Paraneoplastic anti-GAD65 extralimbic encephalitis presented with epilepsy: A case report.

RATIONALE: Autoimmunity targeting glutamic acid decarboxylase 65 (GAD65) is associated with type 1 diabetes mellitus as well as various neurological diseases. In the central nervous system, GAD65 autoimmunity usually presents with limbic encephalitis, whereas extralimbic encephalitis (ELE) has only been reported in a few cases. Moreover, anti-GAD65 ELE in the paraneoplastic context has not yet been reported. PATIENT CONCERNS: A 60-year-old man presented with intermittent cough and sputum for 10 years, with no other diseases. The patient presented with recurrent seizures that were resistant to antiepileptic drugs (AEDs). Chest computed tomography and pathological results confirmed the diagnosis of small cell lung cancer. Paraneoplastic testing found a high level of GAD65 antibodies in his serum, and cerebrospinal fluid analysis revealed lymphocytic pleocytosis, indicating autoimmune encephalitis. Brain magnetic resonance imaging showed multifocal T2 fluid-attenuated inversion recovery hyperintensities in the extralimbic areas including the subcortex and deep white matter of the bilateral frontal lobe, parietal lobe, and insula lobes. DIAGNOSES: Finally, a diagnosis of anti-GAD65 autoimmune ELE with a paraneoplastic etiology from the small cell lung cancer was suspected. INTERVENTIONS: The patient refused any tumor-suppressive treatment or immunotherapy for potential side effects and only received AEDs levetiracetam, sodium valproate, and diazepam. OUTCOMES: The epilepsy of the patient was resistant to AEDs, and the patient died a week after discharge due to disease progression. LESSONS: Anti-GAD65 autoimmune encephalitis can be extralimbic, can present with isolated epilepsy, and extralimbic anti-GAD65 encephalitis can occur with an underlying malignancy.

Intra- and inter-observer agreements in detecting peri-implant bone defects between periapical radiography and cone beam computed tomography: A clinical study.

BACKGROUND/PURPOSE: Information regarding agreements between periapical radiograph (PA) and cone beam computed tomography (CBCT) in detecting peri-implant defect is still scarce. The aim of this clinical study was to compare agreements between PA and CBCT in detecting peri-implant bone defect. MATERIALS AND METHODS: This retrospective clinical study enrolled 32 patients with both PA and CBCT filmed right after implant placement. Four modalities were used for film reading: PA1 (original), PA2 (enhanced brightness/contrast), CBCT1 (selected axial and mesial-distal direction images) and CBCT2 (all data with software). 2 experienced and 2 inexperienced observers scored all films. Intra- and inter-observer agreements were estimated with Cohen's kappa coefficient. Categorized agreements were compared and differences among four modalities were calculated. RESULTS: Agreements of PA were better than CBCT when detecting peri-implant bone defects in inter-observer agreements (median kappa 0.471 vs. 0.192; p = 0.016). Moreover, agreements in experienced observers were better than inexperienced observers (median kappa 0.883 vs. 0.567; p < 0.001). There was significant difference among four modalities except for experienced observer 2 (p = 0.218). CONCLUSION: Agreements of PA are better than CBCT when detecting peri-implant bone defects, especially for inter-observer agreements. Experienced observers are more consistent in assessment than inexperienced ones.

Peri-implant conditions and marginal bone loss around cemented and screw-retained single implant crowns in posterior regions: A retrospective cohort study with up to 4 years follow-up.

The aim of the present study was to identify the peri-implant conditions (bleeding on probing (BOP), pocket probing depth (PPD), modified plaque index (mPI)) and marginal bone loss (MBL, marginal bone level change between follow-up and occlusal loading) around cemented and screw-retained posterior single crowns on tissue-level implants. The study was a retrospective cohort study with up to 4 years (mean 2.5 years) follow-up. Patients with either cemented or screw-retained crowns in posterior regions were included. Implant survival, technical complications, BOP, PPD, mPI, MBL, biologic complications (peri-implant mocositis and peri-implantitis) were evaluated. Mann-Whitney U test was used to test the difference between the screw-retained group (SG) and cemented group (CG). 176 patients (SG: 94, CG: 82) were included. The implant survival rates were 100% in SG and 98.8% in CG. Prosthetic screw loosening was found in 8 restorations (8.7%) at follow-up visit. Peri-implant mucositis rate was significantly higher in the SG group (42.1%) than that in the CG group (32.2%) (P = 0.04). Six patients (6.38%) in the screw-retained group and 5 patients (6.10%) in the cemented group were diagnosed with peri-implantitis, the difference did not reach statistical significance (P>0.05). No significant difference of PPD, mPI and MBL were found between two groups (P = 0.11, 0.13 and 0.08, respectively). High implant survival rates were achieved in both groups. Cemented single crowns on tissue-level implants showed comparable peri-implant conditions in comparison with two-piece screw-retained crowns. Well-designed prospective cohort or randomized controlled clinical trials with longer follow-up are needed to confirm the result.

Fluoxetine-enhanced autophagy ameliorates early brain injury via inhibition of NLRP3 inflammasome activation following subrachnoid hemorrhage in rats.

BACKGROUND: The NLRP3 inflammasome is a multiprotein complex that regulates the innate immune inflammatory response by activating caspase-1 and subsequent IL-1ß and IL-18. Fluoxetine has been shown to have the anti-inflammatory properties in many disease models. However, the effects and mechanisms of these effects of fluoxetine in early brain injury after subarachnoid hemorrhage (SAH) have not been defined. METHODS: The SAH model was induced by an endovascular perforation in adult male Sprague-Dawley (SD) rats weighing 300-320 g. N-Ac-Tyr-Val-Ala-Asp-chloromethyl ketone (AC-YVAD-CMK) was injected intraperitoneally (5 mg/kg) 1 h after SAH. Fluoxetine was administered via intravenous route 6 h after SAH. 3-Methyladenine (3-MA) was intracerebroventricularly injected 20 min before SAH. SAH grade, neurological function, brain water content, propidium iodide (PI) staining, western blot, double immunostaining, and transmission electron microscopy were performed. RESULTS: Expression of caspase-1 increased and peaked at 24 h after SAH. Caspase activation was along with the increased necrotic cells, which occurred mainly in neurons. Necrotic cell death of microglia and astrocyte were also found. Administration of AC-YVAD-CMK, a caspase-1 inhibitor, reduced the expression of IL-1ß and IL-18 and the number of PI-positive cells, attenuated brain edema, and improved neurological function, which was also observed in fluoxetine-treated rats. Furthermore, fluoxetine treatment significantly decreased the expression of NLRP3 and cleaved caspase-1 and upregulated the expression of beclin-1, a marker for autophagy. Finally, the effects of fluoxetine in NLRP3 inflammasome activation were reversed by additional 3-MA administration. CONCLUSIONS: Together, our present study indicated that NLRP3 inflammasome and caspase-1 activation play a deleterious role in early brain injury and fluoxetine mitigates NLRP3 inflammasome and caspase-1 activation through autophagy activation after SAH, providing a potential therapeutic agent for SAH treatment.

Mdivi-1 ameliorates early brain injury after subarachnoid hemorrhage via the suppression of inflammation-related blood-brain barrier disruption and endoplasmic reticulum stress-based apoptosis.

Aberrant modulation of mitochondrial dynamic network, which shifts the balance of fusion and fission towards fission, is involved in brain damage of various neurodegenerative diseases including Parkinson's disease, Huntington's disease and Alzheimer's disease. A recent research has shown that the inhibition of mitochondrial fission alleviates early brain injury after experimental subarachnoid hemorrhage, however, the underlying molecular mechanisms have remained to be elucidated. This study was undertaken to characterize the effects of the inhibition of dynamin-related protein-1 (Drp1, a dominator of mitochondrial fission) on blood-brain barrier (BBB) disruption and neuronal apoptosis following SAH and the potential mechanisms. The endovascular perforation model of SAH was performed in adult male Sprague Dawley rats. The results indicated Mdivi-1(a selective Drp1 inhibitor) reversed the morphologic changes of mitochondria and Drp1 translocation, reduced ROS levels, ameliorated the BBB disruption and brain edema remarkably, decreased the expression of MMP-9 and prevented degradation of tight junction proteins-occludin, claudin-5 and ZO-1. Mdivi-1 administration also inhibited the nuclear translocation of nuclear factor-kappa B (NF-κB), leading to decreased expressions of TNF-ɑ, IL-6 and IL-1ß. Moreover, Mdivi-1 treatment attenuated neuronal cell death and improved neurological outcome. To investigate the underlying mechanisms further, we determined that Mdivi-1 reduced p-PERK, p-eIF2α, CHOP, cleaved caspase-3 and Bax expression as well as increased Bcl-2 expression. Rotenone (a selective inhibitor of mitochondrial complexes I) abolished both the anti-BBB disruption and anti-apoptosis effects of Mdivi-1. In conclusion, these data implied that excessive mitochondrial fission might inhibit mitochondrial complex I to become a cause of oxidative stress in SAH, and the inhibition of Drp1 by Mdivi-1 attenuated early brain injury after SAH probably via the suppression of inflammation-related blood-brain barrier disruption and endoplasmic reticulum stress-based apoptosis.

[Changes of soft tissues in patients with functional and skeletal Angel Class â ¢ malocclusion after FRâ ¢ appliance therapy].

PURPOSE: To compare the changes of soft tissues before and after treatment of functional and skeletal Angle class Ⅲ malocclusion with FRⅢ appliance. METHODS: Thirty patients with functional and skeletal Angel Class Ⅲ malocclusion were selected and treated with FRⅢ appliance，SPSS 22 software package was used to analyzed soft tissue changes before and after treatment. RESULTS: After treatment, FCA,NLA, Pog labial angle,upper lip to E line were increased significantly (P<0.05). Z angle was decreased significantly (P<0.05). Lower lip to E line was decreased significantly (P<0.01). There was no significant difference in H angle, superior sulcus depth, inferior sulcus to H-line, basic upper lip thickness, upper lip strain measurement (P>0.05). CONCLUSIONS: After FRⅢ appliance treatment of Angel Class Ⅲ malocclusion, the convexity of facial profile was increased, type Ⅲ concave profile tends to be flat, the facial profile of patient become more attractive; the protrusion of upper lip was found, the retrusion of lower lip was also present, the convexity of upper lip was increased.

PARP inhibition attenuates early brain injury through NF-κB/MMP-9 pathway in a rat model of subarachnoid hemorrhage.

Poly (ADP-ribose) polymerases (PARPs) play an important role in a range of neurological disorders, however, the role of PARP in early brain injury after subarachnoid hemorrhage (SAH) remains unclear. This study was designed to explore the role and the potential mechanisms of PARP in early brain injury after SAH. Eighty-nine male SD rats were randomly divided into the Sham group, SAH+Vehicle group and SAH+PARP inhibitor (PJ34) group. An endovascular perforation model was used to induce SAH in rats. PJ34 (10mg/kg) or vehicle (0.9% NaCl) was intraperitoneally administered at 5min and 8h after SAH induction. Mortality, SAH grades, neurological function, evans blue extravasation, brain edema, immunofluorescence staining and western blotting were performed. PJ34 reduced BBB permeability and brain edema, improved neurological function and attenuated neuronal cell death in the rat model of SAH. Moreover, PJ34 inhibited the nuclear translocation of NF-κB, decreased the expression of the proinflammatory cytokines IL-1ß, IL-6 and TNF-α, reduced the expression of MMP-9, prevented the degradation of tight junction proteins, and decreased microglia activation. These data indicated that PARP inhibition through PJ34 might be an important therapeutic drug for SAH.

[Measurement of alveolar bone thickness of adult skeletal Class III patients in mandibular anterior region].

PURPOSE: To describe alveolar bone thickness in mandibular anterior region of skeletal Class III malocclusion with the help of Cone-beam CT. METHODS: The subjects were selected from consecutive adult patients seeking orthodontic treatment in Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2008 to March 2011, which included 64 patients diagnosed to be skeletal Class I malocclusion (Class I group) and 66 patients diagnosed to be skeletal Class III malocclusion (Class III group). Both Class I and Class III groups were divided into 3 divisions respectively according to different vertical facial types. Mandibular left central incisor of each subject was chosen for measurement. The labial (L1), lingual (L2) and total (L0)alveolar bone thickness of skeletal Class III patients in mandibular anterior region were assessed using a CBCT analyzing method with Class I group as the control group. Data was processed with SAS8.02 software package. RESULTS: L1(P<0.05),L2(P<0.01) and L0(P<0.01) of Class III group were thinner than those of Class I group. L1 of high-angle Class III malocclusion was thinner than that of average-angle(P<0.01)and low-angle(P<0.01) ones ; L2 of average-angle Class III malocclusion was thinner than that of low-angle ones(P<0.01) and thicker than that of high-angle ones(P<0.05); L0 of low-angle Class III malocclusion was thicker than that of average-angle ones(P<0.01),which was thicker than that of high-angle ones(P<0.01). L1 of Class III group with different vertical facial types was thicker than L2(P<0.01). CONCLUSIONS: Skeletal Class III malocclusion exhibits thinner alveolus around the mandibular incisor apices compared with Class I malocclusion, which shows strong connection with different vertical facial types. Root apices of mandibular anterior teeth of skeletal Class III malocclusion situated closer to labial cortical bone than lingual cortical bone. It is necessary to access the alveolar bone thickness of adult skeletal Class III patients in mandibular anterior region before orthodontic camouflage or surgical-orthodontic treatment. Orthodontic camouflage might not be a reasonable treatment alternative for these patients.

[The role of CBCT in evaluation of alveolar bone state during orthodontic-periodontal treatment].

PURPOSE: To evaluate the role of cone beam computed tomography (CBCT) in evaluation of alveolar bone state during orthodontic-periodontal treatment. METHODS: Twenty patients with periodontal disease seeking for orthodontic-periodontal therapy were selected. The first stage of orthodontics included alignment and leveling arches (treatment) and the average period was 6 months. CBCT for anterior teeth was taken before and after treatment, and alveolar bone density and height were recorded with landmark identification designed by ourselves in this study. The data was analyzed with SPSS16.0 software package for paired t test and interclass correlations (ICC) assessments. RESULTS: Paired t test showed that the alveolar density was significantly reduced after treatment (P=0.02) and no significant change of alveolar height was observed before and after treatment (P=0.74). The value of ICC was more than 0.9 for all intra-observer and inter-observer assessments. CONCLUSIONS: The alveolar bone density decreased during orthodontic treatment and CBCT could be used in evaluation of alveolar bone state. The landmark identification designed by ourselves can offer consistent and reproducible data. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality(Grant No.08DZ2271100). Dr.MA ZG and FAN LF Contributed equally to the study.

[Sagital position of glenoid fossa in Angle Class II malocclusion with mandibular retrusion].

PURPOSE: To evaluate and compare the morphology and position of the glenoid fossa in patients with Class II malocclusion associated with mandibular retrusion and Class I malocclusion in the permanent dentition. METHODS: A sample of 26 subjects(12 males, 14 females, average age 13.4 years) with skeletal and dental Class II malocclusion associated with mandibular retrusion, was compared with a matched group of 31 subjects(12 males, 19 females, aged 12.9 years) with skeletal and dental Class I relationships. The lateral cephalograms were traced and the cephalometric analysis was taken by Nemotec Dental Studio 2006 software before orthodontic treatment. The comparisons between the two groups on the cephalometric measures for the assessment of glenoid fossa were performed by means of an independent samples t test using SPSS 15.0 software package. The correlation and regression analysis was also performed within the measures in the Class II group. RESULTS: The results showed there was significant difference of Wits, GF/Ptm-FH and GF-FMN between the two groups (P<0.01). There was a significant correlation between the GF-FMN vs. AOBO, GF-FMN vs. GF/S-FH, GF/S-FH vs.GF/Ptm-FH, S/Ptm-FH vs. GF/Ptm-FH in the Class II group. The regression equations of the GF-FMN vs. AOBO and GF-FMN vs. GF/S-FH were also obtained (P<0.05). CONCLUSIONS: The Class II malocclusion associated with mandibular retrusion patients have a posteriorly displaced glenoid fossa compared with Class I patients. Cephalometric measurement is a useful tool to evaluate the glenoid fossa morphology and position.

[Diagnostic value of dental implants in the posterior maxilla using cone beam computed tomography].

PURPOSE: To compare the diagnostic value of cone beam computed tomography (CBCT) with orthpantomography(OPG) for dental implants at the posterior maxilla. METHODS: 75 patients (89 positions) with dental implants in the posterior maxilla were assessed with CBCT and orthopantomography. The horizontal height from the top of the alveolar bone to the floor of sinus was measured through CBCT and OPG. The results were processed statistically with SPSS 11.5 software package for Chi-square test. RESULTS: Bone deficiency was detected in 30.34% and 16.85% cases by CBCT and OPG respectively with significant difference(P=0.034). Bone osteointegration was detected in 4.95% and 11.88% cases with CBCT and OPG respectively without significant difference(P=0.413). CONCLUSIONS: The quantity of bone could be evaluated more precisely by CBCT than OPG. The peri-implant bone could be demonstrated more clearly by CBCT than OPG.

[Effect of quality of root canal obturation on the long-term results of root canal therapy].

PURPOSE: The purpose of this study was to analyze the quality of obturation affecting the long-term results of root canal therapy (RCT) by radiographic evaluation. METHODS: Teeth of RCT for 2 or more than 2 years were chosen, and periapical radiographs were taken with paralleling technique. The patients' age, gender, etiology, the time of therapy were recorded. The current apical periodontal status of these endodontically treated teeth were examined and recorded. The data were subjected to univariate and multivariate analysis with SPSS13.0 software package. RESULTS: This study investigated 215 cases with 376 endodontically treated teeth. The success rate was 54.79%. If counted by root canal, there were 513 root canals, the success rate was 61.4%. The quality of obturation including obturation position and obturation density affected significantly the results of root canal therapy (P<0.01). The ideal obturation position for successful treated canals was 0.5-2mm from the radiographic apex. The success rate was higher for a good obturation density, especially in the apical third. No statistically significant differences were found based on gender, age and obturation time. CONCLUSION: The quality of root canal obturation significantly affected the long-term results of root canal therapy.

[Orthodontic treatment for the impacted upper central incisors: report of 28 cases].

PURPOSE: To study the effect of treating the impacted upper central incisors which couldn't erupt by surgical exposure and orthodontic traction. METHODS: 28 cases with 30 impacted upper central incisors were treated with surgical exposure and orthodontic traction. RESULTS: In 1 case, the tooth erupted by traction. but the space was not enough, the child's parents refused extraction of the teeth, which resulted in malalignment of the maxillary incisors. In 1 case, the tooth erupted after 3 months of traction, but the patient gave up further treatment because he had no revisit time. In the remaining 26 cases all the teeth moved into correct position. The average eruption time was 4.5 month (rang: 1 to 10 months). 28 impacted teeth had vital pulp. No root absorption and conglutination were found. CONCLUSIONS: The time of treatment, reasonable orthodontic method, less operative trauma, appropriate traction force, anchorage, control of inflammation are the keys of successful treatment.

[Comparison of dentomaxillary pantomography and periapical radiographs with horizontal tube shift in localizing the impacted teeth].

PURPOSE: To compare the clinic value between dentomaxillary pantomography and periapical radiographs in localization of the impacted teeth. METHODS: 43 impacted teeth were localized with both dentomaxillary pantomography technique and periapical radiographs with horizontal tube shift which is clinically widely used. And a comparison between the two methods was carried out using Chi square test. RESULTS: Both dentomaxillary pantomography and periapical radiographs with horizontal tube shift can relatively precisely demonstrate the position of the impacted teeth. The percentage of the cases which the image and the result of surgery was consistent in the two methods was 93.02% and 95.35% (P>0.05) respectively. There was no statistical difference between the two groups. CONCLUSIONS: Dentomaxillary pantomography can precisely localize the impacted teeth.

[Application of X ray cephalogram in the measurement of adenoids in children].

PURPOSE: To evaluate the clinical value of X ray lateral cephalogram in the measurement of adenoids in children. METHODS: 45 cases (aged from 3 to 13 year old) with adenoid hypertrophy suspected clinically were examined with lateral cephalometric projections, of which 40 cases were examined with lateral nasopharyngeal projections at one time. Then the quality of films were appraisal and the adenoids were measured on the film. Student's X(2) test was used for statistics analysis. RESULTS: X ray lateral cephalogram can distinctly reveal the structure of nasopharynx. The method was simply and reproducible. The quality of the films were determined based on the conjunction between the base of the pterygoid plate and extracranial aspect of the occipital slope, with consideration of the mandibular margin and sphenoid saddle. The conjunction should be clearly demonstrated and the edges of the mandibular margin and sphenoid saddle should be sharp and well demarcated in qualified films. 45 cases were examined with lateral cephalometric projections, 34 cases had standard films, accounting for 76%. 40 cases were examined with lateral nasopharyngeal projections, 21 had standard films, accounting for 53%. The quality of X ray lateral cephalogram was significantly better than lateral nasopharyngeal projections (P<0.05). CONCLUSION: Compared with the routine lateral nasopharyngeal projection, lateral nasopharyngeal cephalogram has images of high quality, is better for showing the nasopharyngeal structures as well as measurement of the adenoids with parenchyma. It is the imaging method of choice for children with OSAHS.