Tongue rehabilitation through the froggy mouth device: case series

Based on the knowledge supporting the position of the tongue in relation to the palate to be the guiding factor of oro-dental growth and the key factor in long-term orthodontic stability after treatment, 6 different case reports show how the Froggy Mouth device changes treatment strategy in rehabilitation of dysfunctional swallowing by relying on the subcortical process, following the principles established by pioneering studies on memorization mechanisms conducted by Eric Kandel (year 2000 Nobel Prize winner in medical field for his research on memorization process).

Early co-circulation of different clades of influenza A/H1N1v pandemic virus in northern Italy

INTRODUCTION

The spatial diffusion over time of pandemic influenza A/HINI virus (A/HIN1v) was surveyed in Northern Italy (nearly 10 million inhabitants)from April to December 2009, and the molecular characteristics of circulating viruses were analyzed to identify the appearance of drift variants. About 45% of analyzed samples were laboratory-confirmed cases of A/HINlv. Sporadic cases occurred until the middle of June 2009, then, case numbers began to increase delineating distinct epidemiological phases of viral circulation.

METHODS

RNA was extracted using RNeasy Mini kit (QIAGEN GmbH, Germany). Virological diagnosis of A/HINlv infection was carried out by real-time RT-PCR assay. Sequence analysis of hemagglutinin (HA) gene was performed through a RT-PCR assay specific for a 995 bp fragment (nt. 64-1,058) in the HAl domain. The nucleotide sequences were obtained by automated DNA sequencing. The HAl sequences were aligned with other sequences collected from GenBank database by ClustalX software. The multiple sequence alignment was used to perform a basic phylogenetic analysis and a phylogenetic tree from HA sequences was constructed.

RESULTS

The HA gene sequences ofA/HINlv analyzed segregated into three genetically distinct clades and were characterized by the appearance of amino acid variations that were progressively fixed in the field viral population under scrutiny.

CONCLUSIONS

These data suggest an early co-circulation of genetically distinct A/HNINv variants and emphasize the importance of a close molecular surveillance to detect rapidly the spread of new viral variants and to define their epidemiological impact.

Prevalence of HCV infection among health care workers in a hospital in central Italy

Health care workers are at risk of acquiring transmissible diseases. Controversial results have been reported about HCV. The aims of the present study are to assess the prevalence of HCV in health care workers in Pistoia General Hospital (central Italy) and to compare prevalence with other groups, particularly with a sample of the general population. Serum samples collected from 511 health care employees engaged in direct clinical task and 222 clerical and nurse school attendees have been tested by ELISA and confirmed by RIBA. Total seroprevalence was 3.8%:4.7% in the first group; 1.8% in the second group. The data showed a slight increase in prevalence by age and not by length of stay in the health care workers' group. Comparison of HCV prevalence with blood donors from the province of Pistoia and the general population from Sersale (Catanzaro, southern Italy), restricted to under-40 subjects, indicates an increasing trend in this order: Blood donors, general population, clerical and nursing school attendees, health care workers' group with the highest value (3.4%). A cohort study is needed to evaluate pattern of HCV seroconversion.

Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulder: single blind study

OBJECTIVE

To evaluate the clinical and radiological response of chronic calcific tendinitis of the shoulder to extracorporeal shock wave therapy (ESWT) in a single blind study.

METHODS

70 patients showing chronic, symptomatic, calcifying tendinitis of the shoulder were examined. A single blind randomised study was performed with 35 patients undergoing a regular treatment (group 1) and 35 a simulated one (group 2). Pain and functional assessment was carried out according to Constant and Murley. Variations in the dimension of the calcification were evaluated by anteroposterior x ray films.

RESULTS

A significant decrease of pain and a significant increase in shoulder function was seen in group 1. Examination by x ray showed partial resorption of the calcium deposits in 40% of cases and complete resorption in 31% of cases in group 1. In the control group no significant decrease of pain and no significant increase in shoulder function was seen. No modifications were observed by x ray examination.

CONCLUSION

Because of its good tolerance, safety, and clinical radiological response, ESWT can be considered as an alternative treatment for chronic calcific tendinitis of the shoulder.

[Diff-Quik(R) staining method for detection and identification of monosodium urate and calcium pyrophosphate crystals in synovial fluids]

The aim of this study was to evaluate whether DQ could prove useful to identify monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals on permanent mounted stained slides. To this end, we studied 27 synovial fluid (SF) samples obtained from the knees of patients with the pseudogout (n=21) and acute gouty arthritis (n=6). Wet analysis for crystal detection and identification was performed within one hour of joint aspiration. In addition, we studied 16 inflammatory synovial effusions obtained from patients with knee arthritis not induced by crystals. For each SF, DQ stained slides were analyzed by 2 experienced doctors in SF analysis. The observers were blinded to the type of crystal present in the SF. Each slide was analyzed by compensated polarized and transmitted light microscopy. SF was considered positive if intracellular and/or extracellular crystals were clearly identified. In addition, the observers were asked to identify the type of the crystals using compensated polarized light microscopy. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the DQ staining method were determined. 51 true positive and 28 true negative specimens were correctly classified (39 CPPD samples, 12 MSU samples, and 28 samples of crystals-unrelated arthropathies). All MSU specimens were correctly diagnosed.

Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis

OBJECTIVE

To evaluate the efficacy of extracorporeal shock wave treatment (ESWT) in calcaneal enthesophytosis.

METHODS

60 patients (43 women, 17 men) were examined who had talalgia associated with heel spur. A single blind randomised study was performed in which 30 patients underwent a regular treatment (group 1) and 30 a simulated one (shocks of 0 mJ/mm(2) energy were applied) (group 2). Variations in symptoms were evaluated by visual analogue scale (VAS). Variations in the dimension of enthesophytosis were evaluated by x ray examination. Variations in the grade of enthesitis were evaluated by sonography.

RESULTS

A significant decrease of VAS was seen in group 1. Examination by x ray showed morphological modifications (reduction of the larger diameter >1 mm) of the enthesophytosis in nine (30%) patients. Sonography did not show significant changes in the grade of enthesitis just after the end of the treatment, but a significant reduction was seen after one month. In the control group no significant decrease of VAS was seen. No modification was observed by x ray examination or sonography.

CONCLUSION

ESWT is safe and improves the symptoms of most patients with a painful heel, it can also structurally modify enthesophytosis, and reduce inflammatory oedema.

Diff Quik staining method for detection and identification of monosodium urate and calcium pyrophosphate crystals in synovial fluids

OBJECTIVE

To evaluate whether the Diff Quik (DQ) staining method might prove useful in identifying monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals on permanent mounted stained slides.

METHODS

27 synovial fluid (SF) samples obtained from the knees of 21 patients with acute CPPD disease and 6 with acute gout were studied. Wet analysis for crystal detection and identification was performed within one hour of joint aspiration. In addition, 16 inflammatory synovial effusions obtained from patients with knee arthritis induced by non-crystalline inflammatory diseases were studied. For each SF, a DQ stained slide was analysed by two of the authors trained in SF analysis. The observers were blinded to the type of crystals present in the SF. Each slide was analysed by compensated polarised as well as transmitted light microscopy. An SF was considered positive if intracellular and/or extracellular crystals were clearly identified. In addition, the observer was asked to identify the type of the crystals using compensated polarised light microscopy. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the DQ staining method were determined.

RESULTS

51 true positive and 28 true negative cases were correctly classified (39 CPPD samples, 12 MSU samples, 28 samples of crystal unrelated arthropathies). Overall, four false positive and three false negative cases were reported. In all the false positive cases, extracellular CPPD crystals were erroneously identified, whereas CPPD crystals present in the SF were not identified in the three false negative cases. All MSU specimens were correctly diagnosed. The overall specificity, sensitivity, and accuracy using DQ stained slides for crystal confirmation were respectively 87.5%, 94.4%, and 91.9%. The PPV was 92.7% and the NPV 90.3%. In particular, the specificity, sensitivity, and accuracy for CPPD detection were 90.9%, 92.9%, and 91.9%, with a PPV of 90.7 and an NPV of 93.0%. All the MSU specimens were correctly identified, providing 100% sensitivity, specificity, accuracy, PPV, and NPV.

CONCLUSIONS

Stained preparations of SF, including DQ stained smears, could provide a useful tool for delayed SF analysis suitable for quality controls, including cytological examination and crystals detection and identification.

Image analysis quantification of substance P immunoreactivity in the trapezius muscle of patients with fibromyalgia and myofascial pain syndrome

OBJECTIVE

Substance P (SP), a neurotransmitter stored within the afferent nociceptive fibers, is likely to be involved in the pathogenesis of musculoskeletal pain. We investigated SP immunoreactive (SP-ir) nerve fibers in the upper trapezius of patients with fibromyalgia (FM) and myofascial pain syndrome (MPS) by immunochemistry.

METHODS

Trapezius muscle obtained from tender points of 9 women with primary FM, from trigger points of 9 women with regional myofascial pain, and from 9 control women were immunostained with anti-SP sera. Quantitative evaluation was performed by computerized image analysis.

RESULTS

No significant differences in the number of SP-ir areas were detected between groups (one way ANOVA: p = 0.2); in contrast, mean optical density (OD) of SP-ir showed a significant difference comparing the groups (one way ANOVA: p < 0.0001). Mean OD of the immunostaining for SP was statistically greater in trapezius muscle of patients with MPS (0.594 +/- 0.096) compared to specimens from patients with FM (0.436 +/- 0.140) (p < 0.05) and controls (0.314 +/- 0.105) (p < 0.05); mean OD of immunostaining for SP was greater in FM specimens than in controls (p < 0.05).

CONCLUSION

Our results point to a peripheral hyperactivity of the peptidergic nervous system in FM as well as in MPS. These findings support the notion of pathogenetic involvement of the afferent nervous system in the development and perception of myofascial pain.

Rotator cuff tear associated with an acromioclavicular cyst in rheumatoid arthritis

We report two cases of a full-thickness rotator cuff tear followed by acromioclavicular cyst formation in patients with longstanding erosive polyarticular rheumatoid arthritis. One of the consequences of a rotator cuff tear is articular instability with upward migration of the humeral head. The ensuing chronic friction against the undersurface of the acromioclavicular joint caused by arm movements can lead to a non-inflammatory effusion of the acromioclavicular joint with cyst formation. Clinical and ultrasonographic features and a pathogenetic hypothesis are discussed.

Degradation of hyaluronic acid by photosensitized riboflavin in vitro. Modulation of the effect by transition metals, radical quenchers, and metal chelators

The effect of photoexcited riboflavin (RF) on the viscosity of hyaluronic acid (HA) solutions has been investigated. UV irradiation of RF causes under aerobic conditions fragmentation of HA and a decrease in the viscosity of its solutions. A decrease of HA viscosity occurs in PO(4)-buffered solutions and is accelerated by high pH, Fe2+ (but much less so by Fe3+), certain metal chelators, and horseradish peroxidase (HRP); it is partially inhibited by catalase and less so by superoxide dismutase (SOD). The reactivity of the system was completely blocked by Tris, ethanol, aspirin, d-manitol, dimethylthiourea (DMTU), dimethylsulfoxide (DMSO), and sodium azide. These results indicate that the most likely chemical species involved in the reaction is the hydroxyl radical. Singlet oxygen ((1)O(2)) generation is suggested by the ability of NaN3 and DMSO to completely inhibit the reactivity of the system. These two agents, however, may also interact with OH. radical, as well and suppress the reactivity of the system. H(2)O(2) and O(2).- seem also to be produced in significant amounts, because catalase and SOD partially block the reactivity of the system. The effect of HRP may be due to hydrogen subtraction from HA and H(2)O(2) reduction to water. Photoexcitation of RF may potentially occur in vitro and in vivo in the organs and tissues that are permeable to light, such as the eye or skin, and damage HA and other cell-matrix components causing inflammation and accelerating aging.

Effect of reactive oxygen species on the biosynthesis and structure of newly synthesized proteoglycans

The effect of reactive oxygen species (ROS) generated by a xanthine oxidase hypoxanthine system (mainly H2O2) on proteoglycan (PG) metabolism and structure was investigated in vitro, using cell monolayers of cultured rabbit articular chondrocytes and purified resident and newly synthesized proteoglycans. It was shown that ROS generated in this system frequently stimulate (at low concentrations), and consistently inhibit (at higher concentrations), the incorporation of 35SO4 and 3H-glucosamine into PG molecules synthesized by cultured chondrocytes. The inhibition of isotopes' incorporation at higher enzyme concentrations was suppressed completely by heating xanthine oxidase and allopurinol with superoxide dismutase (SOD) and catalase. ROS at high concentration also inhibited 3H-uridine incorporation but had no effect on 35SO4 and 3H-uridine uptake by the cells. They also alter hyaluronan (HA) and PG monomers by fragmenting the core protein moiety and destroying the hyaluronic acid binding region. Altered PG monomers do not interact with HA to form complexes, but fragmented HA still retain a significant PG monomer-binding capacity. PG-HA complexes are easily and irreversibly destroyed by ROS. These results suggest that ROS may at low fluxes stimulate PG-synthesis under physiological conditions and alter cartilage metabolism and structure in conditions where they are overproduced, such as in rheumatoid arthritis, and in hemochromatosis and other iron storage diseases.

[Efficacy and tolerability of iloprost in the treatment of digital vasculitis secondary to connective tissue diseases]

The authors have evaluated the effects of long-term treatment of digital vasculitis secondary to various types of connective tissue disease, Systemic Lupus Erythematosus (SLE), Progressive Systemic Sclerosis (PSS), Sjögren's Syndrome (SS), using iloprost. The drug has proven to be effective both in reducing pain and clinical symptoms induced by vasospastic phenomena, as well as in promoting the healing of serious acral ischemic lesions. In the patient with LES, clinical modifications of the local vasculitic phenomena have been associated with a contemporaneous remission of the disease. The persistence of the drug's clinical effects even after suspension of treatment, instrumental and biohumoral changes and concomitant systemic effects on the disease lead to the conclusion that the drug's effect, is not merely due its vasodilating action and its ability to interfere with the coagulative process, but rather must be sought within the context of a morpho-structural repair of the microcirculation.

[Evaluation of the clinico-therapeutic response to oral gold salts in patients with rheumatoid arthritis]

The authors investigated the possible correlation between blood concentrations and clinical outcome in 38 auranofin-treated patients with rheumatoid arthritis, diagnosed according to ARA criteria. The results showed that the whole blood gold concentrations did not correlate with the clinical parameters investigated and some laboratory findings. The authors discuss this lack of correlation, suggesting that a clear genetic disposition can interfere with the clinical response, affecting the metabolism and kinetics of the drug.

[Antalgic efficacy of tiaprofenic acid in models of acute rheumatic pain]

Twenty patients suffering from acute lumbosacral syndromes (Group A) and eight patients suffering from acute gout (Group B) were treated with parenteral tiaprofenic acid (TA). In Group A TA was administered for 7 days at the dosage of 400 mg/daily for the first four days (1 200 mg vial i.m. in the morning, 1 in the evening), from the 5th to the 7th day with 200 mg/daily (1 vial in the evening) and, in Group B, TA was administered for 6 days at the dosage of 600 mg on the first day, (with 1 vial/8 hours of TA 200 mg by parenteral route) the 2nd and 3rd day with 1 vial/12 hours and the 4th and 6th day with 1 vial/daily in the evening. TA was found to be active on all clinical parameters evaluated. The tolerability was also good: only 4 patients with acute lumbosacral syndrome suffered from local pain.

Evaluation of the renal injury from gold salts and nonsteroidal anti-inflammatory drugs in patients with rheumatoid arthritis

The urinary excretion of proteins, N-acetyl-3-glucosaminidase and leucine aminopeptidase, was measured in 50 patients with rheumatoid arthritis (RA), of whom 20 subjects were on nonsteroidal anti-inflammatory drugs (NSAIDs) and 30 on gold salts. No pathological changes of the above-mentioned urinary parameters have been observed in the group of RA patients, in comparison with control subjects and patients suffering from osteoarthritis treated with NSAIDs.

[Plasma levels of apolipoprotein and HDL-cholesterol in patients with rheumatoid arthritis]

The authors have examined the levels of the plasma cholesterol and triglycerides, of the plasma lipoproteins (HDL, LDL, VLDL) and of their main apolipoproteins (apo-A and apo-B) in a group of 64 patients affected by RA and in a population of healthy subjects considered as a contrast group, trying to establish a plausible dislipidemic factor which could justify the major occurrence of coronary heart disease in those patients suffering from RA. Statistical analysis was done with the T-test. There are not differences in the lipoprotein pattern between the group of patients affected by RA and the population of healthy subjects. The obtained result seem to exclude that such a major occurrence of coronary heart disease in the patients suffering from RA may be linked to the alteration of lipidic metabolism.

[Plasma beta-2-microglobulin in rheumatoid arthritis]

The beta 2 microglobulin (beta 2m) is a low molecular weight protein, recognized on the cellular membranes of numerous nucleated cells and strictly correlated to the antigens of Major Histocompatibility Complex. Many authors have demonstrated an increase of the plasmatic beta 2m in different inflammatory diseases and, particularly in rheumatic ones, as Rheumatoid Arthritis (RA), Reiter's syndrome, Ankylosing Spondylitis, Systemic lupus erythematosus. We have also investigated the behaviour of the plasmatic beta 2m in 52 RA patients and in 17 healthy subjects. The beta 2m was measured in serum, by radioimmunoassay. We have demonstrated that the plasmatic beta 2m has moderately increased in the serum of RA patients, even if there is not a significant difference when compared to the normal subjects.

A double-blind, interpatient comparison of plain and slow-release ketoprofen in osteoarthritis

Eighty patients with osteoarthritis of various localization completed a double-blind, parallel-group trial of 2 weeks' duration comparing the efficacy and tolerance of ketoprofen slow-release capsules (150 mg) given either as a morning or a midday or an evening dose with that of ketoprofen conventional capsules (50 mg) 3X daily. All regimens were associated with a statistically significant improvement in pain at rest, pain on active motion, quality of sleep, and spine flexion, but there was no difference between treatments. The tolerance of ketoprofen was also similar in all groups. In view of the alleged better compliance of patients with once-daily medications, the new slow-release formulation of ketoprofen appears to be a useful alternative to the conventional capsules.

[Possible mechanism of action of drugs in the basic therapy of rheumatoid arthritis: effect on platelet aggregation]

As it is known that platelets play an important role in arising and maintaining the inflammation, the authors have studied "in vitro", the effect on platelet aggregation of three drugs (Sodium Aurothiomalate, Auranofin and Penicillamine) used in basic therapy of Rheumatoid Arthritis (RA). The drugs are used in different concentrations and at different times of preincubation. The study was based on the principle of Born and using the Coagg-Salus aggregometer. The platelet aggregation was induced by ADP 2.5 microM. The authors have demonstrated that the above-named drugs inhibit the platelet aggregation induced by ADP in different percentile, according to the concentrations adopted and the time of preincubation with platelets rich plasma. This study seems particularly interesting because it can offer a possible interpretation on the mechanism of action of basic therapy in RA.

[Determination of plasma levels of apolipoprotein E and of HDL-cholesterol in gouty patients]

The authors have examined the levels of the plasma cholesterol and triglycerides, of the plasma lipoprotein (HDL, LDL, VLDL) and of their main apolipoproteins (apo-A and apo-B) in a group of 34 patients affected by gout and in a population of healthy subjects considered as a contrast group, trying to establish a plausible dislipidemic factor which could justify the major occurrence of coronary heart disease in patients suffering from gout. Statistical analysis was done with the t-test. The group of patients affected by gout had significantly higher levels of triglycerides and VLDL-C and lower levels of HDL-C than the population of healthy subjects. The change of the lipoprotein pattern observed in the patients suffering from gout may be linked to reduction of the catabolism of the triglycerides rich lipoprotein. This reduction is probably linked to a inhibition of lipoprotein lipase.

[Determination of the rheumatoid factor in gouty patients]

The authors have examined the incidence of the rheumatoid factor in the serum of a group of 100 patients, 95 males and 5 females, suffering from gout, of whom only 6 suffered from chronic gout. The rheumatoid factor in the serum was measured by RA-test (1:40) and by Waaler-Rose test (1:32). The rheumatoid factor was not present in the examined subjects and so we can state that such serum parameter does not represent, for its negativity, a laboratory index of any evidence in the gout and it doesn't represent a reason for diagnostic doubts with other forms with the rheumatoid factor in the serum.

[Pathogenesis of ankylosing spondylitis: relation between HLA-B 27 and Klebsiella aerogenes]

The Authors attested the evidence of a cross-reactivity among some Klebsiella antigens and HLA B 27 positive lymphocytes, suggesting the hypothesis that Klebsiella may be an initiating agent in ankylosing spondylitis (AS). The Authors determined also serum antibody response against Klebsiella antigens in AS patients. The results obtained are discussed.