Phonetic analysis during treatment with rapid maxillary expander.

OBJECTIVES: To investigate possible changes and/or device-related impairments in phonetic habits produced by rapid maxillary expansion (RME). MATERIALS AND METHODS: Thirty-five patients scheduled for RME were divided into two groups: Group A (banded two-arm Hyrax) and Group B (banded four-arm Hyrax). Speech samples were collected at six time points, before, during and after RME removal. Acoustical analysis was performed using PRAAT and BioVoice analysis tools. Ten volunteers completed a questionnaire on the acceptability of patient's speech. Maxillary dimensions and palatal volume were measured on dental casts before and after expansion using a digital gauge. RESULTS: Voice analysis showed an increase in the peak frequency of fricative consonants (/s/,/ʃ/) after expansion, whereas there was no change of formant frequencies of palatal consonants (/ɲ/,/ʎ/). Vowel /i/ displayed a lowering of the first formant frequency, and an increase in the second and third formant frequencies. After bonding, Group B showed both a greater reduction in the peak frequency of fricatives and a greater increase in the formant frequencies of palatal consonants than Group A. CONCLUSION: Rapid maxillary expansion causes a slight phonetic change in the acoustical parameters of both consonants and vowels. The two-arm Hyrax caused less speech impairment than the four-arm Hyrax during the treatment.

Smartphones Offer New Opportunities in Clinical Voice Research.

Smartphone technology provides new opportunities for recording standardized voice samples of patients and sending the files by e-mail to the voice laboratory. This drastically improves the collection of baseline data, as used in research on efficiency of voice treatments. However, the basic requirement is the suitability of smartphones for recording and digitizing pathologic voices (mainly characterized by period perturbations and noise) without significant distortion. In this experiment, two smartphones (a very inexpensive one and a high-level one) were tested and compared with direct microphone recordings in a soundproof room. The voice stimuli consisted in synthesized deviant voice samples (median of fundamental frequency: 120 and 200 Hz) with three levels of jitter and three levels of added noise. All voice samples were analyzed using PRAAT software. The results show high correlations between jitter, shimmer, and noise-to-harmonics ratio measured on the recordings via both smartphones, the microphone, and measured directly on the sound files from the synthesizer. Smartphones thus appear adequate for reliable recording and digitizing of pathologic voices.

Indentation size effect of cortical bones submitted to different soft tissue removals.

Properties of elasticity, hardness and viscosity are determined for the study of the visco-elastoplastic behavior of bones. The mechanical properties are compared in two upright sections of the bone due to their anisotropy. Besides, influence of hydration treatments leading to structural modifications of collagen and ground substance contents of bones on the mechanical properties is studied on a femoral cortical bovine bone. The treatments applied to the bone are used by forensic anthropologists to remove the soft tissue and modifying the hydration degree coupled to the collagen content. From instrumented indentation experiments, the hardness is characterized by the macrohardness and a hardness length-scale factor stating the hardness-load dependence. The elastic modulus results from the application of the methodology of Oliver and Pharr (1992). The coefficient of viscosity is deduced from a rheological model representing the indenter time-displacement observed under the application of a constant load. As a result, all the mechanical properties are found to be lower in the transverse section in an extent depending on the hydration treatment, i.e. the different values are located between 5% and 25% for the hardness around 0.5GPa, between 25% and 40% for the elastic modulus around 20GPa and between 2% and 35% for the coefficient of viscosity around 60GPa.s. Unexpectedly, the elastic modulus to coefficient of viscosity ratio is found to be independent on the hydration treatment.

Effect of local blood flow in thermal regulation in diabetic patient.

The presence of dysautonomia in diabetic neuropathy is correlated with impairment of vasomotor activity that drives blood microcirculation. Microcirculation, in turn, plays an important role in thermoregulation. In this work, we investigate the changes between two different physiological conditions of diabetic patients, induced by FREMS application, in the control of skin temperature, using a minimally invasive experiment. Skin is warmed up to a fixed temperature (44 °C) for a few minutes, then the heat source is turned off, letting the skin recover its physiological temperature. Both temperature and local blood flow, the latter measured with laser Doppler, are monitored during the experiment. A simple model of the cooling phase is used to evaluate the time constants involved in the process. Results indicate that significant differences exist in the model parameters between the two conditions.

Same-day discharge after catheter ablation for routine arrhythmias: an initial experience.

AIM: Same-day discharge (SDD) in the setting of catheter ablation (CA) is not widely applied. We present our experience concerning SDD in a selected population of patients who underwent CA; the outcome was evaluated in terms of feasibility and safety. METHODS: 401 CA procedures were performed at our institution between January 2008 and December 2009 in 379 patients (65±16 years, 221 men). 336 CA procedures (84%) were considered eligible for SDD, after the exclusion of ventricular arrhythmias, atrial fibrillation, atypical atrial flutter, AV node ablation as well as procedures involving an arterial or transseptal access. Subsequently, a number of clinical and organizational exclusion criteria were applied. RESULTS: 223 patients were actually discharged on the same day of CA (56% of 401 overall CA procedures): 114 atrial flutter (AFL) and 109 supraventricular tachycardia. Many patients were excluded before CA due to a limited availability of the day-hospital facility; this occurred more frequently in the year 2008 than 2009 (45 vs. 2, P=0.0001); in the year 2009 the rate of total CA procedures which underwent SDD was of 68%. Overall, three groin hematomas occurred, all in patients ablated for AFL. Two of them were recognized during the postablation CONCLUSION: SDD can be safely performed in most patients undergoing CA for routine arrhythmias. This may result in a significant impact on daily practice in terms of both organizational improvement and subjective benefit for the patients.

Visceral Kaposi's sarcoma associated with human herpesvirus 8 seroconversion in a heart transplant recipient.

A close association between human herpesvirus-8 (HHV-8) and Kaposi's sarcoma (KS) has been shown in transplant recipients, but donor-to-recipient transmission of HHV-8 is uncommon. Herein we report a case of a heart transplant recipient who had a fatal visceral KS in association with HHV-8 seroconversion at 18 months after transplantation with a donor having positive serology discovered after transplantation.

Late results of double-valve replacement with biologic or mechanical prostheses.

BACKGROUND: We previously showed that the risk of reoperation for structural degeneration of bioprostheses was higher in cases involving patients older than 65 years (p = 0.003) and double-valve replacement (p = 0.02). The purpose of this study was to compare late outcome of mitral-aortic valve replacement using bioprostheses or mechanical valves. METHODS: The bioprosthesis group included all mainland France residents (n = 48) between 55 and 65 years old operated on between 1980 and 1995 for mitral-aortic valve replacement using bioprostheses. The mechanical valve group was obtained by matching each of these patients with a patient operated on using mechanical valves at approximately the same time during the study. RESULTS: In the bioprosthesis group, 10-year survival was 45%+/-8% versus 62%+/-7% in the mechanical valve group (not significant). The linearized reoperation rate was 6.8 per patient-year versus 1.1 per patient-year (p = 0.001), and the linearized reoperative mortality rate was 1.8 per patient-year and 0.7 per patient-year (not significant), respectively. CONCLUSIONS: The reoperative mortality risk after mitral-aortic valve replacement using two bioprostheses does not significantly decrease overall survival after age 65 years.

DDD and single-lead VDD pacing: evaluation of atrial signal dynamic changes.

BACKGROUND: Single-lead VDD pacing systems are an alternative to conventional DDD pacemakers in patients with atrioventricular (AV) block and normal sinus function. HYPOTHESIS: The aim of this study was to assess changes of P-wave amplitude occurring in dynamic conditions in two groups of patients with a single-lead VDD and with a DDD pacing system, respectively. METHODS: Twenty-eight patients with second- or third-degree AV block and normal sinus function were enrolled prospectively into the study. Seventeen patients were implanted with a single-lead VDD pacing system and 11 with a DDD pacemaker. Patients were evaluated at 3 months (all patients) and at 6 months (26 patients) at supine and in dynamic conditions (postural changes, hyperventilation, and during exercise). RESULTS: Mean P-wave values at supine were 1.92 +/- 1.10 mV at 3 months and 1.76 +/- 1.01 mV at 6 months for VDD systems, and 4.63 +/- 2.18 mV at 3 months and 4.58 +/- 2.80 mV at 6 months for DDD pacemakers. In dynamic conditions, P-wave amplitude changes compared with supine condition ranged between -74 and +226% in VDD, and between -53 and +138% in DDD; however P-wave amplitudes showed no significant changes compared with baseline. Moreover, changes in atrial signal amplitudes did not occur randomly, and in both systems P-wave amplitudes remained significantly correlated with supine values. CONCLUSIONS: A wide range of P-wave amplitude variations occurs in different postural conditions or during exercise, both with single-lead VDD and DDD pacing systems. However, with appropriate programming of atrial sensitivity based on supine values, constant atrial tracking can be maintained.

Clinical reliability of single-lead VDD pacing from evaluation of P-wave sensing under dynamic conditions.

In a group of 20 patients implanted with a single-lead VDD pacing system, a wide interindividual variability was found in P-wave amplitude changes occurring under dynamic conditions, even though they were of minor clinical relevance because constant atrial tracking was maintained.

Dynamic aortomyoplasty: clinical experience and thoracoscopic surgery feasibility study.

BACKGROUND: Surgical procedures using the latissimus dorsi (LD) muscle to assist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplasty (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach. MATERIALS AND METHODS: A clinical pilot study on dynamic descending AMP started in June 1995 and included four patients. Two of them could benefit from LD counterpulsation, surviving 6 months and 18 months. Following this clinical experience, we investigated, on an animal model, minimally invasive thoracoscopic surgery for this procedure. Twelve goats underwent endoscopic LD harvest and video-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint. RESULTS: Clinical AMP using open techniques provided extraaortic counterpulsation in NYHA Class IV patients contraindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better patient outcome. Minimally invasive thoracoscopic surgery was feasible and reproducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrated. We concluded that thoracoscopic AMP may provide a minimally invasive approach to cardiac assistance and thus, a new surgical option for patients presenting with chronic heart failure.

Rethinking marital enmeshment: distinguishing intrusiveness from closeness-caregiving among French couples.

Authors recently have suggested that family enrneshment is not synonymous with high levels of closeness or cohesion. A model proposed by Green and Werner clarifies the cohesion-enmeshment domain by distinguishing between closeness-caregiving and intrusiveness as separate relationship processes. This paper examines the cross-cultural applicability of this perspective through a study of 61 married couples in France. The French version of the California Inventory for Family Assessment (CIFA), a self-report measure designed to assess clinically relevant marital dimensions, was employed. In general, spouses' reports of their marital process demonstrated high internal consistency reliabilities. Factor analysis showed meaningful factor structures distinguishing closeness-caregiving and intrusiveness, as predicted, as well as openness of communication. Significant correlations were obtained between CIFA scales and scores on the Marital Adjustment Test. These results are similar for French and American couples. Research implications for studying relationships among French-speaking couples are underlined.

Value of Doppler echocardiography in the detection of low-grade rejections after cardiac transplantation.

Modifications of the diastolic parameters pressure half-time (PHT) and isovolumic relaxation time (IVRT), recorded using cardiac Doppler echocardiography (CDE), were studied in 23 heart transplant recipients and compared to the results of 345 endomyocardial biopsies (EMB) performed on the same day. Two different protocols, analyzing respectively (1) a decrease of 20% or more in IVRT and/or PHT with respect to the mean and (2) a decrease of 20% or more in IVRT and/ or PHT with respect to its preceding value, were used to evaluate the efficiency of CDE in diagnosing mild and moderate rejections. When a mild rejection was detected by EMB, a statistically significant decrease was found in the average CDE parameter values of the patient population. However, these variations were weak and did not differ from the spontaneous variations observed in each patient in the absence of rejection. Thus, it is not surprising that the sensitivity of CDE in the detection of mild rejections was very low (45%) using the most sensitive protocol (variations of the parameters from their preceding value). We conclude that CDE alone does not seem to be sufficient to perform the noninvasive diagnosis of low-grade rejections and must be complemented by other noninvasive methods.

Clinical situations and results of cardiopulmonary support by peripheral access for resuscitation and recovery.

Use of cardiopulmonary support (CPS) by peripheral access with a membrane oxygenator has made considerable progress as a result of the development of centrifugal pumps, percutaneous cannulation, and preheparinized circuits. We have used CPS for resuscitation in 3 cases, for recovery after cardiotomy in 6 cases (myocardial insufficiency, 4; pulmonary arterial hypertension, 1; respiratory insufficiency, 1), and after heart transplantation in 1 case. Of these 10 patients, 3 died during CPS, 5 were successfully weaned, and 2 underwent heart transplantation. Use of CPS is expanding for emergency cardiac assistance. Installation is simple and rapid. It allows recovery of organs pending more invasive and costly techniques.

[Plasma glycosylated residues demonstrated by proton NMR spectroscopy. Value in the detection of heart graft rejection]. / Résidus glycosylés plasmatiques mis en évidence par spectroscopie de RMN du proton. Intérêt dans la détection du rejet de greffe cardiaque.

In conjunction with biopsy and Doppler studies, we analysed by high resolution proton NMR spectroscopy the blood plasma of 22 heart transplant recipients. There was a significant variation in the glycosylated residues of proteins with the development of acute cardiac rejection. A more extensive study is underway to assess the sensitivity and specificity of this approach for the early diagnosis of acute cardiac rejection.