Assessment of sleep disturbance in oral lichen planus and validation of PSQI: A case-control multicenter study from the SIPMO (Italian Society of Oral Pathology and Medicine).

BACKGROUND: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs. METHODS: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered. RESULTS: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values < 0.001**). Moreover, OLPs had higher scores in the HAM-D, HAM-A, NRS, and T-PRI (p-values < 0.001**). No differences in the PSQI sub-items' scores were found between the K-OLPs and nK-OLPs, although nK-OLPs suffered from higher levels of anxiety, depression, and pain (p-values: HAM-A, 0.007**, HAM-D, 0.009**, NRS, <0.001**, T-PRI, <0.001**). The female gender, anxiety, depression (p-value: 0.007**, 0.001**, 0.020*) and the intensity of pain, anxiety, and depression (p-value: 0.006**, <0.001**, 0.014*) were independent predictors of poor sleep (PSQI > 5) in K-OLPs and nK-OLPs, respectively. The PSQI's validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI. CONCLUSIONS: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management.

Lipid-polymer nanoparticles encapsulating curcumin for modulating the vascular deposition of breast cancer cells.

Vascular adhesion and endothelial transmigration are critical steps in the establishment of distant metastasis by circulating tumor cells (CTCs). Also, vascular inflammation plays a pivotal role in steering CTCs out of the blood stream. Here, long circulating lipid-polymer nanoparticles encapsulating curcumin (NANOCurc) are proposed for modulating the vascular deposition of CTCs. Upon treatment with NANOCurc, the adhesion propensity of highly metastatic breast cancer cells (MDA-MB-231) onto TNF-α stimulated endothelial cells (HUVECs) reduces by ~70%, in a capillary flow. Remarkably, the CTCs vascular deposition already reduces up to ~50% by treating solely the inflamed HUVECs. The CTCs arrest is mediated by the interaction between ICAM-1 on HUVECs and MUC-1 on cancer cells, and moderate doses of curcumin down-regulate the expression of both molecules. This suggests that NANOCurc could prevent metastasis and limit the progression of the disease by modulating vascular inflammation and impairing the CTCs arrest. FROM THE CLINICAL EDITOR: In this novel study, lipid nanoparticles encapsulating curcumin were able to prevent metastasis formation and limited the progression of the disease by modulating vascular inflammation and impairing the circulating tumor cells' arrest as a result of down-regulation of ICAM1 and MUC1 in a highly metastatic breast cancer cell line model.

Common carotid and brachial artery hemodynamic alterations in periodontal disease.

AIM: In patients affected by periodontal disease, hypertension and systemic inflammation might cause an arterial hemodynamic derangement; this, in turn, can act as a mediator of the atherogenic process often seen in these patients. This study aimed at a comprehensive hemodynamic evaluation in periodontal patients. METHODS: Fourty-eight subjects participating to a cardiovascular prevention programme were enrolled. Periodontitis, classical risk factors for atherosclerosis, and shear and tensile forces in both carotid and brachial arteries were evaluated. Calculated periodontal indexes were plaque, gingival and pocket deep (PD) indexes. Simple and multiple regression analyses were performed. Afterwards, 30 of them with normal PD index were compared with 30 carefully - matched patients with periodontitis. RESULTS: Brachial and carotid parietal tension were significantly associated with periodontal indexes, especially PD-Sum, in both simple (r = 0.42, p < 0.001 for carotid artery and r = 0.36, p < 0.02 for brachial artery) and multiple regression analyses. Shear stress gave similar results. In case-control analysis, shear stress was lower by 15% and 30%, respectively, in carotid and brachial artery in patients with high PD; common carotid parietal tension was higher. Arterial stiffness resulted not associated with periodontitis. CONCLUSIONS: Periodontal disease is associated to a complex atherosclerotic prone hemodynamic derangement, particularly in large elastic arteries.

Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term.

Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n = 20) or SRP + LLLT (n = 20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P = 0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.

Periodontal disease and carotid atherosclerosis: are hemodynamic forces a link?

OBJECTIVE: The link between periodontal disease and atherosclerosis has not yet been clarified, though systemic inflammation seems to be the common soil for both conditions. Inflammation influences also hemodynamic forces, that act as local risk factors for carotid plaques. It is not known if the link between periodontitis and carotid atherosclerosis is mediated, at least in part, by physical forces. Therefore, aim of the present study was to evaluate the association between carotid shear stress force and periodontal disease. METHODS: Thirty-three subjects underwent complete cardiovascular screening, carotid hemodynamic evaluation and dental inspection. Presence of classical risk factors for atherosclerosis, common carotid peak and mean wall shear stress values and periodontal indices of disease (plaque index, gingival index and pocket deep) have been evaluated. RESULTS: Worse periodontal health was associated to the presence of carotid atherosclerosis. Patients with carotid plaques (n=19) had higher periodontal indices compared with subjects without plaques (n=14) (gingival index: 1.40 ± 0.71 vs. 0.69 ± 0.64, p=0.006). These relations were independent of the presence of cardiovascular risk factors in multiple logistic regression analysis. In the 66 examined common carotids, wall shear stress was inversely related to all periodontal indices (r=0.54, p<0.00001 for peak wall shear stress and gingival index). These relations remained significant also in multiple regression analysis, after correction for cardiovascular risk factors, gender and age. CONCLUSIONS: The present study identifies for the first time a link between periodontal indices and wall shear stress, suggesting that an alteration of hemodynamic profile might contribute to atherosclerosis in subjects with periodontal disease.