[Dental materials and oral care products that can cause contact allergies]. / Tandheelkundige materialen en mondverzorgingsproducten die contactallergieën kunnen geven.

Various restorative and prosthetic materials, dental implants, medicines and cosmetic materials, such as toothpaste and denture cleaning products, are used in oral care. In principle, these materials can cause contact allergies, which can manifest as lichenoid reaction, cheilitis and angioedema. It is usually a local reaction of the oral mucosa and surrounding tissues, but a systemic reaction can also occur elsewhere in the body. If a patient develops complaints from dental materials that could be due to an allergy, it makes sense to investigate this allergologically, although these do not yet show full specificity or sensitivity. After a positive allergological examination, it is possible to examine more specifically whether the patient's complaints match the test result and it can be decided whether it is sensible to replace the dental material and, if so, which material could be an alternative. After removal of the causative allergens, the complaints should disappear completely.

Skin hardening effect in patients with polymorphic light eruption: comparison of UVB hardening in hospital with a novel home UV-hardening device.

BACKGROUND: An effective prophylactic treatment of patients with polymorphic light eruption (PLE) consists of repeated low, gradually increasing exposures to UVB radiation. This so-called UV(B) hardening induces better tolerance of the skin to sunlight. OBJECTIVE: SunshowerMedical company (Amsterdam) has developed an UV (B) source that can be used during taking shower. The low UV fluence of this apparatus makes it an interesting device for UV hardening. In a group of PLE patients, we compared the effectiveness of the irradiation with SunshowerMedical at home with that of the UVB treatment in the hospital. METHODS: The PLE patients were randomized for one of the treatments. The hospital treatment consisted of irradiations with broad-band UVB (Waldmann 85/UV21 lamps) twice a week during 6 weeks. The home UV-device was used each day with the maximal irradiation time of 6 min. The outcome assessment was based on the information obtained from patients' dermatological quality of life (DLQI) questionnaires, the ability of both phototherapies to reduce the provocation reaction and from the patients' evaluation of the long-term benefits of their phototherapies. RESULTS: Sixteen patients completed treatment with SunshowerMedical and thirteen completed treatment in hospital. Both types of phototherapy were effective. There was a highly significant improvement in DLQI with either treatment. In most cases, the hardening reduced or even completely suppressed clinical UV provocation of PLE. The patients using SunshowerMedical at home were, however, much more content with the treatment procedure than the patients visiting the dermatological units. CONCLUSIONS: Both treatments were equally effective in the induction of skin tolerance to sunlight in PLE patients. However, the home treatment was much better accepted than the treatment in the hospital.

Recommendations on scuba diving in Birt-Hogg-Dubé syndrome.

INTRODUCTION: Although very uncommon, severe injury and death can occur during scuba diving. One of the main causes of scuba diving fatalities is pulmonary barotrauma due to significant changes in ambient pressure. Pathology of the lung parenchyma, such as cystic lesions, might increase the risk of pulmonary barotrauma. AREAS COVERED: Birt-Hogg-Dubé syndrome (BHD), caused by pathogenic variants in the FLCN gene, is characterized by skin fibrofolliculomas, an increased risk of renal cell carcinoma, multiple lung cysts and spontaneous pneumothorax. Given the pulmonary involvement, in some countries patients with BHD are generally recommended to avoid scuba diving, although evidence-based guidelines are lacking. We aim to provide recommendations on scuba diving for patients with BHD, based on a survey of literature on pulmonary cysts and pulmonary barotrauma in scuba diving. EXPERT OPINION: In our opinion, although the absolute risks are likely to be low, caution is warranted. Given the relative paucity of literature and the potential fatal outcome, patients with BHD with a strong desire for scuba diving should be informed of the potential risks in a personal assessment. If available a diving physician should be consulted, and a low radiation dose chest computed tomography (CT)-scan to assess pulmonary lesions could be considered.

Modest phenotypic improvements in ASA-deficient mice with only one UDP-galactose:ceramide-galactosyltransferase gene.

BACKGROUND: Arylsulfatase A (ASA)-deficient mice are a model for the lysosomal storage disorder metachromatic leukodystrophy. This lipidosis is characterised by the lysosomal accumulation of the sphingolipid sulfatide. Storage of this lipid is associated with progressive demyelination. We have mated ASA-deficient mice with mice heterozygous for a non-functional allele of UDP-galactose:ceramide-galactosyltransferase (CGT). This deficiency is known to lead to a decreased synthesis of galactosylceramide and sulfatide, which should reduce sulfatide storage and improve pathology in ASA-deficient mice. RESULTS: ASA-/- CGT+/- mice, however, showed no detectable decrease in sulfatide storage. Neuronal degeneration of cells in the spiral ganglion of the inner ear, however, was decreased. Behavioural tests showed small but clear improvements of the phenotype in ASA-/- CGT+/- mice. CONCLUSION: Thus the reduction of galactosylceramide and sulfatide biosynthesis by genetic means overall causes modest improvements of pathology.

Refined X-ray structures of haloalkane dehalogenase at pH 6.2 and pH 8.2 and implications for the reaction mechanism.

The crystal structure of haloalkane dehalogenase from Xanthobacter autotrophicus GJ10 has been refined at 1.9 A resolution at two different pH values, the pH of crystallization (pH 6.2) and the pH of optimal activity (pH 8.2), to final R-factors of 16.8% and 16.4%, respectively. Both models show good stereochemical quality. Two non-glycine residues have main-chain torsion angles that are located outside the "allowed" regions in a Ramachandran plot. One of them is the nucleophilic residue Asp124, which, together with the two other active site residues His289 and Asp260, is situated in an internal, predominantly hydrophobic cavity. The other residue, Asn148, helps stabilize the conformations of two of these active-site residues, Asp124 and Asp260. Comparison of the models at pH 6.2 and pH 8.2 revealed one major structural difference. At pH 6.2, a salt-bridge is present between the N epsilon 2 atom of His289 and the O delta 1 atom of Asp124, while at pH 8.2, this salt-bridge is absent, indicating that the N epsilon 2 atom of the histidine residue is mostly deprotonated at the pH of optimum activity. This is in agreement with the putative reaction mechanism in which the O delta 1 atom of Asp124 performs a nucleophilic attack on the substrate, resulting in an intermediate ester. This ester is subsequently cleaved by a hydrolytic water molecule. The high-resolution data sets clearly show the exact position of this water molecule. It is in an ideal position for donating a proton to the N epsilon 2 atom of His289 and subsequently cleaving the covalently bound intermediate ester, releasing the alcohol product. Detailed investigation of both refined models showed a number of unusual structural features. Four out of 11 helices contain an internal proline residue other than in the first turn. Two other alpha-helices have adopted in their central part a 3(10) conformation. A novel four-residue turn between a helix and a strand, the alpha beta 4 turn, is located at the site of the bend in the central eight-stranded beta-sheet of the dehalogenase structure.

X-ray crystal structure analysis of the catalytic domain of the oncogene product p21H-ras complexed with caged GTP and mant dGppNHp.

The X-ray structures of the 1:1 complexes formed between p21H-ras (residues 1 to 166) and the nucleotides P3-1-(2-nitrophenyl)ethyl guanosine triphosphate ("caged GTP"; pure R- and S-diastereomers) and 3'-O-(N-methylanthraniloyl)-2'-deoxyguanosine 5'-(beta, gamma-imido)-triphosphate ("mant dG-ppNHp"), have been refined to an R-factor of 21.4% (R-caged GTP, 1.85 A resolution), 18.9% (S-caged GTP, 2.5 A resolution) and 17.6% (mant dGppNHp, 2.7 A resolution), respectively. Details of the structure determination, refinement and the structures themselves are presented. The overall structures of the complexes are identical in terms of the general organization of their secondary structure elements and are also identical to that reported for the analogous complex of p21H-ras with GppNHp. The binding of the GTP part is not significantly affected by the additional aromatic group (cage and mant, respectively) in contrast to the original observation on p21:caged GTP using the racemic mixture of R- and S-caged GTP. The main differences in the structures are observed in the region of loop L2 (residues Glu31 to Thr35) where the additional aromatic group attached to the nucleotide comes very close to the side-chain of Tyr32, including backbone displacements of 2.6 A, 2.2 A and 0.3 A for the residues from Glu31 to Thr35 for R-caged, S-caged GTP and mant dGppNHp, respectively. The refined structures provide additional data for the design of new nucleotide analogs and the importance of their stereochemistry as well as for the design of new mutant forms of p21H-ras for further biochemical investigations. The binding mode of mant dGppNHp reveals significant features for the understanding of the fluorescence signals observed in solution.

Non-covalent binding of the heavy atom compound [Au(CN)2]- at the halide binding site of haloalkane dehalogenase from Xanthobacter autotrophicus GJ10.

The Na[Au(CN)2] heavy atom derivative contributed considerably to the successful elucidation of the crystal structure of haloalkane dehalogenase isolated from Xanthobacter autotrophicus GJ10. The gold cyanide was located in an internal cavity of the enzyme, which also contains the catalytic residues. Refinement of the dehalogenase-gold cyanide complex at 0.25 nm to an R-factor of 16.7% demonstrates that the heavy atom molecule binds non-covalently between two tryptophan residues pointing into the active site cavity. At this same site also chloride ions can be bound. Therefore, inhibition of dehalogenase activity by the Au(CN)-2 presumably occurs by competition for the same binding site as substrates.

Alterations of the anterior lens capsule associated with climatic keratopathy.

We describe changes in the anterior lens capsules of older people in Somalia, a country which is close to the equator and with large areas of sand, often highly reflective of sunlight. The capsule changes are confined to the central pupillary area. In order of apparently increasing severity they consist of a white opalescence ('frosting'), an elevation in front of the contour of the rest of the lens to form a plateau, and a 'bag' or herniation of the lens capsule through the pupil. Plateau and bagging taken together are strongly associated with climatic keratopathy (and by inference with reflected ultraviolet exposure), weakly associated with exfoliation syndrome, inversely related to the degree of cataract, and interfere severely with vision.

Metachromatic leukodystrophy: consequences of sulphatide accumulation.

UNLABELLED: Metachromatic leukodystrophy is a lysosomal lipid storage disorder. It is caused by mutations in the gene for arylsulphatase A, an enzyme involved in the degradation of the sphingolipid 3'-O-sulphogalactosylceramide (sulphatide). This membrane lipid can be found in various cell types, but in particularly high concentrations in the myelin of the nervous system. Patients suffer from progressive, finally lethal, demyelination due to accumulation of sulphatide. In the nervous system, lipid storage not only affects oligodendrocytes but also neurons and, in addition, leads to astrogliosis and activation of microglia. At the cellular level, lysosomal sulphatide storage also affects the lipid composition of myelin itself and has consequences for the amount and localization of particular myelin membrane-associated proteins. Here we review data, largely based on an arylsulphatase A knock-out mouse model of metachromatic leukodystrophy. CONCLUSION: The knock-out mouse model of metachromatic leukodystrophy has provided insights into the histopathological and cellular consequences of sulphatide storage.

Identification of a large rearrangement in CYLD as a cause of familial cylindromatosis.

Pathogenic mutations in CYLD can be identified in patients affected with Brooke-Spiegler syndrome, (Familial) Cylindromatosis or multiple familial trichoepithelioma. To date, only technologies which are able to identify small point mutations in CYLD, such as sequence and WAVE analysis, were used. Here we describe the identification of a larger rearrangement identified by Quantitative PCR analysis of CYLD, indicating that a combination of these technologies is necessary when searching for pathogenic mutations in CYLD.

Unusual case of bifocal leptomeningeal melanocytoma in the posterior fossa with seeding in the spinal canal.

A 26-year-old man presented with signs of raised intracranial pressure. CT and MRI of the head demonstrated two separate lesions in the posterior fossa. The radiological differential diagnoses included multiple meningiomas, schwannomas, neurofibromas and subependymomas. Both lesions were surgically resected. Histopathological examination revealed localisations of a leptomeningeal melanocytoma. Leptomeningeal melanocytoma is a rare tumour of the central nervous system. Generally, it has a good prognosis if radical resection can be performed. In cases of subtotal resection, adjuvant radiotherapy should be considered. Local recurrences are common. Less frequently, leptomeningeal metastases and, on rare occasions, distant metastases or progression to malignant melanoma have been described. We describe an unusual case with multiple localisations of melanocytoma in the posterior fossa and spinal canal, with the emphasis being on the radiological findings and diagnosis of this rare tumour. After surgery of the brain, this patient was irradiated on the craniospinal axis.

Points of action in the campaign against blindness in developing countries.

This article provides a survey of the problems of prevention of blindness in developing countries. The World Health Organization estimates that 31 million people are blind and 15 million people partially-sighted. The main cause of blindness is cataract. Other causes are trachoma, glaucoma, xerophthalmia, river blindness, corneal scars and leprosy. Prevention or treatment of these causes is possible in more than 80% of cases. The number of blind persons, however, is still increasing due to the increase in population and the immense shortage of all kinds of ophthalmological equipment and personnel. An effective strategy for the prevention of blindness in developing countries should focus on: more cheap cataract operations, increasing teaching facilities for ophthalmic personnel, integration of ophthalmic care into the general health system and the promotion of blindness prevention in political organizations.

Binding of selenoprotein P to heparin: characterization with surface plasmon resonance.

The binding of selenoprotein P to glycosaminoglycans using heparin as a model compound was studied by surface plasmon resonance. It was found that heparin contains two binding sites for selenoprotein P, a high-affinity, low-capacity site (Kd approximately 1 nM) and a low-affinity, high-capacity site (Kd approximately 140 nM). Binding at both sites is sensitive to pH and ionic strength, and the high-affinity site is abolished by histidine carbethoxylation with diethylpyrocarbonate. The pH and salt dependence of binding suggests electrostatic interactions with heparin. The concentrations of selenoprotein P in plasma (approximately 50 nM) are sufficiently high to facilitate binding of selenoprotein P to proteoglycans on the vascular endothelium, and this may contribute to the formation of a protective barrier against oxidants such as peroxynitrite or hydroperoxides.

Lysosomal sulfoglycolipid storage in the kidneys of mice deficient for arylsulfatase A (ASA) and of double-knockout mice deficient for ASA and galactosylceramide synthase.

The inherited deficiency of arylsulfatase A (ASA) causes lysosomal accumulation of sulfoglycolipids (mainly sulfo-galactosylceramide, S-GalCer ) and leads to metachromatic leukodystrophy in humans. Among visceral organs, kidneys are particularly affected. In the present study, the regional distribution and temporal development of sulfoglycolipid storage in kidneys of ASA-/- mice was investigated histochemically (alcian blue) and ultrastructurally. Furthermore, the sulfoglycolipid storage was examined in kidneys of double-knockout mice, which are incapable of: (a) degrading any sulfolipids (ASA-/-) and (b) synthesizing the major sulfolipid S-GalCer because of deficiency for galactosylceramide synthase (CGT), with the aim to search for additional ASA substrates. In ASA-/- mice, the nephron segments could be ranged in the order of decreasing sulfolipid storage: thin limbs of long-looped nephrons approximately thick ascending limbs > distal convoluted tubules > collecting ducts approximately short thin limbs. Macula densa and proximal tubules were unaffected. In ASA-/-/CGT-/- mice, the long thin limbs and distal convoluted tubules resembled those of ASA-/-/CGT+/+ mice, while the other segments showed less storage. The results suggest that the turnover of sulfolipids in general is highest in the distal nephron except macula densa, and that long thin limbs and distal convoluted tubules are the main sites for turnover of a minor sulfolipid species, which is known to be synthesized in the kidney of CGT-/- mice.