Electromyographic evaluation of a patient treated with extraoral traction: a case report.

BACKGROUND: This work seeks to provide information on the utility of surface electromyography (SEMG) as an aid for diagnosing orthodontic conditions. Classic orthodontic monitoring by radiography, plaster models, cephalometry, and photography can be improved by using SEMG before and during treatment, to prevent clinical worsening and relapses. CASE REPORT: This paper presents the SEMG results for a 10-year-old female patient, orthodontically treated by extraoral traction (EOT). Significant muscular variations in the patient's EMG were observed as she changed different postures and as headgear device was used. CONCLUSION: SEMG should be performed prior to the orthodontic treatment to assess the neuromuscular patient's pattern, in order to prevent strain induced by extraoral forces. EMG can be a valid aid for evaluating the patient's neuromuscular condition before, during, and after orthodontic treatment.

TENS effects on salivary stress markers: A pilot study.

Transcutaneous electrical nerve stimulation (TENS) is extensively used as pain relief through endorphins release. Moreover, recent findings showed a role in the activation of the autonomic nervous system (ANS); it was evidenced by modification in the heart rate variability and ANS-related marker. The objective of this pilot study is to evaluate salivary alpha amylase (sAA) as a marker of stress in two groups of healthy subjects, one receiving ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS) and one without stimulation. Sixty healthy people were enrolled. The test group consisted of 30 participants (15 men, 15 women). The control group consisted of 30 participants (15 men, 15 women). Statistical analysis showed that sAA levels were statistically different between men and women independently from TENS; we hypothesize that treatment could influence sAA levels because it is thought to activate µ opioid receptors. The results of this study seem to indicate that the analysis of sAA, through a non-invasive saliva sample, could be an efficient aid for understanding the functions of the autonomic nervous system.

Trigeminal electrical stimulation with ULFTENS of the dorsal anterior mucosal surface of the tongue: Effects on Heart Rate Variability (HRV).

BACKGROUND: Trigeminal electrical stimulation of the dorsal anterior mucosal surface of the tongue has demonstrated its efficacy in a variety of neurological disorders in which anatomical or functional alterations are present. The pathogenesis of such disorders is often linked to altered arousal circuits, and the benefits of tongue stimulation are attributed to the rebalancing of this system. Dental ULFTENS shows efficacy in acting on the muscular, autonomic system and control of the descending pathways that modulate pain. It is administered at the skin level in the area anterior to the tragus and not on the mucosal surface of the tongue. The use of this stimulation technique at the tongue level could have new applications and clinical results if it were able to reduce the activity of arousal circuits. MATERIAL AND METHOD: A new intraoral device allowed electrical stimulation of the dorsal anterior mucosa of the tongue in 32 healthy young women. The effects on HRV were monitored by photoplethysmographic wave (PPG) and compared with a control group. The HRV parameters studied were RMSSD, HF, LF, LF/HF, REC, DET. RESULTS: The group of stimulated subjects showed a significant change in some of the HRV parameters that was maintained even in the epoch after the end of electrical stimulation. This effect can be considered as a vagal activation and a change of HRV trend. The control group of unstimulated subjects showed an opposite trend. There were no undesirable or annoying effects of stimulation. CONCLUSION: Stimulation of the dorsal anterior (trigeminal) mucosal surface of the tongue with ULFTENS applied with an intraoral device was shown to be able to increase HRV.

Prevalence of myopia in a population with malocclusions.

AIM: The purpose of this study was to investigate the prevalence of myopia among a paediatric population with malocclusions. MATERIALS AND METHODS: A total of 322 consecutive patients of the department of Orthodontics and Gnathology, Dental Clinic, University of L'Aquila, were enlisted for the study and 292 were selected according to the exclusion criteria. Pretreatment diagnostic data, which included radiographic cephalometric and dental cast evaluation, were recorded and presence of myopia was assessed through an ophthalmological examination. Differences in the prevalence of myopia by sex and malocclusion were analysed by using Pearson's chi-square and Fisher's exact tests. RESULTS: According to the sagittal malocclusion, patients were classified as Class I (N=162), Class II division 1 (N=75), Class II division 2 (N=38), or Class III (N=12). No gender influence was found for myopia or malocclusion. No differences were recorded when analysing the influence of sex on the prevalence of myopia in classes of malocclusion. A statistical significant higher prevalence was found for subjects showing myopia in Class II division 1 malocclusion, while no other significant differences were found for prevalence in the other classes of malocclusions. DISCUSSION: Few studies investigated a possible relationship between the ocular and stomatognathic system, and no data are available in the scientific literature. A higher prevalence of myopia was found in patients with Class II division 1: as expected no other significant association was found. CONCLUSION: The findings of the present study suggest a possible association between myopia and Class II, but further studies are needed to confirm and explain this observation.

CD20-targeted measles virus shows high oncolytic specificity in clinical samples from lymphoma patients independent of prior rituximab therapy.

New therapeutic modalities for B-cell non-Hodgkin's lymphomas (B-NHL) are needed, especially for relapsing and aggressive subtypes. Toward this end, we previously generated a fully CD20-targeted and armed measles virus, and tested its efficacy in a xenograft model of mantle cell lymphoma (MCL). Here, we quantify its spread in peripheral blood mononuclear cells and/or tissue of patients with different histological subtypes of B-NHL, including splenic marginal zone lymphoma (SMZL). CD20-targeted MV efficiently infects lymphoma cells from SMZL and MCL while sparing most cells in the CD20-negative population, in contrast to the parental vaccine-lineage MV, which infects CD20-positive and CD20-negative cells equally. Rituximab therapy (4-8 months before relapse) did not interfere with the infectivity and specificity of MV(green)H(blind)antiCD20 in patient lymphoma samples. Thus, CD20-targeted oncolytic virotherapy is likely to be effective after previous antiCD20 therapy.

Mantle cell lymphoma salvage regimen: synergy between a reprogrammed oncolytic virus and two chemotherapeutics.

Measles virus (MV)-PNP H(blind)antiCD20 is a CD20-targeted and prodrug convertase-armed MV that temporarily controls growth of lymphoma xenografts in severe combined immunodeficiency (SCID) mice in combination with fludarabine phosphate (fludarabine). Herein, we examine the replication of this targeted virus and of a vaccine-lineage MV in disease bulks and circulating cells from mantle cell lymphoma (MCL) patients, and show that only the targeted virus is specific for CD20-expressing cells. We then assessed the efficacy of different regimens of administration of this virus in combination with fludarabine and cyclophosphamide (CPA) in an MCL xenograft model. We show that CPA administration before the beginning of virus treatment enhances oncolytic efficacy, likely through temporary immunosuppression. An interval of 1 week between intravenous virus administration and fludarabine treatment further enhanced oncolysis, by synchronizing maximum prodrug convertase expression with fludarabine availability. Finally, three 23-day courses of triple sequential treatment with CPA, virus and fludarabine treatment resulted in complete regression of the xenografts. Secondary disease symptoms interfered with survival, but average survival times increased from 22 to 77 days. These studies document a reprogrammed oncolytic virus, consolidating the effects of two chemotherapeutics, a concept well suited for a phase I clinical trial for MCL patients for whom conventional therapies have failed.

The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide.

OBJECTIVE: To update the follow-up of the Euro-Lupus Nephritis Trial (ELNT), a randomised prospective trial comparing low-dose (LD) and high-dose (HD) intravenous (IV) cyclophosphamide (CY) followed by azathioprine (AZA) as treatment for proliferative lupus nephritis. PATIENTS AND METHODS: Data for survival and kidney function were prospectively collected during a 10-year period for the 90 patients randomised in the ELNT, except in 6 lost to follow-up. RESULTS: Death, sustained doubling of serum creatinine and end-stage renal disease rates did not differ between the LD and HD group (5/44 (11%) vs 2/46 (4%), 6/44 (14%) vs 5/46 (11%) and 2/44 (5%) vs 4/46 (9%), respectively) nor did mean serum creatinine, 24 h proteinuria and damage score at last follow-up. Most patients in both groups were still treated with glucocorticoids, other immunosuppressant agents and blood pressure lowering drugs. After 10 years of follow-up, the positive predictive value for a good outcome of an early drop in proteinuria in response to initial immunosuppressive therapy was confirmed. CONCLUSION: The data confirm that a LD IVCY regimen followed by AZA-the "Euro-Lupus regimen"-achieves good clinical results in the very long term.

Measles virus glycoprotein complex assembly, receptor attachment, and cell entry.

Measles virus (MV) enters cells by membrane fusion at the cell surface at neutral pH. Two glycoproteins mediate this process: the hemagglutinin (H) and fusion (F) proteins. The H-protein binds to receptors, while the F-protein mediates fusion of the viral and cellular membranes. H naturally interacts with at least three different receptors. The wild-type virus primarily uses the signaling lymphocyte activation molecule (SLAM, CD150) expressed on certain lymphatic cells, while the vaccine strain has gained the ability to also use the ubiquitous membrane cofactor protein (MCP, CD46), a regulator of complement activation. Additionally, MV infects polarized epithelial cells through an unidentified receptor (EpR). The footprints of the three receptors on H have been characterized, and the focus of research is shifting to the characterization of receptor-specific conformational changes that occur in the H-protein dimer and how these are transmitted to the F-protein trimer. It was also shown that MV attachment and cell entry can be readily targeted to designated receptors by adding specificity determinants to the H-protein. These studies have contributed to our understanding of membrane fusion by the glycoprotein complex of paramyxoviruses in general.

Antiphospholipid antibody profile: implications for the evaluation and management of patients.

According to the classification criteria of antiphospholipid syndrome, lupus anticoagulant, anticardiolipin and anti-beta(2) glycoprotein I antibody assays are independent risk factors for the occurrence of vascular thrombosis and pregnancy loss. However, it is generally accepted that patients carrying multiple positivity have more a severe disease and higher recurrence rate despite treatment. On the other hand, the diagnostic value of a positive result in one only assay is more controversial, particularly in the presence of clinical manifestations such as deep vein thrombosis or early miscarriages, which are rather common in the general population. In this review we speculate on current and future strategies to interpret different antiphospholipid antibody profiles in the clinical practice.

[Antiphospholipid antibody: laboratory, pathogenesis and clinical manifestations]. / Gli anticorpi antifosfolipidi: il laboratorio, la patogenesi e la clinica (cosa è utile sapere degli anticorpi antifosfolipidi).

Antiphospholipid antibodies (aPL) represent a heterogeneous group of antibodies that recognize various antigenic targets including beta2 glycoprotein I (beta2GPI), prothrombin (PT), activated protein C, tissue plasminogen activator, plasmin and annexin A2. The most commonly used tests to detect aPL are: lupus anticoagulant (LAC), a functional coagulation assay, anticardiolipin antibody (aCL) and anti-beta2GPI antibody (anti-beta2GPI), which are enzyme-linked immunoassay (ELISA). Clinically aPL are associated with thrombosis and/or with pregnancy morbidity. Apparently aPL alone are unable to induce thrombotic manifestations, but they increase the risk of vascular events that can occur in the presence of another thrombophilic condition; on the other hand obstetrical manifestations were shown to be associated not only to thrombosis but mainly to a direct antibody effect on the trophoblast.

Effect on anterior temporalis surface EMG of eyes open-closed condition.

BACKGROUND: The use of rest surface EMG of jaw elevator muscles is still debated. The low voltage recorded in anterior temporalis muscle by electromyography (EMG) in rest position could be affected by electronic noise or by activity coming from other muscles. Our goal was to evaluate the physiological behaviour of the anterior temporalis by surface EMG at rest mandible position during open or closed eyes condition in healthy young subjects without both malocclusion and visual defect. MATERIALS AND METHODS: Surface EMG of anterior temporalis, masseter, digastric, sternomastoid muscle and mandible kinesiographic movement were recorded in 20 young, healthy individuals without both malocclusion and visual defect during open-closed eyes condition. RESULTS: No significant difference was found in surface EMG of anterior temporalis comparing eyes closed to eyes open condition. CONCLUSION: Physiology of open-closed eyes in healthy, young subjects without malocclusion or visual defect does not imply a change in surface EMG of anterior temporalis muscle.

Pseudotyping lentiviral vectors with the wild-type measles virus glycoproteins improves titer and selectivity.

We pseudotyped HIV-1 vectors with cytoplasmic tail-truncated envelope glycoproteins of a wild-type (WT) measles virus (MV). The particles entered the lymphatic cells exclusively through the signaling lymphocyte activation molecule (SLAM, CD150), whereas particles pseudotyped with the MV vaccine strain glycoproteins also recognized the ubiquitous membrane cofactor protein (CD46) as receptor and had less specific cell entry. MV(WT)-HIV vectors reached titers of 10(8) t.u. ml(-1), which were up to 10-fold higher than those of MV(Vac)-HIV vectors, and discriminated between SLAM-positive and SLAM-negative cells, also in mixed cell cultures. As these vectors transduce primary human cells more efficiently than vesicular stomatitis virus-G pseudotyped vectors do, they are promising candidates for gene transfer to human lymphocytes and certain epithelial cells.

Methylenetetrahydrofolate reductase polymorphisms and methotrexate: no association with response to therapy nor with drug-related adverse events in an Italian population of rheumatic patients.

OBJECTIVE: MTHFR is an enzyme involved in the folate pathway. It has been suggested that common polymorphisms in its gene (C677T and A1298C) could be related to different methotrexate (MTX) response and toxicity in rheumatoid arthritis (RA) patients. Agreement has not been found yet and there is no data on rheumatic Italian patients. The aim of this study is to determine if a genetic screening can help in planning the treatment in these patients. METHODS: We enrolled 84 Northern Italian patients affected by RA (n=79), psoriatic arthritis (n=4) and ankylosing spondylitis (n=1), who received MTX. Subjects who achieved at least ACR20 response in 6 months and maintained it during the following 6 months were defined as "responders"; those who did not obtain a disease control after 6 months of MTX were classified as "non responders". Patients who experienced MTX adverse events were defined "with toxicity", those who did not, as "without toxicity". Genotypes were determined by polymerase chain reaction. RESULTS: Genotype frequency was consistent with that reported in a healthy population from Italy. We did not find any statistically significant difference in genotype/allele distribution between the groups. In patients receiving folic acid supplementation MTX toxicity was recorded only in 18 cases (24%), while all the 8 patients not receiving it experienced MTX adverse events (p=0.00). CONCLUSION: In our study we did not find any association between MTHFR genotype/allele and MTX response or toxicity. At the moment there is not sufficient evidence for MTHFR screening in patients who are candidate for MTX.

[Methylenetetrahydrofolate reductase polymorphisms in methotrexate treatment of rheumatoid arthritis patients. Review of the literature and personal experience]. / I polimorfismi della metilentetraidrofolatoreduttasi (MTHFR) nel trattamento con methotrexate di pazienti con artrite reumatoide. Revisione della letteratura ed esperienza personale.

Methotrexate is still a mainstay of rheumatoid arthritis treatment, but a significant variability in drug response is observed among patients. It has been proposed that C677T and A1298C polymorphisms of methylenetetrahydrofolate reductase (MTHFR), an enzyme involved in the folate pathway, could be related to its efficacy and toxicity. Many studies have investigated the predictive value of such polymorphisms for Methotrexate outcome, though with discordant results. Our experience on 79 patients did not find any significant association between genotype and drug response and the review of the literature did not provide sufficient evidences to support the use of MTHFR genetic screening in clinical practice.

How 'hidden' reading frames are expressed.

Secondary reading frames, 'hidden' under other reading frames, are used for coordinated expression of proteins in several eukaryotic viruses. In some genes, ribosomal frameshifting and initiation or reinitiation of protein synthesis on internal AUG codons are translational mechanisms allowing access to such 'hidden' reading frames. In others, secondary reading frames are translated from alternatively spliced or edited mRNAs.

Biased (A-->I) hypermutation of animal RNA virus genomes.

RNA genomes evolve largely on the basis of single point mutations introduced by imprecise RNA polymerases, or by recombination. Clusters of certain transitions (biased hypermutations) were detected first in the genomes of persistent viruses, and in the past year have also been found in the genomes of lytic RNA viruses. A cellular RNA-modifying enzyme probably introduces the clustered transitions and thus contributes to the evolution of RNA viruses.

Isotype switching and titer variation of anti-Ro/SSA antibodies over time in 100 patients with undifferentiated connective tissue disease (UCTD).

OBJECTIVE: To correlate the clinical course of the disease with the titer, the isotype profile and the switch of the anti-Ro/SSA antibodies in a cohort of patients affected by UCTD. METHODS: One hundred selected patients with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis (CIE), and affected by UCTD with a mean follow-up of 7.6 years (SD 4.8 yrs.), were studied. The titer of IgA, IgG and IgM anti-Ro/SSA antibodies was determined in two different sera, obtained at the time of diagnosis and at the last visit, by ELISA with Ro/SSA recombinant proteins as substrate. RESULTS: Thirty-five patients evolved from UCTD to a different connective tissue disease, while 65 showed a stable disease. Anti-Ro/SSA antibodies were detected in 91% and 97% of the patients, at baseline and during follow-up, respectively. IgG dominates the anti-Ro response. The titer of IgA, IgM and IgG anti-Ro/SSA did not differ significantly between the two groups of patients with UCTD. An increasing trend of IgG and IgA anti-Ro/SSA titer could be detected in patients evolving in primary Sjögren's Syndrome (pSS), but only the increase of IgG anti-Ro/SSA was significant (p=0.0235). CONCLUSION: IgG dominates the anti-Ro/SSA response in patients with UCTD. No substantial change of the antibody isotype against Ro/SSA peptides could be observed during follow-up. The titer of IgG anti-Ro/SSA significantly raised in the group of patients evolving in pSS.

[Anti-TNFalpha agents in elderly patients with rheumatoid arthritis: a study of a group of 105 over sixty five years old patients]. / I farmaci biologici anti-TNFalpha nel paziente anziano affetto da artrite reumatoide: studio di una coorte di 105 pazienti ultra-sessantacinquenni.

OBJECTIVE: To evaluate the efficacy and the safety of anti-TNF alfa treatment in elderly patients (>/=65 years old) with active rheumatoid arthritis (RA), in comparison with younger (17-65 years old). METHODS: We considered retrospectively 295 patients, affected by RA and treated with anti-TNF alfa drugs. They were divided in two groups, according to their age, and followed up for two years: over-65-years old patients (190) and under-65-years old patients (105). Effectiveness of drugs was assessed analyzing RA disease activity (DAS28, DAS44, SDAI), functional status (HAQ) and serological parameters (CRP) before and after anti-TNF alfa therapy. Safety was studied considering discontinuation rate of biological disease-modifying antirheumatic drugs, and collateral events rate. RESULTS: At baseline, elderly patients showed higher disease activity's score (DAS 28, DAS44, SDAI, HAQ) with important loss of articular function (worse quality of life, HAQ) than younger patients (p<0.05). During the therapy, improvement in clinical parameters was observed (DAS28, DAS44 and SDAI) with no significant difference between the two groups. In elderly patients disability index, on the contrary, improved less than in younger (p<0.05). After treatment, also CRP decreased less in elderly patients (p<0.05). During the follow-up, 74 over-65-years old patients (38.95%) and 116 under-65-years old patients (38.05%) discontinued anti-TNF alfa therapy because of loss of efficacy (20.52% vs 11.42%), severe adverse events (17.34% vs 25.67%), voluntary discontinuation or good clinical response (1% vs 0.95%). No differences were shown about the frequency and reasons of anti-TNF alfa withdrawal (p>0.05). CONCLUSIONS: Anti-TNF alfa treatment was efficacious and safe in both groups of patients. These drugs induced improvement in disease activity, apart from the age. No functional improvement was observed in HAQ, showing the irreversible loss of articular function and the incomplete recovery in elderly patients. Age doesn't interfere with the possibility to treat elderly patients with anti-TNF alfa drugs.

Neuromuscular diagnosis in orthodontics: effects of TENS on the sagittal maxillo-mandibular relationship.

AIM: This study was conducted in order to assess the changes in the occlusal position of the mandible after ULF (Ultra Low Frequency)-TENS relaxing procedure in subjects in pubertal growth phase with diagnosed Angle Class II division 1 and mandibular dentoalveolar retrusion. MATERIALS AND METHODS: This study was performed on 19 patients (13 females, 6 males) with an Angle Class II division 1, aged between 10 and 15 years old (mean age 12.26, SD 1.32), characterised by mandible dentoalveolar retrusion and optimal vertical facial dimension, diagnosed by clinical and cephalometric evaluation. Diagnostic neuromuscular registrations were made for all subjects. The casts were mounted on articulator in habitual intercuspal position with a tooth-guided wax bite registration. Reference points were chosen at molar level. Subsequently the same casts were mounted in myocentric position and compared to the habitual intercuspal position, assessing the sagittal shift after TENS procedure. STATISTICS: Mean and standard deviation were calculated on the amount of shifting at the left molar reference point after TENS procedure. Analysis of variance (ANOVA), using STATA statistics package, was carried out in order to evaluate the influence of sex and age on the amount of molar shift. RESULTS: Nine subjects showed, in the sagittal plane, a forward mandibular shift in neuromuscular myocentric position compared to habitual intercuspal position. Six subjects showed no differences between habitual and myocentric position in the sagittal plane. Four individuals showed a backward mandible shift after TENS indicating worsening of the II molar class in the sagittal plane. CONCLUSION: This study suggests that TENS recorded occlusion in subjects with Class II division 1 with mandible dentoalveolar retrusion allows to visualise an unusual trend of growth. The advancements of the mandible were not taken into account. These results could offer new diagnosis and prognosis methods for Class II malocclusions.

Osteopathic manipulative treatment (OMT) effects on mandibular kinetics: kinesiographic study.

AIM: The aim of this study was to evaluate the effects of Osteopathic Manipulative Treatment (OMT) on mandibular kinematics in TMD patients. METHODS: The study was conduced on 28 children with non-specific TMD symptoms, limited mouth opening, history of trauma (delivery trauma, accident trauma). Patients were randomly divided into two groups: an OMT group (study group) and a no-intervention group (control group). All subjects underwent a first kinesiographic recording to evaluate the amplitude and velocity of maximal opening-closing movements. Study group patients underwent a second kinesiographic recording 2 months after OMT. Control group patients were submitted to a control kinesiographic recording six months after the first one. Kinesiographic tracings were acquired using the K7I system. RESULTS/STATISTICS: The kinesiographic data of the study group showed a moderate statistically significant difference (p<.07) of maximal mouth opening (MO) parameter and a high statistically significant difference (p<.03) of maximal mouth opening velocity (MOV) parameter. No statistically significative difference (null hypothesis confirmed) of kinesiographic parameters in the control group was observed. CONCLUSION: The results of this study suggest that OMT can induce changes in the stomatognathic dynamics, offering a valid support in the clinical approach to TMD. Multifactorial genesis of chronic disorders is also confirmed.