Buccally or Lingually Tilted Implants in the Lateral Atrophic Mandible: A Three-Year Follow-Up Study Focused on Neurosensory Impairment, Soft-Tissue-Related Impaction and Quality of Life Improvement.

Background and Objectives: In the severely resorbed posterior mandible, implant placement requires either bone regenerative procedures, subperiosteal implants or short implant placement with drawbacks including morbidity and increased treatment costs and duration. To overcome these inconveniences, some unconventional alternatives have been suggested, such as buccally or lingually tilted implants in the lateral mandible, bypassing the inferior alveolar nerve. The aim of the present retrospective study was to evaluate the three-year survival rate of implants inserted in the posterior atrophic mandible, bypassing the inferior alveolar nerve. The assessment was focused on the occurrence of postoperative complications related to neurosensory impairment and soft tissue impaction, as well as overall improvement in quality of life. Materials and Methods: Patients with severe bone atrophy in the lateral area of the mandible were included in the present study. Only the implants tilted either buccally or lingually to bypass the inferior alveolar nerve were analysed. The relation between peri-implant soft tissue and the healing abutment was assessed and a secondary revision surgery was performed when indicated. The Semmes-Weinstein pressure neurological test was used for qualitative assessment of inferior alveolar nerve function and the Geriatric Oral Health Assessment Index (GOHAI) was used for evaluating Oral-Health-Related Quality of Life (OHRQoL). Results: Fourteen implants were placed in nine patients during the evaluation period. Survival rate was 100%, temporary paraesthesia occurred in one patient and a limited definitive paraesthesia was seen in another patient. Mild or significant discomfort related to soft tissue impaction with healing abutment was observed in six out of nine patients. A statistically significant OHRQoL improvement was observed in all patients. Conclusions: Despite the limited number of patients and observation time, insertion of implants buccally or lingually bypassing the inferior alveolar nerve is a predictive treatment option for patients with severe bone atrophy in the posterior mandible.

Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro-Brazil.

INTRODUCTION: Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. OBJECTIVE: This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). METHODS: Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. RESULTS: Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. DISCUSSION: The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.

PAR2, Keratinocytes, and Cathepsin S Mediate the Sensory Effects of Ciguatoxins Responsible for Ciguatera Poisoning.

Ciguatera fish poisoning is caused by the consumption of fish contaminated with ciguatoxins (CTXs). The most distressing symptoms are cutaneous sensory disturbances, including cold dysesthesia and itch. CTXs are neurotoxins known to activate voltage-gated sodium channels, but no specific treatment exists. Peptidergic neurons have been critically involved in ciguatera fish poisoning sensory disturbances. Protease-activated receptor-2 (PAR2) is an itch- and pain-related G protein‒coupled receptor whose activation leads to a calcium-dependent neuropeptide release. In this study, we studied the role of voltage-gated sodium channels, PAR2, and the PAR2 agonist cathepsin S in the cytosolic calcium increase and subsequent release of the neuropeptide substance P elicited by Pacific CTX-2 (P-CTX-2) in rat sensory neurons and human epidermal keratinocytes. In sensory neurons, the P-CTX-2‒evoked calcium response was driven by voltage-gated sodium channels and PAR2-dependent mechanisms. In keratinocytes, P-CTX-2 also induced voltage-gated sodium channels and PAR2-dependent marked calcium response. In the cocultured cells, P-CTX-2 significantly increased cathepsin S activity, and cathepsin S and PAR2 antagonists almost abolished P-CTX-2‒elicited substance P release. Keratinocytes synergistically favored the induced substance P release. Our results demonstrate that the sensory effects of CTXs involve the cathepsin S-PAR2 pathway and are potentiated by their direct action on nonexcitable keratinocytes through the same pathway.

Evidence for a novel subcortical mechanism for posterior cingulate cortex atrophy in HIV peripheral neuropathy.

We previously reported that neuropathic pain was associated with smaller posterior cingulate cortical (PCC) volumes, suggesting that a smaller/dysfunctional PCC may contribute to development of pain via impaired mind wandering. A gap in our previous report was lack of evidence for a mechanism for the genesis of PCC atrophy in HIV peripheral neuropathy. Here we investigate if volumetric differences in the subcortex for those with neuropathic paresthesia may contribute to smaller PCC volumes, potentially through deafferentation of ascending white matter tracts resulting from peripheral nerve damage in HIV neuropathy. Since neuropathic pain and paresthesia are highly correlated, statistical decomposition was used to separate pain and paresthesia symptoms to determine which regions of brain atrophy are associated with both pain and paresthesia and which are associated separately with pain or paresthesia. HIV+ individuals (N = 233) with and without paresthesia in a multisite study underwent structural brain magnetic resonance imaging. Voxel-based morphometry and a segmentation/registration tool were used to investigate regional brain volume changes associated with paresthesia. Analysis of decomposed variables found that smaller midbrain and thalamus volumes were associated with paresthesia rather than pain. However, atrophy in the PCC was related to both pain and paresthesia. Peak thalamic atrophy (p = 0.004; MNI x = - 14, y = - 24, z = - 2) for more severe paresthesia was in a region with reciprocal connections with the PCC. This provides initial evidence that smaller PCC volumes in HIV peripheral neuropathy are related to ascending white matter deafferentation caused by small fiber damage observed in HIV peripheral neuropathy.

Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option.

BACKGROUND/OBJECTIVE: Notalgia paresthetica (NP) is a sensory neuropathy characterized by localized pruritus and pain, presenting with or without a well-circumscribed hyperpigmented patch in the upper back. Abnormal sensations, such as burning, numbness, and paresthesia are often present in patients with NP. In this study, we clinically and radiologically analyzed patients with NP. The literature contains studies describing lidocaine treatments involving intravenous and topical applications for NP. We also investigated the effect of intradermal lidocaine injection on patients with NP. METHODS: A total of 80 patients (45 patients with NP and 35 suffering from dorsalgia without NP) were included in the study. The age, gender and body mass index (BMI) of the patients, and the characteristics of their symptoms were recorded. The severity of pain and pruritus was assessed by the Visual Analog Scale (VAS). Radiography and magnetic resonance imaging of the spine were performed. In this study, we intradermally administered lidocaine diluted with saline into the upper back over three sessions. 1 cc 2% lidocaine was diluted with 5 cc 0.9% saline, and a total of 6 cc lidocaine mixture was obtained. The injection was performed locally at 1-cm intervals around the hyperpigmented patch and segmentally along the C2-T6 spinous processes. These patients were called for a follow-up at the second and fourth weeks and third month. RESULTS: There was no statistically significant difference between the two groups in terms of age, BMI, VAS-pain score, and duration of symptoms (p > 0.05 for all). Forty-six cervical and/or thoracic degenerative changes or herniated nucleus pulposus (HNP) were detected in patients with NP. There was a significantly higher number of HNP at the C6-7 segment and cervical degenerative changes in the NP group (p < 0.05). The VAS-pain and VAS-pruritus scores were significantly decreased at all follow-up sessions, and improvement was sustained by lidocaine up to the third month. CONCLUSION: Cervical degenerative changes and HNP of the C6-7 segment seem to be contributing factors for NP. Local lidocaine can be effective for pain relief and pruritus in NP.

Ulcerative C2 neurocutaneous dysesthesia (trigeminal trophic syndrome in an alternative distribution).

Trigeminal trophic syndrome is an uncommon condition characterized by paresthesia, itch, and self-inflicted wounds following the trigeminal dermatome(s). Similar processes adhering to cervical nerve distributions have been reported, calling into question the specificity of trigeminal trophic syndrome for the trigeminal network. Herein, we report patient with trigeminal trophic syndrome adhering to the C2 dermatome, a previously unreported distribution.

The etiology of notalgia paresthetica: a descriptive study of 117 patients.

BACKGROUND: Notalgia paresthetica (NP) is a neuropathic itching condition unilaterally localized in the midscapular area. It is a common but an underdiagnosed disease, and only a few studies investigating NP etiology with a limited number of patients have been reported in the literature. OBJECTIVE: We aimed to evaluate the demographic, clinical, histopathological, neurological, and radiological findings of NP patients and investigate correlations between them and symptoms of NP to elucidate the etiology of NP. METHODS: One hundred and seventeen consecutive patients diagnosed with NP were included and assessed in a multidisciplinary and prospective manner. We recorded demographic and clinical data and obtained a skin biopsy from the pruritic or hyperpigmented region. Pruritus severity was assessed by visual analogue scale (VAS). All patients were evaluated neurologically with magnetic resonance imaging. RESULTS: The mean age of the patients was 47.08 ± 12.28 years. The disease was more common in females (87.2%). Statistical analysis revealed that VAS scores were independent of the age, gender, and skin type of the patient. We found no significant difference in VAS scores between NP patients with or without comorbidities. Vertebral pathologies detected by MRI and amyloid deposition revealed in histopathology were not among the main factors affecting VAS scores. STUDY LIMITATION: Since consecutive patients enrolled into the study, we could not include equal number of male and female patients. CONCLUSION: We found no correlation between symptom severity and findings from neurological and histopathological evaluations. Further microneurological studies should be carried out to elucidate the etiology of NP.

Primitive Neuroectodermal Tumor of the Prostate with Notalgia and Paraplegia as the Initial Symptoms: A Case Report and Literature Review.

Primitive neuroectodermal tumor (PNET) is a rare and highly malignant neoplasm composed of small round cells, which frequently occurs in children and adolescents. PNET originating from the prostate is even rarer. We report a case of PNET of the prostate with notalgia and paraplegia as the initial symptoms. Positron emission tomography-computed tomography scanning showed hypodense and hypermetabolism on the prostate; subsequently, we ascertained the diagnosis by transrectal ultrasound-guided biopsy. The patient underwent local vertebral radiotherapy combined with five courses of systematic chemotherapy. Disease progressed after 11 months, and the overall survival was 17 months.

Effects of Integrin ß1 on behavior and neurovascular regeneration in rats with cerebral ischemia-reperfusion injury.

OBJECTIVE: The aim of this study is to investigate the effect of Integrin ß1 on neurological behavior and neurovascular regeneration in rats with a cerebral ischemia-reperfusion injury. MATERIALS AND METHODS: Rat middle cerebral artery occlusion (MCAO) was performed with a modified suture embolization method. Neurological function score of each rat was recorded. Cerebral infarct volume was calculated by Image J after TTC stain. Subsequently, behavioral tests were performed to evaluate neuronal damage, including griping strength test, corner test, cylinder test and sucrose preference test. The expression levels of VEGF, HIF-1α, Claudin5, and ZO-1 in rat brain tissues were detected by Western blot and quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR), respectively. RESULTS: Neurological function score of the rat was remarkably decreased after cerebral ischemia-reperfusion. Anti-Integrin ß1 administration aggravated neurological deficit and increased cerebral infarct volume of I/R rats. Symptoms of hemidysesthesia, dyskinesia, and affective disorder of rats were worse after anti-Integrin ß1 administration in I/R rats. Anti-Integrin ß1 administration downregulated VEGF and HIF-1α in rat brain tissues (p<0.05). However, no significant differences in Claudin5 and ZO-1 expressions were found before and after Integrin ß1 treatment. CONCLUSIONS: The inhibition of Integrin ß1 pathway during cerebral ischemia-reperfusion aggravates the behavior and neurovascular regeneration of I/R rats. In the process of cerebral ischemia-reperfusion, Integrin ß1 plays a key role in the repair and protection of neurovascular units by promoting angiogenesis.

Phosphorylated α-synuclein deposits in sural nerve deriving from Schwann cells: A biomarker for Parkinson's disease.

INTRODUCTION: Paresthesia is common in Parkinson's disease (PD) patients. We assumed that peripheral nerve might be implicated. This study aimed to investigate whether phosphorylated α-synuclein (pSNCA) pathology occurred in sural nerve fibers and to explore the underlying pathogenesis of paresthesia of lower limbs associated with PD. METHODS: Clinical assessments and sural nerve biopsy were performed to evaluate clinical characteristics and the deposition of total α-synuclein (tSNCA) and pSNCA in biopsy pieces using immunochemistry methods on 16 PD patients and 15 controls. In addition, immunofluorescence staining was performed using certain antibodies to characterize the component of sural nerve and to localize the expression of pSNCA. RESULTS: Deposition of pSNCA was found in 16/16 PD patients with a high positive percentage of 100% but in 0/15 controls, however, all biopsy pieces showed positive response to tSNCA immunohistological staining in nerve fibers. pSNCA was expressed mainly in Schwann cells but scarcely in axons, demonstrating a novel pattern of pSNCA expression in peripheral nervous system. CONCLUSION: Our findings suggest that peripheral somatic sensory nerve is also involved in SNCA pathology in PD. The search for pSNCA in sural nerve might serve as a novel biomarker for early diagnosis of PD and pSNCA in sural nerve may derive from Schwann cells rather than propagate retrograde along the primary sensory neurons from the central nervous system.

Preoperative evaluation and surgical technique of functional and cosmetic aspects in zygomatic complex fracture patients.

The zygomatico-maxillary complex functions as the principle buttress of the face and is the cornerstone to an individual’s aesthetic appearance. Its fracture not only creates cosmetic deformities owing to its position and facial contour, but can also cause disruption of ocular and mandibular functions. The aim of this study was to evaluate the quality, efficacy and impact of internal fixation of zygomatic complex fractures on functional and cosmetic outcomes. A prospective study was carried out on 100 patients who were divided according to the classification and the severity of injury. Subjective evaluation was submitted based on the patient’s perception of signs and symptoms in the preoperative and postoperative periods. Intraoperative and postoperative assessment of bone reduction quality was made according to the type of the fracture and related difficulties; also, the difference between these groups was observed as functional and esthetic outcome. To optimize the treatment of zygomatic bone fractures, a pre-designed questionnaire was used for subjective evaluation of symptoms and treatment outcome. In 70% of cases, ophthalmologic consultation was taken and was most common in type VII fractures (100% cases). Neurosensory disturbance was the most common finding (60%), followed by diplopia (56R%), pain upon mouth opening (54%) and malar depression (50%). Out of all possible 400 fracture sites in 100 patients of zygomatic complex fractures, 266 (66.5%) fractures were detected by clinical examination, in contrast to 330 (82.5%) on radiological examination, which were highest at zygomatic-maxillary buttress (93%) followed by infraorbital rim (91%) and almost equal among fronto-zygomatic site (72%) and zygomatic arch (74%). The scores from the questionnaire for annoyance were significantly higher for paraesthesia (23%) than for trismus (10%), pain (8.5%), or deformity (8.25%). Residual deformity and pain significantly influenced the total satisfaction. Conclusively, there are many treatment modalities available for zygomatic complex fractures, and the preferred methods should be selected on the basis of fracture type, fracture severity, pre-operative signs and symptoms. Regarding the requirements of fracture site exposure and actual fixation, one priority should be to minimize postoperative complications, morbidity and residual deformities.

Three dimensional versus standard miniplate fixation in the management of mandibular fractures: A meta-analysis of randomized controlled trials.

The aim of this meta-analysis is to evaluate the efficacy of the 3-dimensional miniplate system in comparison with the standard miniplate system for the treatment of mandibular fractures (MFs). A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and PubMed databases. The primary search objective was to identify all papers reporting the results of randomized control trials (RCTs) for the treatment of adults with mandibular fractures, with the aim of comparing the different techniques. The incidence of complications was evaluated; nine studies including 283 patients with different fracture sites were enrolled in the analysis. The results showed no significant differences in overall complications (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.552-1.542; P = 0.81), postoperative infections (OR, 0.99; 95% CI, 0.40-2.48; P = 0.89), wound dehiscence (OR, 0.96; 95% CI, 0.13-7.37; P = 0.96), paresthesia (OR, 0.47; 95% CI, 0.20-1.07; P = 0.11), or malocclusion (OR, 1.8; 95% CI, 0.39-8.32; P = 0.47) between standard miniplates and 3-dimensional miniplates for treating mandibular fractures. Mandibular fractures treated with 3-dimensional miniplates and standard miniplates presented similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using standard miniplates also indicated that the standard miniplate has a promising application in the treatment of mandibular fractures.

[THE COMPARATIVE ANALYSIS RESULTS OF ENDOVASCULAR LASER COAGULATION AND A STANDARD PHLEBECTOMY IN THE TREATMENT OF CHRONIC DISEASES OF THE LOWER EXTREMITIES VEINS].

The results of treatment of 58 patients, suffering chronic diseases of the lower extremities veins, were analyzed. In 28 patients a vertical reflux was eliminated using endovascular laser coagulation, in 32 patients--a standard phlebectomy in accordance to Babcock method was performed. The complications rate was compared as well as the term of the patients' stationary treatment. After elimination of endovascular laser coag- ulation the complications rate and severity is significantly lesser, than after a standard phiebectomy. In accordance to the ultrasonographic duplex scanning data in 12 mo in one patient a partial recanalization of large subcutaneous vein was noted. A total fibrous transformation of the coagulated venous trunks was achieved in 95.24% of the patients. Duration of postoperative stationary treatment have had reduced from (4.8 ± 0.8) to (1.2 ± 0.1) days (p < 0.001).

Hypoxia-induced sensitisation of TRPA1 in painful dysesthesia evoked by transient hindlimb ischemia/reperfusion in mice.

Dysesthesia is an unpleasant abnormal sensation, which is often accompanied by peripheral neuropathy or vascular impairment. Here, we examined the roles of transient receptor potential ankyrin 1 (TRPA1) in dysesthesia-like behaviours elicited by transient hindlimb ischemia (15-60 min) by tightly compressing the hindlimb, and reperfusion by releasing the ligature. The paw-withdrawal responses to tactile stimulation were reduced during ischemia and lasted for a while after reperfusion. Hindlimb ischemia/reperfusion elicited spontaneous licking of the ischemic hindpaw that peaked within 10 min. The licking was inhibited by reactive oxygen species (ROS) scavengers, a TRPA1 antagonist, or TRPA1 deficiency, but not by TRPV1 deficiency. In human TRPA1-expressing cells as well as cultured mouse dorsal root ganglion neurons, the H2O2-evoked TRPA1 response was significantly increased by pretreatment with hypoxia (80 mmHg) for 30 min. This hypoxia-induced TRPA1 sensitisation to H2O2 was inhibited by overexpressing a catalytically-inactive mutant of prolyl hydroxylase (PHD) 2 or in a TRPA1 proline mutant resistant to PHDs. Consistent with these results, a PHD inhibitor increased H2O2-evoked nocifensive behaviours through TRPA1 activation. Our results suggest that transient hindlimb ischemia/reperfusion-evoked spontaneous licking, i.e. painful dysesthesia, is caused by ROS-evoked activation of TRPA1 sensitised by hypoxia through inhibiting PHD-mediated hydroxylation of a proline residue in TRPA1.

[Analysis of the characteristic of pharyngeal paraesthesia patients by high resolution manometry].

OBJECTIVE: To discuss the pressure changing characteristics of upper esophageal sphincter (UES), lower esophageal sphincter (LES) and the esophagus kinetic characteristics of pharyngeal paraesthesia patients. METHOD: To take high resolution manometry in 44 cases of pharyngeal paraesthesia patients and 23 normal subjects separately. According to the RSI score,the 44 patients were divided into group A (the group without reflux, RSI < 13, n = 25) and group B (the group with reflux, RSI ≥ 13, n = 19). RESULT: The UES average resting pressure and average residual pressure of patients group were higher than the control group (P < 0.05); The UES average resting pressure and average residual pressure of group B were higher than group A (P < 0.05); The LES average resting pressure and average residual pressure of group B were lower than group A and the control group (P < 0.05); The comparison of LES average resting pressure and average residual pressure between group A and the control group was not statistically significant (P > 0.05). The esophagus DCI of group B was lower than that of group A and control group (P < 0.05). The esophagus DCI comparison between group A and control group was not statistically significant (P > 0.05). CONCLUSION: The pharyngeal paresthesia symptoms of'patients was associated with the increasing of UES pressure. The pharyngeal paresthesia symptoms of group with reflux was related to low pressure of LES and high pressure of UES. The last part of esophagus of group with reflux had obstacles in powers, which weaken the peristalsis and declined the ability to clear the bolus and gastric reflux material.

[COMPARISON OF INTRAOPERATIVE SCLEROOBLITERATION AND ECHOSCLEROOBLITERATION EFFICIENCY OF VARICOSE DISEASES OF THE LOWER EXTREMITIES C6 CLASS IN PATIENTS BY TYPE II DIABETES MELLITUS].

The experience of surgical treatment of 50 patients for varicose disease of lower extremities, complicated by trophic ulcers, in the presence of diabetes mellitus type II were analysed. During surgery in patients of the 1st group performed a combined phlebectomy, group 2--scleroobliteration and echoscleroobliteration. Using fleboscleroobliteration method helped reduce the frequency of early postoperative complications in (6.5 +/- 1.3) times.