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Pain is rarely communicated alone, as it is often accompanied by emotions such as anger or sadness. Communicating these affective states involves shared representations. However, how an individual conceptually represents these combined states must first be tested. The objective of this study was to measure the interaction between pain and negative emotions on two types of facial representations of these states, namely visual (i.e., interactive virtual agents; VAs) and sensorimotor (i.e., one's production of facial configurations). Twenty-eight participants (15 women) read short written scenarios involving only pain or a combined experience of pain and a negative emotion (anger, disgust, fear, or sadness). They produced facial configurations representing these experiences on the faces of the VAs and on their face (own production or imitation of VAs). The results suggest that affective states related to a direct threat to the body (i.e., anger, disgust, and pain) share a similar facial representation, while those that present no immediate danger (i.e., fear and sadness) differ. Although visual and sensorimotor representations of these states provide congruent affective information, they are differently influenced by factors associated with the communication cycle. These findings contribute to our understanding of pain communication in different affective contexts., (© 2024. The Author(s).)

Background: Plasma cell gingivitis is defined as gingival inflammation comprised of plasma cell infiltrates. This diagnostic criterion is non-specific and underlying mechanisms remain unknown., Objectives: We performed a multidisciplinary clinico-pathological review of cases previously identified as "gingivitis with plasma cell infiltrates", with assessment of putative contributing factors and critical appraisal of the final diagnosis., Materials & Methods: Cases previously identified as "gingivitis with plasma cell infiltrates" between 2000 and 2020 were included from archives from the GEMUB group, a French multidisciplinary network of physicians with expertise on oral mucosa., Results: Among the 37 included cases, multidisciplinary clinico-pathological review allowed differential diagnosis in seven cases (oral lichen planus n=4, plasma cell granuloma n=1, plasmacytoma n=1, and mucous membrane pemphigoid n=1). The remaining cases were classified as "reactive plasma cell gingivitis" (induced by drugs, trauma/irritation or periodontal disease) (n=18) or "idiopathic plasma cell gingivitis" when no contributing factors were identified (n=12). Clinico-pathological characteristics did not differ significantly between "reactive" and "idiopathic" cases, preventing us from identifying specific features of "idiopathic" plasma cell gingivitis., Conclusion: "Plasma cell gingivitis" is a polymorphous, non-specific entity with various aetiologies, of which the diagnosis requires multidisciplinary anatomo-clinical correlation for exclusion of secondary causes of plasma cell infiltration. Although our study was limited by its retrospective design, most cases of "plasma cell gingivitis" appeared to be associated with an underlying cause. We propose a diagnostic algorithm to properly investigate such cases.

Introduction: Oral lichen is a chronic inflammatory disease for which diagnostic management and follow-up are heterogeneous given the absence of specific guidelines in France. Our objective was to develop French multidisciplinary guidelines for the management of oral lichen., Materials and Methods: Working groups from the Groupe d'Etude de la Muqueuse Buccale (GEMUB) formulated a list of research questions and the corresponding recommendations according to the "formal consensus" method for developing practice guidelines. These recommendations were submitted to a group of experts and the degree of agreement for each recommendation was assessed by a scoring group., Results: Twenty-two research questions, divided into 3 themes (nosological classification and initial assessment, induced oral lichenoid lesions, and follow-up) resulted in 22 recommendations. Initial biopsy for histology is recommended in the absence of reticulated lesions. Biopsy for direct immunofluorescence is recommended for ulcerated, erosive, bullous types and for diffuse erythematous gingivitis. Management should include a periodontal and dental check-up, and investigation for extra-oral lesions. Hepatitis C testing is recommended only if risk factors are present. Definitions, triggering factors and the management of "induced oral lichenoid lesions" were clarified. Oral lichen must be monitored by a practitioner familiar with the disease at least once a year, using objective tools., Conclusion: This formalised consensus of multidisciplinary experts provides clinical practice guidelines on the management and monitoring of oral lichen., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Pain assessment and pain care are influenced by the characteristics of both the patient and the caregiver. Some studies suggest that the pain of older persons and of females may be underestimated to a greater extent than the pain of younger and male individuals., Aims: This study investigated the effect of age and sex on prosocial behavior and pain evaluation., Methods: 40 young (18-30 y/o; 20 women) and 40 older adults (55-82 y/o; 20 women) acted as healthcare professionals rating the pain and offering help to patients of both age groups. Trait empathy and social desirability were measured with questionnaires., Results: Linear mixed models showed that older and male patients were offered more help and were perceived as being in more intense pain than younger and female patients., Conclusion: The characteristics of the patients seem to have a greater impact on prosocial behavior and pain assessment compared to those of the observers, which bears significant implications for the treatment of pain in clinical contexts., (© 2021 European Pain Federation - EFIC®.)

Along other breakthroughs in computer sciences, such as artificial intelligence, virtual characters (i.e. digitally represented characters featuring a human appearance or not) are foreseen as potential providers of mental healthcare services. However, their current use in clinical practice is marginal and limited to an assistive role to help clinicians in their practices. Safety and efficiency concerns, as well as a general lack of knowledge and experience, may explain this discrepancy between the expected (sometimes futuristic) and current use of virtual characters. An overview of recent evidence would help pinpoint the main concerns and challenges pertaining to their use in mental healthcare. Objective This paper aims to inform relevant actors, including clinicians, on the potential of virtual characters in mental healthcare practices and to raise awareness on societal challenges regarding their use. Method A narrative literature review was conducted to summarize basic and clinical research findings, and to outline an in-depth discussion on various societal caveats related to the inclusion of virtual characters. Results Basic studies highlight several characteristics of the virtual characters that seem to influence patient-clinician interactions. These characteristics can be classified into two categories: perceptual (e.g. realism) and social features (i.e. attribution of social categories such as gender). To this day, many interventions and/or assessments using virtual characters have shown various levels of efficiency in mental health, and certain elements of a therapeutic relationship (e.g. alliance and empathy) may even be triggered during an interaction with a virtual character. To develop and increase the use of virtual characters, numerous socioeconomic and ethical issues must be examined. Although the accessibility and the availability of virtual characters are an undeniable advantage for their use in mental healthcare, some inequities about their application remain. In addition, the accumulation of biometric data (e.g. heart rate) could provide valuable information to clinicians and could help develop autonomous virtual characters, which raises concerns over issues of security and privacy. This paper proposes some recommendations to avoid such undesirable outcomes. Conclusion Due to their promising features, the inclusion of virtual characters will no doubt be increasingly prevalent in mental healthcare services. All involved actors should thus be informed about specific challenges raised by such breakthroughs. They should also actively participate in discussions regarding the development of virtual characters in order to adopt unified recommendations for their safe and ethical use in mental healthcare.

Although emotion regulation has been proposed to be crucial for empathy, investigations on emotion regulation have been primarily limited to intrapersonal processes, leaving the interpersonal processes of self-regulation rather unexplored. Moreover, studies showed that emotion regulation and empathy are related with increased autonomic activation. How emotion regulation and empathy are related at the autonomic level, and more specifically during differently valenced social situations remains an open question. Healthy adults viewed a series of short videos illustrating a target who was expressing positive, negative, or no emotions during a social situation (Positive, Negative, or Neutral Social Scenes). Prior to each video, participants were instructed to reappraise their own emotions (Up-regulation, Down-regulation, or No-regulation). To assess autonomic activation, RR intervals (RRI), high frequency (HF) components of heart rate variability (HRV), and electrodermal activity phasic responses (EDRs) were calculated. Situational empathy was measured through a visual analogue scale. Participants rated how empathic they felt for a specific target. Up- and Down-regulation were related to an increase and a decrease in situational empathy and an increase in RRI and HF, respectively, compared to the control condition (No-regulation). This suggests increased activity of the parasympathetic branch during emotion regulation of situational empathic responses. Positive compared to Negative Social Scenes were associated with decreased situational empathy, in addition to a slightly but non-significantly increased HF. Altogether, this study demonstrates that emotion regulation may be associated with changes in situational empathy and autonomic responses, preferentially dominated by the parasympathetic branch and possibly reflecting an increase of regulatory processes. Furthermore, the current study provides evidence that empathy for different emotional valences is associated with distinct changes in situational empathy and autonomic responses., Competing Interests: The authors have declared that no competing interests exist.

Gingival enlargements (GEs) can be caused by local, systemic diseases or drugs. Three molecules can be responsible of GEs: ciclosporin, phenytoin and calcium channel blockers (CCBs). We report the case of a 56-year-old male treated by Amlodipine, a CCB, for hypertension for many years and who recently developed a severe GE affecting both mandibular and maxillary arches inducing dental malposition. The histological examination showed non-specific inflammation with a predominance of lymphocytes. Amlodipine was suspected and suspended in agreement with his physician. One month later, the enlargement significantly reduced but GE was so severe and dental malposition so marked that all the teeth but the canines were extracted. No recurrence was noted one year later. This exceptional case should encourage every practitioner to be vigilant with patient treated with CCBs and their potential side effects and consequences., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Despite the huge importance of spoken language production in everyday life, little is known about the manner and extent to which the motor aspects of speech production evolve with advancing age, as well as the nature of the underlying senescence mechanisms. In this cross-sectional group study, we examined the relationship between age and speech production performance using a nonlexical speech production task in which spoken syllable frequency and phonological complexity were systematically varied to test hypotheses about underlying mechanisms. A nonprobabilistic sample of 60 cognitively healthy adults (18-83 years) produced meaningless nonwords aloud as quickly and accurately as possible. Error rate, vocal reaction time (RT), vocal RT variability, vocal response duration, and vocal response duration variability were used as dependent variables to characterize speech production performance. The results showed an overall increase in error rate, which occurred mainly in the final syllable position (coda). There was also an increase in vocal response duration and in duration variability with age, which was moderated by phonological complexity and syllable frequency. Finally, we also found an age-related change in the relationship between vocal RT and vocal response duration. Together, these findings were interpreted as reflecting an age-related decline in the planning and execution of speech movements in cognitively healthy adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: CLOVES syndrome (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal nevi, Skeletal anomalies) is a sporadic malformational syndrome that has recently been described (mutation of PIK3CA), with asymmetric body hypertrophy, lipomatous hamartoma of the trunk and numerous malformations., Patients and Methods: We report a case of CLOVES syndrome initially diagnosed as Proteus syndrome, revealed by infection of a dorsal lipomatous hamartoma. The patient presented with both right lower limb hypertrophy and capillary and venous-lymphatic malformations, associated with dorsal capillary malformations, left cervico-facial hypertrophy, and cervical epidermal hamartoma, all of which are consistent with Proteus syndrome. Imaging of the dorsal lipomatous hamartoma associated with capillary as well as underlying venous-lymphatic malformations and syringomyelia resulted in subsequent correction of the earlier diagnosis of Proteus syndrome to that of CLOVES syndrome., Discussion: Several malformational syndromes are associated with tissue hypertrophy, hamartoma and vascular malformations. Diagnosis of CLOVES syndrome may be delayed due to its fairly close phenotypic similarity to Proteus syndrome. Nevertheless, the prognosis and complications differ. Our case underlines the importance of considering a diagnosis of CLOVES syndrome in the presence of lipomatous hamartoma with hemi-hypertrophy and epidermal hamartoma, in order to enable adequate follow-up with specific monitoring for the possible complications associated with this disease., (Copyright © 2014. Published by Elsevier Masson SAS.)

Background: Pyodermatitis-pyostomatitis vegetans (PPV) is a rare chronic disorder often associated with inflammatory bowel disease. We report an isolated case involving the oral, labial and nasal mucosa., Patients and Methods: A 28-year-old man, in good general condition, presented with a 2-year history of painless stomatitis. The physical examination revealed pustular and exophytic lesions of the jugal, gingival and palatine mucosa on an erythematous background, as well as some pustular and crusted lesions of the lower lip and nostrils. Histopathological analysis revealed epithelial hyperplasia and a suprabasal cleft with some signs of acantholysis and numerous neutrophils and eosinophils. Direct and indirect immunofluorescence assay was negative. There was no associated bowel disease. We concluded on a diagnosis of PPV of younger subjects. The lesions disappeared with oral corticosteroids but with steroid dependency., Discussion: PPV is a rare dermatosis associated in more than 75% of cases with inflammatory bowel disease, usually ulcerative colitis. Lesions of the oral mucosa are a constant finding and are characterised by aseptic pustules on an erythematous background. Skin lesions are pustular and more or less exophytic. To our knowledge, there have been no reports to date of intranasal lesions of PPV.

The desquamative gingivitis is the clinical term given to the gingival manifestation of mucocutaneous diseases. It is characterized by an erythematous, glazed, friable and hemorrhagic gingiva, which can be accompanied by pains. Except the gingiva, the lesions can be localised on other oral mucous membranes or on the skin. The three principal diseases at the origin of the desquamative gingivitis are by order of frequency: the cicatricial pemphigoïd, erosive lichen planus and pemphigus. The knowledge of the clinical, histological and immunohistochemical characteristics of these three affections is essential for the diagnosis and the suitable treatment of the desquamative gingivitis.

Lichen planus (LP) is a chronic inflammatory disease of uncertain etiology. When the gingiva is affected, the LP can appear under several clinical forms. The diagnosis of the gingival lichen planus is based on the anamnesis, the clinical observation and the histological analysis. Various medicamentous and non medicamentous treatments are used to treat gingival LP with random results, due to the lack of knowledge on the etiology and the recidiving character of the lesions. The risk of malignant transformation of gingival LP is weak but it depends on clinical forms, justifying a periodic follow-up of all patients.

Adoptive therapy for cancer using tumor-infiltrating lymphocytes (TIL) has mainly been investigated in cancer patients with advanced stage disease. The limited clinical success has not been encouraging, although this might be explained by poor TIL specificity and/or high tumor burden. To re-evaluate the effectiveness of adoptive therapy, we analyzed the capacity of tumor-reactive TIL injection in preventing the further development of disease in stage III melanoma patients after complete tumor resection. A phase II/III randomized trial was performed on 88 melanoma patients, who received autologous TIL plus interleukin-2 (IL-2) or IL-2 only. The duration of relapse-free survival was analyzed, taking into account the immunological specificity of injected TIL and the number of metastatic lymph nodes removed before treatment. Kaplan-Meyer analysis revealed that the injection of tumor-reactive TIL was statistically correlated with prolonged relapse-free survival in patients with only one metastatic lymph node. Therefore, improved clinical outcome could be obtained after adoptive therapy by selecting appropriate groups of patients and monitoring the specificity of the injected TIL populations.

The aim of this study was to demonstrate the interest of using tumor-infiltrating lymphocytes (TIL) as adjuvant therapy for stage III (regional lymph nodes) melanoma. After lymph node excision, patients without any detectable metastases were randomly assigned to receive either TIL plus interleukin-2 (IL-2) for 2 months, or IL-2 only. The primary endpoint was determination of the duration of the relapse-free interval. Eighty-eight patients determined as eligible for treatment were enrolled in the study. After a median follow-up of 46.9 months, for the study population the analysis did not show a significant extension of the relapse-free interval or overall survival. However, a significant interaction ( P<0.001) was found between the treatment and the number of invaded lymph nodes. In the group with only one invaded lymph node, the estimated relapse rate was significantly lower ( P(adjusted)=0.0285) and the overall survival was increased ( P(adjusted)=0.039) in the TIL+IL-2 arm compared with the IL-2 only arm. No differences between the two arms, either as regards the duration of disease-free survival or overall survival, were noted in the group with more than one invaded lymph node whatever the number of invaded lymph nodes. Treatment was compatible with normal daily activity. This study demonstrates for the first time that the efficiency of TIL in stage III melanoma (AJCC) is directly related to the number of invaded lymph nodes, indicating that tumor burden might be a crucial factor in the efficacy and/or in vitro expansion of T cells specific for autologous tumor antigen, a finding which could be of value in future vaccine development for the treatment of melanoma.

The rationale of treating melanoma patients by infusion with tumor-infiltrating leukocytes (TIL) is to perform an adoptive therapy through injection of tumor-specific T cells. Nonetheless, methods currently used for ex vivo TIL expansion have not been evaluated for their efficacy to expand TAA-specific T cells. We have addressed this question here, using a culture method in which high TIL growth was induced by a polyclonal T cell stimulus. Intracellular cytokine assays were performed to measure the proportion of T cells responding to autologous tumor cells among the lymphocytes from lymph node biopsies (TIL) of 26 patients with stage III melanoma. The data show that TIL from 18 of these patients contained detectable amounts of tumor-specific T cells before expansion. Although they decreased somewhat in percent abundance during expansion, they were still present afterwards, ranging from 0.3 to 13.8%. Since a median number of 1.7 x 10(10) TIL was obtained from these patients (starting from 3.6 x 10(6) TIL), a total amount of tumor-reactive cytokine-secreting TIL of between 2.8 x 10(6) and 1.12 x 10(9) was obtained in each case from 18 patients. The TIL populations from 8 patients did not contain tumor-reactive T cells: neither before expansion, nor after expansion. Lack of tumor-reactive TIL only occurs for patients bearing several tumor-invaded lymph nodes (40%), but not for those having a single invaded lymph node. Therefore, high numbers of tumor-reactive T cells can be produced, through a polyclonal TIL stimulation, from most early stage III melanoma patients but from only about half of the patients with a more disseminated disease. For this last group, the possibility of getting tumor-reactive TIL can be predicted by checking the presence of these cells before expansion.

Thirty-nine tumor-bearing patients with metastatic melanoma were treated with 3 subcutaneous injections of the MAGE-3.A1 peptide at monthly intervals. No significant toxicity was observed. Of the 25 patients who received the complete treatment, 7 displayed significant tumor regressions. All but one of these regressions involved cutaneous metastases. Three regressions were complete and 2 of these led to a disease-free state, which persisted for more than 2 years after the beginning of treatment. No evidence for a cytolytic T lymphocyte (CTL) response was found in the blood of the 4 patients who were analyzed, including 2 who displayed complete tumor regression. Our results suggest that injection of the MAGE-3.A1 peptide induced tumor regression in a significant number of the patients, even though no massive CTL response was produced.

Background: Circulating melanocytes can be detected in peripheral blood of patients with malignant melanoma by means of tyrosinase messenger RNA amplification. In this study we especially examined peripheral blood from patients with stage II melanoma before and after lymph node dissection for the detection of these circulating melanoma cells. Indeed the presence of regional nodal metastasis is one of the most important prognostic factors in patients with cutaneous melanoma., Patients and Methods: Blood samples were collected from 20 normal patients, 42 patients with stage I melanoma and 23 patients with stage III melanoma. Twenty patients with stage II melanoma were tested 3 days before lymph node dissection and 2 à 8 weeks after. To identify circulating melanocytes, we used coupled reverse-transcription and polymerase chain reaction to target tyrosinase messenger RNA., Results: None of the 20 patients with stage II melanoma had detectable circulating melanocytes before lymph node dissection. By contrast, 7 of them became transiently PCR positive in the 8 weeks following surgery. We observed no evidence of correlation between the presence of circulating melanocytes after lymph node dissection and the risk of relapse within 6 months after surgery or the presence of capsule breaking or the number of involved lymph nodes. Sixty-nine percent of stage III patients and none of stage I patients were found to have circulating melanocytes., Discussion: Our study suggests that melanoma cells could circulate transiently after lymph node dissection. Confrontation of our results with literature data, despite important discrepancies related in part to sensibility technique, shows that the presence of circulating melanoma cells is correlated to the clinical stage. Prognostic value of these circulating cells need to be further assessed by prospective studies with large number of patients and long follow-up.

Introduction: The aim of this work was to study the effectiveness and safety of a combined therapy with dacarbazine, cisplatin and interferon alpha in the treatment of metastatic melanoma., Patients and Methods: Sixteen patients, including 15 with one or more visceral metastases, were treated with dacarbazin 400 mg/m2, cisplatin 100 mg/m2 repeated every 28-day and interferon alpha-2a 3.10(6) IU subcutaneously 3 times weekly. Fifty percent of patients had at least 3 different sites of metastases. Ten patients had previously received one or more specific treatment for their melanoma., Results: The overall response was 25 p. 100 (2 complete responses and 2 partial responses). The two complete responses were obtained on liver, lung and cutaneous metastases and remain in sustained, unmaintained remission for 22 and 24 months. Administration of this treatment was well tolerated, the most prevalent toxicity being hematologic. At present, responding patients have a median survival of 26 months+ since the beginning of the treatment, compared to 7 months for non responding patients., Discussion: Dacarbazine and cisplatin combined chemotherapy has been used at various doses with an overall response rate of 14 to 37 p. 100, similar to our results. However, duration of complete response in our study (22 months+ and 24 months+) seem more prolonged than in studies using dacarbazine and cisplatin at dose of 100 mg/m2/21 d (7 to 9 months) and comparable to studies using dacarbazine and cisplatin at dose of 150 mg/m2/28 d or more (15 months+ to 19 months+ and 24 months+) but with less toxicity. Therefore addition of interferon alpha might be of interest in the maintain of complete remissions and perhaps in the prolongation of survival of responding patients as it has already been suggested with the dacarbazine-interferon alpha combination.