediately before and after the session. Autonomic nervous function (heart rate (HR) variability) and blood biomarkers (cortisol, DHEA-S, TNF-α, IL-6, IFN-γ, IFN-α, prolactin, carnitine, TGF-β1, BDNF, MHPG, and HVA) were compared before and after the session.

Results

Sitting isometric yoga significantly reduced the POMS fatigue score (p?<?0.01) and increased the vigor score (p?<?0.01). It also reduced HR (p?<?0.05) and increased the high frequency power (p?<?0.05) of HR variability. Sitting isometric yoga increased serum levels of DHEA-S (p?<?0.05), reduced levels of cortisol (p?<?0.05) and TNF-α (p?<?0.05), and had a tendency to reduce serum levels of prolactin (p?<?0.1). Decreases in fatigue scores correlated with changes in plasma levels of TGF-β1 and BDNF. In contrast, increased vigor positively correlated with HVA.

Conclusions

A single session of sitting isometric yoga reduced fatigue and increased vigor in patients with CFS. Yoga also increased vagal nerve function and changed blood biomarkers in a pattern that suggested anti-stress and anti-inflammatory effects. These changes appear to be related to the short-term fatigue-relieving effect of sitting isometric yoga in patients with CFS. Furthermore, dopaminergic nervous system activation might account for sitting isometric yoga-induced increases in energy in this patient population.

Trial registration

University Hospital Medical Information Network (UMIN CTR) UMIN000009646. Registered Dec 27, 2012.

     

DAS28: a useful instrument to monitor infliximab treatment in patients with rheumatoid arthritis

The Disease Activity Score using 28 joint counts (DAS28) has been developed in a cohort of patients with rheumatoid arthritis in which only conventional anti-rheumatic treatments were used. It has extensively been validated to monitor disease activity in daily clinical practice as well as in clinical trials. The study of Vander Cruyssen and colleagues showed that the DAS28 correlated best with the decisions of rheumatologists to increase the infliximab dose because of insufficient response. This result once more confirms the validity of the DAS28 to monitor disease activity in patients with rheumatoid arthritis and to titrate treatment with biologicals.     

Partial caudal duplication in a newborn associated with meningomyelocele and complex heart anomaly

BACKGROUND: Caudal duplication is a spectrum of rare congenital anomalies with a possible heterogeneous pathogenesis including incomplete separation of monovular twins. METHODS: We report an autopsy case of a full-term infant with incomplete caudal duplication syndrome associated with multiple anomalies. RESULTS: These anomalies included a duplicated penis; double urinary bladder with an attenuated tunica muscularis; duplication of lower bowel with two ilia, appendices and colons; colonic hypogangliosis and left imperforated anus associated with rectourethral fistula. Other anomalies consisted of sacral meningomyelocele, sacral duplication with hypoplastic left sacrum and pelvic bones, muscle atrophy and hypoplasia of the left lower extremity, abnormal lobation of liver with stomach entrapment, omphalocele, and right atrial isomerism syndrome. The complex pattern of anomalies suggests the possibility that partial caudal duplication might be part of the spectrum of conjoined twinning.     

Catestatin is useful in detecting patients with stage B heart failure

Screening patients with stage B heart failure(HF) may be one strategy for reducing human morbidity. To describe catestatin levels in different stages of HF and evaluate the diagnostic utility of catestatin for detecting stage B HF, we included 300 patients. Catestatin, BNP testing and echocardiogram were performed. Our studies showed catestatin decreased gradually from stage A to C. There was significant difference between stage A and B. Cutoff value for detecting stage B HF was 19.73?ng/ml for catestatin with 90% sensitivity and 50.9% specificity. These results may have implications in the new method to detect patients with stage B HF.     

Catestatin is useful in detecting patients with stage B heart failure

Screening patients with stage B heart failure(HF) may be one strategy for reducing human morbidity. To describe catestatin levels in different stages of HF and evaluate the diagnostic utility of catestatin for detecting stage B HF, we included 300 patients. Catestatin, BNP testing and echocardiogram were performed. Our studies showed catestatin decreased gradually from stage A to C. There was significant difference between stage A and B. Cutoff value for detecting stage B HF was 19.73?ng/ml for catestatin with 90% sensitivity and 50.9% specificity. These results may have implications in the new method to detect patients with stage B HF.     

Sensory reinnervation and sensibility in skin transplants

Reinnervation and sensibility were investigated in patients previously subjected to split thickness skin transplantation after excision of skin and subcutaneous fat for treatment of malignant melanoma. All patients except one showed poor sensibility and no neurofilament positive sensory nerve fibres were detected. Most patients had heat and pain sensibility but with a higher threshold than on the control side. It is suggested that this heat pain sensibility is mediated from nerve fibres in the underlying tissue. In one patient, however, sensibility was encountered and in this patient neurofilament positive sensory nerve fibres were observed in the dermis and epidermis.     

Visual and somatosensory contributions to infant sitting postural control

Abstract

There are a limited number of studies that have investigated sitting posture during infancy and the contribution of the sensory systems. The goal of this study was to examine the effects of altered visual and somatosensory signals on infant sitting postural control. Thirteen infants (mean age?±?SD, 259.69?±?16.88?days) participated in the study. Initially, a single physical therapist performed the Peabody Developmental Motor Scale to determine typical motor development. Then the child was placed onto a force platform under four randomized conditions: (a) Control (C) – sat independently on the force plate, (b) Somatosensory (SS) – Sat independently on a foam pad (low density), (c) Visual (VS) – sat independently on the force plate while the lights were turned off creating dim lighting, and (d) Combination of b and c (NVSS). Center of pressure (COP) data from both the anterior-posterior (AP) and the medial-lateral (ML) directions were acquired through the Vicon software at 240?Hz. The lights off conditions, both VS and NVSS, lead to increased Root Mean Square (RMS) and Range values in the AP direction, as well as increased Lyapunov Exponent (LyE) values in the ML direction. Altered visual information lead to greater disturbances of sitting postural control in typically developing infants than altered somatosensory information. The lights off conditions (VS and NVSS), unveiled different control mechanisms for AP and ML direction during sitting. Thus, the present findings confirm the dominance of vision during the early acquisition of a new postural accomplishment.