Incidence of white spot lesions among patients treated with clear aligners and traditional braces

Objectives:To compare the incidence of white spot lesions (WSLs) among patients treated with aligners and those treated with traditional braces.Materials and Methods:A group of 244 aligner patients (30.4 ± 14 years) was compared to a group of 206 patients (29.2 ± 11.5 years) treated with traditional fixed braces. Consecutive cases in the late mixed or permanent dentitions who had high-quality pre- and posttreatment digital photographs available were included in the study. Each set of photographs was independently evaluated by two investigators to determine pretreatment oral hygiene (OH), fluorosis, and WSLs, as well as changes in OH and WSLs during treatment.Results:Approximately 1.2% of the aligner patients developed WSLs, compared to 26% of the traditionally treated patients. The numbers of WSLs that developed were also significantly (P < .001) less among the aligner patients. The aligner patients developed three new WSLs, while the traditionally treated patients developed 174 WSLs. The incidence of WSLs was greater for the maxillary than for the mandibular teeth, and it was greater for the canines than for the incisors. For the patients treated with traditional braces, fair or poor pretreatment OH, worsening of OH during treatment, preexisting WSLs, and longer treatment duration significantly (P < .05) increased the risk of developing WSLs during treatment.Conclusions:Patients treated with aligners have less risk of developing WSLs than do patients treated with traditional braces, which could be partially due to shorter treatment duration, or better pretreatment OH.     

Unique neuromyelitis optica pathology produced in naïve rats by intracerebral administration of NMO-IgG

Animal models of neuromyelitis optica (NMO) are needed for elucidation of disease mechanisms and for testing new therapeutics. Prior animal models of NMO involved administration of human anti-aquaporin-4 immunoglobulin G antibody (NMO-IgG) to rats with pre-existing neuroinflammation, or to naïve mice supplemented with human complement. We report here the development of NMO pathology following passive transfer of NMO-IgG to naïve rats. A single intracerebral infusion of NMO-IgG to adult Lewis rats produced robust lesions around the needle track in 100 % of rats; at 5 days there was marked loss of aquaporin-4 (AQP4), glial fibrillary acidic protein (GFAP) and myelin, granulocyte and macrophage infiltration, vasculocentric complement deposition, blood–brain barrier disruption, microglial activation and neuron death. Remarkably, a distinct ‘penumbra’ was seen around lesions, with loss of AQP4 but not of GFAP or myelin. No lesions or penumbra were seen in rats receiving control IgG. The size of the main lesion with loss of myelin was greatly reduced in rats made complement-deficient by cobra venom factor or administered NMO-IgG lacking complement-dependent cytotoxicity (CDC) effector function. However, the penumbra was seen under these conditions, suggesting a complement-independent pathogenesis mechanism. The penumbra was absent with NMO-IgG lacking both CDC and antibody-dependent cellular cytotoxicity (ADCC) effector functions. Finally, lesion size was significantly reduced after macrophage depletion with clodronate liposomes. These results: (i) establish a robust, passive-transfer model of NMO in rats that does not require pre-existing neuroinflammation or complement administration; (ii) implicate ADCC as responsible for a unique type of pathology also seen in human NMO; and (iii) support a pathogenic role of macrophages in NMO.     

Axe I,Axe II ou Troubles mentaux et Troubles de la personnalité

Objectives

Since the publication of the third edition of the American classification the Diagnostic and Statistical Manual of mental disorders (DSM-III), psychiatric clinical syndromes and personality disorders appear in two distinct axes, axis I and II. In the fifth revision of the manual (DSM-5), published in May 2013, this distinction no longer exists and personality disorders now appear among other mental disorders. The aim of this paper is to try to pinpoint the clinical and epistemological stakes therein.

Method

The particular interest of this distinction was to attract the attention of the practitioners on the personality of the patients, independently of their psychiatric diagnoses. However today, its scientific justification appears insufficient. Numerous arguments are in favour of a continuity between the two axes and the nosographical reorganisation of anxiety, depression and personality disorders. This clarification summarises the principle tendencies that have emerged over the past ten years regarding the classification of personality disorders, with increasing dissatisfaction with the traditional categorical model and a growing interest in a dimensional perspective. These tendencies are illustrated by the recommendations drawn up by the DSM-5 task force on personality and personality disorders.

Results

The criticisms of the scientific world regarding theses recommendations have been strong. This article summarises the main arguments developed here and there, and the evolution of the task force's reflections up to the final decisions that were published in December 2012. No real consensus exists on the best dimensional model to be retained; even if the system most studied is, without doubt, the five-factor model, known as the ‘Big Five’.

Discussion

This system was studied above all in psychology, and its applicability to psychopathology, which could obviously be envisaged, requires adjustments and further validation studies before being finally adopted.

Conclusion

The return to a single axis perspective for personality disorders also justifies in depth reflection on the limits of normality and on the general definition of a mental disorder that has never been the subject of a true consensus in our profession.     

Time-dependent hardening of blood clots quantitatively measured in vivo with shear-wave ultrasound imaging in a rabbit model of venous thrombosis

Objective

Provide in vivo blood clot hardening evolution with ultrasound using supersonic imaging of shear waves.

Methods

We conducted a prospective study in flow stasis-induced venous thrombosis within jugular veins of white female New Zealand rabbits. Blood clot elasticity was noninvasively measured in vivo using the Young's modulus (in kilopascals), on a 2-hour and a 2-week periods after thrombus induction. Monitoring was followed by a necropsy and ex vivo mechanical characterization to validate the existence and elasticity of explanted thrombi.

Results

Stagnant blood in the region of interest underwent clotting and progressive hardening with thrombus aging. The mean Young's moduli varied from 1.0 ± 0.6 kPa (at 10 min) to 5.3 ± 1.6 kPa (at 2 hours), then to 25.0 ± 6.8 kPa (at 14 days) post-surgery. Mean ex vivo moduli of 6.2 ± 0.7 kPa at 2 hours and 29.0 ± 2.4 kPa at 2 weeks agreed with in vivo measures.

Conclusions

Supersonic imaging of shear waves provides consistent quantitative non-invasive elasticity measurements not available with standard compression ultrasound imaging for diagnosing and following venous thromboembolism. This information translatable to humans could aid in determining whether continued anticoagulant treatment is necessary, especially in the setting of unprovoked venous thromboembolism.     

Identification of neuronal substrates implicates Pak5 in synaptic vesicle trafficking

Synaptic transmission is mediated by a complex set of molecular events that must be coordinated in time and space. While many proteins that function at the synapse have been identified, the signaling pathways regulating these molecules are poorly understood. Pak5 (p21-activated kinase 5) is a brain-specific isoform of the group II Pak kinases whose substrates and roles within the central nervous system are largely unknown. To gain insight into the physiological roles of Pak5, we engineered a Pak5 mutant to selectively radiolabel its substrates in murine brain extract. Using this approach, we identified two novel Pak5 substrates, Pacsin1 and Synaptojanin1, proteins that directly interact with one another to regulate synaptic vesicle endocytosis and recycling. Pacsin1 and Synaptojanin1 were phosphorylated by Pak5 and the other group II Paks in vitro, and Pak5 phosphorylation promoted Pacsin1-Synaptojanin1 binding both in vitro and in vivo. These results implicate Pak5 in Pacsin1- and Synaptojanin1-mediated synaptic vesicle trafficking and may partially account for the cognitive and behavioral deficits observed in group II Pak-deficient mice.     

Radiocarbon dates from the Grotte du Renne and Saint-C��saire support a Neandertal origin for the Chatelperronian

The transition from the Middle Paleolithic (MP) to Upper Paleolithic (UP) is marked by the replacement of late Neandertals by modern humans in Europe between 50,000 and 40,000 y ago. Châtelperronian (CP) artifact assemblages found in central France and northern Spain date to this time period. So far, it is the only such assemblage type that has yielded Neandertal remains directly associated with UP style artifacts. CP assemblages also include body ornaments, otherwise virtually unknown in the Neandertal world. However, it has been argued that instead of the CP being manufactured by Neandertals, site formation processes and layer admixture resulted in the chance association of Neanderthal remains, CP assemblages, and body ornaments. Here, we report a series of accelerator mass spectrometry radiocarbon dates on ultrafiltered bone collagen extracted from 40 well-preserved bone fragments from the late Mousterian, CP, and Protoaurignacian layers at the Grotte du Renne site (at Arcy-sur-Cure, France). Our radiocarbon results are inconsistent with the admixture hypothesis. Further, we report a direct date on the Neandertal CP skeleton from Saint-Césaire (France). This date corroborates the assignment of CP assemblages to the latest Neandertals of western Europe. Importantly, our results establish that the production of body ornaments in the CP postdates the arrival of modern humans in neighboring regions of Europe. This new behavior could therefore have been the result of cultural diffusion from modern to Neandertal groups.     

IL28B alleles associated with poor hepatitis C virus (HCV) clearance protect against inflammation and fibrosis in patients infected with non-1 HCV genotypes

Genetic polymorphisms near IL28B are associated with spontaneous and treatment-induced clearance of hepatitis C virus (HCV), two processes that require the appropriate activation of the host immune responses. Intrahepatic inflammation is believed to mirror such activation, but its relationship with IL28B polymorphisms has yet to be fully appreciated. We analyzed the association of IL28B polymorphisms with histological and follow-up features in 2335 chronically HCV-infected Caucasian patients. Assessable phenotypes before any antiviral treatment included necroinflammatory activity (n = 1,098), fibrosis (n = 1,527), fibrosis progression rate (n = 1,312), and hepatocellular carcinoma development (n = 1,915). Associations of alleles with the phenotypes were evaluated by univariate analysis and multivariate logistic regression, accounting for all relevant covariates. The rare G allele at IL28B marker rs8099917-previously shown to be at risk of treatment failure-was associated with lower activity (P = 0.04), lower fibrosis (P = 0.02) with a trend toward lower fibrosis progression rate (P = 0.06). When stratified according to HCV genotype, most significant associations were observed in patients infected with non-1 genotypes (P = 0.003 for activity, P = 0.001 for fibrosis, and P = 0.02 for fibrosis progression rate), where the odds ratio of having necroinflammation or rapid fibrosis progression for patients with IL28B genotypes TG or GG versus TT were 0.48 (95% confidence intervals 0.30-0.78) and 0.56 (0.35-0.92), respectively. IL28B polymorphisms were not predictive of the development of hepatocellular carcinoma. CONCLUSION: In chronic hepatitis C, IL28B variants associated with poor response to interferon therapy may predict slower fibrosis progression, especially in patients infected with non-1 HCV genotypes.