Differential diagnosis of jaw pain using informatics technology

This study aimed to deduce evidence‐based clinical clues that differentiate temporomandibular disorders (TMD)‐mimicking conditions from genuine TMD by text mining using natural language processing (NLP) and recursive partitioning. We compared the medical records of 29 patients diagnosed with TMD‐mimicking conditions and 290 patients diagnosed with genuine TMD. Chief complaints and medical histories were preprocessed via NLP to compare the frequency of word usage. In addition, recursive partitioning was used to deduce the optimal size of mouth opening, which could differentiate TMD‐mimicking from genuine TMD groups. The prevalence of TMD‐mimicking conditions was more evenly distributed across all age groups and showed a nearly equal gender ratio, which was significantly different from genuine TMD. TMD‐mimicking conditions were caused by inflammation, infection, hereditary disease and neoplasm. Patients with TMD‐mimicking conditions frequently used “mouth opening limitation” (P < .001), but less commonly used words such as “noise” (P < .001) and “temporomandibular joint” (P < .001) than patients with genuine TMD. A diagnostic classification tree on the basis of recursive partitioning suggested that 12.0 mm of comfortable mouth opening and 26.5 mm of maximum mouth opening were deduced as the most optimal mouth‐opening cutoff sizes. When the combined analyses were performed based on both the text mining and clinical examination data, the predictive performance of the model was 96.6% with 69.0% sensitivity and 99.3% specificity in predicting TMD‐mimicking conditions. In conclusion, this study showed that AI technology‐based methods could be applied in the field of differential diagnosis of orofacial pain disorders.     

Comparison between burning mouth syndrome patients with and without psychological problems

The purpose of this study was to compare clinical and socio-demographic characteristics between burning mouth syndrome (BMS) patients with and without psychological problems. Of 644 patients with symptoms of oral burning, 224 with primary BMS were selected on the basis of laboratory testing, medical history, and psychometric tests: 39 with psychological problems (age 62.5 ± 11.5 years) and 185 without psychological problems (age 58.4 ± 11.4 years). Comprehensive clinical and socio-demographic characteristics, including psychological profiles and salivary flow rates, were compared between the two groups. No significant difference in sex ratio, duration and diurnal pattern of symptoms, unstimulated whole saliva flow rate, or marital status was found between the groups. The patients with psychological problems had a significantly higher mean age, reduced stimulated whole saliva flow rate, and lower level of education than those without psychological problems. The patients with psychological problems also displayed higher rates and greater severity of various types of BMS-related symptom in most parts of the oral mucosa, higher rates of stress-related symptoms, and greater difficulties in daily activities. The severity of taste disturbance was the factor most significantly correlated with the level of psychometry. In conclusion, psychological problems in BMS patients are associated with an aggravation of BMS symptoms.     

A monokine regulates colony-stimulating activity production by vascular endothelial cells

Human umbilical vein endothelial cells were cultured in supernatants of peripheral blood monocytes that had been cultured for 3 days with and without lactoferrin. Colony-stimulating activity (CSA) was measured in supernatants of the endothelial cell cultures and appropriate control cultures using normal, T-lymphocyte-depleted, phagocyte-depleted, low- density bone marrow cells in colony growth (CFU-GM) assays. Monocyte- conditioned medium contained a nondialyzable, heat labile factor that enhanced 4-15--fold the production of CSA by endothelial cells. The addition of lactoferrin to monocyte cultures reduced the activity of this monokine by 69%. Lactoferrin did not inhibit CSA production by monokine-stimulated endothelial cells. Therefore, vascular endothelial cells are potent sources of CSA, the production of CSA by these cells is regulated by a stimulatory monokine, and the production and/or release of the monokine is inhibited by lactoferrin, a neutrophil- derived putative feedback inhibitor of granulopoiesis. Inasmuch as a similar monokine is known to stimulate CSA production by fibroblasts and T lymphocytes, we suggest that mononuclear phagocytes play a pivotal role in the regulation of granulopoiesis by recruiting a variety of cell types to produce CSA.     

再发骨质疏松性椎体压缩骨折保守治疗患者出院后生存质量

目的：对比初次和再发骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者保 守治疗的生存质量,了解再次骨折对此类患者生存质量各方面的影响。方法：回顾性观察治疗OVCFs后出现再骨折 的患者30名(再骨折组)和同时期行保守治疗OVCFs后未发生再骨折的基本条件相似的患者30例(对照组),比较两组出 院后3个月时SF-36简明健康健康状况调查表的调查结果。结果：再骨折组治疗后的8个维度均不同程度较对照组变差 (均P<0.01)。结论：再骨折组患者的生存质量明显低于对照组,并且会进一步影响患者的心理预期、情绪和社会活动 的各个方面。     

Coeliac disease in children in Christchurch,New Zealand:Presentation and patterns from 2000-2010

AIM: To evaluate the presentation patterns of a cohort of children diagnosed with coeliac disease(CD) at Christchurch Hospital, New Zealand.METHODS: Children aged 16 years or less diagnosed with CD at Christchurch Hospital, Christchurch, New Zealand, over the 11 year period between 2000 and 2010 were identified retrospectively. Diagnosis of CD was based upon standard histological criteria of endoscopically-obtained duodenal biopsies. Overlapping search methods were used to identify all relevant diagnoses within the time period. Endoscopy reports and histology findings were reviewed to confirm diagnosis. The numbers of diagnoses per year were calculated and changes in annual rates over the study period were delineated. Available records were reviewed to ascertain presenting symptoms, baseline anthropometry and the indication for referral for each child. In addition, the results of relevant investigations prior to diagnosis were accessed and reviewed. These key investigations included the results of coeliac serology testing(including tissue transglutaminase and endomysial antibodies) as well as the results of tests measuring levels of micronutrients, such as iron. In addition, the histological findings of concurrent biopsies in the oesophagus and stomach were reviewed. RESULTS: Over the 11 year study period, 263 children were diagnosed with CD at this New Zealand paediatric facility. Children were diagnosed from late infancy to 16.9 years: the largest subgroup of children(n = 111) were diagnosed between 5 and 12 years of age. The numbers of children diagnosed each year increased from 13 per year to 31 per year over the 11 years(P = 0.0095).Preschool children(aged less than 5 years) were more likely to have low weight, and to have diarrhoea and abdominal pain prior to diagnosis. Older children(over 5 years of age) most commonly presented with abdominal pain. Fifty-six(21.6%) of the 263 children were diagnosed following screening in high risk groups, with 38 of these children having no symptoms at diagnosis. Mean weight Z scores were lower in children aged less than five years than children aged 5-12 years or older children(-0.4096 ± 1.24, vs 0.1196 ± 0.966 vs 0.0901 ± 1.14 respectively: P = 0.0033). CONCLUSION: Increasing numbers of children were diagnosed with CD in this New Zealand centre over this time, with varied presentations and symptoms.