Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación / Optic neuritis in paediatric patients: Experience over 27 years and a management protocol

Introducción y objetivos: Se presenta nuestra experiencia en neuritis óptica (ON) y se elabora un protocolo diagnóstico-terapéutico, que contempla descartar otras causas, principalmente infecciosas y se elabora una hoja informativa para padres.Material y métodoEstudio descriptivo retrospectivo de los pacientes con ON en 27 años (1990-2017). Revisión de evidencia científica para elaboración del protocolo y hoja informativa.ResultadosEn nuestra sección de neuropediatría se valoraron 20.744 niños en 27 años, 14 con ON: 8 ON aisladas, una esclerosis múltiple (EM), un episodio clínicamente aislado (CIS), 3 encefalomielitis agudas diseminadas y un paciente con ON aislada que el año anterior había sufrido una encefalomielitis aguda diseminada. Edades entre 4-13 años, 50% varones. Mayores de 10 años, 8 pacientes: 7 ON aisladas y un EM. Bilaterales 9, retrobulbares 3. Resonancia magnética cerebral normal en 7, solo afectación del nervio óptico en 2 y con desmielinización del SNC en 5 casos. Recibieron corticoterapia 13/14. Un caso vacunado de meningococo-C el mes anterior. Todos evolucionaron favorablemente, salvo la EM. Se presentan el protocolo y la hoja de información.ConclusionesHabitual curso favorable. En niños a partir de 10 años, con factores de riesgo de desarrollar EM o neuromielitis óptica (presencia de hiperseñales en RM cerebral, bandas oligoclonales, anti-NMO, recurrencia de ON), se consensúa con Neurología el inicio de tratamiento inmunomodulador. Utilidad del protocolo para la toma de decisiones diagnósticas, de seguimiento y tratamiento, de una patología poco frecuente pero con posibles repercusiones importantes. Importancia de la protocolización y hojas informativas. (AU)

Introduction and objective: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents.Material and methodsWe conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet.ResultsOur neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients’ age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided.ConclusionsON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important. (AU)

Water-mediated height artifacts in dynamic atomic force microscopy.

Amplitude modulation atomic force microscopy is one of the most broadly used techniques for the nanoscale characterization of a large variety of surfaces because it can routinely provide topography images with nanometer and subnanometer resolution in air, i.e. under ambient conditions, using available commercial instruments. The topographic map results from the convolution of the different interactions (van der Waals, capillary, adhesion, etc.) sensed by the probe and the presence of nanometer-thick water films on both the surface and the tip of the probe, as is usually the case under ambient conditions, can lead to apparent heights markedly different from the real heights due to formation and rupture of water menisci, particularly when the surfaces exhibit regions with different affinity to water (hydrophilic and hydrophobic). In order to systematically explore such a well-known but usually ignored phenomenon, we have performed a combined experimental and theoretical study using (hydrophobic) self-assembled monolayers of stearic acid grown on (hydrophilic) freshly cleaved mica surfaces and a simplified point mass on a spring model to simulate the tip dynamics. We show that, depending on the operation parameters (free oscillation amplitude and setpoint), the apparent heights can vary in magnitude and sign (contrast inversion) and, most important, that the true height cannot be measured in the presence of water layers when surface affinity to water is not homogeneous even if menisci are not formed. We suggest to revise, within the perspective of the present investigation, those published works where the determination of heights is critical.

Dipolar origin of water etching of amino acid surfaces.

The etching induced by water on hydrophobic (001) surfaces of enantiomeric L-, D- and racemic DL-valine crystals has been characterized by means of atomic force microscopy (AFM) at ambient conditions. Well-defined chiral parallelepipedic shallow patterns, one bilayer deep, are observed for the enantiomeric crystals with sides (steps) oriented along low index crystallographic directions. Hence, chirality can be readily identified by visual inspection of an AFM image after etching. The formation of such regular patterns can be rationalized using basic concepts of electrical dipolar interactions. The key factor that determines the relative etching rate for each step and thus defines the shape of the etching patterns is the orientation of the molecular dipoles with respect to the step edge. The simplicity of the approach allows the prediction of the effect of water etching on other amino acid crystals as well as the effect of the interaction of water with amino acid molecules forming part of more complex structures.

Strong water-mediated friction asymmetry and surface dynamics of zwitterionic solids at ambient conditions: L-alanine as a case study.

Water molecules strongly interact with freshly cleaved (011) surfaces of L-alanine single crystals at low relative humidity (below 10%) promoting diffusion of L-alanine molecules. Species mobility is enhanced above ~40% leading to the formation of two-dimensional islands with long-range order through Ostwald ripening. Scanning force microscopy experiments reveal that both, islands and terraces, are identical in nature (composition and crystallographic structure) but a relevant friction asymmetry appearing upon water-surface interaction evidences that orientation dependent properties exist between them at the molecular level. We interpret this observation as due to water incorporation in the topmost surface crystal structure. Eventually, for high humidity values, surface dissolution and roughening occur.

Amphiphillic organic crystals.

The amphiphillic character, that is, the capacity to simultaneously attract and repel water, has been traditionally reserved to organic molecules such as phospholipids and surfactants, containing both hydrophilic and hydrophobic groups within the same molecule. However, this general concept can be extended to artificial structures such as micrometer-sized particles, the so-called Janus particles, and patterned surfaces. Here we provide an example of an amphiphillic crystalline solid, l-alanine, by combining atomic force microscopy measurements performed on two different cleavage surfaces showing contrasting behaviors when exposed to water vapor, with computer simulations that allow us to clarify the dipolar origin of this behavior. Although we take l-alanine as an example, our results should apply quite generally to dipolar molecular crystals.

Influence of the macroscopic shape of the tip on the contrast in scanning polarization force microscopy images.

We demonstrate that a quantitative analysis of the contrast obtained in electrostatic force microscopy images that probe the dielectric response of the sample (scanning polarization force microscopy (SPFM)) requires numerical simulations that take into account both the macroscopic shape of the tip and the nanoscopic tip apex. To simulate the SPFM contrast, we have used the generalized image charge method (GICM), which is able to accurately deal with distances between a few nanometers and several microns, thus involving more than three orders of magnitude. Our numerical simulations show that the macroscopic shape of the tip accounts for most of the SPFM contrast. Moreover, we find a quasi-linear relation between the working tip-sample distance and the contrast for tip radii between 50 and 200 nm. Our calculations are compared with experimental measurements of the contrast between a thermally grown silicon oxide sample and a few-layer graphene film transferred onto it.

Enamel pearls and cervical enamel projections on 2 maxillary molars with localized periodontal disease: case report and histologic study.

Presented here is an unusual case of teeth with aberrant enamel. One small and 3 large enamel pearls were identified in 2 maxillary third molars of a patient. One long enamel projection was connected to one of the large enamel pearls, along with 2 short cervical enamel projections. The ectopic enamel was associated with advanced localized periodontal destruction. After extraction, the molars were investigated radiographically and under the scanning electron microscope. The 3 large pearls contained distinct dentinal cones. The enamel of the pearls and the long cervical projection exhibited most of the structural attributes of crown enamel but were somewhat irregular, with variable shape and course of the prisms. Morphologic considerations suggest that these enamel pearls were aberrations and should not be regarded as attempts at new cusp or new tooth formation.

Identification of G-protein coupled receptor subunits in normal human dental pulp.

To respond appropriately to their environment, dental pulp cells must integrate informational input from multiple ligands, such as neuropeptides, growth factors, and vasoactive amines. These ligands act through multiple intracellular signaling pathways. G-protein coupled receptor subunits play a major role in this process, providing a mechanism for coordinated regulation of both messengers and effectors. Increasing number of neuropeptides have been found in pulpal tissue. However, there is no data about molecular identification of G-protein subunits in human dental pulp. To identify the postreceptor mechanism involved in dental pulp cell signal transduction, we performed a Western blot analysis of different G-protein subunits. Biopsy specimens of human dental pulp were prepared and subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis, followed by analysis with appropriate antibodies. We detected G alpha q/alpha 11, short and long forms of G alpha s, beta common, Gio-3, and Gil-2 antigens with a molecular weight approximately 42 kDa, 42 and 45 kDa, 36 kDa, 40 kDa, and 40 kDa, respectively. These results indicate that human pulp cells possess the cellular machinery to respond to sensory neuropeptides when they are released from the peptidergic nerve fibers. On this basis, the relationships of postdevelopmental, age-dependent, and pathophysiological disorders of G-proteins subunits in dental pulp could be studied.

In vitro effect of the resin component bisphenol A on substrate adherence capacity of macrophages.

This study was design to investigate the "in vitro" effect of bisphenol A (BPA), a component of resin used in dentistry, on viability, and substrate adherence capacity of macrophages. Peritoneal macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. Viability was determined by trypan blue exclusion. As a test of macrophage adhesion, the adherence capacity of macrophages to a plastic surface was determined and the adherence index was calculated. Assays were conducted in Eppendorf tubes for 60 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2 in air. BPA did not alter significantly macrophage viability at concentrations as high as 10(-5) M, but BPA decreased in a dose-dependent manner the adherence index of rat peritoneal macrophages. Control peritoneal macrophages showed an adherence index = 81.5 +/- 7.9%. In the presence of 10(-8) M BPA, the Al of macrophages decreased to 41.4 +/- 12.2% (p < 0.05). Higher BPA concentrations (10(-7) to 10(-5) M) also caused a significant inhibition of the adherence index. Half-maximal inhibition (IC50) was obtained at 4.92 +/- 0.39 x 10(-6) M BPA. The in vitro study shows that the resin component BPA can alter macrophage adhesion. Taking into account that adhesion is the first step in the phagocytic process of macrophages and in antigen presentation, BPA could inhibit macrophage function and modulate immune and inflammatory responses in dental pulp and periapical tissues.

Talon cusp affecting permanent maxillary lateral incisors in 2 family members.

The term talon cusp refers to a relatively rare dental anomaly in which an accessory cusplike structure projects from the cingulum area or cement-enamel junction. The condition can occur in either maxillary or mandibular anterior teeth in both the primary and permanent dentitions. This article reports 2 cases of talon cusp affecting consanguineous first cousins: a case of bilateral talon cusps on the permanent maxillary lateral incisors of a 16-year-old girl, and a case of talon cusp on the maxillary permanent lateral incisor of an 11-year-old boy. The talon cusps caused clinical problems that were related to caries or occlusal interferences. The presence of the dental anomaly in 2 members of the same family suggests that genetic inheritance may be a causative (related) factor. Examination of relatives could facilitate early diagnosis of the talon cusp and aid in preventing carious and occlusal problems.

Comparative effects of two endodontic irrigants, chlorhexidine digluconate and sodium hypochlorite, on macrophage adhesion to plastic surfaces.

This study was designed to compare the "in vitro" effect of chlorhexidine digluconate, proposed as a new irrigant solution, with sodium hypochlorite, the currently irrigant solution used to disinfect the root canal system before obturation of the canal, on substrate adherence capacity of macrophages. Inflammatory macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. The adherence capacity of macrophages to a plastic surface was determined. Assays were conducted in Eppendorf tubes for 15 min of incubation at 37 degrees C in an humidified atmosphere of 5% CO2 in air. The adherence index was calculated. Chlorhexidine digluconate inhibited substrate adherence capacity of macrophages in all conditions tested. Half-maximal inhibition (IC50) was observed at 1:5.6 dilution. Chlorhexidine digluconate was less potent than 5.25% sodium hypochlorite (IC50 = 1:24.1 dilution) in inhibiting substrate adherence capacity of macrophages. Taking into account that substrate adherence is the first step in the phagocytic process of macrophages and in antigen presentation, chlorhexidine digluconate could inhibit macrophage function and modulate inflammatory reactions at the level of inflamed periapical tissues.

Number of roots and canals in maxillary first premolars: study of an Andalusian population.

A study of 150 extracted maxillary first premolars from citizens of Seville, Andalusía, southern Spain, revealed 60 teeth with one root (40.0%), 85 teeth with two roots (56.7%) and five teeth with three roots (3.3%). The distribution of root canal shapes in the sample showed that all teeth with two or three roots had type I root canals (each canal had one apical foramen). Conversely, most of the single-rooted maxillary first premolars had root canal shape type II (two canals converging in the same apical foramen). Only 1.3% of the teeth had a unique orifice in the pulp chamber and only one root canal. These results emphasized the importance of good knowledge of the root canal morphology and the need for a careful radiographic examination as part of competent root canal therapy of maxillary first premolars.

Effect in vitro of Tifell (formocresol-eugenol) on macrophage adhesion.

The purpose of this study was to investigate the effect in vitro on macrophage adhesion of Tifell (formocresoleugenol), used as an intracanal medicament and in therapeutic pulpotomies in primary teeth, Macrophages were obtained from Wistar rats. As a test of macrophage phagocytic function the adherence capacity of macrophages to a plastic surface was determined. Assays were carried out in Eppendorf tubes after 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% carbon dioxide. The adherence index (AI) was calculated. Results showed that Tifell decreased significantly (P < 0.05) the AI of macrophages. Half maximal inhibition of AI was obtained at 1:334.5 Tifell dilution (AI = 27.75; P < 0.05). Taking into account that substrate adherence is the first step in the phagocytic action of macrophages and in antigen presentation, Tifell could inhibit macrophage function and modulate immune and inflammatory responses in dental pulp and periapical tissues.

Concomitant hypohyperdontia: simultaneous occurrence of a mesiodens and agenesis of a maxillary lateral incisor.

A 13-year-old boy appeared for evaluation with a missing maxillary left lateral incisor. He also had an abnormally shaped tooth in the midline between his maxillary central incisors. This mesiodens had an incompletely developed root. The unusual association of these 2 anomalies is discussed as a possible transposition of the lateral incisor to the mesiodens position.

System of 14C-glucose incorporation in axenic cultures of Entamoeba invadens: IP-1 strain.

BACKGROUND: It has been described that the walls of the amebic cysts from Entamoeba invadens are composed mainly of chitin, a polysaccharide of amino-sugars. It is also known that the synthesis of this polysaccharide is closely related to the degradation of the intracellular glycogen in this organism. Nevertheless, it is not known whether the intracellular glycogen is really the source of the glucose requirements for the synthesis of the cell wall. METHODS: To determine the relationship between the wall cyst synthesis and glycogen degradation, it was considered to develop an in vitro culture cell system to label this polysaccharide with radioactive glucose. In this study, a system of 14C-glucose incorporation in axenic cultures of E. invadens was developed. The experiments in the study were carried out to recognize if an increase occurred in the 14C-glucose incorporation into ameba when the amount of the radioactivity used was increased, or whether this incorporation is a dependent metabolic stage. RESULTS: The results showed that the amount of glucose incorporation reached similar values of 4.5 x 10(-12) mmol per cell in both cases. A different slope in the glucose kinetic incorporation between the cultures previously subjected to glucose depletion and the standard cultures was observed. CONCLUSIONS: This axenic method of radioactive glucose incorporation in Entamoeba invadens could facilitate the analysis on a greater scale of the metabolism of this nutrient.

Effects of formocresol alone vs. formocresol with eugenol on macrophage adhesion to plastic surfaces.

PURPOSE: The purpose of this study was to compare the in-vitro effects of a European-based formocresol formulation that incorporates eugenol with formocresol alone on the adhesion of macrophages to plastic surfaces. METHODS: Macrophages were obtained from Wistar rats. The adherence capacity of macrophages to a plastic surface was determined. Assays were carried out in Eppendorf tubes incubated for 15 min at 37 degrees C in a humidified atmosphere of 5% CO2. The adherence index was calculated. RESULTS: Results showed that both formocresol/eugenol and formocresol alone significantly decreased the adherence index of macrophages. The formocresol formulation that incorporated eugenol was more potent in inhibiting macrophage adhesion than formocresol alone. CONCLUSIONS: Taking into account that adherence to a substrate is the first step in the phagocytic process of macrophages and in antigen presentation, both formocresol formulations could inhibit macrophage function and modulate immune and inflammatory responses in dental pulp and periapical tissues.

The effect of the bleaching agent sodium perborate on macrophage adhesion in vitro: implications in external cervical root resorption.

The purpose of this study was to investigate the in vitro effect of sodium perborate, which is used as a bleaching agent in the treatment of discolored pulpless teeth, on substrate adherence capacity of macrophages. Inflammatory macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. As a test of macrophage adhesion, the adherence capacity of macrophages to a plastic surface was determined. Assays were conducted in Eppendorf tubes for 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2. The adherence index was calculated. Results showed that sodium perborate decreased in a dose-dependent manner and decreased significantly (p < 0.05) the adherence index of rat peritoneal macrophages. Sodium perborate was less potent than sodium hypochlorite and eugenol in inhibiting macrophage adhesion. The inhibitory effect of sodium perborate on macrophage adhesion further supports the concept that this agent is not implicated in external cervical root resorption associated with intracoronal bleaching.

Intracoronal radiolucency in an incompletely erupted permanent molar with a diagnosis of pericoronitis: importance of radiographic examination.

Because of clinical signs and symptoms, a diagnosis of pericoronitis in a partially erupted, partially impacted first molar was made. A more thorough diagnosis was made with the help of a periapical radiograph that showed caries and thus revealed an irreversible pulpitis. Appropriate treatment was the result.

Effect of eugenol on macrophage adhesion in vitro to plastic surfaces.

This study was performed to investigate the in vitro effect of eugenol on substrate adherence capacity of macrophages. Macrophages were obtained from Wistar rats. The adherence capacity of macrophages to the plastic surface of Eppendorf tubes was determined. Assays were carried out in these tubes for 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2 in air. Control peritoneal macrophages showed an adherence index = 52.5%. Eugenol decreased the adherence index of macrophages in a dose-dependent manner. A 1:1000 dilution of eugenol decreased the adherence index of macrophages by 16.6% (P < 0.05). Lower dilutions (1:100 and 1:10) greatly decreased the adherence index by 51% and 96.2% respectively (P < 0.01). Taking into account that substrate adherence is the first step in the phagocytic process of macrophages and in antigen presentation, eugenol could inhibit macrophage function and modulate immune and inflammatory reactions in dental pulp and periapical tissues.