Occlusal dysesthesia: a qualitative systematic review of the epidemiology, aetiology and management

Occlusal dysesthesia refers to a persistent complaint of uncomfortable bite sensation with no obvious occlusal discrepancy. This systematic review aimed to draw a picture of such patients, to present an agreement of previously reported diagnostic criteria and to analyse the evidence level of the recommended management approaches. An electronic search for all relevant reports on occlusal dysesthesia was thoroughly performed based on previous nomenclatures (e.g. phantom bite, occlusal hyperawareness) in PubMed and The Cochrane Library in July, 2011. A total of 84 reports were matched, among which only 11 studies were included after a two-step (abstract and detailed full-text revision) screening process. Additionally, a thorough manual review of reference lists of the included reports enabled the inclusion of two additional studies. Data analysis revealed that 37 occlusal dysesthesia patients presented a mean age of 51.7 ± 10.6 years and were predominantly women (male/female: 1/5.1) with symptom duration of more than 6 years (average: 6.3 ± 7.5 years) and with concomitant psychological disturbances (e.g. mood disorders, somatoform disorders, personality disorders). Only four authors presented diagnostic criteria for occlusal dysesthesia, which served as the basis for an agreement in the diagnostic criteria. Treatment approaches included psychotherapy, cognitive/behaviour therapy, splint therapy and prescription of anti-depressants or anti-anxiety drugs. Classification of evidence level of management approaches, however, revealed that most of them were expert opinions with single- or multiple-case report(s). Future studies are necessary for a deeper understanding of the mechanisms behind the occlusal dysesthesia symptoms, and consequently, for improvements in evidence-based management approaches.

Role of mineralocorticoid receptor/Rho/Rho-kinase pathway in obesity-related renal injury

OBJECTIVE:

We examined whether aldosterone/Rho/Rho-kinase pathway contributed to obesity-associated nephropathy.

SUBJECTS:

C57BL/6J mice were fed a high fat or low fat diet, and mice on a high fat diet were treated with a mineralocorticoid receptor antagonist, eplerenone.

RESULTS:

The mice on a high fat diet not only developed obesity, but also manifested renal histological changes, including glomerular hypercellularity and increased mesangial matrix, which paralleled the increase in albuminuria. Furthermore, enhanced Rho-kinase activity was noted in kidneys from high fat diet-fed mice, as well as increased expressions of inflammatory chemokines. All of these changes were attenuated by eplerenone. In high fat diet-fed mice, mineralocorticoid receptor protein levels in the nuclear fraction and SGK1, an effector of aldosterone, were upregulated in kidneys, although serum aldosterone levels were unaltered. Furthermore, aldosterone and 3β-hydroxysteroid dehydrogenase in renal tissues were upregulated in high fat diet-fed mice. Finally, in cultured mesangial cells, stimulation with aldosterone enhanced Rho-kinase activity, and pre-incubation with eplerenone prevented the aldosterone-induced activation of Rho kinase.

CONCLUSION:

Excess fat intake causes obesity and renal injury in C57BL/6J mice, and these changes are mediated by an enhanced mineralocorticoid receptor/Rho/Rho-kinase pathway and inflammatory process. Mineralocorticoid receptor activation in the kidney tissue and the subsequent Rho-kinase stimulation are likely to participate in the development of obesity-associated nephropathy without elevation in serum aldosterone levels.

Self-reported remission, difficulty, and satisfaction with nonsurgical therapy used to treat anterior disc displacement without reduction

OBJECTIVE

The purpose of this study was to identify the appropriate treatment element for initial anterior disc displacement without reduction subjects.

STUDY DESIGN

Sixty-nine consecutive patients with temporomandibular joint disc displacement without reduction confirmed on magnetic resonance images were randomly divided into 3 experimental treatment groups. The treatment of group 1 consisted of short-term nonsteroidal anti-inflammatory drugs and self-care instructions (palliative care group); group 2, nonsteroidal anti-inflammatory drugs, self-care instructions, and occlusal appliance and mobilization therapy (physical medicine group); and group 3, no treatment (control group). Outcomes were assessed by means of a 5-item questionnaire that evaluated (1) symptom improvement, (2) difficulty of treatment, and (3) satisfaction with treatment during the 8-week observation period.

RESULTS

Improvement scores in the palliative care group were significantly better than those in the physical medicine group or the no-treatment group. Satisfaction scores showed no significant difference among the 3 groups. Difficulty from treatment for the physical medicine group was significantly greater than that for other 2 groups.

CONCLUSION

These data suggest that palliative care would be more appropriate as the initial therapy to treat painful anterior disc displacement without reduction.

Complete resection of leiomyosarcoma of the suprarenal inferior vena cava without caval replacement

Objective: To successfully treat leiomyosarcoma of the suprarenal segment of the inferior vena cava (IVC) by section without caval replacement.

Methods: Multiple occlusive clamps were used to maintain haemodynamic stability. Measurement of the stump pressure of the distal IVC and both renal veins was employed to evaluate venous congestion.

Results: Use of these techniques allowed avoidance of suprarenal IVC reconstruction in our patient, who had well-developed collateral veins.

Conclusions: Our experience indicates that reconstruction is not always mandatory.

Molecular Paramagnetic Semiconductor: Crystal Structures and Magnetic and Conducting Properties of the Ni(dmit)2 Salts of 6-Oxoverdazyl Radical Cations (dmit = 1,3-Dithiol-2-thione-4,5-dithiolate)

Four kinds of 1:1 and 1:3 salts of 3-[4-(trimethylammonio)phenyl]-1,5-diphenyl-6-oxoverdazyl radical cation ([1](+)) and its mono- and dimethyl derivatives ([2](+) and [3](+)) with Ni(dmit)(2) anions (dmit = 1,3-dithiol-2-thione-4,5-dithiolate) ([1](+)[Ni(dmit)(2)](-) (4), [2](+)[Ni(dmit)(2)](-) (5), [3](+)[Ni(dmit)(2)](-) (6), and [1](+)[Ni(dmit)(2)](3)(-) (7)) have been prepared, and the magnetic susceptibilities (chi(M)) have been measured between 1.8 and 300 K. The chi(M) values of salts 5 and 7 can be well reproduced by the sum of the contributions from (i). a Curie-Weiss system with a Curie constant of 0.376 (K emu)/mol and negative Weiss constants (THETAV;) of -0.4 and -1.7 K and (ii). a dimer system with strong negative exchange interactions of 2J/k(B) = -354 and -258 K, respectively. The dimer formations in Ni(dmit)(2) anions have been ascertained by the crystal structure analyses of salts 4-6. In salts 4 and 6, Ni(dmit)(2) dimer molecules are sandwiched between two verdazyl cations, indicating the formation of a linear tetramer in 4 and 6. The magnetic susceptibility data for salts 4 and 6 have been fitted to a linear tetramer model using an end exchange interaction of 2J(1)/k(B) = -600 K and a central interaction of 2J(2)/k(B) = -280 K for 4 and 2J(1)/k(B) = -30 K and 2J(2)/k(B) = -580 K for 6, respectively. The results of the temperature dependence of the g(T) value in salts 4-6 obtained by ESR measurement also support the above analyses. The 1:1 salts 4-6 are insulators. On the other hand, the conductivity of the 1:3 salt 7 at 20 degrees C was sigma = 0.10 S cm(-)(1) with an activation energy E(A) = 0.099 eV, showing the semiconductor property. Salt 7 is a new molecular paramagnetic semiconductor.

Four-year longitudinal course of TMD symptoms in an adult population and the estimation of risk factors in relation to symptoms

AIMS

To investigate the natural course of symptoms of temporomandibular disorders (TMD) in a non-patient population and to estimate the strength of the relationship between several hypothesized risk factors and precipitation and perpetuation of the symptoms.

METHODS

A total of 672 randomly selected citizens of Okayama City was requested to answer the same self-administered questionnaire that they had answered 4 years earlier. The mailed questionnaire failed to reach 58 subjects at the second survey, and 367 of the remaining subjects (59.8%) responded. The fluctuation of TMD symptoms was assessed by comparison of 6 pairs of answers for questions regarding temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise, headache, neck pain, and shoulder stiffness. Six factors (age under 40, female, clenching habit, history of extrinsic trauma, sleep disturbance, and family history of TMD) were tested for their relative risk in precipitating and perpetuating each TMD symptom by the use of its confidence interval to define significance.

RESULTS

The incidence of TMD symptoms ranged from 6.1% (TMJ pain) to 12.9% (TMJ noise). More than half of the subjects who had reported TMJ and neck pain at the initial survey no longer reported these symptoms at the second survey, whereas TMJ noise and shoulder stiffness remained in more than 70% of the subjects. Individuals under 40 years old had a 3.3:1 increased risk of precipitating TMJ noise (P < 0.01), individuals with a history of extrinsic trauma had a 2.85:1 increased risk of precipitating limited mouth opening (P < 0.01), and females had a 2.81:1 increased risk of perpetuating TMJ pain (P < 0.01).

CONCLUSION

The possible etiologic significance of these factors in TMD should be validated by future research.

Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction

The common methods for treating anterior disk displacement without reduction (ADDwor) are not based on randomized controlled clinical trials. Our study evaluated non-surgical treatments in 69 MRI-confirmed ADDwor subjects (m/f = 6/63). Subjects were randomly assigned to a control group and one of two treatment groups. Outcomes included maximum mouth opening, visual analogue scale of pain, and daily activity limitation. Calibrated examiners collected data at the initial interview and at 0, 2, 4, and 8 weeks of treatment. At the eight-week point, within-group improvements were present for all variables, for all groups. Between-group differences were not highly evident, with only mean daily activity limitation for the self-care/NSAID group being significantly lower than that of the occlusal appliance/jaw mobilization + self-care/NSAID group at the two- and four-week time-points. These results suggest that ADDwor subjects will improve with only minimal treatment intervention, and no significant difference was evident for the treatments tested and the control condition.

The long-term effect of occlusal therapy on self-administered treatment outcomes of TMD

Because of a lack of substantial scientific data, the efficacy of occlusal therapy for the management of temporomandibular disorders (TMD) is still controversial. Of a total of 1405 consecutive TMD patients examined over the last 10 years, 369 (26.3%) were determined to have completed treatment at least 1 year before the present survey. A sample questionnaire was mailed to each patient in this sample population. The questionnaire failed to reach 46 patients; of the 323 patients who received the questionnaire, 260 (80.5%) responded. The mean duration of time between their last visit and this survey was 3.7 years. The questionnaire elicited information on treatment outcomes, present treatment needs, and current signs and symptoms. Participants were divided into two treatment groups: (a) those who underwent some occlusal therapies (Phase II) following successful reversible therapies (Phase I) (20 men and 114 women); and (b) those who underwent reversible therapy only (33 men and 93 women). Participants were further differentially diagnosed into five diagnostic subgroups of TMD, based on the clinical examination at the initial visit, tomography, and, for some patients, magnetic resonance imaging. The subgroups included myalgia, arthralgia, anterior disc displacement with an without reduction, and osteoarthritis/osteoarthrosis. Only 12.3% of the total population surveyed reported lack of improvement to an acceptable level and further need for treatment. The remaining patients reported satisfactory results in the reduction of TMD symptomatology and no further need for treatment, because their symptoms had either disappeared or improved to an acceptable level. Regardless of treatment groups and diagnostic subgroups, the current subjective signs and symptoms were negligible in most patients, and mean mouth openings were in the normal range. No particular diagnostic subgroups seemed to have significantly better outcome following Phase II occlusal therapy. These results suggest that the majority of TMD signs and symptoms improve to an acceptable level with only reversible therapy, and the long-term value of additional occlusal therapy following reversible therapy is minimal. Therefore, permanent occlusion-changing therapies apparently are not generally needed to maintain TMD symptom reduction over time.

Effect of skeleton size on the performance of octadecylsilylated continuous porous silica columns in reversed-phase liquid chromatography

We prepared continuous porous silica rods that had silica skeletons with sizes of 1.0-1.7 microns and through-pores of 1.5-1.8 microns, and evaluated their performance as a column in reversed-phase liquid chromatography. The mesoporous silica monoliths (mesopore size: 14 or 24 nm) were derivatized to C18 phase by on-column reaction with octadecyldimethyl-N,N-diethylaminosilane. The C18 silica rods gave minimum plate heights of 10-15 microns for aromatic hydrocarbons in 80% methanol and of 20-30 microns for insulin in acetonitrile-water mixtures in the presence of trifluoroacetic acid. The performance of the silica rods at a high flow-rate was much better than that of conventional columns packed with 5 microns C18 silica particles with pores of 12 or 30 nm, especially for high-molecular-mass species. Silica rods with the smaller sized silica skeletons resulted in Van Deemter plots showing a minimum plate height linear velocity of the mobile phase and a smaller dependence of plate height on the linear velocity. Separation impedance of less than 1000 was achieved with the continuous silica columns. The higher performance and lower pressure drop of silica rods at high flow-rates compared with particle-packed columns is provided by the small silica skeletons and large through-pores.

An experimental study on intestinal vascular lesions: a comparison between the effects of arterial and venous occlusion in the acute phase

In order to clarify what early ischemic changes are produced by venous interruption in the intestine, intestinal vascular lesions caused by peripheral venous ligation were compared with those caused by arterial ligation in rabbits. With less than 30 min ligation, there were only 4 specimens from a total 13 without injury following venous ligation, whereas there were 7 from a total 11 without injury following arterial ligation. After 30 min venous ligation, both the mucosal and submucosal layers of all 10 specimens were affected, while following arterial ligation, 3 of the 11 specimens showed no histological changes. Moreover, in 3 of the remaining 8 specimens from the latter group, the injury was confined to within the mucosal layer. Thus, in cases of venous interruption, intestinal injury might be evoked earlier with more severe damage than in cases of arterial interruption.

Clinical trials of long-term RF local hyperthermia for advanced gastric cancer

The effect of local hyperthermotherapy (HT) using 13.56-MHz radiofrequency (RF) capacitive heating was evaluated in 25 patients with unresectable or recurrent gastric cancer. HT was carried out once to 3 times a week for a duration of one hour at each session. Patients who underwent RF-HT frequently showed maintenance of performance status, symptomatic improvement and a reduction in tumor size. Moreover, the survival time of 9 patients who had numerous metastases to the distant peritoneum was significantly high (p less than 0.01), compared with 42 historical control patients who also had massive peritoneal dissemination, but had not received HT. The results of this study therefore indicate RF-HT to be a favorable modality in the palliative treatment of patients with far-advanced gastric cancer.

[Experimental and clinical studies of cefmenoxime in the field of obstetrics and gynecology]

The study group was organized to evaluate the usefulness of cefmenoxime (CMX) injection, a new synthetic cephalosporin, for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made by the society and the following results were obtained. 1. The peak distribution of CMX's MIC for E. coli, Klebsiella sp., Enterobacter sp., Bacteroides sp. and Peptococcus sp. isolated from obstetrical and gynecological infections with relatively high frequencies area 0.1, less than or equal to 0.05, 0.2, 3.13, 1.56 micrograms/ml, respectively, with an inoculation of 10(6) cells/ml. 2. When 1 g of CMX is administered by intravenous drip infusion for 1 hour, the maximum concentrations in various tissues of female genital organs were as follows: 14.2 and 13.2 micrograms/g in ovary and oviduct, respectively, at 1.20 hours after the start of administration, and 16.9 and 26.3 micrograms/g in corpus uteri and cervix uteri, respectively, after 1 hour. As for the transfer to the exudate in the pelvic dead cavity, the peak concentration was 15.6 micrograms/ml after 2.13 hours. 3. In the clinical studies, CMX was given to 258 cases with female genital organ infections and others. As for the clinical effects, with exclusion of 3 cases in which other antibiotics are concomitantly used, responses were excellent in 76 cases, good in 162 cases and poor in 17 cases, among 255 cases in total. The efficacy rate was 93.3%. The efficacy rates by diseases were 97.1% (68/70) for intrauterine infections, 88.8% (79/89) for intrapelvic infections, 98.4% (62/63) for adnexitis, and 100% (23/23) for infections of external genital organs. As for the clinical effects on causative bacteria, the efficacy rates were 100% (19/19) for single infections due to Gram-positive bacteria, 94.8% (55/58) for single infections due to Gram-negative bacteria, and 88.2% (15/17) for single infections due to anaerobic bacteria. And its efficacy rates were 89.6% (69/77) for mixed infection cases. Side effects were observed in 2 cases (0.8%); 1 case with eruption, and 1 case with diarrhea and vomiting. As for abnormal laboratory findings, lower white blood cell count was observed in 2 cases and elevation of the values regarding hepatic functions in 9 cases. All cases were returned to the normal after the completion of the administration. Cefmenoxime showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that cefmenoxime will be useful addition to the antibiotics for the therapy of these infections.

[Effects of bromocriptine on FSH and LH secretion in women with euprolactinemic anovulation (author's transl)]

A few reports have been given that Bromocriptine effected not only on the hyperprolactinemic anovulations but also on the euprolactinemic anovulations. This study was performed to examine the underlying mechanism, 5 mg of Bromocriptine was daily administered for 30 days to 38 women with euprolactinemic anovulations. The basal secretions of FSH, LH and Prolactin and also the responsiveness to LH-RH, TRH and estradiol were examined. 31.6% of oligomenorrhea, anovulatory cycle and Ist. grade amenorrhea showed ovulatory cycles, however, no ovulations were observed in IInd. grade amenorrhea. The basal levels of FSH and LH significantly increased but the basal levels of Prolactin decreased by Bromocriptine. The responsiveness of FSH to LH-RH was markedly promoted but LH showed no significant change. Serum FSH was suppressed in estrogen loading test after Bromocriptine, which was poorly changed before. On the other hand, serum LH was markedly elevated by estradiol after Bromocriptine, which showed poor elevation before. These results conclude that: 1) Ovulation is induced by Bromocriptine administration in euprolactinemic anovulations. 2) Bromocriptine promotes the FSH and LH secretion from the pituitary and also promotes the reserve of FSH in the pituitary. 3) Bromocriptine promotes the sensitivity of the estrogen feedback in the hypothalamus.

Health effects of acrylonitrile in acrylic fibre factories

The relationship between the degree of exposure and biological effects of acrylonitrile (AN) was studied in 102 workers whose exposure period exceeded five years, and in 62 matched controls, all of whom had been randomly sampled from six acrylic fibre factories in Japan. The six factories were classified into three groups on the basis of AN concentration at workplaces. The most highly exposed group of subjects showed an eight-hour average AN concentration of 4-2 ppm by personal sampling, a mean urinary AN concentration of 360 microgram/1 and a mean urinary thiocyanate concentration of 11-4 mg/1. Medical examination, including the indocyanine green excretion test and multiple clinical chemistry determinations, failed to detect any health effect attributable to AN. Slight liver damage may possibly occur in more highly exposed workers. Urinary AN and thiocyanate determinations may provide more accurate estimates of low-grade exposure (less than 5 ppm).