Risk Assessment of Transmission of Sporadic Creutzfeldt-Jakob Disease in Endodontic Practice in Absence of Adequate Prion Inactivation

BACKGROUND: Experimental results evidenced the infectious potential of the dental pulp of animals infected with transmissible spongiform encephalopathies (TSE). This route of iatrogenic transmission of sporadic Creutzfeldt-Jakob disease (sCJD) may exist in humans via reused endodontic instruments if inadequate prion decontamination procedures are used. METHODOLOGY/PRINCIPAL FINDINGS: To assess this risk, 10 critical parameters in the transmission process were identified, starting with contamination of an endodontic file during treatment of an infectious sCJD patient and ending with possible infection of a subsequent susceptible patient. It was assumed that a dose-risk response existed, with no-risk below threshold values. Plausible ranges of those parameters were obtained through literature search and expert opinions, and a sensitivity analysis was conducted. Without effective prion-deactivation procedures, the risk of being infected during endodontic treatment ranged between 3.4 and 13 per million procedures. The probability that more than one case was infected secondary to endodontic treatment of an infected sCJD patient ranged from 47% to 77% depending on the assumed quantity of infective material necessary for disease transmission. If current official recommendations on endodontic instrument decontamination were strictly followed, the risk of secondary infection would become quasi-null. CONCLUSION: The risk of sCJD transmission through endodontic procedure compares with other health care risks of current concern such as death after liver biopsy or during general anaesthesia. These results show that single instrument use or adequate prion-decontamination procedures like those recently implemented in dental practice must be rigorously enforced

How Do Stress Exposure and Stress Regulation Relate to Borderline Personality Disorder?

Borderline personality disorder (BPD) is a severe and frequent disorder characterized by a pervasive pattern of instability affecting impulse control, emotional regulation, cognitive processing, self-image and interpersonal relationships. Patients’ personal histories are often marked by stressful or traumatic experiences, either unique or repeated. Moreover, while clinical signs of the disorder include both chronic and acute features, acute features are mostly triggered by acute stressful situations. Such features include transient cognitive distortion, intense anger, uncontrollable impulsivity, and self-harm behavior – including suicide – and contribute to the burden of the disease. In this paper, we review the various aspects (epidemiological, clinical, and physiological) contributing to the relationship between BDP and stress. In particular, we explore the statistical association between stress exposure and the emergence of BPD while taking into account other psychopathologies, such as post-traumatic stress disorder. Then, the different aspects of stress responses (namely, the phenomenological, behavioral, hormonal, neuro-vegetative and neural responses) are reviewed in BPD patients. Pathophysiological hypotheses are formulated to explain the differences in responses between BPD patients and healthy subjects and their relation to BPD symptoms. Although the pathogenesis remains uncertain, our conclusions seem to reflect a specific biological and neural pattern of altered stress perception and regulation in BPD

Phénoménologie expérientielle des crises d'Algie Vasculaire de la Face Essai de cartographie d'un territoire subjectif et indicible (la douleur)

L algie vasculaire de la face (AVF) se manifeste par des crises douloureuses hémicraniennes très intenses, accompagnées par des signes neurovégétatifs. Pendant les crises, les patients présentent le plus souvent une agitation importante, ce qui s oppose au comportement des patients souffrant d autres types d algies faciales récurrentes, telles que la migraine. D'autres manifestations, telles que la pulsion suicidaire percritique, semblent très spécifiques de cette pathologie.Dans ce travail, nous avons cherché à explorer le plus précisément possible ce qui se passe au cours d une crise d AVF sur les plans comportemental et psychique. Nous avons d'abord mis au point un hétéro-questionnaire, testé sur un effectif de 35 patients. Puis, nous avons mis en oeuvre auprès de 10 sujets une approche phénoménologique en première personne. Nous avons pu ainsi dégager des éléments permettant de proposer une structure de l'expérience crise d'AVF , et les implications qui en découlent.D'abord, la synthèse de ces résultats, dans une démarche neurophénoménologique, nous permet de proposer des hypothèses sur les mécanismes et les localisations anatomiques qui sous-tendent la maladie et la survenue des crises.Ensuite, l'analyse des vécus de conscience des sujets en cours de crise nous éclaire sur l'expérience de soi, du monde, d'autrui à l 'épreuve de la douleur aigüe.Enfin, un retour sur la genèse de ce travail nourrit une réflexion épistémologique sur la place des données en première personne dans la constitution de la sémiologie médicale, dans la recherche en sciences émotives, et dans le soin possible d'une personne qui souffre.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Phénoménologie expérientielle de l’algie vasculaire de la face (AVF)

International audienceObjectives: Cluster headache (CH) is a rare disease (1 to 3 / 1000), predominant in men (sex ratio: 4 men / 1 woman) and characterized by frequent very painful paroxystic attacks occurring sometimes 8 times by day. CH is a disease without lesion and impairs the quality of life of patients. Attacks occur only on the same hemiface and can last from 15 minutes to 3 hours. The pain is particularly severe and a frequent and extreme psychiatric symptomatology is observed during the attacks. Treatments are rare and not always efficient: sumatriptan, oxygen, LSD, psilocybin. In this paper we try to answer to the question: "What does that make you to have a cluster headache attack ? ", using elicitation interview developed by Vermersch. Patients and methods: Ten patients have been interviewed using elicitation interview (EI) (40-50 mn for one interview). All these patients (7 men and 3 women) T suffer from chronic or episodic CH, with a mean age of 43 years. The patients come from the Lariboisiere hospital (Paris), and more precisely from the center of headache urgency. EI allows describing the pre-reflexive consciousness contents. The method is described in Balzani and coll., and in Petitmengin and coll (see bibliography). Data analysis were performed using Interpretative phenomenological analysis (IPA). Results: From the EI, we have distinguished three phenomenological axes, following Heidegger’s philosophy: 1) An alteration of being-to-the-world with a strong unbearable feeling of imprisonment, and physical restriction. At the same time the patients present a stereotypical and automatic behavior with few motor schemes and escaping strategies. When pain arises, they want to leave and to go very far. Aggressive behavior frequenly occur. Sometimes, the patients are not able to perform the sumatripan injection, due to a motor inhibition. Some patients try to do autohypnosis or other methods to resist to the pain. 2) An alteration of being-to-the self, going from the corporal distortion to the body dissolution. At the onset of symptoms, the patient does the experience of physical deformation, particularly of the face, with strong vegetative symptoms. The patient is not able to control corporeal manifestations: tears, mad thinks, incoherent projects in order to stop the crisis. Some patients want to remove the part of their body where the pain is the most intense (eye, for example). There is a losing of the body limits and a loss of the time orientation. In many cases the pain is unbearable and patients want to commit suicide. At the extreme, the sensation of self seems destroyed, and some patients evoke an experience similar than Near Death Experiences, or describe an experience of swaying in emptiness or imminent death. 3) An alteration of being-to-the-other, going from the imperative solitude to the acceptance for a presence without words. Solitude is the most experience for the patients. They cannot accept anybody. Another person is unbearable, because asking questions about the crisis. In the same time, the patient is scared of this solitude since he is not able to speak about his painful experience. In summary, the structure of the self is altered, and thinking is completely disturbed. The experience of time and space is modified and apragmatism is a consequence of this intense pain. During the crisis, pain is central and the patient lives a kind of dissolution, near death: a self-dismantling.Conclusion: The EI have allowed us to describe precisely the painful experience of subjects with a cluster headache. This experience is very rich and very intense. EI, as a phenomenological method, is a very useful method to describe more precisely the symptomatology of a disease, because it pays attention to the effective experience of the pathological flesh, as compared to the pathological body.L’Algie Vasculaire de la Face (AVF) se manifeste par des accès douloureux paroxystiques fréquents et invalidants. L’intensité de la douleur est exceptionnellement sévère. Dans l’AVF, des manifestations psychiques ou comportementales sont retrouvées en cours de crise, avec une sémiologie pour le moins singulière, voire extrême. Ce travail phénoménologique veut tenter de répondre à la question : « Qu’est-ce que cela vous fait d’avoir une crise d’AVF ? » en utilisant la méthode dite d’entretien d’explicitation des vécus conscients. Trois axes phénoménologiques se différencient : (1) une altération de l’Être-au-monde attestée par une impression de restriction physique et d’enfermement insupportable, imposé, sans échappatoire ; (2) une altération de l’Être-à-soi qui va de la déformation à la dissolution ; (3) et une altération de l’Être-à-l’autre allant de la solitude impérative à la seule acceptation d’une présence sans mots

Distinguish self- and hetero-perceived stress through behavioral imaging and physiological features

International audienc

Full Data Extracted- STT

This file colligates all data and parameters extracted from the analysis of the experimental movies after segmentation

Pre-linguistic infants employ complex communicative loops to engage mothers in social exchanges and repair interaction ruptures

International audienceLanguage has long been identified as a powerful communicative tool among humans. Yet, pre-linguistic communication, which is common in many species, is also used by human infants prior to the acquisition of language. The potential communicational value of pre-linguistic vocal interactions between human infants and mothers has been studied in the past decades. With 120 dyads (mothers and three- or six-month-old infants), we used the classical Still Face Paradigm (SFP) in which mothers interact freely with their infants, then refrain from communication (Still Face, SF), and finally resume play. We employed innovative automated techniques to measure infant and maternal vocalization and pause, and dyadic parameters (infant response to mother, joint silence and overlap) and the emotional component of Infant Directed Speech (e-IDS) throughout the interaction. We showed that: (i) during the initial free play mothers use longer vocalizations and more e-IDS when they interact with older infants and (ii) infant boys exhibit longer vocalizations and shorter pauses than girls. (iii) During the SF and reunion phases, infants show marked and sustained changes in vocalizations but their mothers do not and (iv) mother–infant dyadic parameters increase in the reunion phase. Our quantitative results show that infants, from the age of three months, actively participate to restore the interactive loop after communicative ruptures long before vocalizations show clear linguistic meaning. Thus, auditory signals provide from early in life a channel by which infants co-create interactions, enhancing the mother–infant bond

Data from: Pre-linguistic infants employ complex communicative loops to engage mothers in social exchanges and repair interaction ruptures

Language has long been identified as a powerful communicative tool among humans. Yet, pre-linguistic communication, which is common in many species, is also used by human infants prior to the acquisition of language. The potential communicational value of prelinguistic vocal interactions between human infants and mothers has been studied in the past decades. With 120 dyads (mothers and 3 or 6-month-old infants), we used the classical Still-Face Paradigm (SFP) in which mothers interact freely with their infants, then refrain from communication (Still Face, SF), and finally resume play. We employed innovative automated techniques to measure infant and maternal vocalization and pause, and dyadic parameters (infant response to mother, joint silence and overlap) and the emotional component of Infant Directed Speech (e-IDS) throughout the interaction. We showed that : (1) during the initial free play mothers use longer vocalizations and more e-IDS when they interact with older infants and (2) infant boys exhibit longer vocalizations and shorter pauses than girls. (3) During the SF and reunion phases, infants show marked and sustained changes in vocalizations but their mothers do not and (4) mother-infant dyadic parameters increase in the reunion phase. Our quantitative results show that infants, from the age of 3 months, actively participate to restore the interactive loop after communicative ruptures long before vocalizations show clear linguistic meaning. Thus, auditory signals provide from early in life a channel by which infants co-create interactions, enhancing the mother-infant bond