Principal component analysis of the biopsychosocial features relevant to temporomandibular disorders.

OBJECTIVES: This study aimed to explore the dimensionality of three biopsychosocial constructs with multiple subdimensions, including the Symptom Checklist-90-Revised (SCL-90R), pain catastrophizing scale (PCS) and Pittsburgh Sleep Quality Index (PSQI), and to identify the latent dimensions of five biopsychosocial constructs (SCL-90R, PCS, PSQI, pain severity, and pain interference) using the principal component analysis (PCA) in patients with temporomandibular disorder (TMD). SUBJECTS AND METHODS: A secondary analysis of a previous cross-sectional study comprising 1488 patients with painful TMD was conducted using multiple questionnaires. RESULTS: PCA of the SCL-90R and PCS identified one factor, which explained 60.8% and 80.2% of the total variance, respectively. For the PSQI, three factors explained 61.3% of the variance. PCA resulted in two main orthogonal components: factor 1, which comprised a combination of scores for pain severity, pain interference and global scores of PCS, and PSQI; and factor 2, which comprised one measure of the SCL-90R. Factors 1 (46.5%) and 2 (20.0%) explained 66.5% of the total variance. CONCLUSION: The findings of this study revealed that five measures can be primarily categorised into two latent constructs of the psychological (affective) and pain-related (sensory-cognitive) dimensions. These core components could be applied in clinical settings and for research purposes.

Influence of government-driven quality assessment program on patients with chronic obstructive pulmonary disease.

BACKGROUND: The Korean Health Insurance Review and Assessment Service (HIRA) has launched the Chronic Obstructive Pulmonary Disease (COPD) Quality Assessment Program (CQAP) since 2014. We aimed to reveal the influence of this national program on clinical outcomes and the burden of COPD in Korea. METHODS: The CQAP is conducted annually. We used healthcare claims data linked with the results of the program provided by HIRA between May 2014 and April 2017. Patients were considered to have COPD if they visited a hospital for COPD management during the assessment term. Those who visited a medical institution for COPD and were prescribed COPD medications at least twice were assessed by the CQAP (assessed subjects, AS; not-assessed subjects, NAS). CQAP evaluated the pulmonary function test conduction rate, regular visitation rate, and prescription rates of COPD medications. RESULTS: Among the 560,000 patients with COPD, about 140,000 were assessed by the CQAP annually. In both groups, the pulmonary function test conduction rate and inhaled bronchodilator prescription rate improved since 2014. Compared to the NAS group, the risk of admission and all-cause mortality rate in the AS group were significantly reduced by 21.2% and 40.7%, respectively. In patients who were assessed for 3 consecutive years, all of the above variables were high at baseline and were not improved much from implementation of CQAP. In matching analysis, we observed this improvement to be limited in the COPD quality assessment year. CONCLUSIONS: The CQAP by the health insurance bureau has improved the management protocol and prognosis of COPD.

Profiling thermal pain using quantitative sensory testing in patients with trigeminal nerve injury.

OBJECTIVES: To investigate the thermal pain phenotypes using QST in patients with unilateral trigeminal nerve injury and to explore whether these different thermal pain phenotypes are associated with clinical and psychophysical characteristics. METHODS: This retrospective study included 84 patients diagnosed with posttraumatic trigeminal neuropathy involving inferior alveolar nerve (IAN) and lingual nerve (LN). Data on clinical characteristics, subjective symptoms including hypoesthesia, dysesthesia, and allodynia, and objective signs using thermal QST were collected and explored. RESULTS: Three heat (heat hypoalgesia, heat hyperalgesia, and within normal range) and cold pain phenotypes (cold hypoalgesia, cold hyperalgesia, and within normal ranges) were identified, respectively. Thermal hypoalgesia was more frequently observed than thermal hyperalgesia. Heat hypoalgesia regardless of cold pain abnormalities appears to be associated with subjective negative symptoms, while thermal hyperalgesia seems to have little relationship with negative and positive symptoms. Thermal pain phenotypes were associated with loss of innocuous thermal sensation. Unlike heat pain phenotypes, cold pain phenotypes differed between IAN injury and LN injury. CONCLUSION: The thermal pain phenotypes identified in this study seem to be related to clinical and psychophysical findings differently. These results would be a good starting point for assessing posttraumatic trigeminal neuropathy and interpreting the thermal QST results.

Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders.

BACKGROUND: Pain related to temporomandibular disorder (TMD) usually affects jaw function. In patients with TMD, little is known about the biopsychosocial relevance to jaw functional limitations. OBJECTIVE: This study explored the impact of biopsychosocial risk factors on jaw functional limitation in patients with painful TMD. METHODS: A comprehensive set of patient-reported outcomes (PROs), consisting of pain severity (Brief Pain Inventory), psychological stress (Symptom Checklist-90-Revised), catastrophising thought (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-TMD), sleep quality (Pittsburgh Sleep Quality Index) and jaw functional limitation (Jaw Functional Limitation Scale-20), were administered, and clinical examinations were performed in patients with TMD. RESULTS: This study included the data obtained from 131 patients with painful TMD. In the logistic regression analysis, biomedical factors (age, sex, pain duration and TMD phenotype) were not associated with jaw functional limitation. Correlations were higher in the order of sleep quality (ρ = 0.946), pain severity (ρ = 0.582), pain catastrophising (ρ = 0.535), kinesiophobia (ρ = 0.486) and emotional distress (ρ = 0.268). Multiple regression analysis demonstrated three predictors, including pain severity (p = .001), kinesiophobia (p = .023) and sleep quality (p < .001) for jaw functional limitation. In the mediation analysis, the indirect effect of pain severity on the association between sleep and limitation was significant (p < .0001). CONCLUSION: Jaw functional limitation is associated with biopsychosocial factors. In particular, sleep may be a core risk factor for functional limitation in patients with painful TMD.

Quantitative and qualitative sensory testing results are associated with numbness rather than neuropathic pain in patients with post-implant trigeminal neuropathy: a cross-sectional pilot study.

Purpose: This study aimed to characterize the sensory profile of patients with post-implant trigeminal neuropathy and identify the association between subjective symptoms and objective signs including psychophysical testing and radiographic imaging. This study further evaluated to the association between quantitative sensory testing (QST)/qualitative sensory testing (QualST) and the severity of nerve injury graded by radiographic imaging. Materials and methods: This retrospective study included 34 patients diagnosed with post-implant trigeminal neuropathy. Data on the neuropathic pain symptom inventory (NPSI), thermal and electric QST, bedside QualST, and cone beam computed tomography (CBCT) was collected and the association between these variables were analysed. Results: Numbness was the most common subjective symptom and evoked pain was the most frequent neuropathic pain. There was no significant correlation between negative and positive symptoms. Spearman's rank correlation analyses indicated that objective findings including QST/QualST correlated with a sensory loss profile rather than a gain of function profile. Moderate positive correlations between some positive symptoms and the score of QualST were observed. The Mann-Whitney U test showed that subjective symptoms did not differ according to the severity of nerve damage according to CBCT, but the electric QST and QualST was discriminative. Conclusions: This study suggests that QST/QualST associated with the severity of nerve damage according to CBCT might be useful in assessing numbness in patients with negative and positive symptoms after implant surgery, but may be of marginal utility in the evaluation of neuropathic pain within the limitation of this cross-sectional study with small sample size.

Comparison of unpleasant and pain thresholds of thermal stimuli in the orofacial regions: a psychophysical study using quantitative sensory testing in healthy young men.

Purpose/Aim: To gain a better understanding of the psychophysics of thermal pain perception in a clinical setting, this study investigated whether thermal thresholds of unpleasantness are different from pain thresholds of cold and heat stimuli. Of particular interest was the relationship between unpleasantness and pain thresholds for cold vs heat stimuli. MATERIAL AND METHODS: Thirty healthy male volunteers (mean age 26.1 years, range 23 to 32 years) participated. Thermal detection, cold pain (CPT) and heat pain (HPT) thresholds were measured at 5 trigeminal sites by the method of limits using quantitative sensory testing (QST), followed by cold unpleasant (CUT) and heat unpleasant (HUT) thresholds. RESULTS: The temperatures at which individuals first reported thermal sensations as unpleasant or painful substantially differed among subjects. CUT exhibited a higher mean value with less variability than CPT, and HUT presented a lower mean than HPT (p < .001). As with CPT, CUT did not show any significant difference between the test sites. On the other hand, HUT, like HPT, exhibited site differences (p < .001). There was moderate correlation between CUT and CPT, whereas HUT and HPT were strongly correlated. The relationship between unpleasant and pain thresholds of cold vs heat stimuli was significantly different even when controlling for test site variability (p < .001). CONCLUSION: These findings indicate that unpleasant and pain thresholds to thermal stimuli differ in healthy young men. Of particular note is the distinct relationship of unpleasant and pain thresholds of cold vs heat stimuli, revealing the thermal difference in temperature transition from unpleasantness to pain.

Normal-weight obesity is associated with increased risk of subclinical atherosclerosis.

BACKGROUND: Subjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL). In this study, we aimed to evaluate whether NWO individuals have higher rates of subclinical atherosclerosis compared to NWL subjects. METHODS: From a large-scale health checkup system, we identified 2078 normal weight (18.5 ≤ BMI < 25 kg/m(2)) subjects with no previous history of coronary artery disease who underwent analysis of atherosclerosis using coronary computed tomography angiography (CCTA) and pulse wave velocity (PWV). NWO was defined as normal BMI and highest tertile of body fat percentage by sex (men ≥ 25. 4 % and women ≥ 31.4 %). CCTA was performed using a 64-detector row CT. A plaque was defined as a structure >1 mm(2) within and/or adjacent to the vessel lumen and classified according to the presence/proportion of intraplaque calcification. RESULTS: NWO subjects (n = 283) demonstrated metabolic dysregulation compared to NWL individuals (n = 1795). After adjusting for age, sex, and smoking, NWO individuals showed higher PWV values than NWL individuals (1474.0 ± 275.4 vs. 1380.7 ± 234.3 cm/s, p = 0.006 by ANCOVA). Compared with NWL subjects, NWO subjects had a higher prevalence of soft plaques even after age, sex, and smoking adjustment (21.6% vs. 14.5%, p = 0.039 by ANCOVA). The PWV value and the log{(number of segments with plaque) + 1} showed a positive correlation with numerous parameters such as age, systolic blood pressure, visceral fat, fasting glucose level, serum triglyceride level, and C-reactive protein (CRP) in contrast to the negative correlation with high-density lipoprotein-cholesterol level. The visceral fat was an independent determinant of log{(number of segments with plaque) + 1} (ß = 0.027, SE = 0.011, p = 0.016) even after adjustment for other significant factors. Most importantly, NWO was an independent risk factor for the presence of soft plaques (odds ratio 1.460, 95 % confidence interval 1.027-2.074, p = 0.035) even after further adjustment for multiple factors associated with atherosclerosis (blood pressure, blood glucose, lipid level, CRP, medication, smoking status, physical activity). CONCLUSIONS: NWO individuals carry a higher incidence of subclinical atherosclerosis compared with NWL individuals, regardless of other clinical risk factors for atherosclerosis.

Influence of test site and baseline temperature on orofacial thermal thresholds.

AIMS: To investigate thermal thresholds of selected orofacial sites, determine if there is a relationship between thermal thresholds at each site, and analyze the influence of two different baseline temperatures on thermal thresholds at the tongue tip. METHODS: Thirty healthy men (mean age, 26 years) participated. Cold detection (CDT), warm detection (WDT), cold pain (CPT), and heat pain (HPT) thresholds were measured bilaterally at five orofacial sites (mentum, lower lip, cheek, forehead, and tongue tip). Relations between thermal thresholds at each test site were assessed. Thermal sensitivity of the tongue tip was compared at two different baseline temperatures (32°C and 36°C). One-way ANOVA, Turkey post-hoc test, paired t test and Pearson's correlation were used for statistical analyses. RESULTS: There was a significant difference for CDT, WDT, and HPT between test sites (ANOVA, P < .001) but no significant difference for CPT (P = .634). Subjects sensitive to cooling were sensitive to warming at the mentum (r = 0.379), tongue tip (r = 0.610), and cheek (r = 0.431) but not at the other test sites. There was a strong negative correlation between CPT and HPT at all test sites. There was no significant difference for CDT and WDT at the baseline temperature of 36°C (paired t test, P = .660), but there was a significant difference at the baseline temperature of 32°C (P < .001). There were no significant differences between CPTs at the two different baseline temperatures (P = .773), while a significant difference existed between HPTs (P = .034). CONCLUSION: Thermal thresholds varied between the orofacial test sites, and baseline temperature affected thermal sensitivity of the tongue. Subjects who were relatively sensitive to cold tended to be more sensitive to heat.

Temporomandibular disorders and autonomic dysfunction: Exploring the possible link between the two using a questionnaire survey.

OBJECTIVE: To assess autonomic function and investigate factors related to its dysfunction in patients with temporomandibular disorders (TMD) from a biopsychosocial perspective. METHODS: Seventy-six patients with TMD were investigated by clinical examination and questionnaires concerning biopsychosocial aspects (The Brief Pain Inventory, the Pain Catastrophizing Scale, and the Symptom Checklist-90-Revised) and autonomic dysfunction (The COMPASS 31). RESULTS: Seventy-one patients were included in the study. The result of multiple regression analysis showed that four variables (sex, depression, age, and pain interference) were significantly associated with autonomic dysfunction. Increased orthostatic intolerance and bladder dysfunction were observed in females and males, respectively. Younger age was associated with higher orthostatic intolerance, while higher pain interference was associated with higher secretomotor dysfunction and bladder dysfunction. Further, higher depression scores were linked to higher scores in the gastrointestinal subdomain. CONCLUSION: Autonomic dysfunction may affect TMD-related pain in the context of a biopsychosocial perspective.

Relevance of sleep, pain cognition, and psychological distress with regard to pain in patients with burning mouth syndrome.

Objective: To clarify the influence of sleep, psychological distress, and pain catastrophizing on the pain experience in patients with burning mouth syndrome (BMS).Methods: Ninety-three patients with BMS were investigated by reviewing medical records and questionnaires using the Brief Pain Inventory (BPI), Pittsburgh Sleep Quality Index (PSQI), Symptom Checklist-90 revised (SCL-90R), and pain catastrophizing scale (PCS).Results: Of the 65 patients included in the study, 81.5% and 66% showed high PSQI and PCS scores, respectively. The PSQI, PCS, and SCL-90R scores correlated positively with pain interference. The result of multiple regression analysis demonstrated that helplessness and rumination of PCS significantly add to the prediction of pain interference.Discussion: Pain catastrophizing rather than psychological distress and sleep quality seems to be associated with pain experience in patients with BMS. Therefore, targeting pain catastrophizing, specifically rumination and helplessness, might lead to reduction of pain-related disability in BMS patients.

Phenotyping 1488 patients with painful temporomandibular disorders and its relevance to subjective sleep quality: A key step for stratified medicine.

Objective: To investigate biopsychosocial characteristics and sleep quality among three TMD phenotypes and to identify the influential factors on sleep quality among those patients.Methods: Retrospective data from chart review and self-reported questionnaires included demographics, the Brief Pain Inventory, the Pain CatastropPain Prospective Evaluation and Risk Assessmenthizing Scale, the Symptom Check List-90 Revised, and the Pittsburgh Sleep Quality Index.Results: A total of 1488 patients with painful TMD (female, 63.8%) were included and stratified into three groups: joint pain (n = 570), muscle pain (n = 542), and joint-muscle combined pain (n = 376). There were significant differences among demographic characteristics, pain experience, pain catastrophizing, and psychological distress of the three groups. Poor sleep quality presented in 78.4% of all patients. Sleep quality was significantly associated with TMD phenotypes, sex, and a helplessness component of pain catastrophizing.Discussion: This patient-centered and stratified approach will allow clinicians to come one step closer to personalized medicine.

Impact of the Asthma Quality Assessment Program on Burden of Asthma.

BACKGROUND: In 2013, the Korean Health Insurance Review and Assessment Service launched the Asthma Quality Assessment Program (AQAP) to assess whether patients with asthma were well managed. OBJECTIVE: To show the impact of the AQAP on the medical utilization behavior for asthma. METHODS: We used claims data linked with the results of the AQAP performed between July 2013 and June 2017. Asthma was determined when subjects visited hospital for asthma. Subjects who used asthma medications on at least 2 different occasions were assessed by the AQAP (assessed subjects [Ass]; not-assessed subjects [NASs]). The AQAP evaluated conduction rate of the pulmonary function test, routine visit rate, and prescription rate of asthma medications. Primary clinics were classified as "good" and "not-good" clinics according to the results of the AQAP. RESULTS: Of the 4.3 million subjects with asthma screened, about 0.8 million were assessed by the AQAP annually. Both the conduction rate of pulmonary function test and the prescription rate of inhaled corticosteroids in the ASs and NASs were improved. In addition, the risk of admission and yearly all-cause mortality were significantly reduced (risk reduction rate, 17.1 and 24.4%, respectively, both P < .001) in the AS group compared with the NAS group. However, effects of the AQAP varied according to the subgroup, and they were restricted to the assessment term. In addition, the admission rate and all-cause mortality were decreased by 94.7% and 45.3%, respectively, in "good" clinics as opposed to the "not-good" clinics. CONCLUSIONS: Performing the AQAP improved both the management protocol and prognosis of asthma in Korea.

Enhanced osteoconductivity of micro-structured titanium implants (XiVE S CELLplus) by addition of surface calcium chemistry: a histomorphometric study in the rabbit femur.

OBJECTIVES: This study evaluated the osseointegration in rabbit cancellous bone of titanium (Ti) implants with a micro-topographically complex surface structure produced by grit-blasting/acid-etching with or without the addition of surface calcium ion (Ca) chemistry. MATERIAL AND METHODS: Micro-structured Ti implants (XiVE S CELLplus screw implant, Dentsply Friadent GmbH) were hydrothermally treated in an alkaline Ca-containing solution to produce a nano-structured Ca-incorporated oxide surface layer. The surface characteristics were evaluated by scanning electron microscopy and stylus profilometry before and after Ca surface treatment. Twenty implants (10 control and 10 experimental) were placed in the femoral condyles of 10 New Zealand White rabbits. Histomorphometric analysis was performed 6 weeks after implantation. RESULTS: Ca-incorporated and untreated control implants showed similar surface morphologies and surface roughness values at the micron scale. Untreated micro-structured Ti implants achieved a high degree of bone-to-implant contact (BIC), and Ca incorporation further increased BIC% (P<0.05). Active new bone apposition was found on surfaces of Ca-incorporated implants in areas of loose trabeculae. CONCLUSION: The nano-structured Ca-incorporated oxide surface significantly enhanced osteoconductivity of micro-structured Ti implants in rabbit cancellous bone. Results indicate that this surface produced by simple hydrothermal treatment may be effective in improving the osseointegration of implants with micro-topographically complex surface structures in areas of loose cancellous bone.

Job stress and its related factors among Korean dentists: An online survey study.

OBJECTIVES: The aims of this study were to investigate the dentists' job-related stress using the newly developed Dentist Job Stress (DJS) questionnaire, and to explore the relationships among sociodemographic factors, job stress and mental health indicators, including psychosocial stress, depression, anxiety and sleep among Korean dentists. MATERIALS AND METHODS: An online survey including 1,520 dentists was conducted using the Brief Encounter Psychological Instrument-Korean version (BEPSI-K), the Center for Epidemiologic Studies Depression Scale (CES-D), the State-Trait Anxiety Index (STAI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The response rate was 15.2% (n = 231). The DJS questionnaire consisted of environmental and vocational factors, and Cronbach's α coefficient was 0.69. Dentists' job stress was significantly associated with income (P = 0.0230), work time (P = 0.0009) and job satisfaction (P < 0.0001). A bivariate correlation study revealed that the BEPSI-K, CES-D, STAI-S and PSQI exhibited a significant correlation with the DJS scale. Multiple regression analysis found that depression, job satisfaction and sleep quality were associated with dentists' job stress, and this model accounted for 37.9% of the variation in the DJS scale (P < 0.0001). CONCLUSIONS: The findings of this study revealed that the DJS questionnaire showed acceptable validity and reliability, and dentists' job stress was associated with depression, job satisfaction and sleep quality. The major implication of this study is that a stress-management programme focusing on practical ways to improve the mental health status and job satisfaction of dentists is critical to the reduction of occupational stress among Korean dentists.

Therapeutic vitamin delivery: Chemical and physical methods with future directions.

Vitamins are a diverse group of "life nourishing" molecules that are essential for proper childhood development, and for maintaining health throughout adulthood into old age. Vitamin supplementation is an important strategy for reducing the severe and chronic effects of malnutrition in subsets of the population of the developing world. Additionally, the precise role of many vitamins in certain conditions, including cancer and cardiovascular disease, remains an area of active research, although guidelines for vitamin supplementation in otherwise adequately nourished populations remain controversial. This review describes vitamin delivery methods and techniques, focusing on the most recent advances and novel approaches. Specific attention has been given to physical methods and novel formulations for delivery with an emphasis on reporting pros and cons of each technique and highlighting future directions. Of particular interest is the potential for transdermal delivery of certain vitamins, which is an approach that may provide advantages in some populations (e.g. for vitamin D), but that still requires considerable additional research and clinical validation.

Pyruvate kinase isozyme type M2 (PKM2) interacts and cooperates with Oct-4 in regulating transcription.

The Oct-4 gene encodes a transcription factor that plays an important role in maintaining the pluripotent state of embryonic stem cells and may prevent expression of genes activated during differentiation. Although its role in maintaining embryonic stem cell pluripotency is well established, there is still little known about the binding partners that regulate its function. To identify proteins that control Oct-4 function, we used affinity chromatography on immobilized Oct-4 (POU) together with MALDI-TOF (matrix-assisted laser-desorption ionization-time-of-flight) MS (mass spectrometry) and isolated a novel Oct-4-interacting protein, pyruvate kinase type M2 (PKM2 or M2-PK). PKM2 is an isozyme of pyruvate kinase that is specifically expressed in proliferating cells, such as embryonic stem cells, embryonic carcinoma cells, as well as cancer cells. Oct-4 and PKM2 were co-affinity precipitated from cell extracts, and glutathione S-transferase pull-down assays revealed that the POU DNA binding domain of Oct-4 was required for interaction with PKM2. In addition, the C-terminal domain of PKM2 (amino acids 307-531) was involved in binding to Oct-4. Moreover, ectopic expression of the PKM2 enhanced Oct-4-mediated transcription. These observations indicate that the transactivation potential of the Oct-4 transcription factor is positively modulated by PKM2.

The use of an in vitro adenosine triphosphate-based chemotherapy response assay to predict chemotherapeutic response in breast cancer.

The adenosine triphosphate-based chemotherapy response assay (ATP-CRA) has the advantages of standardization, evaluability, reproducibility, and accuracy, and can be performed on relatively small numbers of tumor cells. A total of 43 patients were enrolled in the present study, and chemosensitivity tests were successfully performed in 40 (93.0%) of these patients. Twenty of the 40 received neoadjuvant chemotherapy or chemotherapy for metastatic breast cancer. The chemotherapy regimens used were doxorubicin plus docetaxel (n=9, 45.0%) or doxorubicin plus paclitaxel (n=11, 55.0%). Mean cell death rate, as determined by ATP-CRA, was lower in non-responders than in responders to therapy (P=0.012). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for ATP-CRA were 78.6%, 100%, 100%, 66.7%, and 85.0%, respectively. Diagnostic accuracy achieved by immunohistochemistry using estrogen receptor or progesterone receptor was lower than that achieved using ATP-CRA. Expression of p53, erb-B2, Ki67, Bcl-2, Bcl-xL, and annexin I was not significantly associated with response to chemotherapy. Our results show that ATP-CRA has high specificity and positive predictive value for predicting response to chemotherapy.

The EWS-Oct-4 fusion gene encodes a transforming gene.

The t(6;22)(p21;q12) translocation associated with human bone and soft-tissue tumours results in a chimaeric molecule fusing the NTD (N-terminal domain) of the EWS (Ewing's sarcoma) gene to the CTD (C-terminal domain) of the Oct-4 (octamer-4) embryonic gene. Since the N-terminal domains of EWS and Oct-4 are structurally different, in the present study we have assessed the functional consequences of the EWS-Oct-4 fusion. We find that this chimaeric gene encodes a nuclear protein which binds DNA with the same sequence specificity as the parental Oct-4 protein. Comparison of the transactivation properties of EWS-Oct-4 and Oct-4 indicates that the former has higher transactivation activity for a known target reporter gene containing Oct-4 binding. Deletion analysis of the functional domains of EWS-Oct-4 indicates that the EWS (NTD), the POU domain and the CTD of EWS-Oct-4 are necessary for full transactivation potential. EWS-Oct-4 induced the expression of fgf-4 (fibroblast growth factor 4) and nanog, which are potent mitogens as well as Oct-4 downstream target genes whose promoters contain potential Oct-4-binding sites. Finally, ectopic expression of EWS-Oct-4 in Oct-4-null ZHBTc4 ES (embryonic stem) cells resulted in increased tumorigenic growth potential in nude mice. These results suggest that the oncogenic effect of the t(6;22) translocation is due to the EWS-Oct-4 chimaeric protein and that fusion of the EWS NTD to the Oct-4 DNA-binding domain produces a transforming chimaeric product.

Pain Catastrophizing Mediates the Effects of Psychological Distress on Pain Interference in Patients with Orofacial Pain: A Cross-Sectional Study.

AIMS: To investigate whether pain catastrophizing has not only direct effects as a predictor of pain-related interference but also indirect effects as a mediator in the relationship between psychological distress and pain interference and to examine the mediating roles of subtypes of catastrophizing (magnification, rumination, and helplessness) between psychological distress and interference. METHODS: This retrospective study included 815 patients with orofacial pain aged 18 to 81 years. All participants completed a set of self-administered questionnaires concerning pain interference (Brief Pain Inventory), psychological distress (Symptom Checklist-90-Revised), and pain catastrophizing (Pain Catastrophizing Scale) at the first consultation. The associations between these three variables were calculated using mediation path analysis. RESULTS: Pain catastrophizing predicted pain interference. In addition, 34% of the variance in pain interference attributable to psychological distress was mediated by catastrophizing when controlling for pain duration and severity. The greatest portion of the mediating effect of catastrophizing was attributable to the helplessness component. CONCLUSION: Within the limitations of cross-sectional studies, this study demonstrated that pain catastrophizing mediates the effects of psychological distress on pain interference in patients with orofacial pain. Most of the mediating effects were attributable to the helplessness component of pain catastrophizing. Cognitive behavioral therapy targeting pain catastrophizing, specifically helplessness, could potentially reduce pain-related disability in orofacial pain patients.

Risk factors for the efficacy of oral appliance for treating obstructive sleep apnea: A preliminary study.

OBJECTIVE: To identify potential risk factors of response to oral appliance in patients with obstructive sleep apnea (OSA). METHODS: Fifteen OSA patients were enrolled. Clinical characteristics, cephalometric measurements, and the results of home sleep testing were retrospectively obtained at baseline, and a sleep test was done again at the end of treatment. RESULTS: Twelve subjects were responders and three were non-responders. The diastolic blood pressure, minimum pulse rate, SNA (Angle between sella-nasion and nasion-A point), ANB (Anteroposterior maxilla/mandible discrepancy), and facial convexity of non-responders was higher than those of responders. Unlike AHI, non-responders showed a lower lowest oxygen saturation (%) than responders. DISCUSSION: Elevated diastolic pressure and minimal pulse rate, higher skeletal convexity and lowered lowest oxygen saturation might be risk factors to oral appliance efficacy in the OSA patients. More research in a large sample is needed to verify the results of the current study.