Assessment of psychological changes in young children during dental treatment: Analysis of the autonomic nervous activity and electroencephalogram.

BACKGROUND: Understanding the emotional changes in children during dental treatment is necessary for providing stress-free care. AIM: To objectively assess the stress associated with dental treatment in children, based on the autonomic nervous activity and the electroencephalogram (EEG). DESIGN: Twenty-two children aged 4-9 years were recruited from outpatients of a paediatric clinic. Electrocardiogram and EEG were recorded throughout the treatment to analyze the autonomic nervous activities and the powers of brain waves, respectively. Changes in these measurements during each treatment process were evaluated in two age groups: 4-6 years and 6-9 years. RESULTS: Elevations in sympathetic activities accompanied by decreased parasympathetic activities induced by stress were observed during rubber dam setting (RD) in the age group of 4-6 years and during infiltration anesthesia (IA), RD, and cavity preparation with a dental turbine (CP-T) in the age group of 6-9 years. Stress-related beta wave increments in EEG were observed during IA and CP-T in the age group of 6-9 years but not in the age group of 4-6 years. CONCLUSION: Monitoring the autonomic nervous activities during treatments is useful in assessing stresses in a wide age of young children, whereas EEG monitoring is applicable only to children older than 6 years.

Serum Reactive Oxygen Metabolites as a Predictor of Clinical Disease Activity Index, Simplified Disease Activity Index, and Boolean Remissions in Rheumatoid Arthritis Patients Treated With Biologic Agents.

Introduction Reactive oxygen metabolites (ROMs) are metabolite hydroperoxides in the blood, and their serum levels were associated with the disease activity score 28 (DAS28) in patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether ROMs would be predictive of the clinical disease activity index (CDAI) remission, simplified disease activity index (SDAI) remission, or Boolean remission. Materials and methods Fifty-one biologic agents (BA)-naïve RA patients were included in this observational study. Associations between ROMs, C-reactive protein, matrix metalloproteinase-3, DAS28-erythrocyte sedimentation rate (ESR), CDAI, SDAI, and health assessment questionnaire (HAQ) at 12 weeks and the DAS28, CDAI, SDAI, and Boolean remission rates at 52 weeks were investigated. Results The DAS28, CDAI, SDAI, and Boolean remission rates at 52 weeks were 66.7, 52.9, 54.9, and 54.9%, respectively. A multivariate logistic regression analysis revealed that ROMs and HAQ at 12 weeks were associated with the CDAI, SDAI, and Boolean remission at 52 weeks. Receiver operating characteristic analyses demonstrated that the cut-off value for CDAI, SDAI, and Boolean remission was 389.5 U.Carr. Conclusion Reactive oxygen metabolites at 12 weeks of initial treatment with BAs was a predictor for CDAI, SDAI, and Boolean remission at 52 weeks. Serum levels of ROMs may be a useful biomarker in the current treatment strategy aiming at early remission of RA.

Does Abatacept Increase Postoperative Adverse Events in Rheumatoid Arthritis Compared with Conventional Synthetic Disease-modifying Drugs?

OBJECTIVE: To investigate whether abatacept (ABA) causes more adverse events (AE) than conventional synthetic disease-modifying antirheumatic drugs (csDMARD) after orthopedic surgery in patients with rheumatoid arthritis (RA). METHODS: A retrospective multicenter nested case-control study was performed in 18 institutions. Patients receiving ABA (ABA group) were matched individually with patients receiving csDMARD and/or steroids (control group). Postoperative AE included surgical site infection, delayed wound healing, deep vein thrombosis or pulmonary embolism, flare, and death. The incidence rates of the AE in both groups were compared with the Mantel-Haenszel test. Risk factors for AE were analyzed by logistic regression model. RESULTS: A total of 3358 cases were collected. After inclusion and exclusion, 2651 patients were selected for matching, and 194 patients in 97 pairs were chosen for subsequent comparative analyses between the ABA and control groups. No between-group differences were detected in the incidence rates of each AE or in the incidence rates of total AE (control vs ABA: 15.5% vs 20.7% in total, 5.2% vs 3.1% in death). CONCLUSION: Compared with csDMARD and/or steroids without ABA, adding ABA to the treatment does not appear to increase the incidence rates of postoperative AE in patients with RA undergoing orthopedic surgery. Large cohort studies should be performed to add evidence for the perioperative safety profile of ABA.

Effect of biological agents on synovial tissues from patients with rheumatoid arthritis.

Objectives: To compare the inflammation of synovium before and after biological agents in the patients with rheumatoid arthritis (RA) and to investigate the association between synovial histopathology and disease activity.Methods: Synovial tissues were obtained during operations from 34 patients before and after treatment with biological agents. The synovial tissue was evaluated using hematoxylin and eosin staining. Synovial histopathology was evaluated by Rooney score.Results: The Rooney score was also significantly decreased after treatment with biological agents in all items (p < .001). After the treatment with biological agents, Moderate disease activity group had significantly higher scores of focal aggregates of lymphocytes (p = .02), diffuse infiltrates of lymphocytes (p = .019), and the Rooney total scores (p = .002) than remission and low disease activity groups.Conclusion: Our results demonstrated that biological agents significantly decreased the RA synovial inflammation and synovial histopathology in sublining layer reflected disease activity.

Serum levels of reactive oxygen metabolites at 12 weeks during tocilizumab therapy are predictive of 52 weeks-disease activity score-remission in patients with rheumatoid arthritis.

BACKGROUND: To verify whether serum levels of reactive oxygen metabolites (ROM) are predictive of future clinical remission in patients with rheumatoid arthritis (RA) receiving tocilizumab (TCZ) therapy. METHODS: A total of 46 patients with RA receiving TCZ therapy were enrolled in this study. Patients were divided into remission and non-remission groups based on disease activity score 28 (DAS28)-erythrocyte sedimentation rate (ESR) or clinical disease activity index (CDAI) at 52 weeks. Associations between serum levels of ROM, C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3) at 4 and 12 weeks and the remission by DAS28-ESR and CDAI at 52 weeks were investigated. RESULTS: There were no significant differences in CRP and MMP-3 between DAS- or CDAI-remission and non-remission groups at 12 weeks. However, ROM in DAS-remission group were significantly lower than those in the non-remission group. For ROM, the area under the curve of the receiver operating characteristic curve was 0.735 and the cut-off value that distinguished DAS-remission group from non-remission group was 305.5 U. Carr (sensitivity: 70.0%, specificity: 72.2%). A multivariate logistic regression analysis revealed that ROM at 12 weeks was associated with DAS-remission at 52 weeks (odds ratio: 6.067, 95% confidence interval: 1.305-28.203). CONCLUSION: Serum levels of ROM at 12 weeks during TCZ therapy may be predictive of DAS-remission at 52 weeks in patients with RA.

Predictive factors for radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs (bDMARDs): Results of 3 to 4 years of follow-up.

Objectives: Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints.Methods: Seventy-one RA patients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment.Results: RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months).Conclusion: Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.

Effects of oral stimulation with capsaicin on salivary secretion and neural activities in the autonomic system and the brain.

BACKGROUND/PURPOSE: Although it has been reported that capsaicin ingestion has effects of protecting stomach mucosa and promoting energy consumption, physiological responses to oral stimulation with capsaicin has not been elucidated. Therefore, we investigated the effect of oral capsaicin stimulation on oral health and mental conditions by measuring changes in salivation, autonomic nervous activity and electroencephalogram (EEG). MATERIALS AND METHODS: Eighteen healthy adults participated in this study. The stimulus concentrations of capsaicin and five basic taste solutions were determined based on the measured threshold of each stimulus in each subject. The weight of secreted saliva and the changes in concentrations of salivary secretory immunoglobulin A (SIgA) induced by capsaicin and taste stimuli were measured. Salivary α-amylase activity and heart rate variability (HRV) were measured as indicators of autonomic nervous activity. From EEG, psychological condition was analyzed by measuring the powers of theta, alpha, and beta bands. RESULTS: The salivary secretion rate was significantly increased by stimulation with capsaicin, NaCl, and citric acid compared with deionized water, and capsaicin demonstrated the most potent effect among tested stimuli. The secreted amount of SIgA per minute was elevated by capsaicin stimulation. Salivary α-amylase activity and HRV analysis demonstrated an elevation of sympathetic nervous activity induced by capsaicin. EEG analysis showed a significant increase in beta band power. CONCLUSION: These results suggest that oral stimulation with capsaicin may be effective in improving oral conditions by increasing salivary flow and SIgA secretion, and in enhancing physical and mental conditions as indicated by sympathetic nerve and EEG changes.

[The latest treatment of the forefoot and ankle of the patients with rheumatoid arthritis].

Operative therapy for the foot and ankle disorders of rheumatoid arthritis (RA) have been changing with advances in drug therapy. The surgical techniques, joint-preserving procedure for the RA foot and total ankle arthroplasty for the RA ankle, are the surgical techniques which allow patients with RA not only to relief their pain but also obtain higher lower limb function. Recently, more and more patients with RA have been receiving joint-preserving procedure for the foot or total ankle arthroplasty for the ankle. Therefore, in this article, we would like to describe surgical therapy for the lower limb of patients with RA.

Does use of a biologic agent increase the incidence of postoperative infection in surgery for rheumatoid arthritis after total joint arthroplasty?

OBJECTIVES: The goal of the study was to examine the influence of biological agents on postoperative infections such as surgical site infection (SSI) and late infection in patients with rheumatoid arthritis after total joint arthroplasty at our hospital between January 2006 and December 2011. METHODS: The patients were divided into groups with (Bio group, 267 joints) and without (Non-Bio group, 300 joints) treatment with biological agents. We examined the incidence of postoperative infection in Bio group and Non-Bio group. Multivariate logistic regression analysis was performed to identify the risk factor of postoperative infection. RESULTS: The incidences of superficial and deep SSI were 0.37% and 1.0%, respectively, in the Bio group, and 0.67% and 0%, respectively, in the Non-Bio group, with no significant difference between the two groups. The incidences of late infection were 1.0% and 0% in the Bio and Non-Bio groups, respectively, again with no significant difference between the groups. Multivariate logistic regression analysis revealed the following values for the surgery of the foot and ankle region [P = 0.001, odds ratio (OR) = 19.27; 95% confidence interval (CI) 4.67-79.45]. The use of biological agents was not a risk factor for postoperative infection. CONCLUSIONS: These results suggest that the use of biological agents does not significantly increase the incidences of SSI and late infection after orthopedic surgery in patients with rheumatoid arthritis after total joint arthroplasty.

Low Level Laser Therapy for chronic knee joint pain patients.

BACKGROUND AND AIMS: Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain. MATERIALS AND METHODS: Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm(2) per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks. RESULTS: A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). After treatment, no significant differences were observed in the knee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment. CONCLUSION: The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee.

Perioperative complications in elective surgery in patients with rheumatoid arthritis treated with biologics.

We retrospectively investigated the influence of biological agents on delayed wound healing and the occurrence of postoperative surgical site infection (SSI) in patients after surgery for rheumatoid arthritis. The patients were divided into two groups-those with and without treatment with biological agents (276 and 278 joints, respectively)-and adverse events (delay in wound healing and SSI) were investigated. Wound healing was delayed in 11.4% of total knee arthroplasty (TKA) operations, 16.7% of total ankle arthroplasty operations, and 9.7% of foot surgeries in the treatment group, and in 5.5% of TKA operations, 12.5% of total elbow arthroplasty operations, and 5.7% of foot surgeries in the non-treatment group. The difference in the incidence of delayed wound healing between the two groups was not statistically significant. In the treatment group, postoperative superficial and deep infection developed in one and two joints, respectively. In the non-treatment group, superficial infection developed in one joint. There was no statistically significant difference between the two groups. These findings suggest that the use of biological agents may not affect the incidence of postoperative adverse events related to wound healing and SSI.

Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis.

The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.

Tumor necrosis factor-alpha promotes the expression of osteoprotegerin in rheumatoid synovial fibroblasts.

OBJECTIVE: To clarify the regulation of osteoprotegerin (OPG) expression in rheumatoid synovial fibroblasts by investigating the effect of tumor necrosis factor-alpha (TNF-alpha) and the mechanism of TNF-alpha-induced OPG expression. METHODS: OPG expression was examined by Northern blot hybridization and reverse transcriptase-polymerase chain reaction in synovial fibroblasts from patients with rheumatoid arthritis (RA) and osteoarthritis (OA) and subjects with no inflammatory condition. Amounts of OPG in conditioned medium were determined by ELISA. The effect of OPG on TNF-alpha-induced osteoclastogenesis was investigated in primary cultures of RA synovial cells. RESULTS: OPG was highly expressed in RA synovial fibroblasts compared to OA and noninflammatory synovial fibroblasts. Different levels of OPG expression were found among patients with RA. TNF-alpha induced OPG expression in all synovial fibroblasts, even OA and noninflammatory fibroblasts, and expression occurred to a remarkable degree in RA fibroblasts. The OPG expression was upregulated by TNF-alpha in a time- and dose-dependent manner. TNF-alpha-induced OPG expression was inhibited by hymenialdisine, a nuclear factor-kappaB inhibitor, in a dose-dependent manner, and expression was inhibited by soluble TNF receptor/Fc fusion protein I (TNFs-RI/Fc), not by TNFs-RII/Fc. In contrast, TNF-alpha-induced osteoclastogenesis in primary cultures of RA synovial cells was inhibited by the addition of OPG. CONCLUSION: These results suggest that OPG is highly expressed and is upregulated by TNF-alpha in rheumatoid synovial fibroblasts. TNF-alpha-induced OPG expression is mediated predominantly through TNF-RI. Although TNF-alpha is known to stimulate bone destruction, TNF-alpha-induced upregulation of OPG may contribute to self-protection from the bone destruction in RA.