Revisione critica dei risultati e nuovi algoritmi decisionali sulla chirurgia dell'OSAS

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated whit loud snoring, disrupted sleep and observed apnoeas. Surgery aims to alleviate symptoms of daytime sleepiness, improve quality of life and reduce the signs of sleep apnoea recordered by polysomnography. Surgical intervention for snoring and OSAHS includes several procedures, each designed to increase the patency of the upper airway. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty with or without tonsillectomy, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate. More significant, however, particularly in cases of severe OSA, is hypopharyngeal or retrolingual obstruction related to an enlarged tongue, or more commonly due to maxillomandibular deficiency. Surgeries in these cases are aimed at reducing the bulk of the tongue base or providing more space for the tongue in the oropharynx so as to limit posterior collapse during sleep. These procedures include tongue-base suspension, genioglossal advancement, hyoid suspension, lingualplasty, and maxillomandibular advancement. We reviewed 269 patients undergoing to osas surgery at the ENT Department of Forlì Hospital in the last decade. Surgery was considered a success if the postoperative apnea/hypopnea index (AHI) was less than 20/h. According to the results, we have developed surgical decisional algorithms with the aims to optimize the success of these procedures by identifying proper candidates for surgery and the most appropriate surgical techniques. Although not without risks and not as predictable as positive airway pressure therapy, surgery remains an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Successful surgery depends on proper patient selection, proper procedure selection, and experience of the surgeon. The intended purpose of medical algorithms is to improve and standardize decisions made in the delivery of medical care, assist in standardizing selection and application of treatment regimens, to reduce potential introduction of errors. Nasal Continuous Positive Airway Pressure (nCPAP) is the recommended therapy for patients with moderate to severe OSAS. Unfortunately this treatment is not accepted by some patient, appears to be poorly tolerated in a not neglible number of subjects, and the compliance may be critical, especially in the long term if correctly evaluated with interview as well with CPAP smart cards analysis. Among the alternative options in Literature, surgery is a long time honoured solution. However until now no clear scientific evidence exists that surgery can be considered a really effective option in OSAHS management. We have design a randomized prospective study comparing MMA and a ventilatory device (Autotitrating Positive Airways Pressure – APAP) in order to understand the real effectiveness of surgery in the management of moderate to severe OSAS. Fifty consecutive previously full informed patients suffering from severe OSAHS were enrolled and randomised into a conservative (APAP) or surgical (MMA) arm. Demographic, biometric, PSG and ESS profiles of the two group were statistically not significantly different. One year after surgery or continuous APAP treatment both groups showed a remarkable improvement of mean AHI and ESS; the degree of improvement was not statistically different. Provided the relatively small sample of studied subjects and the relatively short time of follow up, MMA proved to be in our adult and severe OSAHS patients group a valuable alternative therapeutical tool with a success rate not inferior to APAP.

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.

Characterisation of the cell-transistor coupling

Die Verbindung von elektrisch aktiven, lebenden Zellen zu extrazellulären Sensorsystemen eröffnet vielfälige Möglichkeiten im Bereich der Biosensorik. Die vorliegende Arbeit leistet einen Beitrag zum tieferen Verständnis der elektrischen Kopplungsmechanismen zwischen den biologischen und elektronischen Teilen solcher Hybridsysteme. Es wurden dazu drei Hauptbereiche bearbeitet:Ein System zur extrazellulären Signalableitung an lebenden Zellen bestehend aus einem Sensorchip, einem Vorverstärkerkopf und einem Hauptverstärker wurde weiterentwickelt.Als Sensoren wurden entweder Metallmikroelektroden-Chips mit 64 Kanälen oder Feldeffekt Transistoren-Chips mit 16 Kanälen (FET) eingesetzt. Es wurden zusätzlich spezielle FET Sensoren mit Rückseitenkontakten hergestellt und eingesetzt.Die elektrische Kopplung von einzelnen Nervenzellen der neuronalen Zell-Linien SH-SY5Y und TR14 oder primär kultivierten Neuronen aus dem Hirnstamm oder dem Hippocampus von embryonalen Ratten mit den extrazellulären Sensoren wurde untersucht. In der 'whole-cell' Patch-Clamp Technik wurden die Beiträge der spannungsgesteuerten Na+- und K+-Ionenkanäle zur extrazellulären Signalform identifiziert. Die Simulation der Signale mit einem Ersatzschaltkreis (Punkt-Kontakt Modell), der in PSPICE implementiert wurde, deutet auf eine starke Abhängigkeit der Signalformen in bezug auf Konzentrationsänderungen von Na+- und K+-Ionen im Volumenbereich zwischen Zelle und den ionensensitiven Transistoren hin. Ein empirisch erweitertes Punkt-Kontakt Modell wurde daraufhin vorgestellt.Im dritten Teil der Arbeit wurden Zellschichten von Kardiomyocyten embryonaler Ratten auf den extrazellulären Sensoren kultiviert. Die Eignung eines solchen Hybridsensors als Modellherz fuer das pharmazeutische Screeing wurde durch Messungen mit Herzstimulanzien und -relaktanzien bestätigt.

Evidenza del coinvolgimento di geni nell'insorgenza delle schisi labio-palatine

The CL/P are the most common and easily recognizable craniofacial malformations with a complex etiology that requires the involvement of genetic and environmental components. The analysis of the genetic component shows more than 14 loci and genes involved in the onset of the disease. I’ve selected and investigated some of the possible candidate genes for CL/P. MYH14 gene, that maps on chromosome 19, on the OFC3 locus, and shows a strong homology with MYH9 gene. I’ve also investigated TP63 and MID1 genes, that are responsible respectively for EEC syndrome and Opitz syndrome, both of them presenting cleft. I’ve also decided to investigate JAG2 because TP63 product regulates the this gene, and both of them are component of the Notch signalling pathway. I’ve, also, studied the MKX and LMO4 genes. MKX is an important development regulator that is highly expressed in palatal mesenchyme, and map in the region responsible for Twirler mutation that cause cleft in mouse. LMO4 is necessary for neural tube development and cooperating with Grhl3, promotes cellular migration during morphogenetic events like “in utero” cleft healing. Low folate levels and high levels of homocysteine increase the risk of cleft, genes involved in their metabolism may be of interest in cleft occurrence. I’ve decided to investigate BHMT and CBS genes coding for enzymes involved in homocysteine metabolism. I’ve also investigated BHMT2 gene that maps close to BHMT and presents with him a 73% of homology. I’ve performed a linkage analysis using SNPs mapping in the genes and their boundaries, for each gene, for MKX and LMO4 I’ve also performed a sequencing analysis. My results for MID1 and CBS genes support the hypothesis of a possible role of these genes in cleft. I’ve found borderline association values for JAG2, MKX and LMO4 genes.

Caratteristiche ortopediche-ortodontiche in pazienti affetti da Sindrome di Nooan

La sindrome di Noonan (SN) è una patologia a trasmissione autosomica dominante caratterizzata da bassa statura, difetti cardiaci congeniti, dismorfia facciale. In letteratura sono stati pubblicati pochi case reports riguardanti le condizioni orali-facciali in pazienti affetti da SN. Obiettivo. Individuare patologie di pertinenza ortopedico-ortodontica caratteristiche della sindrome utilizzando un campione di pazienti con diagnosi di SN. Metodi. Un gruppo di 10 pazienti affetti da SN è stato sottoposto a esame obiettivo extraorale ed intraorale, ortopantomografia, teleradiografia latero-laterale, impronte delle arcate dentarie. Le misurazioni sulle TLL sono state effettuate sulla base dell'analisi MBT; i valori palatali provengono dai modelli di studio dell’arcata superiore. È stata utilizzato il test t-Student per mettere a confronto il gruppo di studio e il gruppo di controllo riguardo le misure cefalometriche e i valori palatali. Risultati. Nel gruppo di studio sono state rilevate anomalie di numero (un dente deciduo soprannumerario e una agenesia di un dente permanente). Il test t-Student rivela differenze statisticamente significative per 7 variabili cefalometriche su 13 e per 2 variabili palatali. Conclusioni. Basandosi su questo studio è possibile concludere che i pazienti con SN mostrano II classe scheletrica di tipo mandibolare, crescita iperdivergente, tendenza al morso aperto scheletrico, palatoversione degli incisivi superiori, palato stretto. Questi risultati possono fornire informazioni utili sia per la diagnosi di SN sia per la pianificazione del corretto trattamento ortodontico.

Untersuchung der Bindung des humanen Papillomvirus HPV16 an Heparansulfate der Zelloberfläche

In 99,7% aller Zervixkarzinome kann die DNA humaner Papillomviren (HPV) nachgewiesen werden, die somit den Hauptauslöser für eine der häufigsten Krebserkrankungen bei Frauen weltweit darstellen. HPV16 ist verantwortlich für etwa 50% aller Zervixkarzinome. Für die Infektion von Zellen mit HPV16 ist die Interaktion mit Heparansulfatproteoglykanen der Zelloberfläche essentiell. Um Aminosäuren auf der Oberfläche des majoren Kapsidproteins L1 von HPV16 zu identifizieren, die zu dieser Interaktion beitragen, wurden im Rahmen dieser Arbeit zahlreiche Punktmutanten hergestellt und analysiert. Der Austausch der drei Lysine K278, K356 und K361 zu Alaninen führte zu signifikant verminderter Zell-, Heparin- und Heparansulfatbindung, die noch weiter reduziert wurde, wenn zwei oder drei der Lysine gleichzeitig mutiert waren. Auch die Infektiosität der mutanten Pseudovirionen war stark beeinträchtigt, die Trippelmutante zeigte nur noch 5% Infektiosität. Diese Ergebnisse demonstrieren, dass die drei Lysine gemeinsam die Bindestelle für Heparansulfate bilden. Ihr Austausch zu Argininen beeinflusste die Infektiosität der Partikel hingegen nicht, was bestätigt, dass die Interaktion mit Heparansulfaten von der positiven Ladungsdichte abhängt und nicht sequenzspezifisch ist. Die drei Lysine befinden sich auf der Spitze des HPV16-Kapsomers in einer flachen Tasche, die aufgrund ihrer Struktur bereits früher als potentielle Rezeptorbindestelle vorgeschlagen wurde. Fab-Fragmente des bindungsneutralisierenden Antikörpers H16.56E, dessen Epitop in direkter Nachbarschaft der Lysine liegt, inhibierten die heparansulfatvermittelte Zellbindung viraler Partikel. Auch Epitope anderer bindungsneutralisierender Antikörper befinden sich in der Nähe. Dies untermauert die Hypothese, dass die Lysine K278, K356 und K361 die Heparansulfatbindestelle von HPV16 bilden. Der Austausch von Threoninen, die genau zwischen den Lysinen liegen, hatte keine Auswirkung auf Bindung der Partikel und Infektiosität. Sie könnten jedoch durch die Bildung von Wasserstoffbrücken die Bindung an Heparansulfat stabilisieren. Die Bedeutung der Lysine K278, K356 und K361 bei der primären Interaktion von HPV16 mit Heparansulfaten konnte durch die Computersimulation der Interaktion der Virusoberfläche mit einem Heparinmolekül bestätigt werden. Des Weiteren konnten Anforderungen ermittelt werden, die eine solche Interaktion an das Heparinmolekül stellt. Weiterhin zeigten die Ergebnisse dieser Arbeit, dass basische Aminosäuren in der interkapsomeren Grube nicht an der primären Zellbindung an Heparansulfate beteiligt zu sein scheinen, aber eine Rolle bei sekundären Interaktionen mit der Zelloberfläche spielen könnten.

SANS (USH1G) in USH-Proteinnetzwerken von Photorezeptorzellen der Vertebratenretina

Das Usher Syndrom (USH) führt beim Menschen zur häufigsten Form erblicher Taub-Blindheit und wird aufgrund klinischer Merkmale in drei Typen unterteilt (USH1-3). Das Ziel dieser Arbeit war die Analyse der Expression und subzellulären Lokalisation des USH1G-Proteins SANS („Scaffold protein containing Ankyrin repeats and SAM domain“) in der Retina. Ein weiterer Fokus lag auf der Identifikation neuer Interaktionspartner zur funktionellen Charakterisierung von SANS. Im Rahmen der vorliegenden Arbeit konnte ein USH-Proteinnetzwerk identifiziert werden, das im Verbindungscilium und benachbarter Struktur, dem apikalen Innensegment von Photorezeptorzellen lokalisiert ist. Als Netzwerkkomponenten konnten die USH-Proteine SANS, USH2A Isoform b (USH2A), VLGR1b („Very Large G-protein coupled Receptor 1b“, USH2C) sowie Whirlin (USH2D) ermittelt werden. Innerhalb dieses Netzwerkes interagieren die Gerüstproteine SANS und Whirlin direkt miteinander. Die Transmembranproteine USH2A Isoform b und VLGR1b sind durch die direkte Interaktion mit Whirlin in ciliären-periciliären Membranen verankert und projizieren mit ihren langen Ektodomänen in den extrazellulären Spalt zwischen Verbindungscilium und apikalem Innensegment. Darüber hinaus konnte die Partizipation von SANS an Mikrotubuli-assoziiertem Vesikeltransport durch Identifikation neuer Interaktionspartner, wie dem MAGUK-Protein MAGI-2 („Membrane-Associated Guanylate Kinase Inverted-2“) sowie Dynaktin-1 (p150Glued) eruiert werden. Die Funktion des ciliären-periciliären USH-Proteinnetzwerkes könnte demnach in der Aufrechterhaltung benachbarter Membranstrukturen sowie der Beteiligung der Positionierung und Fusion von Transportvesikeln liegen.

Characterization of the structure and iron uptake mechanisms of the Staphylococcus aureus ferric hydroxamate-binding lipoprotein FhuD2

The Reverse Vaccinology (RV) approach allows using genomic information for the delineation of new protein-based vaccines starting from an in silico analysis. The first powerful example of the application of the RV approach is given by the development of a protein-based vaccine against serogroup B Meningococcus. A similar approach was also used to identify new Staphylococcus aureus vaccine candidates, including the ferric hydroxamate-binding lipoprotein FhuD2. S. aureus is a widespread human pathogen, which employs various different strategies for iron uptake, including: (i) siderophore-mediated iron acquisition using the endogenous siderophores staphyloferrin A and B, (ii) siderophore-mediated iron acquisition using xeno-siderophores (the pathway exploited by FhuD2) and (iii) heme-mediated iron acquisition. In this work the high resolution crystal structure of FhuD2 in the iron (III)-siderophore-bound form was determined. FhuD2 belongs to the Periplasmic Binding Protein family (PBP ) class III, and is principally formed by two globular domains, at the N- and C-termini of the protein, that make up a cleft where ferrichrome-iron (III) is bound. The N- and C-terminal domains, connected by a single long α-helix, present Rossmann-like folds, showing a β-stranded core and an α-helical periphery, which do not undergo extensive structural rearrangement when they interact with the ligand, typical of class III PBP members. The structure shows that ferrichrome-bound iron does not come directly into contact with the protein; rather, the metal ion is fully coordinated by six oxygen donors of the hydroxamate groups of three ornithine residues, which, with the three glycine residues, make up the peptide backbone of ferrichrome. Furthermore, it was found that iron-free ferrichrome is able to subtract iron from transferrin. This study shows for the first time the structure of FhuD2, which was found to bind to siderophores ,and that the protein plays an important role in S. aureus colonization and infection phases.

Die Microsauria des mitteleuropäischen Rotliegend

ZusammenfassungrnAlle bekannten Exemplare der Amphibien-Gruppe Microsauria des mitteleuropäischen Rotliegend wurden untersucht sowie – für die kladistische Untersuchung – ihre nächsten Verwandten. Im Saar-Nahe-Becken sind vier Arten aus zwei Microsauria-Gattungen nachzuweisen: Batropetes niederkirchensis n. sp., Batropetes palatinus n. sp., Batropetes appelensis n. sp. und Altenglanerpeton schroederi n. sp.. Aus dem Döhlen-Becken bei Dresden stammt Batropetes fritschi.rnDie Rekonstruktionen legen nahe, dass die in Seeablagerungen gefundenen Batropetes-Arten kleine, terrestrisch lebende Microsaurier waren, die sich von Insekten oder deren Larven ernährten. Ihre mittlere Gesamtlänge beträgt fast 8 cm, ihr Rumpf ist auffallend kurz mit je nach Art 17 oder 19 Präsakralwirbeln. Sie besitzen große von Wülsten umgebene Augenöffnungen, ein großes Pinealforamen, drei längs angeordnete Grübchen auf den Frontalia, dreispitzige Zähne, einen zahnlosen Gaumen und vier kurze kräftige Extremitäten. Becken- und Schultergürtel sind komplett verknöchert, außer den bei Batropetes appelensis und Batropetes fritschi knorpeligen Coracoid-Anteilen. Die Batropetes-Arten unterscheiden sich bezüglich Form, Proportionen bzw. Verknöcherungsgrad einiger Knochen im cranialen und postcranialen Skelett. rnDie kladistischen Untersuchungen ergeben für die Arten der monophyletische Gattung Batropetes, dass Batropetes appelensis den übrigen Arten gegenübersteht und Batropetes palatinus mit Batropetes fritschi eine Schwestergruppe zu Batropetes niederkirchensis bildet. Mit den etwas jüngeren texanischen Gattungen Carrolla und Quasicaecilia bildet Batropetes die monophyletische Familie Brachystelechidae. rnAltenglanerpeton schroederi, nur durch ein schlecht erhaltenes Exemplar überliefert, besitzt einen massiv gebauten Schädel, kaum länger als breit mit annähernd dreieckigem Umriss, ohne Anzeichen für Seitenlinien, mit kleiner rundlicher Orbita, sehr breiter Interorbitalregion und bis weit vor die Orbita reichendem Jugale. Sein langer Rumpf umfasst mindestens 30 lepospondyle Präsakralwirbel. Wegen der unvollkommenen Entwicklung der Gliedmaßen kann diese Art nicht auf vier Beinen gelaufen sein und lebte möglicherweise in der Laubschicht wühlend oder in Sümpfen. Altenglanerpeton ist keiner bestimmten Microsauria-Familie zuzuordnen und steht den Pantylidae, Gymnarthridae, Goniorhynchidae und Ostodolepidae am nächsten, wobei zu letzteren die meisten morphologischen Ähnlichkeiten bestehen.rnAußerdem sind mit isolierten Einzelknochen, insbesondere Wirbeln, Microsauria und andere Gruppen lepospondyler Amphibien ohne Bestimmung der Gattung und Art aus wenigen stratigraphischen Niveaus des Saar-Nahe-Beckens überliefert. rn

Palatal swelling as the first and only manifestation of extranodal follicular non-Hodgkin lymphoma: a case presentation

Non-Hodgkin lymphomas (NHLs) in the head and neck region are malignant lymphoid neoplasms that usually originate from B-lymphocytic cell lines. Primary extranodal manifestations of this hematolymphoid tumor in the oral cavity are rare and involve the maxillary jaw including the palatal soft tissues, the mandible, and gingival tissues in patients between 60 and 70 years of age without sex predilection. This case report of an extra-nodal NHL in the palate of a 75-year-old patient emphasizes the importance of accurate clinical, radiographic, and histologic diagnostic procedures to avoid delayed diagnosis or inappropriate treatment strategies. Chemotherapy, radiotherapy, or a combination of the two with a regular clinical and hemic follow-up is recommended.

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.

The binding mode of side chain- and C3-modified epothilones to tubulin

The tubulin-binding mode of C3- and C15-modified analogues of epothilone A (Epo A) was determined by NMR spectroscopy and computational methods and compared with the existing structural models of tubulin-bound natural Epo A. Only minor differences were observed in the conformation of the macrocycle between Epo A and the C3-modified analogues investigated. In particular, 3-deoxy- (compound 2) and 3-deoxy-2,3-didehydro-Epo A (3) were found to adopt similar conformations in the tubulin-binding cleft as Epo A, thus indicating that the 3-OH group is not essential for epothilones to assume their bioactive conformation. None of the available models of the tubulin-epothilone complex is able to fully recapitulate the differences in tubulin-polymerizing activity and microtubule-binding affinity between C20-modified epothilones 6 (C20-propyl), 7 (C20-butyl), and 8 (C20-hydroxypropyl). Based on the results of transferred NOE experiments in the presence of tubulin, the isomeric C15 quinoline-based Epo B analogues 4 and 5 show very similar orientations of the side chain, irrespective of the position of the nitrogen atom in the quinoline ring. The quinoline side chain stacks on the imidazole moiety of beta-His227 with equal efficiency in both cases, thus suggesting that the aromatic side chain moiety in epothilones contributes to tubulin binding through strong van der Waals interactions with the protein rather than hydrogen bonding involving the heteroaromatic nitrogen atom. These conclusions are in line with existing tubulin polymerization and microtubule-binding data for 4, 5, and Epo B.

A closer look at the high affinity benzodiazepine binding site on GABAA receptors

Ligands of the benzodiazepine binding site of the GABA(A) receptor come in three flavors: positive allosteric modulators, negative allosteric modulators and antagonists all of which can bind with high affinity. The GABA(A) receptor is a pentameric protein which forms a chloride selective ion channel and ligands of the benzodiazepine binding site stabilize three different conformations of this protein. Classical benzodiazepines exert a positive allosteric effect by increasing the apparent affinity of channel opening by the agonist γ-aminobutyric acid (GABA). We concentrate here on the major adult isoform, the α(1)β(2)γ(2) GABA(A) receptor. The classical binding pocket for benzodiazepines is located in a subunit cleft between α(1) and γ(2) subunits in a position homologous to the agonist binding site for GABA that is located between β(2) and α(1) subunits. We review here approaches to this picture. In particular, point mutations were performed in combination with subsequent analysis of the expressed mutant proteins using either electrophysiological techniques or radioactive ligand binding assays. The predictive power of these methods is assessed by comparing the results with the predictions that can be made on the basis of the recently published crystal structure of the acetylcholine binding protein that shows homology to the N-terminal, extracellular domain of the GABA(A) receptor. In addition, we review an approach to the question of how the benzodiazepine ligands are positioned in their binding pocket. We also discuss a newly postulated modulatory site for benzodiazepines at the α(1)/β(2) subunit interface, homologous to the classical benzodiazepine binding pocket.

Oral mucosal morphea: a new variant

Morphea is a cutaneous disorder characterized by an excessive collagen deposition. While in almost all cases the sclerosing process exclusively affects the skin, there are anecdotal cases in which associated mucosal involvement has been described. We here report the case of a woman developing a whitish indurated plaque over the left upper vestibular mucosa and hard palate leading to dental mobility and exposure of the roots of several teeth. Cone beam computed tomography of the left maxilla showed bone resorption involving the upper cuspid to the second molar region with widened periodontal ligament spaces, while light microscopy studies demonstrated epithelial atrophy and fibrosis of the dermis extending into the submucosa with hyalinization of subepithelial collagen. Our observation expands the spectrum of clinical presentations of morphea and provides the first example of isolated oral morphea. Its recognition is important to avoid significant local complications.

[Tobacco-associated lesions of the oral mucosa]

Consumption of tobacco can result not only in a multitude of different general health problems like carcinoma of the lung, ischaemic cardiac diseases, peripheral vascular diseases, stroke, chronic-obstructive pulmonary diseases or peptic ulcers, but also in pathologic lesions of the oral mucosa. Benign oral lesions from smoking or consumption of smokeless tobacco are the so-called smoker's palate and smoker's melanosis. On the other hand, tobacco-associated lesions like oral leukoplakia or oral squamous cell carcinoma are already potentially life-threatening diseases that in general require active treatment. The following review article will present and discuss the typical lesions of the oral mucosa that result from chronic tobacco consumption. The aim of this article is to demonstrate dental health care providers the needs and benefits of tobacco use cessation in a dental setting, especially regarding stomatologic sequelae and consequences. The present article is the first in a series of articles from the Swiss task force "Smoking - Intervention in the private dental office" on the topic "tobacco use and dental medicine".