Comparing the use of static versus dynamic images to evaluate a smile.

STATEMENT OF PROBLEM: Smile analysis, as part of the overall facial analysis, is an important component of diagnosis and treatment planning in the esthetic rehabilitation of a patient. Most studies that refer to smile analysis are based on static images. A more comprehensive evaluation can be made with dynamic video images that can be stopped at the most appropriate frame to ensure the best static images for analysis. PURPOSE: The purpose of this clinical study was to evaluate the posed and dynamic smiles of both sexes, considering the type of smile, prevalence of gingival display, dental display at rest, dentogingival display at posed and spontaneous smile, and lip mobility, through digital image acquisition (photographs and video clips) manipulated by using a software program. MATERIAL AND METHODS: Three photographs and 1 video clip were made for each of the 380 voluntary participants aged between 18 and 32 years by using an iPhone 6 iSight 8 MP camera, Moment lens, and artificial 5500 Kelvin light (IceLight). Digital files were evaluated by using a software program (Keynote), determining each point to be evaluated with posed and spontaneous smiles. RESULTS: With static images, 90% of women and 74% of men had gingival display, with only 35% of women and 21% of men having continuous gingival display. With dynamic analysis, these values increased to 100% of women and 95% of men having gingival display and 62% of men and 81% of women having a continuous gingival display (P<.05). The difference between dentogingival display during posed and spontaneous smiles was clear, with 68% of the participants having 2.25 mm more gingival display. Women tend to show slightly more dental display at rest, posed and spontaneous dentogingival display, as well as lip mobility, than men. CONCLUSIONS: The type of smile changes significantly when posed and spontaneous smiles are compared. Women generally show more gingiva and teeth in all the parameters evaluated than men. Dental treatments should be individually planned according to each patient's smile characteristics.

Prevalence of tooth forms and their gender correlation.

OBJECTIVE: This study evaluated different tooth shapes from female and male genders, matching them with the firstly proposed pure basic forms, and proposed different hybrid shapes; it also evaluated the percentage of correct gender identification of lay people, dentists and dental students. MATERIALS AND METHODS: Standardized digital photos were taken from 460 people and analyzed by 3 experts regarding genders and tooth forms: pure basic forms-oval (O), triangular (T), square (S) and rectangular (R); and combined hybrid forms-oval-rectangular (OR), triangular-rectangular (TR), triangular-oval (TO), square-oval with flat lateral incisors (SOF), and square-oval with scalloped lateral incisors (SOS). Then, correct gender identification (%) was evaluated among lay people, dentists and dental students (n = 10). RESULTS: Pure forms showed less prevalence in the population studied (O:6.52%; S:3.48%; T:3.26%; R:2.39%) than hybrid ones (TO:20.87%; SOS:20.65%; OR:19.57%; SOF:16.96%;TR: 6.30%). Tooth gender selection among different evaluators was not significantly different (≈50% correct answers). CONCLUSIONS: No correspondence exists between tooth shapes and patient genders. Pre-standardized pure tooth forms appeared less than hybrid ones, while the most frequently found in the population studied were TO, SOS, and OR forms, disregarding genders. CLINICAL SIGNIFICANCE: Esthetic perception is an increasingly important criterion critical to satisfy patients. The correlation of reported tooth shapes with specific genders was not reliably observed in natural smiles. Tooth shapes should be selected according to the wishes of the patient rather than by previously believed gender specific tooth shapes. Pure basic tooth forms should be complemented with the addition of combination forms to more accurately portray forms found in nature.

Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Next generation sequencing reveals the association of DRB3*02:02 with type 1 diabetes.

The primary associations of the HLA class II genes, HLA-DRB1 and HLA-DQB1, and the class I genes, HLA-A and HLA-B, with type 1 diabetes (T1D) are well established. However, the role of polymorphism at the HLA-DRB3, HLA-DRB4, and HLA-DRB5 loci remains unclear. In two separate studies, one of 500 subjects and 500 control subjects and one of 366 DRB1*03:01-positive samples from selected multiplex T1D families, we used Roche 454 sequencing with Conexio Genomics ASSIGN ATF 454 HLA genotyping software analysis to analyze sequence variation at these three HLA-DRB loci. Association analyses were performed on the two HLA-DRB loci haplotypes (DRB1-DRB3, -DRB4, or -DRB5). Three common HLA-DRB3 alleles (*01:01, *02:02, *03:01) were observed. DRB1*03:01 haplotypes carrying DRB3*02:02 conferred a higher T1D risk than did DRB1*03:01 haplotypes carrying DRB3*01:01 in DRB1*03:01/*03:01 homozygotes with two DRB3*01:01 alleles (odds ratio [OR] 3.4 [95% CI 1.46-8.09]), compared with those carrying one or two DRB3*02:02 alleles (OR 25.5 [3.43-189.2]) (P = 0.033). For DRB1*03:01/*04:01 heterozygotes, however, the HLA-DRB3 allele did not significantly modify the T1D risk of the DRB1*03:01 haplotype (OR 7.7 for *02:02; 6.8 for *01:01). These observations were confirmed by sequence analysis of HLA-DRB3 exon 2 in a targeted replication study of 281 informative T1D family members and 86 affected family-based association control (AFBAC) haplotypes. The frequency of DRB3*02:02 was 42.9% in the DRB1*03:01/*03:01 patients and 27.6% in the DRB1*03:01/*04 (P = 0.005) compared with 22.6% in AFBAC DRB1*03:01 chromosomes (P = 0.001). Analysis of T1D-associated alleles at other HLA loci (HLA-A, HLA-B, and HLA-DPB1) on DRB1*03:01 haplotypes suggests that DRB3*02:02 on the DRB1*03:01 haplotype can contribute to T1D risk.

Autoclaved bone autograph reconstituted with autologous bone marrow.

BACKGROUND: Bone reconstruction is a common problem in the oncological setting. Mandibular reconstruction is done with microvascularized free flaps, but noticeable differences in shape and size exist in relation to the normal mandible; consequently, new reconstructive methods are desirable. We explored the feasibility of recovering osseous viability using a sterilized mandibular segment reconstituted with autologous bone marrow. METHODS: A 6- to 7-cm mandibular segment was excised in three Creole dogs. The segment was autoclaved for 40 min. The bone was then drilled, producing 3-mm holes every 10-mm. Bone was reconstituted with autologous bone marrow from the iliac spine mixed with particulated bone. Bone autograph was installed underneath the latissimus dorsi muscle. RESULTS: On week four after surgery, dogs received colloidal rhenium and were placed in a gamma camera. The study showed uptake of the radiotracer in the bone graft, demonstrating viability of bone marrow. One hour later, the autograph was excised in two dogs and a histopathological study corroborated the viability of the bone marrow and the formation of new vessels and osteoid. On week twelve, the third dog was administered MDP-99Tc and placed in a gamma camera. Results proved production of new bone. CONCLUSIONS: Osseous reconstruction with microvascularized flaps may cause problems, but sterilized bone reconstituted with bone marrow becomes viable. This observation eventually would allow osseous reconstruction, including the mandibule, easily and reliably in patients with osseous tumors. Autoclaved bone reconstituted with bone marrow recovers its viability.

HLA class I and genetic susceptibility to type 1 diabetes: results from the Type 1 Diabetes Genetics Consortium.

OBJECTIVE: We report here genotyping data and type 1 diabetes association analyses for HLA class I loci (A, B, and C) on 1,753 multiplex pedigrees from the Type 1 Diabetes Genetics Consortium (T1DGC), a large international collaborative study. RESEARCH DESIGN AND METHODS: Complete eight-locus HLA genotyping data were generated. Expected patient class I (HLA-A, -B, and -C) allele frequencies were calculated, based on linkage disequilibrium (LD) patterns with observed HLA class II DRB1-DQA1-DQB1 haplotype frequencies. Expected frequencies were compared to observed allele frequencies in patients. RESULTS: Significant type 1 diabetes associations were observed at all class I HLA loci. After accounting for LD with HLA class II, the most significantly type 1 diabetes-associated alleles were B*5701 (odds ratio 0.19; P = 4 × 10(-11)) and B*3906 (10.31; P = 4 × 10(-10)). Other significantly type 1 diabetes-associated alleles included A*2402, A*0201, B*1801, and C*0501 (predisposing) and A*1101, A*3201, A*6601, B*0702, B*4403, B*3502, C*1601, and C*0401 (protective). Some alleles, notably B*3906, appear to modulate the risk of all DRB1-DQA1-DQB1 haplotypes on which they reside, suggesting a class I effect that is independent of class II. Other class I type 1 diabetes associations appear to be specific to individual class II haplotypes. Some apparent associations (e.g., C*1601) could be attributed to strong LD to another class I susceptibility locus (B*4403). CONCLUSIONS: These data indicate that HLA class I alleles, in addition to and independently from HLA class II alleles, are associated with type 1 diabetes.

HLA DPA1, DPB1 alleles and haplotypes contribute to the risk associated with type 1 diabetes: analysis of the type 1 diabetes genetics consortium families.

OBJECTIVE: To determine the relative risk associated with DPA1 and DPB1 alleles and haplotypes in type 1 diabetes. RESEARCH DESIGN AND METHODS: The frequency of DPA1 and DPB1 alleles and haplotypes in type 1 diabetic patients was compared to the family based control frequency in 1,771 families directly and conditional on HLA (B)-DRB1-DQA1-DQB1 linkage disequilibrium. A relative predispositional analysis (RPA) was performed in the presence or absence of the primary HLA DR-DQ associations and the contribution of DP haplotype to individual DR-DQ haplotype risks examined. RESULTS: Eight DPA1 and thirty-eight DPB1 alleles forming seventy-four DPA1-DPB1 haplotypes were observed; nineteen DPB1 alleles were associated with multiple DPA1 alleles. Following both analyses, type 1 diabetes susceptibility was significantly associated with DPB1*0301 (DPA1*0103-DPB1*0301) and protection with DPB1*0402 (DPA1*0103-DPB1*0402) and DPA1*0103-DPB1*0101 but not DPA1*0201-DPB1*0101. In addition, DPB1*0202 (DPA1*0103-DPB1*0202) and DPB1*0201 (DPA1*0103-DPB1*0201) were significantly associated with susceptibility in the presence of the high risk and protective DR-DQ haplotypes. Three associations (DPB1*0301, *0402, and *0202) remained statistically significant when only the extended HLA-A1-B8-DR3 haplotype was considered, suggesting that DPB1 alone may delineate the risk associated with this otherwise conserved haplotype. CONCLUSIONS: HLA DP allelic and haplotypic diversity contributes significantly to the risk for type 1 diabetes; DPB1*0301 (DPA1*0103-DPB1*0301) is associated with susceptibility and DPB1*0402 (DPA1*0103-DPB1*0402) and DPA1*0103-DPB1*0101 with protection. Additional evidence is presented for the susceptibility association of DPB1*0202 (DPA1*0103-DPB1*0202) and for a contributory role of individual amino acids and DPA1 or a gene in linkage disequilibrium in DR3-DPB1*0101 positive haplotypes.

HLA DR-DQ haplotypes and genotypes and type 1 diabetes risk: analysis of the type 1 diabetes genetics consortium families.

OBJECTIVE: The Type 1 Diabetes Genetics Consortium has collected type 1 diabetic families worldwide for genetic analysis. The major genetic determinants of type 1 diabetes are alleles at the HLA-DRB1 and DQB1 loci, with both susceptible and protective DR-DQ haplotypes present in all human populations. The aim of this study is to estimate the risk conferred by specific DR-DQ haplotypes and genotypes. RESEARCH DESIGN AND METHODS: Six hundred and seven Caucasian families and 38 Asian families were typed at high resolution for the DRB1, DQA1, and DQB1 loci. The association analysis was performed by comparing the frequency of DR-DQ haplotypes among the chromosomes transmitted to an affected child with the frequency of chromosomes not transmitted to any affected child. RESULTS: A number of susceptible, neutral, and protective DR-DQ haplotypes have been identified, and a statistically significant hierarchy of type 1 diabetes risk has been established. The most susceptible haplotypes are the DRB1*0301-DQA1*0501-DQB1*0201 (odds ratio [OR] 3.64) and the DRB1*0405-DQA1*0301-DQB1*0302, DRB1*0401-DQA1*0301-DQB*0302, and DRB1*0402-DQA1*0301-DQB1*0302 haplotypes (ORs 11.37, 8.39, and 3.63), followed by the DRB1*0404-DQA1*0301-DQB1*0302 (OR 1.59) and the DRB1*0801-DQB1*0401-DQB1*0402 (OR 1.25) haplotypes. The most protective haplotypes are DRB1*1501-DQA1*0102-DQB1*0602 (OR 0.03), DRB1*1401-DQA1*0101-DQB1*0503 (OR 0.02), and DRB1*0701-DQA1*0201-DQB1*0303 (OR 0.02). CONCLUSIONS: Specific combinations of alleles at the DRB1, DQA1, and DQB1 loci determine the extent of haplotypic risk. The comparison of closely related DR-DQ haplotype pairs with different type 1 diabetes risks allowed identification of specific amino acid positions critical in determining disease susceptibility. These data also indicate that the risk associated with specific HLA haplotypes can be influenced by the genotype context and that the trans-complementing heterodimer encoded by DQA1*0501 and DQB1*0302 confers very high risk.

Conditional genotype analysis: detecting secondary disease loci in linkage disequilibrium with a primary disease locus.

A number of autoimmune and other diseases have well established HLA associations; in many cases there is strong evidence for the direct involvement of the HLA class II peptide-presenting antigens, e.g., HLA DR-DQ for type 1 diabetes (T1D) and HLA-DR for rheumatoid arthritis (RA). The involvement of additional HLA region genes in the disease process is implicated in these diseases. We have developed a model-free approach to detect these additional disease genes using genotype data; the conditional genotype method (CGM) and overall conditional genotype method (OCGM) use all patient and control data and do not require haplotype estimation. Genotypes at marker genes in the HLA region are stratified and their expected values are determined in a way that removes the effects of linkage disequilibrium (LD) with the peptide-presenting HLA genes directly involved in the disease. A statistic has been developed under the null hypothesis of no additional disease genes in the HLA region for the OCGM method and was applied to the Genetic Analysis Workshop 15 simulated data set of Problem 3, which mimics RA (answers were known). In addition to the primary effect of the HLA DR locus, the effects of the other two HLA region simulated genes involved in disease were detected (gene C, 0 cM from DR, increases RA risk only in women; and gene D, 5.12 cM from DR, rare allele increases RA risk five-fold). No false negatives were found. Power calculations were performed.

Association of non-HLA genes with type 1 diabetes autoimmunity.

Approximately 50% of the genetic risk for type 1 diabetes is attributable to the HLA region. We evaluated associations between candidate genes outside the HLA region-INS, cytotoxic T-lymphocyte-associated antigen (CTLA)-4, interleukin (IL)-4, IL-4R, and IL-13 and islet autoimmunity among children participating in the Diabetes Autoimmunity Study in the Young (DAISY). Children with persistent islet autoantibody positivity (n = 102, 38 of whom have already developed diabetes) and control subjects (n = 198) were genotyped for single nucleotide polymorphisms (SNPs) in the candidate genes. The INS-23Hph1 polymorphism was significantly associated with both type 1 diabetes (OR = 0.30; 95% CI 0.13-0.69) and persistent islet autoimmunity but in the latter, only in children with the HLA-DR3/4 genotype (0.40; 0.18-0.89). CTLA-4 promoter SNP was significantly associated with type 1 diabetes (3.52; 1.22-10.17) but not with persistent islet autoimmunity. Several SNPs in the IL-4 regulatory pathway appeared to have a predisposing effect for type 1 diabetes. Associations were found between both IL-4R haplotypes and IL-4-IL-13 haplotypes and persistent islet autoimmunity and type 1 diabetes. This study confirms the association between the INS and CTLA-4 loci and type 1 diabetes. Genes involved in the IL-4 regulatory pathway (IL-4, IL-4R, IL-13) may confer susceptibility or protection to type 1 diabetes depending on individual SNPs or specific haplotypes.

Association of IL4R haplotypes with type 1 diabetes.

We have investigated, in 282 multiplex Caucasian families (the Human Biological Data Interchange Repository), the association of type 1 diabetes with polymorphisms in the IL4R gene. IL4R encodes a subunit of the interleukin-4 receptor, a molecule critical to T-helper cell development. By genotyping eight different IL4R single-nucleotide polymorphisms (SNPs) and identifying haplotypes (complex alleles) in the multiplex type 1 diabetic families who were stratified for HLA genotype, we have observed significant evidence of linkage and association of the IL4R gene to type 1 diabetes. In particular, we have identified a specific haplotype that appears to be protective and observed that this protective effect is strongest among individuals not carrying the HLA DR3/DR4 genotype (which confers the strongest genetic risk for type 1 diabetes). These findings suggest an important role for the IL4R gene in immune-related disease susceptibility and illustrate the value of using multi-SNP haplotype information in association studies.

PHYLOGENETIC ESTIMATION OF PLASMID EXCHANGE IN BACTERIA.

The existence of differential horizontal gene transfer may be assessed by comparing the phylogenetic trees derived from two different genes. We use this concept to estimate quantitatively the amount of plasmid exchange that has occurred in a bacterial population. By means of computer simulations we studied the effect of gene transfer on the topological distortion between two phylogenetic trees: one obtained from an euchromosomal gene and another from a plasmid-borne sequence, which may be subjected to horizontal transfer. The basic assumptions of our simulations were (a) that plasmid exchange had occurred recently (after the last population split); and (b) that either the amount of chromosomal horizontal exchange was negligible or that it was only a fraction of the amount of plasmid exchange in which case we will be estimating relative amounts of plasmid transfer. We found that the topological difference between two such trees is a function of the number of plasmid exchange events that have occurred. It can be explained by a logistic model that relates the average distortion index between two trees (dT ) to the number of transfer events (x). The behavior remains the same under different conditions that were tested (symmetry of the topology, number of taxa in the tree, effect of reconstruction errors, mutation after plasmid transfer). We have also tried our method on empirical data from the literature and estimated the amount of gene transfer that may have occurred among Sym plasmids in agricultural field populations of Rhizobium leguminosarum biovar phaseoli. We found that between 15.77 to 29.98% of all genetic types in these populations have been either the source or the target of a plasmid transfer event. When the comparisons were made among trees derived exclusively from plasmid probes this value dropped to 2.00%. Phylogenetic trees derived from symbiotic and nonsymbiotic sequences were also used to infer the number of gene transfer events among 11 isolates from R. galegae. The estimated number of transfer events of symbiotic sequences was 10.515 (although we do not know out of how many genetic types). We concluded that intraspecific transfer of symbiotic sequences is widespread in these two species of the genus Rhizobium.

Características del infante y la relación materno-infantil / Characteristics of the infant and the maternal infantile relation

Trabajo dividido en tres partes, abordando los conceptos generales de lo que a Recién Nacido Sano se refiere; la primera parte subtitulada: Habilidades de neonato sano describe las funciones de sus sentidos, los alcances que tiene, trayendo consigo todo un cúmulo de capacidades que poco a poco irá desarrollando. Diferencias temperamentales es el segundo apartado, puesto que cada niño varia en infinitas formas con respecto a otro, ya sea en apariencia, forma de ser, movimientos, sueño, niveles de irritabilidad. Y la tercera parte: Optimización del desarrollo a través de la relación materno infantil; trata sobre la interrelación entre padres e hijos, la capacidad de respuesta, formas de comunicación, satisfacciones, estímulos. Concluyendo que es necesario recalcar que el niño trae a la relación con su familia, además de una serie de habilidades, su propio estilo personal y que es necesario encontrar congruencia entre el temperamento de la madre y otros cuidadores con el niño

Mesa de discusión: manejo familiar del niño con problemas al nacimiento / Discussion table: family managment of the child with problems of childbirth

Se trata interdisciplinariamente la manera en que se deberá de manejar la problemática del niño que nace con problemas físicos, resalta además la importancia de los factores psicológicos a nivel del desarrollo del niño y del impacto y manejo familiar. Las relaciones que se susitan a partir del nacimiento el informe a los padres, las posibilidades de vida del recién nacido; el seguimiento de estos niños, el manejo médico adecuado; las inquietudes de los padres de hijos con malformaciones congénitas son canalizadas al servicio genético, se planea una sesión llamada Asesoramiento Genético o Consejo Genético y tiene por objeto resolver estas dudas además de ampliar información. El impacto psicológico que causa la venida de un niño con malformaciones, la reacción familiar, muchas veces distinta de un conyuge a su pareja