Complications hépatobiliaires associées à l’insuffisance intestinale chez l’adulte et l’enfant

The treatment of chronic intestinal failure, of which the main cause is the short bowel syndrome, is based on parenteral nutrition. Intestinal failure-associated liver disease, which may worsen toward cirrhosis, is the most threatening intestinal failure-associated complication. Risk factors for intestinal failure-associated liver disease are related to parenteral nutrition modalities and to the underlying disease. Bowel rest and short bowel syndrome are risk factors for biliary lithiasis. Steatosis is mainly secondary to nutritional factors (excess of glucose and/or lipids, continuous parenteral nutrition). The main risk factors of cholestasis are intestinal resection, intestinal bacterial overgrowth, excess of long-chain polyunsaturated ω6 fatty acids and phytosterols from some lipid emulsions. Liver chronic inflammation, another risk factor for intestinal failure-associated liver disease, is related to recurrent infections, bacterial or toxinic translocation, high intake of long-chain polyunsaturated ω6 fatty acids as precursors of inflammatory mediators. Fibrosis, secondary to any lesions, could progress toward cirrhosis with portal hypertension and liver failure. In such condition, the only life-saving treatment is a combined liver-intestinal transplantation. The prevention is based on the identification of patients with high risk of complicated liver disease, and on the optimal management of both underlying disease and parenteral nutrition. Routine surveillance is based on biological markers of variable sensitivity and specificity, and ultrasonography. Liver biopsy is required to diagnose fibrosis, especially prior to decide for an isolated intestinal transplantation or combined intestine-liver transplantation.     

Evaluation of the validity of the Bolton Index using cone-beam computed tomography (CBCT)

Aims: To evaluate the reliability and reproducibility of calculating the Bolton Index using cone-beam computed tomography (CBCT), and to compare this with measurements obtained using the 2D Digital Method. Material and Methods: Traditional study models were obtained from 50 patients, which were then digitized in order to be able to measure them using the Digital Method. Likewise, CBCTs of those same patients were undertaken using the Dental Picasso Master 3D® and the images obtained were then analysed using the InVivoDental programme. Results: By determining the regression lines for both measurement methods, as well as the difference between both of their values, the two methods are shown to be comparable, despite the fact that the measurements analysed presented statistically significant differences. Conclusions: The three-dimensional models obtained from the CBCT are as accurate and reproducible as the digital models obtained from the plaster study casts for calculating the Bolton Index. The differences existing between both methods were clinically acceptable. Key words:Tooth-size, digital models, bolton index, CBCT.     

Traumatic bone cyst of the mandible: a review of 26 cases

The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws.ObjectiveTo describe the clinical, surgical and radiographic findings of traumatic bone cysts.Material and MethodA retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered.ResultsTwenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions.ConclusionA higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.     

Bursts and oscillations as independent properties of neural activity in the parkinsonian globus pallidus internus

Bursts and oscillatory modulations in firing rate are hallmark features of abnormal neuronal activity in the parkinsonian Globus Pallidus internus (GPi). Although often implicated together in the pathophysiology of parkinsonian signs, little is known about how burst discharges and oscillatory firing (OF) relate to each other. To investigate this question, extracellular single-unit neuronal activity was recorded from 132 GPi cells in 14 Parkinson's disease patients. We found that burst firing was equally prevalent in OF and non-oscillatory firing (NOF) cells (p > 0.5). More than half of the cells were characterized by either aperiodic bursty activity or OF, but not both. OF and NOF cells had statistically-indistinguishable levels of mean burstiness (p = 0.8). Even when bursting and OF co-existed in individual cells, levels of burstiness and oscillatory power were seldom correlated across time. Interestingly, however, the few OF cells with spectral peaks between 8–13 Hz (α-range) were substantially burstier than other cells (p < 0.01) and showed an unique burst morphology and stronger temporal correlations between oscillatory power and burstiness. We conclude that independent mechanisms may underlie the burst discharges and OF typical of most neurons in the parkinsonian GPi.     

Risk Factors for Varicella Susceptibility Among Refugees to Toronto,Canada

Several outbreaks of varicella have occurred among refugees. We aimed to estimate the prevalence of varicella susceptibility among refugees, and identify risk factors for varicella susceptibility. All refugees rostered at Crossroads Clinic in Toronto, Canada in 2011–2014 were included in our study. Varicella serology was assessed at the initial visit. Refugees’ age, sex, education, time since arrival, and climate and population density of birth country were abstracted from the chart. Multivariate logistic regression was used to identify risk factors for varicella susceptibility. 1063 refugees were rostered at Crossroads Clinic during the study; 7.9 % (95 % CI 6.1, 9.7) were susceptible to varicella. Tropical climate (OR 3.20, 95 % CI 1.53, 6.69) and younger age (OR_{per year of age} 0.92, 95 % CI 0.88–0.96) were associated with increased varicella susceptibility. These risk factors for varicella susceptibility should be taken into account to maximize the cost-effectiveness of varicella prevention strategies among refugees.     

Analysis of junior doctor supervision in Australasian emergency departments

Background: Supervision of junior doctors in ED is vital but limited literature exists on how it is provided. Objective: To assess Australasian ED supervision and review regional legislature supervision requirements. Methods: Between December 2008 and June 2009 emails containing a link to a cross‐sectional survey were sent to Directors of Emergency Medicine Training in all Australasian ED accredited for advanced training. Non‐responding ED were subsequently contacted by telephone or email. Regional legislature supervision requirements were obtained from postgraduate medical councils. Results: A total of 103 (98.1%) of 105 ED participated. Senior review in person was mandatory in 43.2% of ED for patients of PGY1 (postgraduate year 1 doctors) and 6.1% of ED for patients of PGY2 (P < 0.001). Of ED without mandatory review, 13% had written guidelines detailing which patients required review. When ED consultants were on‐site, they most commonly provided supervision in 60.2% of ED and shared supervision equally with registrars in 35.7% of ED; when consultants were off‐site registrars most commonly provided supervision in 87.6% of ED. Fewer major regional/rural base hospitals had 24 h PGY3 or above supervision than major referral and urban district hospitals (82.6% vs 100% and 100%, P < 0.01). Regional legislature requirements varied with no universal guidelines. Conclusion: There are significant differences between supervision requirements for PGY1 and PGY2. A minority of ED in Australasia do not have 24 h supervision by PGY3 or higher. Few ED have written guidelines for supervising PGY1 and PGY2. The majority of registrar supervision occurs without consultant oversight. Legislature requirements for supervision in ED are variable between regions.     

Investigating the predictive value of whole-brain structural MR scans in autism: A pattern classification approach

Autistic spectrum disorder (ASD) is accompanied by subtle and spatially distributed differences in brain anatomy that are difficult to detect using conventional mass-univariate methods (e.g., VBM). These require correction for multiple comparisons and hence need relatively large samples to attain sufficient statistical power. Reports of neuroanatomical differences from relatively small studies are thus highly variable. Also, VBM does not provide predictive value, limiting its diagnostic value.Here, we examined neuroanatomical networks implicated in ASD using a whole-brain classification approach employing a support vector machine (SVM) and investigated the predictive value of structural MRI scans in adults with ASD. Subsequently, results were compared between SVM and VBM. We included 44 male adults; 22 diagnosed with ASD using “gold-standard” research interviews and 22 healthy matched controls.SVM identified spatially distributed networks discriminating between ASD and controls. These included the limbic, frontal-striatal, fronto-temporal, fronto-parietal and cerebellar systems. SVM applied to gray matter scans correctly classified ASD individuals at a specificity of 86.0% and a sensitivity of 88.0%. Cases (68.0%) were correctly classified using white matter anatomy. The distance from the separating hyperplane (i.e., the test margin) was significantly related to current symptom severity. In contrast, VBM revealed few significant between-group differences at conventional levels of statistical stringency.We therefore suggest that SVM can detect subtle and spatially distributed differences in brain networks between adults with ASD and controls. Also, these differences provide significant predictive power for group membership, which is related to symptom severity.