Classification of temporomandibular joint sounds based upon their reduced interference distribution

Temporomandibular joint (TMJ) sounds were recorded in 98 orthodontic retention patients, mean age 19 ± 8–6 (s.d.) years, by interview, auscultation and electronic recording. Sounds were found by auscultation in 41% and by interview in 32% of the subjects, more often in females than in males (P ≤ 0.05). A new method for time-frequency analysis, the reduced interference distribution (RID), was used to classify the electronic sound recordings into five subclasses, RID types 1–5, based upon location and number of their energy peaks. RID types 1–3 had a few energy peaks close in time. RID types 4–5, typical of subjects with crepitation, had multiple energy peaks occurring close in time for a period of 20–300 ms. RID type 1, found in 45% of the subjects, typical of patients with clicking, had its dominant energy peak located in a frequency range ≤600 Hz and was significantly more common in the female than in the male subjects (P≤ 0.01). RID type 2, found in 68% of the subjects, with the dominant peak in the range 600–1200 Hz, and RID type 3, found in 38% of the subjects, with the peak in the frequency range >1200 Hz, were found to have a similar gender distribution. RID type 4, found in 49% of the subjects, had the energy peaks distributed in the frequency range ≤600 Hz. RID type 5, found in 43% of the subjects, more often in females than in males (P≤ 0.05), had the peaks distributed over the whole frequency range from about 30 Hz up to about 3000 Hz. In conclusion, a more detailed classification could be made of the TMJ sounds by displaying the RIDs than by auscultation. This suggests that RID classification methods may provide a means for differentiating sounds indicating different types of pathology.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74694/1/j.1365-2842.1996.tb00809.x.pd

The wave forms of temporomandibular joint sound clicking and crepitation

The aim of the present study was to determine the sound wave forms which correspond to auscultatory findings of temporomandibular joint (TMJ) clicking and crepitation. Such knowledge is important when selecting parts of digital recordings for spectral analysis. Electronic digital recordings were made with a sampling rate of 44 100 Hz from 60 subjects, including 51 patients referred for suspected rheumatological disease and nine healthy subjects. Accelerometers with the bandwidth 20–3600 Hz were used for all subjects and complementary recordings were made from a subgroup of nine subjects using a measurement microphone with the bandwidth 20–20 000 Hz. The clicking sounds could be classified into different types according to differences in temporal period duration ( T ) as measured on the analogue display. One type of clicking, found in 51% of the patients, had a T of 2–20 ms. Another type, found in 70% of the subjects, had a T of less than 1 ms, often as low 0.2 ms. This type of clicking was not seen at all in the analogue display if the sampling rate was below 3 000 Hz. The character of the two types of clicking differed: the short duration sounds had a very high pitch, while the pitch of the longer duration sound was lower. Crepitation was found in 63% of the subjects and was observed to be composed of a series of short duration sounds, occurring with brief (less than 10 ms) intervals. It is concluded that the accelerometer (or microphone) bandwidth should cover the entire audible range (20–20 000 Hz), and that sampling rates must be much higher than 3000 Hz, and preferably greater than 10 000 Hz, before the true significance of electronically recorded joint sounds/vibrations can be determined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74177/1/j.1365-2842.1996.tb00810.x.pd

Mortality in systemic sclerosis: an international meta-analysis of individual patient data.

Contains fulltext : 48864.pdf (publisher's version ) (Closed access)PURPOSE: Studies on mortality associated with systemic sclerosis have been limited by small sample sizes. We aimed to obtain large-scale evidence on survival outcomes and predictors for this disease. METHODS: We performed a meta-analysis of individual patient data from cohorts recruited from seven medical centers in the United States, Europe, and Japan, using standardized definitions for disease subtype and organ system involvement. The primary outcome was all-cause mortality. Standardized mortality ratios and predictors of mortality were estimated. The main analysis was based only on patients enrolled at each center within 6 months of diagnosis (incident cases). RESULTS: Among 1645 incident cases, 578 deaths occurred over 11,521 person-years of follow-up. Standardized mortality ratios varied by cohort (1.5 to 7.2). In multivariate analyses that adjusted for age and sex, renal (hazard ratio [HR] = 1.9; 95% confidence interval [CI]: 1.4 to 2.5), cardiac (HR = 2.8; 95% CI: 2.1 to 3.8), and pulmonary (HR = 1.6; 95% CI: 1.3 to 2.2) involvement, and anti-topoisomerase I antibodies (HR = 1.3; 95% CI: 1.0 to 1.6), increased mortality risk. Renal, cardiac, and pulmonary involvement tended to occur together (P <0.001). For patients without adverse predictors for 3 years after enrollment, the subsequent risk of death was not significantly different from that for the general population in three cohorts, but was significantly increased in three cohorts that comprised mostly referred patients. Analyses that included all cases in each center (n = 3311; total follow-up: 19,990 person-years) yielded largely similar results. CONCLUSION: Systemic sclerosis confers a high mortality risk, but there is considerable heterogeneity across settings. Internal organ involvement and anti-topoisomerase I antibodies are important determinants of mortality