Manifestazioni Cranio-facciali delle Neurofibromatosi

The term neurofibromatosis (NF) subsumes at least seven different genetic disorders associated by the presence of neurofibromas located in the skin, oral cavity, visceral and skeletal level. As NF1 (Von Recklinghausen disease), one of the most common genetic diseases, can have oral manifestations, dentists have to be aware about pathognomonic features. The thesis’ target is the literature’s review on the NF1 manifestations either systemic or cefalic area and these features’ research in a specimen of 30 patients NF1 affected. NF1 is manifested in the cefalic area locating either in the jaws (isolated neurofibromas, ipoplasia or bone structures absence) or soft tissues (fibromas and neurofibromas located in: cheeck, lips, oral mucosa, tongue, mouth’s floor, gingiva and palate). Frequently, NF1 patients are affected by dental anomalies of position, number and eruption, that determinates the possibility of orthopaedic-orthodontic problems. An increased prevalence of the caries risk and a possible pulpar involvement of neurofibromas is reported. Clinical and radiographical typical signs of the disease and specific indications for the differential diagnosis with other oral pathologies are described (cysts and odontogenic tumors, periapical lesions of endodontic origin and severe parodontitis). The importance of screening programs and periodical follow-ups (biannual dental visits from the age of four years, annual X-ray checks from the age of six) is supported by the high frequency of manifestations at hard and soft tissues level of the cefalic area and by the documented risk of malignant transformation.

Ergebnisse der Behandlung mit Kortikalisschrauben

Im Rahmen der vorliegenden Dissertation wurden 106 Minipins bei 62 Patienten (29 Männer und 33 Frauen)untersucht.rnÜberlebensrate betrug 76,4%. Misserfolge, die zum Verlust der Minipins führten wie Mukositis, Lockerung oder Wurzelperforation, stellten sich in 23,7 % (n=25) der Fälle ein. Dabei gingen beim Auftreten von Mukositis 9 von 14 (8,5 %), bei der Lockerung der Minischrauben 8 von 10 (7,5 %) der Minischrauben verloren. Eine Wurzelperforation trat in einem Fall auf. rnDie einzige lingual im Unterkiefer implantierte Schraube ging verloren. Implantation palatinal im Oberkiefer führte in zwei von vier Fällen zum Verlust. rnDie Sofortbelastung der kieferorthopädischen Kortikalisschrauben erscheint ein praktikables Belastungskonzept zu sein.rnDie Verlustraten bei der vestibulären Implantation betrugen 3,8 % (n=4) für den Oberkiefer und 15,1 % (n=16) für den Unterkiefer.rnBei der Implantation in befestigte bzw. unbefestigte Mukosa betrug die Überlebensrate entsprechend 83,3 % (n=72) und 62,3 % (n=22). rn

Untersuchung von T-Zell-vermittelten Immunantworten in der murinen und humanen kutanen Leishmaniasis

Für die Ausheilung von L. major-Infektionen ist eine effektive Th1-/Tc1-Antwort unerlässlich. Dennoch sind bis heute nicht alle Mechanismen der schützenden Immunabwehr beim Menschen und in der Maus endgültig geklärt. Deshalb bestand das Ziel der vorliegenden Arbeit darin, Th1-/Tc1-Antworten und damit die Schnittstelle zwischen angeborenem und adaptivem Immunsystem eingehender zu untersuchen. Für diesen Ansatz wurde zunächst der Einfluss des genetischen Hintergrundes auf den Verlauf der Infektion anhand von BALB/c- und C57BL/6-Zellen analysiert. Als entscheidender Faktor für Heilung und Suszeptibilität wurde mit Hilfe von Knochenmarkschimären die Herkunft der T und/oder B Zellen identifiziert. Erst die Aktivierung durch Th1-/Tc1-Zellen versetzt L. major-infizierte Makrophagen in die Lage, die intrazellulären Parasiten abzutöten. In diesem Aktivierungsprozess spielt die TNF-induzierte Signalweiterleitung über den TNF-Rezeptor 1 (TNF-R1) eine wichtige Rolle. TNF-R1 ist mit dem Signalmolekül FAN assoziiert. In dieser Arbeit konnte anhand von Mäusen, denen FAN fehlt, die Involvierung dieses Moleküls in der Induktion eines Th1-Zytokinsprofils und in der Kontrolle der Parasitenzahl sowie der lokalen Begrenzung der Infektion gezeigt werden. Weiterhin wurde unter Verwendung immundefizienter Mäuse die Realisierbarkeit eines PBMC-Transfermodells geprüft. Ein solches wird zur Validierung an Mäusen gewonnener Erkenntnisse und als präklinisches Testsystem der humanen kutanen Leishmaniasis dringend benötigt. In allen getesteten Stämmen ließ sich durch den Transfer humaner PBMC die L. major-Infektion beeinflussen. Humane CD4+ und CD8+ T-Zellen waren an den Infektionsstellen präsent und es konnten antigenspezifische Immunreaktionen nnachgewiesen werden. Das PBMC-Transfermodell konnte durch die Transplantation humaner Haut auf immundefiziente Mäuse zusätzlich entscheidend verbessert werden. In diesen Transplantaten ließen sich L. major-Infektionen etablieren und durch zusätzlichen Transfer von PBMC die Zahl humaner CD45+ Zellen an der Infektionsstelle deutlich steigern. In ihrer Gesamtheit trägt die vorliegende Arbeit wesentlich zum Verständnis der Determinanten von Heilung und Suszeptibilität der kutanen Leishmaniasis bei und zeigt neue Ansatzpunkte für eine Beeinflussung des Krankheitsverlaufes auf. Die Etablierung eines präklinischen Testmodells der humanen Leishmaniasis ist entscheidend, um das Wissen über die murine Leishmaniasis auf die humane Erkrankung zu übertragen. So kann dem dauerhaften Problem der Entwicklung von Vakzinen an Mäusen, die keine Wirksamkeit gegen die humane Erkrankung zeigen, begegnet werden. Ein vollständig etabliertes Modell wird es ermöglichen, der humanen Erkrankung zugrundeliegende Mechanismen zu untersuchen und Patienten-spezifisch aber auch allgemeingültig Vakzinierungs-Ansätze und Therapien unter experimentellen Bedingungen zu testen.

Detektion von Nickel- und Cobaltspezies in einzelnen lebenden Zellen mit hoher lateraler Auflösung

Übergangsmetallen wie Nickel und Cobalt kommt meist eine große Bedeutung als Cofaktor in Enzymen oder Metallkomplexen im Metabolismus von Lebewesen zu. Da eine sehr geringe Konzentration dieser Übergangsmetalle in einer Zelle für deren Funktionalität ausreicht, ist eine konstante Konzentration der Spurenelemente in einer Zelle angestrebt. Durch meist anthropogene Einflüsse sind Pflanzen und Menschen zunehmend hohen Konzentrationen von Übergangsmetallen ausgesetzt, die in Abhängigkeit von ihrer Spezies, der Konzentration und der Lokalisation unterschiedliche Toxizitäten aufweisen können. Die Speziation von Metallen wurde bisher mittels gängiger Analyseverfahren, wie der ICP-MS und ähnlicher Verfahren, anhand von bulk-Material durchgeführt. Durch die Entwicklung von optischen Sensoren für Metallionen war es möglich, diese Metalle auch in lebenden Zellen mittels Fluoreszenzmikroskopie zu lokalisieren. Ke und Kollegen (2006, 2007) nutzten einen solchen optischen Sensor - Newport Green DCF, um die Aufnahme von Nickel in humane A543 Lungenbronchialepithelzellen nach Inkubation mit dem wasserlöslichen NiCl2 (0,5 mM und 1 mM) sowie den wasserunlöslichen Verbindungen Ni3S2 (0,5 µg/cm2 und 1 µg/cm2) und NiS (2,5 µg/cm2) nachzuweisen und zu lokalisieren und konnten damit eine Akkumulation von Nickel im Zytoplasma und im Zellkern aufzeigen. Dabei war bei wasserlöslichen und wasserunlöslichen Nickelverbindungen Nickel nach 24 h im Zytoplasma und erst nach 48 h im Zellkern zu beobachten.rnrnDa Nickel und Cobalt keine detektierbare Eigenfluoreszenz unter den gegebenen Bedingungen zeigten, wurde für den optischen Nachweis von Nickel und Cobalt mit dem konfokalen Laser-Raster Mikroskop (CLSM) nach der Zugabe der verschiedenen wasserlöslichen und wasserunlöslichen Metallverbindungen NiCl2, NiSO4, Ni3S2 und CoCl2 in einzelnen lebenden humanen Gingiva-Fibroblasten, sowie in Pflanzenzellen in dieser Arbeit ebenfalls der optische Sensor Newport Green DCF genutzt. Korrespondierend zu den Ergebnissen früherer Arbeiten von Ke et al. (2006, 2007), in denen die Nickelaufnahme bei Konzentrationen von >0,5 mM NiCl2 bzw. >0,5 µg/cm2 Ni3S2 gezeigt wurde, wurde Nickel in Fibroblasten in Abhängigkeit von der Spezies mit steigender Metallkonzentration von 100 µM bis 500 µM nach 16 h im Zytoplasma und zunehmend nach 24 h bis 48 h im Zellkern detektiert. Bei der wasserunlöslichen Verbindung Ni3S2 war der Nachweis von Nickel im Zellkern bereits nach 16 h bis 24 h erfolgreich. Zusätzlich wurden weitere Strukturen wie das Endoplasmatische Retikulum, die Mitochondrien und die Nukleoli durch eine starke Fluoreszenz des optischen Sensors bei Colokalisationsexperimenten mit Organell-spezifischen Fluoreszenzfarbstoffen als target für die Nickelbindung vermutet. Die Lokalisation von Cobalt in den Fibroblasten entsprach weitgehend der Lokalisation von Nickel. Im Zellkern war die Cobaltlokalisation jedoch auf die Nukleoli beschränkt. Weiterführende Versuche an humanen Gingiva-Fibroblasten zeigten, dass die Aufnahme der Metalle in die Fibroblasten pH-Wert abhängig war. Niedrige pH-Werte im sauren pH-Bereich verringerten die Aufnahme der Metalle in die Zellen, wobei ein pH-Wert im basischen Bereich keinen bedeutenden Unterschied zum neutralen pH-Bereich aufwies. Im Vergleich zu den Fibroblasten war in Pflanzenzellen zu jedem Zeitpunkt, auch bei geringen Konzentrationen der Metallverbindungen sowie des optischen Sensors, Nickel und Cobalt in den Zellkernen detektierbar. Durch die Eigenschaft der Pflanzenzellen eine Vakuole zu besitzen, war Nickel und Cobalt hauptsächlich in den Vakuolen lokalisiert. Weitere Strukturen wie das Endoplasmatische Retikulum, die Mitochondrien oder auch die Zellwand kamen bei Pflanzenzellen als target in Frage.rnrnDie Fluoreszenz und Lokalisation der Metalle in den Fibroblasten waren unabhängig von der Spezies sehr ähnlich, sodass in den Zellen die Spezies anhand der fluoreszenzmikroskopischen Aufnahmen kaum unterschieden werden konnten. Lambda-Scans in verschiedenen regions of interest (ROI) wurden durchgeführt, um durch die Fluoreszenzspektren Hinweise auf eine charakteristische Beeinflussung der Bindungspartner von Nickel und Cobalt oder dieser Metalle selbst in den Zellen auf den optischen Sensor zu bekommen und diese dadurch identifizieren zu können. Das Ziel der parallelen Detektion bzw. Lokalisation und gleichzeitigen Speziation bestimmter Nickel- und Cobaltpezies in einzelnen lebenden Zellen konnte in dieser Arbeit durch den optischen Sensor Newport Green DCF nicht erreicht werden.

Three-dimensional electroanatomic entrainment map in atypical atrial flutter late after heart transplantation

Atrial flutter in the donor part of orthotopic heart transplants has been reported and successfully treated by radiofrequency ablation of the cavotricuspid isthmus, but mapping and ablation of atypical flutter circuits may be challenging.(1) Entrainment mapping has been used in combination with activation mapping to define the mechanism of atypical atrial flutter. Here, we report a case where colour-coded three-dimensional (3D) entrainment mapping allowed us to accurately determine and visualize the 3D location of the reentrant circuit and to plan the ablation of a left atrial flutter without the need for activation mapping.

Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect

QUESTIONS UNDER STUDY / PRINCIPLES: Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. METHODS: We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. RESULTS: The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. CONCLUSIONS: These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.

Orthodontic therapy and gingival recession: a systematic review

To perform a systematic review on the effect of changes in incisor inclination owing to orthodontic treatment and the occurrence of gingival recession. PubMed, EMBASE Excerpta Medica and CENTRAL of the Cochrane Library were searched and a hand search was performed. From 1925 articles identified, 17 articles were finally included: six experimental animal studies and 11 retrospective clinical studies in humans. More proclined teeth compared with less proclined teeth or untreated teeth had in most studies a higher occurrence or severity of gingival recession. Contradictory results were found regarding a possible statistically significant correlation between the extent of gingival recession and the amount of incisor proclination during treatment, width of attached gingiva, hygiene, periodontal condition or thickness of the symphysis. There are no high quality animal or clinical studies on this topic. Movement of the incisors out of the osseous envelope of the alveolar process may be associated with a higher tendency for developing gingival recessions. The amount of recession found in studies with statistically significant differences between proclined and non-proclined incisors is small and the clinical consequence questionable. Because of the low level of evidence of the included studies, the results should be considered with caution. Further randomized clinical studies including clinical examination of hygiene and gingival condition before, during and after treatment are needed to clarify the effect of orthodontic changes in incisor inclination and the occurrence of gingival recession.

Oral leukoplakia in China: a review

BACKGROUND: Most prevalence studies on oral leukoplakia (OL) in China have been published in the Chinese language. The present review on the literature in Chinese aimed at making the data available to colleagues who are not familiar with the Chinese language. METHODS: The overall rate and 95% confidence interval of OL were calculated using Excel 2003. RESULTS: Overall prevalence of OL was 9.18% (95%CI = 9.06-9.30%). Gender ratio of prevalence was 8.03:1 (males/females). Prevalence was high in age groups over 40 years with the highest in the group aged 60-69 years (21.04%, 95%CI = 19.95-22.13%). The buccal mucosa was most commonly affected (47.08%, 95%CI = 46.52-47.64%), followed by lip (39.09%), palate (9.85%), gingiva (1.80%), and tongue (1.46%). The prevalence in smokers was 23.43% and in non-smokers 1.93%. Among three variants of smoking, the traditional Hanyan pipe smoking carried the highest risk for the development of OL followed by cigarette and Shuiyan water pipe smoking. The rate of alcohol drinkers with OL was 54.50% and 22.21% in individuals without OL. No case of oral cancer was found in six surveys. CONCLUSIONS: The present data on the prevalence of OL in China are comparable to those in other parts of the world. Some traditional smoking habits, however, are particular to certain regions of China.

Evaluation of chronic HCV infection in transplanted livers using a modified histological activity index

The majority of histopathological classifications of primary chronic viral hepatitis and recurrence of HCV infection in liver transplants is based on the histological activity index (HAI) introduced by Knodell et al in 1981; however, correlation between HAI and clinical/laboratory data is poor. Therefore, the aim of this study was to present a modification of HAI (mHAI) adapted to distinct features of graft infection, and to evaluate its usefulness in the description of disease activity.

Potent antifibrotic activity of mTOR inhibitors sirolimus and everolimus but not of cyclosporine A and tacrolimus in experimental liver fibrosis

Recurrence of chronic hepatitis C and progressive fibrosis in liver transplants is frequent and impairs both graft and patient survival. Whether or not the choice of immunosuppression affects progression of fibrosis remains unclear. The aim of the present study was to compare the potential of the commonly used immunosuppressants to halt experimental liver fibrosis progression.

[Hand transplantation - fiction or reality?]

Hand transplantation has been indicated in selective patients after traumatic upper extremity amputation and only performed in a few centers around the world for the last decade. In comparison to solid organ transplantation, there is a challenge to overcome the host immunological barrier due to complex antigenicity of the different included tissues, the skin being the most susceptible to rejection. Patients require lifelong immunosuppression for non life-threatening conditions. Minimization of maintenance immunosuppression represents the key step for promoting wider applicability of hand transplantation. Current research is working towards the understanding mechanisms of composite tissue allograft (CTA) rejection. Worldwide, in 51 patients 72 hands (21 double hand transplants) and once both arms have been successfully transplanted since 1998.

Bovine pericardium based non-cross linked collagen matrix for successful root coverage, a clinical study in human

Introduction The aim of this study was to clinically assess the capacity of a novel bovine pericardium based, non-cross linked collagen matrix in root coverage. Methods 62 gingival recessions of Miller class I or II were treated. The matrix was adapted underneath a coronal repositioned split thickness flap. Clinical values were assessed at baseline and after six months. Results The mean recession in each patient was 2.2 mm at baseline. 6 Months after surgery 86.7% of the exposed root surfaces were covered. On average 0,3 mm of recession remained. The clinical attachment level changed from 3.5 ± 1.3 mm to 1,8 ( ± 0,7) mm during the observational time period. No statistically significant difference was found in the difference of probing depth. An increase in the width of gingiva was significant. With a baseline value of 1.5 ± 0.9 mm an improvement of 2.4 ± 0.8 mm after six month could be observed. 40 out of 62 recessions were considered a thin biotype at baseline. After 6 months all 62 sites were assessed thick. Conclusions The results demonstrate the capacity of the bovine pericardium based non-cross linked collagen matrix for successful root coverage. This material was able to enhance gingival thickness and the width of keratinized gingiva. The percentage of root coverage achieved thereby is comparable to existing techniques. This method might contribute to an increase of patient's comfort and an enhanced aesthetical outcome.

Periosteal BMP2 activity drives bone graft healing

Bone graft incorporation depends on the orchestrated activation of numerous growth factors and cytokines in both the host and the graft. Prominent in this signaling cascade is BMP2. Although BMP2 is dispensable for bone formation, it is required for the initiation of bone repair; thus understanding the cellular mechanisms underlying bone regeneration driven by BMP2 is essential for improving bone graft therapies. In the present study, we assessed the role of Bmp2 in bone graft incorporation using mice in which Bmp2 has been removed from the limb prior to skeletal formation (Bmp2(cKO)). When autograft transplantations were performed in Bmp2cKO mice, callus formation and bone healing were absent. Transplantation of either a vital wild type (WT) bone graft into a Bmp2(cKO) host or a vital Bmp2(cKO) graft into a WT host also resulted in the inhibition of bone graft incorporation. Histological analyses of these transplants show that in the absence of BMP2, periosteal progenitors remain quiescent and healing is not initiated. When we analyzed the expression of Sox9, a marker of chondrogenesis, on the graft surface, we found it significantly reduced when BMP2 was absent in either the graft itself or the host, suggesting that local BMP2 levels drive periosteal cell condensation and subsequent callus cell differentiation. The lack of integrated healing in the absence of BMP2 was not due to the inability of periosteal cells to respond to BMP2. Healing was achieved when grafts were pre-soaked in rhBMP2 protein, indicating that periosteal progenitors remain responsive in the absence of BMP2. In contrast to the requirement for BMP2 in periosteal progenitor activation in vital bone grafts, we found that bone matrix-derived BMP2 does not significantly enhance bone graft incorporation. Taken together, our data show that BMP2 signaling is not essential for the maintenance of periosteal progenitors, but is required for the activation of these progenitors and their subsequent differentiation along the osteo-chondrogenic pathway. These results indicate that BMP2 will be among the signaling molecules whose presence will determine success or failure of new bone graft strategies.

The Daughters of Bridget McGhee

When Huxley proposed, Blythe imagined herself fifty years into the future at his funeral. He was such a good man, they’d say. Seventy-two is too young, they’d say. She’d nod and, she had imagined, remember this moment – them lounging in her bed during the early afternoon with the sunlight threatening to burst from behind the drawn shades, him lying on his side with his left arm anchored around her waist, and the tickle of his thumb as he traced circles on her bellybutton. She rubbed her nose against his neck and breathed. His scent was different from that of Walter. Huxley smelled of pears and basil. Walter smelled of leather and soap. She didn’t smell Walter intentionally, of course. He walked into the White Dog the prior day while she was drinking a mint-mocha cappuccino and studying for an exam on medical physiology. The wind whiffed his odor towards her. She didn’t look at him, but she couldn’t stop from inhaling. “People get married after college,” Huxley swung his right leg over and straddled her, forcing her to look at him. “It’s almost been a year since we graduated. It’s what we should do.” She had wondered if he could donate organs if he were seventy-two years old. Not his liver or heart or anything like that, of course, but maybe his eyes. It’d be a shame if they couldn’t preserve his eyes. She noticed them first: they were alert and misty blue, like Santa’s. But then she wondered if eye characteristics like color were even changed during cornea transplants. Walter had plain brown eyes. She hated brown eyes. She told people that she had brown eyes, because they were dark and no one ever looked close enough. Except Huxley. They were at dinner with mutual friends and were talking about eye color, and how they all wished that theirs were like those of the young Afghan girl on the 1985 cover of National Geographic.

The Effect Of Osteoprotection On Immune Reconstitution Post Bone Marrow Transplant

Specialized microenvironments have been known to strongly influence stem cell fate in hematopoiesis. The interplay between osteolineage cells, specifically the mature osteoblast, and the hematopoietic stem cell (HSC) niche have been of particular note. Recently, preliminary unpublished data obtained in the Scadden laboratory suggests the critical role of the osteoblast in regulating T cells. The goal of this project was to initially determine whether stimulating the osteoblast in the HSC niche leads to increased immune reconstitution after hematopoietic stem cell transplant (HSCT). These results indicated that while bone manipulation pre-transplant may have a positive effect on T and B lymphocyte cell recovery, bone manipulation post-transplant seems to have a suppressing effect. Additionally, stimulation of the osteoblast may have an inhibitory effect on the regeneration of GR1+ myeloid cells. Based on these results, we then sought to determine how osteoprotection pre-HSCT modifies the kinetics of graft-versus-host disease (GVHD) and impacts the regeneration of immune cells. The data from this phase of my experiment suggests a possible immediate benefit in stimulation of the osteoblast in response to GVHD prior to HSCT. The overall results from my thesis project demonstrate a promising relationship between pre-HSCT stimulation of the osteoblast and lymphocyte recovery post-HSCT. ¿