Passive elastography of the esophagus: from model to preliminaryin-vivoexperiments using diameter measurements.

Numerous diseases alter the esophagus elasticity, such as eosinophilic esophagitis and esophageal motility disorders like achalasia. The possibility to measure these modifications using minimally invasive techniques is a key issue for the diagnosis of such pathologies. The commercially available EndoflipTM(endoluminal functional lumen imaging probe) can be used to measure the luminal cross-sectional diameter of the esophagus at different points and over time, and is used in clinical routine to assess esophageal distensibility. We used this probe to track the propagation of shear waves similar to those that are produced naturally by natural waves, to compute wavelength of the esophagus using passive elastography algorithms. To assess the feasibility of such measurements, we compared the wavelengths obtained with the probe in polyvinyl alcohol (PVA) gel tubes to those obtained for the same tubes with optical tracking of their edges using a camera. We first compared the wavelength obtained with homogeneous gel tubes with both techniques, and then used paired gel tubes of different elasticities to investigate the possibility to measure different wavelengths. Although, the wavelength computed using the probe and the camera showed some small differences, qualitative differentiation of the tubes was achieved when using paired tubes with different elasticities. Using the camera, a wavelength of 61 mm was measured for the hard tube, and 35 mm for the soft tube. Using the probe, wavelengths of 61 mm and 38 mm were measured, respectively. Therefore, we demonstrate here the feasibility of using this probe to track wave propagation and to determine the wavelengths in gel tubes of different stiffnesses. This analysis was also taken to a preliminaryin-vivostudy that allowed tracking of natural waves in the esophagus using the luminal probe, which indicates that this technique can also be usedin vivoto measure the stiffness of the esophagus.

Finding Dental Harm to Patients through Electronic Health Record-Based Triggers.

BACKGROUND: Patients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs). METHODS: We developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs. RESULTS: Of the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room. CONCLUSION: By developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future. KNOWLEDGE TRANSFER STATEMENT: A retrospective review of patients' health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record-based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered.

Cortical Auditory-Evoked Responses in Preterm Neonates: Revisited by Spectral and Temporal Analyses.

Characteristic preterm EEG patterns of "Delta-brushes" (DBs) have been reported in the temporal cortex following auditory stimuli, but their spatio-temporal dynamics remains elusive. Using 32-electrode EEG recordings and co-registration of electrodes' position to 3D-MRI of age-matched neonates, we explored the cortical auditory-evoked responses (AERs) after 'click' stimuli in 30 healthy neonates aged 30-38 post-menstrual weeks (PMW). (1) We visually identified auditory-evoked DBs within AERs in all the babies between 30 and 33 PMW and a decreasing response rate afterwards. (2) The AERs showed an increase in EEG power from delta to gamma frequency bands over the middle and posterior temporal regions with higher values in quiet sleep and on the right. (3) Time-frequency and averaging analyses showed that the delta component of DBs, which negatively peaked around 550 and 750 ms over the middle and posterior temporal regions, respectively, was superimposed with fast (alpha-gamma) oscillations and corresponded to the late part of the cortical auditory-evoked potential (CAEP), a feature missed when using classical CAEP processing. As evoked DBs rate and AERs delta to alpha frequency power decreased until full term, auditory-evoked DBs are thus associated with the prenatal development of auditory processing and may suggest an early emerging hemispheric specialization.

SALL4 and NFATC2: two major actors of interstitial 20q13.2 duplication.

Interstitial duplication within the long arm of chromosome 20 is an uncommon chromosome structural abnormality. We report here the clinical and molecular characterization associated with pure 20q13.2 duplication in three unrelated patients. The most frequent clinical features were developmental delay, facial dysmorphism, cardiac malformation and skeletal anomalies. All DNA gains occurred de novo, ranging from 1.1 Mb to 11.5 Mb. Compared with previously reported conventional cytogenetic analyses, oligonucleotides array CGH allowed us to refine breakpoints and determine the genes of interest in the region. Involvement of SALL4 in cardiac malformations and NFATC2 gene disruption in both cardiac and skeletal anomalies are discussed.

Nlgn4 knockout induces network hypo-excitability in juvenile mouse somatosensory cortex in vitro.

Neuroligins (Nlgns) are postsynaptic cell adhesion molecules that form transynaptic complexes with presynaptic neurexins and regulate synapse maturation and plasticity. We studied the impact of the loss of Nlgn4 on the excitatory and inhibitory circuits in somatosensory cortical slices of juvenile mice by electrically stimulating these circuits using a multi-electrode array and recording the synaptic input to single neurons using the patch-clamp technique. We detected a decreased network response to stimulation in both excitatory and inhibitory circuits of Nlgn4 knock-out animals as compared to wild-type controls, and a decreased excitation-inhibition ratio. These data indicate that Nlgn4 is involved in the regulation of excitatory and inhibitory circuits and contributes to a balanced circuit response to stimulation.

[The early maladaptive schemas: a study in adult patients with anxiety disorders]. / Les schémas précoces dysfonctionnels: étude chez des patients adultes souffrant d'un trouble anxieux.

The theory of early maladaptive schemas was initiated by Young, who postulated that each pathology is supported by one or several schemas. Adults with anxiety disorders more activate schemas that controls. This hyper activate schemas would go back the childhood. In this study, we measure some cognitive schema's activation, with the Schmidt and al. Questionnaire: this schema's questionnaire measures the dysfunctional schemas in actual way. Our purpose was to compare early maladaptive schema's activation of adults with anxiety disorders and adults healthy. The results indicate that each dysfunctional schema is more significatively activate by the adults with anxiety disorders that adults healthy. He doesn't exist schema typical of anxiety, but just a more important activation of all schemas of adults with -anxiety disorders. All subjects (with anxiety disorder and healthy) activate the schemas in the same order. It would appear that schema who imply an action of subject was more activate. So, in our study, we doesn't observe schema typical of anxiety, as opposed to postulate of Young and Klosko. In fact, in comparison with healthy subjects, all early maladaptive schemas of subjects with anxiety disorders were hypervalent. The order of schema's activation was the same in the two groups, but the activation in the anxious is always more important that in the healthy. All early maladaptive schemas would so hyperactivate in the anxious and a important activation of this schemas in the infancy would predispose to adult's anxious pathology. We consider this research as a preliminary work about early maladaptive schemas. In order to specify the research about schemas in the anxious, il will be interesting to observe this schemas according to different anxious disorders and to study prospectively the evolution of child's schemas.

Forensic dental identifications in the greater Houston area.

In order to confirm the identity of the deceased, 1.7% of the deaths (162 cases) evaluated at the Harris County Medical Examiner's Office during the time period of this study required a forensic dental evaluation. Data were collected and analyzed. The manner of death was ranked in order as follows: 30% homicide; 20% accident of various types other than motor vehicle accidents; 18% motor vehicle accidents; 16% remain undetermined; 9% natural causes; and 7% suicide. The cause of death was: 24% asphyxia, smoke inhalation, or thermal burn injuries; 23% blunt-force trauma; 18% miscellaneous causes of death; 15% undetermined; 13% gun shot wounds; and 7% asphyxia. The condition of the remains were: 38% charred or incinerated; 31% decomposing; 18% skeletal remains; 6% "fresh" or recently deceased; 4% fragmented; and 3% severely beaten or mangled with displacement of the maxillomandibular region, complicating the dental identification procedure. The gender was: 62% male; 34% female; and 4% undetermined. The race was: 55% Caucasian; 19% Hispanic; 14% black; 1% Asian; and 11% undetermined. The age was: 2% from 0 to 10 years of age; 9% from 11 to 20; 21% from 21 to 30; 18% from 31 to 40; 13% from 41 to 50; 8% from 51 to 60; 5% from 61 to 70; 4% from 71 to 80; 1% from 81 to 90; and 19% undetermined. Further evaluation of these and future dental identification cases will provide valuable data to help prepare the forensic dentist for the wide variety of cases that must be evaluated in the course of their careers.

Peptide immunization indicates that CD8+ T cells are the dominant effector cells in trinitrophenyl-specific contact hypersensitivity.

The identity of the effector T cell population involved in contact hypersensitivity is still questionable with evidence promoting both CD4+ or CD8+ T cells. Previous experimental studies have relied on the in vivo depletion of T cell subsets using antibody, or the use of knock-out mice with deficiencies in either CD4+ or CD8+ T cell-mediated immunity. To address the role of the class I- and class II-mediated pathways of T cell activation in contact hypersensitivity responses in mice with an intact immune system, we utilized various trinitrophenyl-derivatized peptides, which bind specifically with H-2Kb (major histocompatibility complex class I) or H-2I-Ab (major histocompatibility complex class II). The subcutaneous injection of major histocompatibility complex class II-specific, but not of class I-binding, hapten-derivatized peptides in incomplete Freund's adjuvant induced specific, albeit low, contact hypersensitivity responsiveness to trinitrochlorobenzene. When bone-marrow-derived dendritic cells, however, were pulsed with the same peptides and administered intradermally, the opposite result was observed, namely that the class I binding peptides induced contact hypersensitivity responses similar to that observed after epicutaneous trinitrochlorobenzene application. In contrast, dendritic cells pulsed with major histocompatibility complex class II binding peptides did not reproducibly sensitize for contact hypersensitivity responses. Surprisingly, both immunization protocols efficiently induced CD8+ effector T cells. These results support the notion that CD8+ T cells are the dominant effector population mediating contact hypersensitivity responsiveness and that the CD4+ T cell subset only contributes little if at all.

Burned beyond recognition: systematic approach to the dental identification of charred human remains.

Forensic dental evaluation methods for use in a systematic approach to the dental identification of charred human remains are described. A systematic, conservative approach prevents the loss of valuable dental information before a thorough picture of the individual's dental remains has been adequately documented. The presenting conditions of fire victims are explained and illustrated with photographs, and a series of illustrations and text describe the damage seen in the dentition of the fire victim. A systematic four-stage process for gaining access to the intraoral structures of charred human remains is outlined and illustrated. Utilizing methods of access to the oral structures that maintain the integrity of the dentition through each stage of the evaluation of charred remains will prevent the loss of potential dental information before a thorough dental charting, intra-oral photographs, and radiographs can be obtained.

The dental management of a patient with a cocaine-induced maxillofacial defect: a case report.

There are several dental complications associated with cocaine abuse, including adverse reactions to dental anesthetics, post-operative bleeding, and cellulitis, which can lead to necrosis of orbital, nasal, and palatal bones. Following is a report of the initial treatment rendered to a patient who had destroyed most of her hard palate over a ten-year period of cocaine abuse. There are no classic socio-economic or educational profiles for abusers of cocaine. Drug abuse victims may present as patients in any dental office. Though there are certain classic physiological and psychological symptoms of their condition, they may not display symptoms at all.

Analysis of mouse dendritic cell migration in vivo upon subcutaneous and intravenous injection.

Dendritic cells (DC) have an increasingly important role in vaccination therapy; therefore, this study sought to determine the migratory capacity and immunogenic function of murine bone-marrow (BM)-derived DC following subcutaneous (s.c.) and intravenous (i.v.) injection in vivo. DC were enriched from BM cultures using metrizamide. Following centrifugation, the low-buoyant density cells, referred to throughout as DC, were CD11c(high), Iab(high), B7-1(high) and B7-2(high) and potently activated alloreactive T cells in mixed lymphocyte reactions (MLR). In contrast, the high-density cells expressed low levels of the above markers, comprised mostly of granulocytes based on GR1 expression, and were poor stimulators in MLR. Following s.c. injection of fluorescently labelled cells into syngeneic recipient mice, DC but not granulocytes migrated to the T-dependent areas of draining lymph nodes (LN). DC numbers in LN were quantified by flow-cytometric analysis, on 1, 2, 3, 5 and 7 days following DC transfer. Peak numbers of around 90 DC per draining LN were found at 2 days. There was very little migration of DC to non-draining LN, thymus or spleen at any of the time-points studied. In contrast, following i.v. injection, DC accumulated mainly in the spleen, liver and lungs of recipient mice but were largely absent from peripheral LN and thymus. The ability of DC to induce T-cell-mediated immune responses was examined using trinitrobenzenesulphate (TNBS)-derivatized DC (TNBS-DC) to sensitize for contact hypersensitivity responses (CHS) in naive syngeneic recipients. Following s.c. injection, as few as 105 TNBS-DC, but not TNBS-granulocytes, sensitized for CHS responses. However, the same number of TNBS-DC failed to induce CHS following i.v. injection. In summary, this study provides new and quantitative data on the organ specific migration of murine BM-derived DC following s.c. and i.v. injection. The demonstration that the route of DC administration determines the potency of CHS induction, strongly suggests that the route of immunization should be considered in the design of vaccine protocols using DC.

Self-assessment of the forensic value of dental records.

One of the most important aspects of a person's dental record may well prove to be it's potential value should the forensic dental identification of their remains become necessary. The better the quality of the antemortem dental records, the easier and faster the identification of the remains will be. The forensic dentist must be able to select identifying features by decoding the deceased's antemortem dental records. A study was conducted on two groups of dentists who were asked to self-assess the forensic dental value of the dental records maintained in their own practices. The three most frequently recorded identifying dental features, other than caries and restorations, were the presence of diastemas, displaced or rotated teeth, and dental anomalies. Surveyed dentists imbedded identifying information into the removable prosthetic devices fabricated for their patients an average of only 64% of the time. Only 56% of the two groups combined felt that their dental chartings and written records would be extremely useful in dental identifications. It is concluded that the quality of antemortem dental records available for comparison to postmortem remains varies from inadequate to extremely useful. Practicing dentists can become valuable members of the dental identification process by developing and maintaining standards of record keeping which would be valuable in restoring their patients' identity.

Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes: report of a case and literature review.

Tetrasodium and/or tetrapotassium pyrophosphate (Ppi) is the anticalculus component of most tartar control dentifrices on the market today. While pyrophosphates alone are not responsible for hypersensitivity reactions, several modifications which may lead to adverse oral manifestations may occur when pyrophosphates are added to a dentifrice. First, tetrasodium pyrophosphate in a dentifrice forms a slightly alkaline solution upon oral use which could irritate oral membranes. Second, increased concentrations of flavoring agents, known to be sensitizers, are needed to mask the strong bitter taste of pyrophosphates. Third, increased concentrations of detergents, capable of producing hypersensitivity reactions, are necessary to allow the pyrophosphates to become soluble in the dentifrice. Fourth, a pre-existing condition of reduced salivary flow may augment hypersensitivity to tartar control toothpastes. While pyrophosphates have been approved as additives in dentifrices, these compounds along with the increased concentrations of flavorings and detergents and their higher intraoral alkalinity are strongly implicated as the causative factor in certain hypersensitivity reactions.