miR-146a and miR-155 expression in PBMCs from patients with Sjögren's syndrome.

BACKGROUND: An increasing number of studies have revealed that microRNA (miRNA) contributes to the pathogenesis of autoimmune diseases. The objective of this study is to investigate the miR-146a and miR-155 levels in peripheral mononuclear blood cells from patients with primary Sjögren's syndrome (pSS) who were not receiving medications and to examine the correlations between these miRNA levels and the clinical features of the disease. METHOD: Using real-time polymerase chain reaction analysis of miRNAs, the miR-146a and miR-155 expression levels were assessed in peripheral mononuclear blood cells from 27 patients with pSS and 22 healthy controls, and the relationships between these miRNA levels and the visual analog scale (VAS) scores for dry mouth, dry eyes, and parotid gland swelling were investigated. RESULTS: Compared with the healthy controls, the miR-146a expression level was significantly increased in the patients with pSS (P = 0.0182) and was positively correlated with the VAS scores for parotid swelling (r = 0.4475, P = 0.0192) and dry eyes (r = 0.4051, P = 0.0361). Although the miR-155 expression level was significantly decreased in the patients with pSS (P = 0.0131), the miR-155 expression positively correlated with the VAS score for dry eyes (r = 0.4894, P = 0.0096). CONCLUSION: Our results demonstrated miR-146a overexpression and miR-155 underexpression in the peripheral mononuclear blood cells of the patients with pSS. Furthermore, the expression levels of these miRNAs correlated with the patients' clinical features. Our data suggest that miR-146a and miR-155 might play important roles in the pathogenesis of pSS and that their expression levels may be useful for diagnosing pSS and for predicting disease activity and therapeutic responses.

The role of salivary duct morphology in the aetiology of sialadenitis: statistical analysis of sialographic features.

Morphologic characteristics of salivary ducts may contribute to stagnation of saliva. The authors hypothesized that some features might contribute to development of submandibular and parotid sialadenitis. 106 digital subtraction sialograms (DSS) were retrospectively reviewed for: degree of sialadenitis, length of Wharton's and Stensen's ducts (SD), and angle of Wharton's duct (WD) genu. Student's t test was used for independent samples to statistically compare normal and sialadenitis groups. The effect of independent variables (age, gender, side, degree of sialadenitis) on the dependent variable (length or angle) were tested using regression analysis. Submandibular duct sialadenitis was mild (67%), moderate (8%), or severe (25%); parotid duct sialadenitis was mild (57%), moderate (18%), or severe (25%). Mean length of normal WD was 58.2 mm, and 56.3 mm with sialadenitis. Mean length of normal SD was 52 mm, and 53 mm with sialadenitis. The mean angle of WD genu was 115° in normal ducts, and 119° with sialadenitis. None of the independent variables affected variation in length or angle. There were no statistical differences in duct length or measured angle between normal and sialadenitis groups. There is a wide variation in salivary duct morphology but this does not appear to be associated with the cause of sialadenitis.

The relationship between sialographic images and clinical symptoms of inflammatory parotid gland diseases.

OBJECTIVE: The objective of this study was to evaluate the relationship between sialographic images and clinical symptoms of inflammatory parotid gland diseases. MATERIALS AND METHODS: Clinical symptoms including swelling, pain, the duration of these symptoms, and degree of salivation were examined on 83 parotid glands from 64 patients. Swelling and pain were classified into 4 categories. Duration of any symptom was recorded in months and the degree of salivation was classified into 4 groups by inspection and massage. Sialography was performed and panoramic radiographs were taken later to examine the evacuation state of the contrast medium. The degree of inflammation on sialographic images was evaluated in 3 areas (the main duct, the intraglandular duct, and the parenchyma) by rating 4 grades respectively under the consensus of 3 radiologists. A Fisher's exact test and a Pearson correlation were used for statistical analyses. RESULTS: The degree of salivation showed significant correlation between the presence of inflammation and the grades of inflammation on sialographic images. There was also a correlation between the grades of inflammation of the sialographic images and the amount of retention of the contrast medium. There was no significant relationship between the grades of inflammation of the sialographic images with swelling or pain. CONCLUSION: The grade of inflammation of a sialographic image has correlated with a degree of salivation.

Classification and management of chronic sialadenitis of the parotid gland.

Saliva has numerous oral functions and multiple functions in relation to digestion in the upper gastrointestinal tract. Chronic salivary hypofunction can lead to severe adverse health outcomes. Chronic sialadenitis is one of the major conditions that can cause salivary hypofunction. A correct diagnosis and management of chronic sialadenitis is essential for the recovery of salivary hypofunction. Chronic sialadenitis of the parotid gland is often seen in the clinic, sometimes also referred to as recurrent pyogenic parotitis, recurrent parotitis, non-obstructive parotitis, sialadenitis or obstructive parotitis, among other terms. The literature describes several different classifications and denominations for chronic sialadenitis of the parotid gland. These various classifications and denominations complicate the definition and diagnostic criteria, and if chronic sialadenitis of the parotid gland can develop into Sjogren's syndrome remains unclear. Treatment of this condition is also a challenging problem. Here, we review the presented classification and denomination of chronic sialadenitis of the parotid gland, proposing a classification based on the disease entities identified in a long-term follow-up investigation, and discuss the treatment principles for the condition.

Primary Sjögren's syndrome in children and adolescents: are proposed diagnostic criteria applicable?

OBJECTIVE: To compare the proposed criteria for the diagnosis of primary Sjögren's syndrome (pSS) in childhood to the validated American-European Consensus Group (AECG) classification criteria for pSS in adults. METHODS: Charts of 7 children with pSS seen at British Columbia's Children's Hospital (BCCH) and data on 128 children identified through Medline in the English language literature between 1963 and 2003 were reviewed for pediatric and AECG criteria for pSS. The presence of > or = 4 criteria was required to satisfy the respective classification criteria. The expert clinical opinion of pediatric rheumatologists was considered the gold standard for diagnosis. RESULTS: A total of 24/62 (39%) cases satisfied the AECG criteria; 47/62 (76%) satisfied the proposed pediatric criteria. Inclusion of recurrent parotitis increased the sensitivity of the pediatric clinical criteria. From the cases, 78/133 (59%) satisfied the pediatric oral symptom criteria; only 6/78 (8%) had xerostomia in the absence of recurrent parotitis. There was no reported case of recurrent conjunctivitis in the absence of keratoconjunctivitis sicca. We found 101/130 (78%) cases had at least one positive autoantibody test result [antinuclear antibodies (ANA), rheumatoid factor (RF), SSA, SSB]; 78/123 (63%) had autoantibodies to SSA or SSB. CONCLUSION: The AECG adult criteria for pSS should not be applied to children as the sensitivity is unacceptably low. The inclusion of recurrent parotitis increases the sensitivity of the pediatric criteria, and recurrent parotitis should alert the clinician to the possibility of pSS. The inclusion of recurrent conjunctivitis did not improve the sensitivity over the AECG ocular criteria. The addition of ANA and RF to the AECG criteria did not change the number of patients satisfying the criteria for pediatric pSS.

[Analysis of parotid sialography and intervention in 78 cases of chronic pyogenic parotitis].

OBJECTIVE: To study the value of parotid sialography and intervention in the diagnosis and treatment of chronic pyogenic parotitis. METHODS: Undertake the technique of parotid sialography with 48% Lipiodol ultra-fluide (France) under X-ray upon 78 patients who were given systemic anti-infections and supporting treatments only with non-obvious-results, and classify all the cases into chronic obstructive (21 cases) and nonobstructive parotitis (57 cases) according to the results of sialography through microcatheter, then go on with bacterial culture and drug sensitivity test. Filling treatments were carried out on obstructive parotitis cases through the duct with mixed liquor consisting of 2% lidocanine, 1% methylviolet. In the same way, alpha-chymotrypsin, amikacin, lidocaine was used in nonobstructive cases. RESULTS: The cure rate of chronic obstructive parotitis was 80.95%, the cure rate of chronic nonobstructive parotitis was 87.72%. CONCLUSION: The method of parotid sialography and intervention in the diagnosis and treatment of chronic pyogenic parotitis is an effective way to treat chronic pyogenic parotitis.

Chronic suppurative parotitis: a proposed classification.

OBJECTIVE: To propose a practical and reasonable classification of chronic suppurative parotitis (CSP) on the basis of the various entities. MATERIAL AND METHODS: Clinical, laboratory, sialographic, scintigraphic, histopathologic (including ultrastructural) study of recurrent parotid swellings (RPS) was performed in 291 patients over a 10-year period. RESULTS: It is suggested that CSP should be classified into recurrent parotitis in childhood (RPC), recurrent parotitis in adults (RPA), chronic obstructive parotitis (COP) and should be differentiated from other subdivisions including subclinical Sjögren's syndrome (SCSS), chronic parotid swelling of Sjögren's syndrome and sialadenosis with retrograde infection. RPA is a continuation of recurrent parotid swelling from childhood (RPC) to adulthood. Remission can take place spontaneously in RPC and RPA so that self-conservative therapy is mainly used for reducing the parotid swellings. COP is recurrent parotid swellings and/or purulent discharge resulting from various obstructive factors. Mild COP can recover completely with the use of conservative methods, severe COP is often resistant to conservative treatment and should be treated with surgical modality or injection of methyl violet into the diseased gland. Treatment with methyl violet is considered as a convenient and practical method with a definite effect. SCSS is an autoimmune disease and should be treated as systemic disease. CONCLUSIONS: Because there exists confusion in the nomenclature of RPS this revised classification is based on the various entities and can be used as a guide in the diagnosis and treatment of RPS.

[Sialographic changes in chronic obstructive parotitis related to clinical and pathologic findings].

This study presents a study on 23 patients with chronic obstructive parotitis (COP) in whom the sialographic changes are related to the clinical and histopathological features. The sialographic changes are divided into 4 types. The stimulated parotid flow rate (SPFR) is normal in sialography Type I patients, while SPFR is significantly reduced in Type II, III, and IV patients, as compared with healthy persons. The changes under light microscope consist of irregular dilatation and chronic inflammation of main and branching ducts with saliva deposits in the enlarged luminal system. Ultrastructural changes include degeneration of ductal epithelial cells, marked proliferation of periductal fibrous tissue, and moderate electron-dense deposits in the lumen of the dilated peripheral ducts. The extent of the histopathologic changes largely parallel the severity of the sialographic changes. These findings indicate that COP is a common inflammatory disease and that the sialographic classification reflects the severity of the disease.

Sialographic changes related to clinical and pathologic findings in chronic obstructive parotitis.

This paper presents the results from a study of 23 patients with chronic obstructive parotitis (COP) in whom the sialographic changes were related to the clinical and histopathologic features. The sialographic changes were divided into four types. The stimulated parotid flow rate (SPFR) was normal in sialography Type I patients, while SPFR was significantly reduced in Types II, III, and IV patients, as compared with healthy persons. The changes observed by light microscopy were irregular dilation and chronic inflammation of main and branching ducts with saliva deposits in the enlarged luminal system. Ultrastructural changes included degeneration of ductal epithelial cells, marked proliferation of periductal fibrous tissue, and moderately electron-dense deposits in the lumen of the dilated peripheral ducts. The extent of the histopathologic changes largely paralleled the severity of the sialographic changes. These findings indicate that COP is a relatively common inflammatory disease and that the sialographic classification reflects the severity of the disease.

Conductas en infectología / Behavior in infectology

Excelente, conciso y actualizado texto sobre diagnóstico y tratamiento de Enfermedades Infecciosas y temas relacionados (por ej.: infecciones en el paciente con cáncer, fiebre de origen desconocido, uso racional de antibióticos en el hospital, infecciones vinculadas con catéteres vasculares, causas infecciosas de esterilidad, infecciones en pacientes con sistemas de derivación o shunt ventrículo-peritoneal, etc, etc). Infecciones del aparato respiratorio. Del aparato circulatorio. Del sistema nervioso. Del aparato digestivo. Del aparato genitourinario. Oculares. Osteoarticulares. De piel y partes blandas. Infecciones severas y su control. En pacientes inmunocomprometidos. Patología infecciosa prenatal y perinatal. Enfermedades exantematicas. Infecciones ganglionares y glandulares. Toma de muestras para bacteriología. Antibioticoterapia. Inmunoprofilaxis y quimioprofilaxis en condiciones especiales

Conductas en infectología / Behavior in infectology

Excelente, conciso y actualizado texto sobre diagnóstico y tratamiento de Enfermedades Infecciosas y temas relacionados (por ej.: infecciones en el paciente con cáncer, fiebre de origen desconocido, uso racional de antibióticos en el hospital, infecciones vinculadas con catéteres vasculares, causas infecciosas de esterilidad, infecciones en pacientes con sistemas de derivación o shunt ventrículo-peritoneal, etc, etc). Infecciones del aparato respiratorio. Del aparato circulatorio. Del sistema nervioso. Del aparato digestivo. Del aparato genitourinario. Oculares. Osteoarticulares. De piel y partes blandas. Infecciones severas y su control. En pacientes inmunocomprometidos. Patología infecciosa prenatal y perinatal. Enfermedades exantematicas. Infecciones ganglionares y glandulares. Toma de muestras para bacteriología. Antibioticoterapia. Inmunoprofilaxis y quimioprofilaxis en condiciones especiales