Orofacial aspects of juvenile idiopathic arthritis in children

Aims: This thesis, which investigates orofacial aspects and temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA), aims to improve knowledge about the variables to include in a clinical examination, radiographic imaging techniques, and whether saliva can be used as a medium for disease monitoring. Material and methods: In a prospective longitudinal study comprising 59 children diagnosed with JIA, clinical and radiological data were collected. Demographic data and data on patient history of localized pain and dysfunction were recorded. Clinical examinations were performed according to the Research Diagnostic Criteria for Temporomandibular Disorders at baseline and repeated after one year and after two years. Radiological examinations were performed with panoramic imaging (PAN) and cone beam computed tomography (CBCT) at baseline and at the two-year follow-up. A classification system for how to grade TMJ morphology on PAN and CBCT was proposed and evaluated using radiological data from this longitudinal study. In a case control study, stimulated whole saliva was collected from 30 children with JIA and 30 healthy age-matched controls. Self-reported orofacial pain was recorded, and saliva flow rate calculated. Saliva samples were analyzed for presence and concentration of 21 immunological active proteins using the Luminex system and customized R&B bead-based immunoassay. Results: The result from the longitudinal study showed a higher proportion of TMJ deformities in children self-reporting TMJ pain and dysfunction. However, self-reported pain was not predictive of change in TMJ status over time. TMJ deformities were associated with a smaller maximum unassisted mouth opening (MUO), palpatory TMJ pain, and TMJ crepitations, but palpatory muscle pain, although common, did not correlate with TMJ deformities. Predictive of finding TMJ deformities was number of years with disease and a smaller MUO. When using the proposed classification system for TMJ morphology, PAN and CBCT recognized presence of TMJ abnormality equally well. The reliability of PAN to distinguish between normal and abnormal TMJ morphology was good, and CBCT was found to be superior for assessing the severity of TMJ abnormality. Regarding presence of immunological biomarkers in saliva, 14 of 21 examined proteins were found in the saliva samples. However, no significant differences in concentrations were found between children with JIA and healthy children. No difference in saliva flow rate was observed between children with JIA and controls, but there was an association between lower salivary flow rate and children reporting orofacial pain regardless of group. Conclusion: In children with JIA, self-reported TMJ pain and dysfunction were common. A high degree of TMJ deformities were found, but clinical variables only showed subtle variations from what is considered normal. No single clinical variable was found to predict or indicate TMJ involvement in JIA. Regarding radiological methods evaluated, the technique that provides diagnostically acceptable information at the lowest radiation dose should be used. The result showed that PANs can be used to determine whether TMJ deformities are present in children with JIA; however, this finding needs to be confirmed in future studies. Furthermore, with the current level of knowledge and based on the results presented, saliva cannot be recommended as a medium for monitoring disease activity in JIA

Djurägares syn på cytostatikabehandling av hund

Chemotherapy is one of the most important methods of treatment available today for the treatment of neoplastic diseases and gives many patients an increased quality of life and a prolonged survival time (McKnight, 2003). The object of this study was to find out more about owners’ views on and experiences of chemotherapy of dogs when it comes to for example quality of life, side effects and if they would make the same decision and treats their dog again in the future. A questionnaire was in the spring of 2009 sent out to the owners of 100 dogs that had been treated with chemotherapy for neoplastic diseases at Universitetsdjursjukhuset, Sveriges Lantbruksuniversitet (SLU) in Uppsala between 2002 and 2008. The response rate was 67 %. The majority of the owners in the study seem to be satisfied with the chemotherapy and their decision to treat their dogs. About two thirds of the owners would make the same decision and treat their dog again if they in the future got a new dog which developed a neoplastic disease. Approximately the same number (72 %) would recommend someone else to treat their dog. Only 12 % of the owners replied that they regretted treating their dog with chemotherapy. Just over half of the owners (57 %) replied that their dog had suffered from one or more side effects from the chemotherapy. The most common side effects seen by the owners were nausea and/or vomiting and diarrhea. 49 % of the owners thought that the side effects and/or decrease in quality of life that their dog suffered from in connection with the chemotherapy were acceptable, while only 8 % thought they were unacceptable. 55 % of the owners thought that their dog’s quality of life seen over the entire treatment period had been as good as or almost as good as before the dog got sick. 15 % considered their dog’s quality of life during the treatment period to be slightly decreased compared to before it got sick and 22 % answered that their dog’s quality of life had been severely decreased during shorter or longer periods of time. Chemotherapy can be feared to entail risks for both the person handling the drugs and for the person who handles the recently treated dog and for example its urine, faeces and vomits. 69 % of the owners answered that they had not been worried about these risks when their dog underwent chemotherapy, while 16 % answered that they had been concerned about these risks. Only 3 % of the owners hesitated to let their dog undergo chemotherapy because of these risks. Almost half of the owners (48 %) thought that the price of the treatment was either a little or much too high. 40 % thought the price was acceptable

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Faith Within Therapy : - Christian clients´experience of their own, as well as their therapist´s, approach to faith in God within psychotherapy

Syftet var att undersöka hur troende kristna som gått i psykoterapi, upplevt att de själva och terapeuten förhållit sig till gudstron. Författarna har använt en halvstrukturerad kvalitativ intervjuform för studiens genomförande. Sammanfattningsvis framkom att respondenterna inför en psykoterapi haft farhågor om att bli bemötta och tolkade i ramar som varit oförenliga med det egna seendet, men att farhågorna i de reella psykoterapierna inte besannats. Vidare framkom att respondenterna förhållit sig till sin gudstro genom att anpassa sig till terapeuternas inställning. Det betyder att om terapeuterna visat sig vara villiga att prata om tron, har respondenterna delgivit den. Har däremot terapeuterna verkat obekväma med trossamtal, har respondenterna bytt ämne. Terapeuterna har, enligt respondenterna, varit sparsmakade i att själva initiera trossamtal och haft en avvaktande, men respektfull hållning gentemot respondentens gudstro. Respondenterna uttryckte även att samtal om trons kopplingar till den psykologiska problematiken upplevs som berikande, men ansågs inte nödvändigt för framgångsrika terapier

Salivary biomarkers in children with juvenile idiopathic arthritis and healthy age-matched controls : a prospective observational study.

Monitoring the immune system's regulation and signaling using saliva could be of interest for clinicians and researchers. Saliva, a biofluid with close exchange with serum, is influenced by circadian variance and oral factors such as masticatory function. This study investigated the detectability and concentration of cytokines and chemokines in saliva in children with juvenile idiopathic arthritis (JIA) as well as saliva flow and the influence of orofacial pain on saliva flow. Of the 60 participants (7-14 years old) enrolled, 30 had a diagnosis of JIA and active disease, and 30 were sex- and age-matched healthy controls. Demographic data and three validated questions regarding presence of orofacial pain and dysfunction were recorded. Stimulated whole saliva was collected and analyzed using a customized R&amp;D bead-based immunoassay with 21 targeted biomarkers. Fourteen of these were detectable and showed similar levels in both children with JIA and controls: TNF-alpha, TNFRSF1B, MMP-2, MMP-3, IL-1alpha, IL-1beta, IL-6R alpha, IL-8, S100A8, CCL2, CCL3, IL-10, CCL11, and CXCL9. In addition, there was no difference in salivary flow rate between groups, but there was an association between orofacial pain and reduced saliva flow rate for both groups.Trial registration: ClinicalTrials.gov Protocol id: 2010/2089-31/2

Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study

Abstract This study aimed to clinically evaluate temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) and the ability to identify and/or predict development of TMJ-deformities over time using cone beam computed tomography (CBCT). The predictive value of self-reported TMJ pain was also assessed. A prospective longitudinal cohort study comprising 54 children with JIA, 39 girls and 15 boys, was performed. All children had active disease at baseline, 50% with the subtype oligoarthritis. Repeated clinical orofacial and CBCT examinations were performed over a two-year period. At baseline, 39% had radiographic TMJ deformities (24% unilateral, 15% bilateral), at 2-year follow-up, 42% (p > 0.05). Both progressing and improving TMJ deformities were observed. An association was found between TMJ-deformities and self-reported TMJ pain at baseline (p = 0.01). Maximum unassisted mouth opening (MUO) was smaller for children with TMJ-deformities (p < 0.05). The prevalence of palpatory muscle pain was high (48–59%) but not predictive of development of TMJ-deformities. TMJ noises increased over time and crepitations were associated with TMJ-deformities (p < 0.05). In conclusion, in children with JIA, self-reported TMJ pain and dysfunction were common and predictive of TMJ deformities. TMJ deformities were associated with smaller MUO and palpatory TMJ pain as well as crepitations. Trial registration. ClinicalTrials.gov Protocol id: 2010/2089-31/2

Framtidsfrågor Restaureringskonst 2016-2017 Kungl Konsthögskolan

Restaureringskonst vid Kungl Konsthögskolan i Stockholm har läsåret 2016-2017 haft temat Framtidsfrågor. Utöver professionskunskap och teori har fronten och framtidsfrågor inom ämnet studerats. Publikationen visar en del av årets arbete i form av artiklar. Praktisk träning i dokumentation och värdering avspeglas liksom gemensamma studieresor, föreläsningar och milstolpar inom restaurering. Framtidsfrågor har inga enkla svar med för att kunskapsuppbyggnaden ska ligga i fronten är Restaureringskonst en aktiv deltagare i diskussionen