Effect of water calcium, copper, and silver on branchial Na+ permeability in a characid and cichlid fish.

We tested the hypothesis that water Ca2+ is involved in control of branchial Na+ permeability in low pH tolerant convict cichlids and black neon tetras. We measured Na+ efflux in water with different Ca2+ concentrations during exposure to low pH, silver, and copper, at levels which are known to stimulate Na+ efflux. For convict cichlids at pH 7.5 exposure to 0 µmol L-1 Ca2+caused Na+ efflux to rise 2.5 times above controls at 100 µmol L-1 Ca2+. However, raising [Ca2+] to 500 µmol L-1 had no effect. Upon exposure to pH 3.5 (control [Ca2+]) Na+ efflux rose almost 5× and increasing the [Ca2+] 5-fold did not reduce the magnitude of stimulation. Exposure to 1 µmol L-1 silver and 25 µmol L-1 copper stimulated Na+ efflux 7×, and 2×, respectively. Raising [Ca2+] concentration during metal exposure halved the stimulation of Na+ efflux caused by silver, and eliminated the stimulation elicited by copper. For black neon tetras raising or lowering water [Ca2+] had no effect on Na+ efflux at pH 7.5. Exposure to pH 3.5 caused Na+ efflux to rise 2.5× but changing [Ca2+] had no effect. Exposure to 1 µmol L-1 silver, or 25 µmol L-1 copper caused Na+ efflux of tetras to rise 4-fold and 3-fold, respectively. Raising [Ca2+] during silver exposure reduced the stimulation of Na+ efflux by about 50%, but during copper exposure increased [Ca2+] had no effect on stimulation of Na+ efflux. These results suggest water Ca2+ plays a role in control of branchial Na+ permeability in cichlids, but perhaps not tetras. In addition, the silver and copper concentrations required to inhibit Na+ uptake and stimulate Na+ efflux were higher than the concentrations used on non-characids and non-cichlids, which indicates that our fish are much more tolerant of these metals.

Reliability of clinician judgements of bruxism.

Bruxism is considered to be a parafunctional disorder requiring treatment and is viewed as a risk factor for the development of temporomandibular disorders (TMDs). The purpose of this investigation is to examine the reliability of clinician judgements of bruxism severity. Twenty dentists who are faculty members in a dental school examined 29 stone casts and gold-plated models of individual teeth for evidence of bruxism. Ordinal ratings of bruxism severity for the 29 augmented models were made on two occasions, approximately 3 months apart. Inter-rater reliability among all clinicians, evaluated using intraclass correlation coefficients (ICCs), was poor at both time one and time two (i.e. ICC = 0.33 and 0.32, respectively), with somewhat better reliability found among those clinicians with above-average time elapsed since completion of dental training (i.e. ICC = 0.48 and 0.50 for time 1 and time 2, respectively). Three-month test-retest reliabilities were fair (ICC = 0.46) for the full group of raters and were unrelated to clinicians' degree of confidence in their ratings. These results indicate a need to standardize methods for clinical assessment of bruxism. Additionally, they have implications for studies using clinical assessments of bruxism to test the association between bruxism and other conditions such as TMDs.

Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain?

Both the efficacy and mechanism of any effect of oral splint therapy for patients with temporomandibular disorders (TMDs) are a matter of controversy. To address these issues, this study tested the hypothesis that oral splints produce the most marked pain relief for those TMD patients with myofascial face pain (MFP) who also brux (i.e. grind or clench) more than other MFP patients. In a 6-week randomized controlled clinical trial, 52 women with MFP were randomly assigned to receive either a full-coverage hard acrylic splint or a palatal-only splint. Bruxism was assessed both by self-report and by an objective assessment of molar microwear changes over a 2-week period prior to the start of the trial. Tested across multiple outcome measures, results indicated that those receiving the full-coverage splint had marginally better improvement on some pain-related measures than those receiving the palatal splint, but severity of bruxism did not moderate the therapeutic effect of the full-coverage splint. These findings strongly argue against the belief that oral splints reduce MFP by reducing bruxism and raise questions about the importance of bruxism in the maintenance of MFP.

A comparative evaluation of loading times and exposures for permanent prostate brachytherapy.

The loading of needles for loose seed implantation of the prostate gland results requires a significant amount of effort and some radiation exposure to members of the medical staff. This study was performed to quantify the time spent and exposure levels associated with implant preparation, as well as to investigate any improvement in the time or exposure burden due to the introduction of a new loading device. The movements and radiation exposures for two single, highly experienced dosimetrists were monitored for ten conventionally loaded iodine implant cases. These same cases were reloaded with dummy sources using the sleeved system to determine time savings, if any. Two of these ten cases were then loaded with live sources using the sleeved system to determine relative exposure to the loading staff between the two methods. The results were then analyzed to generate per-seed and per-needle loading time and exposure burdens. Formulas are presented that may be used to determine the average time to load implants and the resultant staff exposure, both with the conventional technique and with the sleeved method. On the average, it takes an experienced loader 48 min to prepare an implant for the operating room, receiving a hand dose of about 10 mrem and a whole body dose of about 1 mrem. The sleeved system reduced these values by at least half. The time and exposure burden associated with the preparation of iodine loose seed implants has been characterized. The use of the sleeved needles resulted in significant time and exposure reductions for the medical staff.

[Social environment and social network: extent and resources of the daily life of elderly persons]. / Aktionsraum und soziales Netzwerk: Reichweite und Ressourcen der Lebensführung im Alter.

The study asks for factors determining the activity space of the aged. Indicators of old people's activities space are the number of their outdoor activities and their use of the local supply of public facilities. Controversial hypothesis are won from ecological gerontology and psychological attachment theory. At issue in the first place is how personal social networks mold older people's outdoor behavior. Another hypothesis assumes social support of the elderly to be exposed to the laws of reciprocity. The study makes use of a poll titled "life-organization of older people" that was conducted by the German Youth Institute in 1993. Respondents were German 55- to 79-year-olds (N = 4130). Analyses rely on multifactorial analyses of variance. Results back attachment theory and the reciprocity thesis.

Widespread pain and the effectiveness of oral splints in myofascial face pain.

BACKGROUND: The research literature reaches inconsistent conclusions about the efficacy of oral splints for treating myofascial face pain. This investigation hypothesizes that their effectiveness varies as a function of the presence or absence of widespread pain. METHODS: In a randomized, controlled clinical trial, 63 women with myofascial face pain were assigned to use of either an active, maxillary, flat-plane, hard acrylic splint or a palatal splint that did not interfere with occlusion. Participants also were classified according to the presence or absence of widespread pain throughout the body. After six weeks, groups were compared regarding pain on palpation, self-reported pain and functional outcome. RESULTS: Overall, the findings showed a modest tendency for subjects receiving the active vs. the palatal splint to exhibit improvement on self-reported pain and functional outcome. On further division of the sample into subjects with local vs. widespread pain, the general pattern showed that patients with widespread pain who received an active splint did not experience improvement, while patients with local pain who received the active splint did. CONCLUSIONS: The presence or absence of widespread pain may help to define the specific circumstances under which oral splints should be prescribed for patients with myofascial face pain. CLINICAL IMPLICATIONS: Clinicians should screen patients with myofascial face pain for the presence of widespread pain, since this comorbid symptom pattern may be a contraindication for the use of oral splints.

Comorbid fibromyalgia accounts for reduced fecundity in women with myofascial face pain.

OBJECTIVE: This study examined factors related to reduced fecundity among women with myofascial face pain (MFP) arising from hypotheses concerning the role of neurohormonal factors in MFP and associated conditions. DESIGN: Fecundity rates among 162 MFP cases and 173 demographically equivalent acquaintance female controls were compared. OUTCOME MEASURES: Fecundity indicators and factors underlying differential fecundity rates were investigated. RESULTS: It was determined that female cases with MFP had significantly fewer children and were more likely to have never been pregnant. Although women with MFP were more likely than controls to indicate that volitional factors related to their health discouraged them from any or additional pregnancies, these factors did not account for lower rates of fecundity. MFP cases also did not differ from controls on self-reported indicators of infertility. Moreover, we show that reduced fecundity was restricted to the subgroup of MFP cases who reported a history of fibromyalgia. CONCLUSIONS: Reduced fecundity in women with MFP is restricted to those who self-report a history of fibromyalgia. Possible mechanisms for reduced fecundity in fibromyalgia are discussed. These findings highlight the need to screen for widespread pain among women with regional myofascial pain syndromes.

Myofascial face pain. Clinical characteristics of those with regional vs. widespread pain.

BACKGROUND: The authors conducted a study to determine whether there are differences in salient clinical characteristics between patients who have both myofascial face pain, or MFP, and comorbid fibromyalgia, or FM, and patients who have MFP but not FM. METHODS: The authors enrolled in the study 162 female subjects who had histories of MFP. In physical examinations at the time of initial consultation, they recorded facial pain signs and symptoms. At the research interview follow-up (seven years post-consultation), participants were screened for a lifetime history of FM and other health problems. In addition, psychiatric interviewers conducted the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, to assess each patient's history of depression and other psychiatric disorders. RESULTS: Of the 162 participants, 38 (23.5 percent) reported a history of FM. At the time of treatment for MFP, both the FM and non-FM groups had similar signs and symptoms of MFP. At the time of the research interview follow-up, participants with FM histories were significantly less likely than those without FM histories to report that they were free of MFP. On recall, those with FM histories reported experiencing more symptoms of MFP. Those with FM histories also were more likely to have had major depression and to report somatization symptoms. Finally, those who had FM more commonly had a history of facial pain's interference with social and occupational functioning and had more severe pain than did those without FM. CONCLUSIONS: Patients who have MFP and a history of widespread pain suggestive of FM are likely to have more persistent and debilitating MFP and to have higher rates of depression and somatization symptoms than those who have no history of widespread pain.

Somatosensory amplification and affective inhibition are elevated in myofascial face pain.

OBJECTIVE: This study was designed to determine whether affective inhibition and somatosensory amplification are elevated in patients with a history of myofascial face pain (MFP). These processes may underlie a tendency to express distress in somatic rather than affective terms, leading to somatized or masked depression. DESIGN: Women (n = 162) with a history of MFP were compared with demographically equivalent women (n = 173) without MFP histories on self-report scales of affective inhibition and somatosensory amplification. Structured psychiatric interviews and health histories were conducted. In addition, a first-degree relative of 106 myofascial face pain subjects and 118 control subjects completed these same self-report scales. RESULTS: MFP cases and controls differed significantly on measures of affective inhibition and somatosensory amplification. History of depression or current psychological distress did not account for group differences. Elevated levels of somatosensory amplification were confined to MFP women with active symptoms. Finally, although both somatosensory amplification and affective inhibition showed a tendency to run in families, familial transmission did not account for case/control differences. CONCLUSIONS: Affective inhibition and somatosensory amplification are likely to be elevated in patients with MFP. Although not accounted for by psychiatric symptomatology, the possibility that these response styles are reactive to coping with chronic face pain cannot be ruled out.

Phantom tooth pain: a new look at an old dilemma.

UNLABELLED: The aim of this paper is to review the current knowledge of phantom tooth pain, a neuropathic facial pain disorder, thought to result from peripheral nerve injury. Phantom tooth pain is a deafferentation pain disorder of persistent toothache in teeth that have been denervated (usually by root canal treatment) or pain in the area formerly occupied by teeth prior to their extraction. The pain usually extends to the facial structures adjacent to tissues that have undergone deafferentation. The clinical characteristics, differential diagnosis, epidemiology, and treatment of phantom tooth pain are reviewed. Suggestions for further research include the need for controlled treatment trials and modification of current criteria. CONCLUSIONS: Phantom tooth pain has much in common with other phantom pain disorders. In the absence of controlled clinical trials specifically directed to phantom tooth pain, treatment should be guided by standards used for other neuropathic pain disorders. Revised diagnostic criteria for phantom tooth pain are proposed.

Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses.

A number of explanations have been proposed to account for findings that rates of depression are elevated in persons with chronic, non-malignant pain disorders (CNPDs); for example, that CNPDs are variants of depression (e.g. 'masked depression'), that the stress of living with CNPDs contribute to the onset of depression ('diathesis-stress'), or that the correlation of CNPDs and depression is a methodological artifact of studying treatment-seeking samples. These alternative hypotheses are tested for one specific CNPD, chronic myofascial face pain, using a family study methodology. The procedure was to conduct direct psychiatric interviews with 106 patients with a history of carefully diagnosed myofascial face pain, 118 acquaintance controls without personal histories of myofascial face pain, and a random sample of adult first degree relatives of these case and control probands. The probands were further subdivided into four roughly equal samples consisting of cases with and without personal histories of major depressive disorder (MDD), and controls with and without personal histories of MDD. Dates of initial onsets of myofascial face pain and MDD in patient probands were obtained from interviews and records. The main results were that, compared to control probands without personal histories of MDD, MDD and depressive spectrum disorders (DSD) were elevated in the first degree relatives of control probands with personal histories of early onset MDD, but not in the first degree relatives of myofascial face pain probands with or without personal histories of early or late onset MDD. This outcome is consistent with the hypothesis that living with chronic myofascial face pain contributes to elevated rates of depression. It is inconsistent with the alternative hypotheses that this CNPD is a variant of depression or that the elevated MDD rates are simply an artifact of selection into treatment. The implications of these results and additional results consistent with them are discussed.

Medically unexplained chronic orofacial pain. Temporomandibular pain and dysfunction syndrome, orofacial phantom pain, burning mouth syndrome, and trigeminal neuralgia.

Orofacial pain syndromes pose a dilemma for physicians. Even when the patient is referred, quality medical care requires that the physician be acquainted with current evidence-based practice. Such practice may be radically different from the traditional view. This article reviews the differential diagnosis and treatment of the most common medically unexplained orofacial syndromes.

Self-reported systemic, immune-mediated disorders in patients with and without proplast-teflon implants of the temporomandibular joint.

PURPOSE: This study investigates the self-reported immune-related health status of patients exposed to Proplast-Teflon (P/T) temporomandibular joint (TMJ) implants, comparing their health status with a group of patients who were not exposed to any alloplastic TMJ implants. It also compares those whose implants were removed with those in whom they were retained. PATIENTS AND METHODS: Patients seen in a single oral and maxillofacial surgical practice completed a detailed self-report questionnaire about physical symptoms and disorders. Sixty-four had received P/T implants, and 22 were unexposed to any TMJ alloplastic implant. Of the P/T-exposed group, 44 had removed and 20 had retained implants. RESULTS: In general, P/T-exposed patients did not differ from unexposed patients in rates of reported immune-mediated and somatization-related conditions, allergies, or symptoms of environmental sensitivity. However, patients with removed P/T implants reported significantly more problems in all categories of conditions than those with retained P/T implants. This difference was no longer statistically significant after controlling for pain severity and sex. CONCLUSIONS: Although P/T-exposed patients do not report more systemic health conditions than similar patients who were unexposed to alloplastic jaw implants, those with removed implants report more conditions and are more likely to be seen in clinical practice. This may lead to a bias in the general perception regarding the systemic health status of P/T-exposed patients. In addition, effects may be secondary to high levels of pain and dysfunction among patients with removed implants, rather than implant exposure itself. Future prospective research is needed to identify factors associated with implant failure.

Myofascial TMD does not run in families.

This study tests whether facial pain or associated symptoms and disorders aggregates in first degree relatives of those with myofascial temporomandibular disorders (M/TMD). We randomly selected one first degree relative of 106 probands with a lifetime history of M/TMD and one first degree relative of 118 acquaintance control probands with no history of M/TMD. Relatives were directly interviewed about the lifetime occurrence of a broad range of painful and non-painful health conditions and symptoms. Analyses revealed that rates of facial pain, symptoms of TMDs, and a range of other musculoskeletal conditions were not significantly different in first degree relatives of M/TMD probands and first degree relatives of controls. In addition, proband descriptors of facial pain severity or disability did not significantly predict the likelihood of having a first degree relative with one or more TMD-related symptoms. These results indicate that M/TMD is not a familial disorder.

Systemic health consequences of alloplastic implants of the TMJ: a pilot study.

The aim of this study was to examine the relation between alloplastic temporomandibular joint (TMJ) implants and immune-associated systemic health problems. The authors compared 14 patients who received alloplastic TMJ implants with 31 TMJ patients who had never received surgery on the self-reported occurrence of symptoms and systemic disorders that are associated with problems of immunomodulation. Those with alloplastic jaw implants reported similar or lower rates of surveyed physical disorders than nonsurgical TMJ participants. When the rates were summed across symptom categories and physical disorders, implant participants had significantly fewer symptoms and disorders than nonsurgical participants (P < 0.01). This first report on systemic health problems in alloplastic TMJ implant patients found no evidence of elevated rates of systemic disorders that are associated with problems of immunomodulation.

Patterns of TMJ surgery: evidence of sex differences.

This study investigated the records from one insurance company's reimbursed claims for any TMD-related treatment. Females were disproportionately represented among those treated by surgical means.