Bidirectional casual effects between periodontitis and Sjögren's syndrome: a Mendelian randomization study / 口腔疾病防治

Objective@#To evaluate the bidirectional association between periodontitis and Sjögren's syndrome using the Mendelian randomization (MR) method.@*Methods@#Genome-wide association study (GWAS) data of periodontitis (N = 45 563) and Sjögren's syndrome (N = 214 435) were selected to meet the requirements of the same ethnicity and different regions. Inverse variance-weighted (IVW), MR-Egger, and weighted median (WM) tests were used to evaluate the causal effect. Cochran's Q statistics, MR-Egger intercept, MR-PRESSO and leave-one-out analysis were used as sensitivity analyses to assess the stability and reliability of the results.@*Results@#After screening, the GWAS data of Sjögren's syndrome were based on the Finnish region, and the periodontitis GWAS data were based on the UK region, both of which originated from European ancestry. Using IVW (OR = 1.017, 95% CI = 0.956-1.082), MR-Egger (OR = 0.985, 95% CI= 0.956-1.082), and WM (OR =1.021, 95% CI = 0.948-1.099), no causal effect of Sjögren's syndrome on periodontitis was found using any of the three methods. Conversely, no causal effect of periodontitis on Sjögren's syndrome was found (IVW, OR = 1.024, 95% CI = 0.852-1.230; MR-Egger, OR = 0.978, 95% CI = 0.789-1.212; WM, OR = 1.024, 95% CI = 0.846-1.260). The sensitivity analyses indicated that the results were stable and reliable. Cochran's Q test and MR-PRESSO revealed that there was no significant heterogeneity among the instrumental variables, which included single nucleotide polymorphisms (SNPs). The intercept of MR-Egger regression indicated no pleiotropy in the included SNPs. No individual SNP was found that significantly affected the results using the leave-one-out method.@*Conclusion@#This study does not support a bidirectional causal effect between periodontitis and Sjögren's syndrome.

Evaluation of the efficacy of cevimeline in improving the clinical symptoms of patients with primary Sjögren′s syndrome / 口腔疾病防治

Objective@# To investigate the clinical efficacy of cevimeline as a pharmacotherapeutic approach to stimulating gland activity in improving the symptoms and signs of primary Sjögren syndrome (pSS).@*Methods@#Sixty-three patients diagnosed with pSS who attended the Affiliated Huai'an Hospital of Xuzhou Medical University from January 2018 to September 2019 were included in this trial. They were randomly assigned to the therapeutic group and control group. All patients were recalled at baseline and after 2 weeks, 3 months and 6 months. Measurement of salivary and lacrimal flow as well as evaluation of subjective symptoms was performed at the follow-up. @*Results@# Fifty-eight patients completed the trial and were included in the statistical analysis. There was a significant difference between the two groups in the measurement of salivary and lacrimal flow at the second week and third month (P < 0.05). Improvement in subjective symptoms of oral, ocular and gland was detected at the third month (P < 0.05). At the sixth month, compared with the control group, only the salivary gland symptom score of the treatment group was statistically significant (P < 0.05). @*Conclusion@#Cevimeline has good specificity and safety and can increase salivary and lacrimal flow and improve subjective symptoms of pSS in a short time.

Re-cognition of chronic obstructive diseases of the parotid gland / 口腔疾病防治

@#Chronic obstructive diseases of the parotid gland are common clinically, with repeated swelling and a prolonged course and poor treatment outcomes. Based on the summarization of clinical practice and related literature, from the viewpoint of etiology, parotid obstructive diseases can be classified as mechanical obstructions, specific obstructions and non-specific obstructions. The principles of fluid mechanics are introduced to explain the formation of parotid obstructions. According to the different causes, the methods of changing the flow pattern of saliva in the parotid to reduce the resistance and relieve the obstruction, are proposed, such as mechanical factors removals, application of drugs that promote saliva secretion and lower saliva viscosity, ductal expansion under endoscopy and stent placement, and embolization of collateral ducts. These managements can effectively increase the salivary flow rate, reduce the occurrence of the saliva stranded and parotid gland obstructions.

Point-of-care ultrasound identification of pneumatosis intestinalis associated with Henoch-Schönlein purpura gastrointestinal involvement: A case report / 世界急诊医学杂志（英文）

@#Henoch-Schönlein purpura (HSP) is the commonest vasculitis in children, typically affecting children aged three to ten years.[1] It is a multi-systemic vasculitis mediated by type III hypersensitivity with deposition of immunoglobulin. An immune complex-mediated vasculitis affects small vessels of the skin, joints, kidneys, and gastrointestinal (GI) tracts. HSP is usually a self-limiting condition and resolves within six to eight weeks.[1] HSP tends to involve the GI tract and symptoms may occur before skin manifestations. Proximal small bowel and distal ileum are the sites that usually involved.[2,3] Colicky abdominal pain is the predominant GI manifestation and can be debilitating. Severe GI complications such as massive GI bleeding, intussusception, protein losing enteropathy, and pancreatitis can uncommonly occur.[2,4] Imaging is often required in the evaluation of HSP with GI involvement. However, there is little pediatric literature on the role of point-of-care ultrasound (POCUS) by pediatric emergency physicians in the identification of pneumatosis intestinalis (PI) in HSP.

A rare neurodegenerative disorder with a novel mutation in ROGDI and Rett- like phenotype: Kohlschütter- Tönz syndrome

@#Kohlschütter-Tönz syndrome (KTZS) is a rare neurodegenerative disorder that presents with seizures, developmental delay, psychomotor regression, hypoplastic dental enamel morphology characteristic for amelogenesis imperfecta, and dysmorphologies. Genetic analysis has identified loss of function mutations within the coding region of the ROGDI and SLC13A5 genes in KTZS. In this report, we documented the clinical, radiological, electroencephalographic, and genetic results of a 3.5-year-old Turkish girl, born to nonconsanguineous parents, who was the first patient diagnosed with KTZS in Turkey. The patient presented with Rett syndrome-like phenotype, neurodevelopmental delay, refractory seizures, and amelogenesis imperfecta. After obtaining informed consent, chromosomal DNAwas extracted from the peripheral blood of our patient and her parents. To investigate the moleculardiagnosis of the patient, the clinical exome sequencing was performed. The Sanger sequencing analysiswas performed for all of the family members for the validation and segregation of this mutation. PubMed/Medline, Web of Science, and Google Scholar were also searched to find all of the publisheddata on KTZS. The literature comprises 18 published studies about KTZS. The genetic analysis of ourpatient revealed a novel homozygous c.201-1G>T mutation in the ROGDI gene. The same mutationwas also found to be heterozygous in her mother and father. The mutation caused alternative splicingof the ROGDI translation and resulted in a disruption of the ROGDI protein.

Research status of IgG4⁃related sialadenitis / 口腔疾病防治

@#IgG4⁃related sialadenitis (IgG4⁃RS) is a type of autoimmune disease that has been recognized in recent years, and the pathogenesis remains unclear. IgG4⁃RS mainly affects the submandibular gland and parotid gland and is characterized by diffuse painless swelling of the bilateral salivary glands and/or lacrimal glands, usually lasting more than 3 months. Some patients have accompanying hearing loss or hearing impairment, sinusitis, lymphadenopathy and other symptoms; nearly half of patients have different degrees of salivary gland secretion disorders. Most patients have elevated serum IgG4 levels, but they cannot be used as the only marker for diagnosis. Histopathology remains the“gold standard”for diagnosis. Presently, submandibular gland biopsy is often used for diagnosis. Histopathology showed lym⁃phoplasmacytic infiltration, occlusive phlebitis, striated fibrosis; immunohistochemistry showed IgG4 + /IgG + plasma cells >40%, and IgG4 + plasma cell/high⁃power field vision > 10. Glucocorticoids are regarded as first⁃line drugs for the treat⁃ment of this disease. Clinically, glucocorticoids are often combined with immunosuppressive agents such as cyclophos⁃phamide, but no standard drug regimen exists. Most patients have a significant short⁃term treatment effect, and the long⁃term prognosis requires further study. Patients with a recurrence tendency should adjust the hormone dose over time. In the future, further research is needed regarding the pathogenesis and treatment of the disease to improve the clinical di⁃agnosis rate and therapeutic effect.

Evolution of diagnostic criteria for Sjögren′s Syndrome / 口腔疾病防治

@#Sjögren′s syndrome lacks a single and objective diagnostic index, and its diagnosis often requires comprehensive analysis according to classification criteria. With increasing research and a deepening understanding of the disease, the classification criteria are constantly being adjusted and revised. The sensitivity and specificity of the diagnosis have gradually improved, which has the value of diagnostic criteria largely. Since 1965, more than ten diagnostic criterias for Sjögren′s syndrome have been published. After debate and experience, international criteria with wide applicability have gradually replaced regional criteria. In the evolution of the diagnostic criteria, the diagnostic rules and evaluation methods have become more concise and unified. Techniques with poor specificity and operative difficulty, which are not easy to popularize or apply in the clinic, have gradually been eliminated. A diagnostic system based on an objective examination and subjective symptoms has gradually formed, and lip gland biopsy and serum autoantibody sampling have demonstrated great diagnostic value. The optimization of diagnostic rules makes the diagnosis of this disease more efficient and scientific. This paper reviews the characteristics of and differences in diagnostic criteria for Sjögren′s syndrome and analyzes the internal logic of the evolution of different diagnostic criteria in light of development in research on the disease with the hope of benefitting the diagnosis, treatment and related research of Sjögren′s syndrome.

Rehabilitation for Motor Neuron Syndrome and Sjögren's Syndrome: A Case Report / 中国康复理论与实践

@#Objective To explore the rehabilitation and outcome of motor neuron syndrome and Sjögren's syndrome. Methods A patient with motor neuron syndrome and Sjögren's syndrome was reviewed. Results The patient expressed progressive quadriparesis and slurred speech. Electromyogramphy displayed upper and lower motor neuron damage. Sonography showed diffuse lesions in parotid gland and submandibular gland. Laboratory tests displayed markedly elevated levels of SSA and Ro52 antibodies. After a course of intravenous immunoglobulin (IVIG) and four weeks of comprehensive rehabilitation, the patient improved in terms of speech, muscle strength, balance, posture control and activities of daily living. She failed to achieve further improvement after another IVIG and glucocorticoid two months later, but fortunately her symptoms did not deteriorate. Conclusion The patient with motor neuron syndrome and Sjögren's syndrome might benefit from IVIG and appropriate rehabilitation.

Solitary parotid duct sialolith in a patient with Sjörgren’s syndrome: Report of a case

@#Sjörgren’s syndrome is an uncommon chronic autoimmune disorder that affects exocrine glands. Sialolithiasis is an obstructive salivary gland disease which is also uncommon in the parotid salivary gland. The existing literature has documented the occurrence of multiple calcifications within the parenchyma of the parotid glands in patients with Sjörgren’s syndrome. This report describes the first case of right parotid duct solitary sialolith formation in a 64 year old female patient with Sjörgren’s syndrome. Whether the salivary stone encountered in this case represents an oral manifestation of Sjörgren’s syndrome or is just a co-incidental finding was discussed.

Introduction to the System of Diagnosis and Treatment in the Traditional Chinese Medicine / 日本東洋医学雑誌

Traditional Chinese Medicine (TCM) revolves around the philosophical principles of Yin and Yang, and the Five Elements.The process of diagnosing, then treating with TCM, is called Bensho-Ronti (a traditional logic-based mythology). Specifically, it means diagnosing the patient (Bensho) using four diagnostic procedures, called Shishin, then formulating and applying therapies (Ronti) which correspond to the diagnosis. Herein, we survey the flow of this TCM.

Crucial Role of Tissue-specific Apoptosis on the Development of Primary Sjögren's Syndrome / Oral Science International

Primary Sjögren's syndrome is an autoimmune disorder characterized by lymphocytic infiltrates and destruction of the salivary and lacrimal glands, and systemic production of autoantibodies to the ribonucleoprotein (RNP) particles SS-A/Ro and SS-B/La, leading to clinical symptoms of dryness of the mouth and eyes (sicca syndrome). Autoreactive T cells bearing the CD4 molecule may recognize an unknown self antigen, triggering autoimmunity in the salivary and lacrimal glands. Although several candidate autoantigens including α-fodrin have been reported in Sjögren's syndrome, the pathogenic roles of the autoantigens in initiation and progression of SS are still unclear. It is possible that individual T cells activated by an appropriate self antigen can proliferate and form a restricted clone. Recent evidence suggests that the apoptotic pathway plays a central role in making T cells tolerant to tissue-specific self antigen, and may drive the autoimmune phenomenon. We recently reported that tissue-specific apoptosis in estrogen-deficient mice may contribute to autoantigen cleavage, leading to the development of autoimmune exocrinopathy. The studies reviewed imply that tissue-specific apoptosis and caspase-mediated α-fodrin proteolysis are involved in the progression of autoimmune lesions in Sjögren's syndrome. Moreover, Fas ligand (FasL) and its receptor Fas are essential in the homeostasis of the peripheral immune system. It is considered that a defect in activation-induced cell death (AICD) of effector T cells may result in the development of autoimmune exocrinopathy in Sjögren's syndrome.

The Effects of Unkei-To on Patients with Primary Sjoegren's Syndrome / 日本東洋医学雑誌

Unkei-to was used successfully to treat three patients with primary Sjögren's syndrome (pSjS). The first case was a 67-year-old woman. In April 1993, she visited Tonami General Hospital with the symptom of dry eyes. Her condition was diagnosed as pSjS from being antinuclear antibody (ANA) positive, dry eye, and decrease of saliva secretion. She used eye drops, but her dry eye did not improve, she visited our department in June 1995. Administration of Unkei-to improved her symptoms after 6 months of treatment.<br>The second case was a 73-year-old woman. In 1987, she was treated in our hospital for lumbago based on spondylosis. In 1991, she began to suffer from pain and swelling of the right sterno-clavicular joint (RSCJ) and was admitted. She was anti-SS-A/Ro ANA positive, schirmer's test was positive, lymphocyte infiltration was observed by lip biopsy, and thus pSjS was diagnosed. Treatment with Unkei-to resulted in the improvement of pain and swelling of RSCJ, as well as a decrease in serum C-reactive protein. But a favorable effect on dry mouth was not attained in this case.<br>The third case involved a 39-year-old woman who began to experience polyarthralgia and dry mouth in June 1991. She visited a neighborhood hospital and was diagnosed as pSjS from hyper γ-globulinemia, anti SS-A ANA positivity, and decrease of saliva secretion. She first visited our hospital in March 1994. We administered Keishikaryojutubu-to and improvement of polyarthralgia was observed. Subsequently, she suffered from symptoms of dry eye and dry mouth. We treated her with Unkei-to, which improved the symptoms of dryness, but not polyarthralgia in this case.<br>These observations suggest that Unkei-to might be a useful agent for the treatment of pSjS.