Topographic Positions of the Wharton's Duct Orifice in Children.

PURPOSE: Sialoendoscopic, orthodontic, and surgical interventions within the floor of the mouth require precise knowledge of the topography of the Wharton's duct orifices which is still lacking for the pediatric population. We aimed to establish a normative database for the topography of these orifices in children. METHODS: The prospective cross-sectional analytic study was performed during January to December 2021. The distances between the mandible gonions and each orifice and the lingual frenulum were defined as primary outcome variables. The secondary outcome variables were the inter-position of the orifices and their location against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and age groups (4 to 7, 8 to 14, 15 to 17 years old) as the primary predictor variables. The data were evaluated by a 3-way ANOVA for analysis of selected distances with the level of significance at P ≤ .05. The correlation analysis between sex and locations of the orifices was performed using χ2 criterion (95% confidence interval) and r ≥ 0.60 was counted as a strong correlation. RESULTS: The study involved 3,000 healthy children from 4 to 17 years of age. The orifices were symmetrical (89.3%), frenulum-independent (78.0%) openings that were usually located in the middle part of the floor of the mouth. The distance between the orifices varied from 0 mm in the frenulum-attached cases to 4.6 ± 1.8 mm for 4 to 7 years old, 7.6 ± 1.9 mm for 8 to 14 years old, and 9.1 ± 2.6 mm for 15 to 17 years old individuals. The orifices were attached to the frenulum (5.7%), were frenulum-related (16.3%), and frenulum-independent (78.0%). The sagittal asymmetry of the orifices was noted in 10.7%, and in 1.6% the lateral asymmetry was detected. No statistically significant sex-related differences were noted. CONCLUSION: In the pediatric population, the Wharton's duct orifices are usually symmetrical frenulum-independent openings that are located in the middle part of the floor of the mouth. The distance between the orifices normatively varies according to sex and age. The size of the mandible does not influence the positions of the orifices. The position of the duct orifices must be established prior to submandibular sialoendoscopy, orthodontic interventions, frenotomy, and other oral surgeries.

Immediate physical needs of refugees during the Ukrainian armed conflict of 2022.

PURPOSE: The study assessed the physical needs of Ukrainian refugees and internally displaced persons during the ongoing Ukrainian armed conflict of 2022. We aimed to investigate the immediate physical needs of the refugees that may affect their somatic condition during the armed conflict when they did not yet reach their final destination or just reached a safety zone. METHODS: The questionnaire-based prospective repeated cross-sectional study (three study groups) and the longitudinal study (one group) were undertaken in Ukraine and Israel among 19,101 refugees and 828 controls from February 24 to April 9. We assessed the availability of basic somatic necessities (water, food, clothing, hygiene, and sleep) and the general physical fatigue of internal, moving abroad, and arriving to safety refugees with scores ranging from 35 (normal) to 7 (extremely inadequate). RESULTS: The average score of 26.8 ± 1.8 indicates that the participants experienced somatic problems even being healthy. In Ukraine, the score for moving abroad refugees (n = 16,449) dropped from 26.8 ± 0.6 to 23.5 ± 0.6 (p = 0.03) during the study period. Internally displaced persons (n = 1200) remained physically stable with a score of 27.5 ± 0.7. In Israel, group-organized refugees (n = 796) were relatively normal somatically (30.0 ± 0.6) while independent refugees (n = 656) were exhausted having a score of 24.2 ± 0.7 (p = 0.03 vs. group-organized). CONCLUSION: During hostilities, refugees, internally displaced persons, and regular inhabitants are somatically affected but to varying degrees. For refugees, group-organized travel abroad is the best option to maintain adequate physical condition, followed by an internal refugee status, and travel abroad independently (the worst strategy).

The Normative Topographic Position of the Wharton's Duct Orifice in Adults.

PURPOSE: We aimed to establish a normative database for the topography of Wharton's duct orifices and to indicate the localization and distances of the orifices against other oral structures. METHODS: The prospective study involved 3,000 healthy adults. We measured the cranial index, the distances between the mandible gonions and the orifices and between each orifice and the lingual frenulum, the position of the orifices against each other, and against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and the headform (dolichocephalic, brachycephalic, and mesocephalic). RESULTS: The distance between the orifices varied from 0 mm in the frenulum-attached cases to11.0 ± 2.3 mm in cases of the male brachycephalic skull. The correlation with sex was found for the localization of the frenulum-related orifices (r = 0.64 for females). The orifices were attached to the frenulum (5.9%), were frenulum-related (16.2%), and frenulum-independent (77.9%). The sagittal asymmetry of the orifices was noted in 11.8%, and in 2.1%, the lateral asymmetry was detected. CONCLUSION: In most of the cases, the Wharton's duct orifices are symmetrical frenulum-independent openings that are usually located in the middle part of the floor of the mouth or close to the mandibular alveolar ridge. The distance between the orifices varies according to sex and the type of the skull. The precise position of the duct orifices must be established prior to sialoendoscopy of the submandibular glands, a botulinum toxin injection around the mandible, tongue traction maneuvers, frenotomy, and other oral surgeries.

Thermal Comfort in School Classes in the Era of Global Warming: A Prospective Multicenter Study.

BACKGROUND: We investigated adolescents' feelings of thermal comfort during the educational process in various geographical locations far apart and present recommendations for the adjustment of the thermal environment in schools. METHODS: The prospective international multicenter study took place in 8 locations on different continents. The survey in the form of a questionnaire was carried out among 2800 healthy high school students. The study was divided into "cold season survey," "warm-season survey," and heat wave survey. RESULTS: The statistically significant difference between the "cold season survey" score of 4.04 (discomfort) and "warm-season survey" score of 3.47 (slight discomfort) (p = .04) indicates that students feel more thermal discomfort during winter months in all 8 locations. The heat wave survey score was 4.53 (discomfort). During the cold season, 29.24% of high school students felt themselves in full thermal comfort and 76.48% of the students felt themselves relatively comfortable (slightly cool-comfortable-slightly warm). CONCLUSIONS: Even during the ongoing process of climate change, the cold season discomfort remains the main problem for students in classes. This tendency is present in different continents as a universal problem. We recommend keeping an entrance hall and classroom temperatures at different levels and to advise students about proper clothing.

Owls and larks do not exist: COVID-19 quarantine sleep habits.

BACKGROUND: The coronavirus pandemic presented a unique opportunity to study the daily temporal patterns and sleep habits of humans. The question to be explored was: Are there discernible differences in sleep between the normal operational environment and the stay-at-home condition? METHODS: This international prospective study analyzed results from the sleep-wake patterns questionnaire, daily logs, and interviews. Surveys were administered to the healthy volunteers (age 15-60 y) with stay-at-home for a month or more, without previous sleep disorders and mood-related complaints; volunteers were not involved in online education/work daily timetable-related activities. RESULTS: We analyzed 3787 subjects with average stay-at-home of 65 ± 9 days. The most significant changes in sleep occurred during the first ten days when the difference between weekdays and weekends disappeared and changes occurred in napping habits. The majority of the participants (66.8%) shifted toward eveningness when the self-selected sleep was possible and 1869 volunteers appeared to be owls (49.4%), 823 (21.7%) exercised "typical" sleep, 478 (12.6%) were larks, and 617 (16.3%) participants were completely desynchronized to the end of stay-at-home. In addition, 497 participants (13.1%) alternated their sleep habits. The most of the desynchronized participants (n = 414) were older than 50 years (age correlation r = 0.80), and predominantly males (n = 297, r = 0.76). CONCLUSION: In self-selected sleep conditions, the timing of sleep and sleep habits significantly differ from those of socially and economically fixed daily routine conditions. The changes in daily temporal patterns of humans during a prolonged stay-at-home situation indicate that human sleep habits may change according to existing living conditions.

Stay-at-home circumstances do not produce sleep disorders: An international survey during the COVID-19 pandemic.

OBJECTIVE: The anxiety-related insomnia and other sleep disorders were mentioned as possible side effects of quarantine and stay-at-home conditions. The questions to be explored were: Are there discernable differences in hours of sleep and sleep habits between the normal operational environment and the stay-at-home condition? and How seriously anxiety-induced insomnia or other sleep disorders may affect individuals during the stay-at-home? METHODS: This international prospective study analyzed results from the sleep-wake patterns questionnaire, daily logs, and interviews. During COVID-19 pandemic, surveys were administered to the healthy volunteers with stay-at-home for 14 days or more, without previous sleep disorders; volunteers were not involved in online education/work daily timetable-related activities. RESULTS: We analyzed 14,000 subjects from 11 countries with average stay-at-home of 62 days. The most significant changes in sleep occurred during the first 14 days of stay-at-home. The difference in the sleep duration between weekdays and weekends disappeared. Most of the participants discontinued using alarm clocks. The total sleep time increased in duration up to 9:10 ± 1:16 to the end of the quarantine/stay-at-home (+1:34, p = 0.02). The age-dependent changes in napping habits occurred. Only 1.8% of participants indicated insomnia during the first 14-day period with a decline to 0.5% after two months of stay-at-home. CONCLUSION: During the stay-at-home situation, both duration and timing of sleep significantly differ from those of daily routine and most humans sleep longer than in a schedule-dependent operational environment. An appearance of anxiety-induced insomnia is extremely rare if a healthy individual is already in the stay-at-home situation.

Knowledge and attitudes of adolescents to e-cigarettes: an international prospective study.

PURPOSE: The aim of the study was to assess the familiarity of adolescents with e-cigarettes. We performed a survey to investigate the frequency of their contact with e-cigarettes, beliefs about this sort of smoking (vaping), and their real knowledge of its effects. METHODS: The survey was carried out among 1600 high school students in the USA, Israel, Ukraine and Australia. The questionnaire comprised three parts, each with five questions. The first part was designed to assess the frequency of contact with the phenomenon. The second part assessed misconceptions and opinions concerning vaping. The third part questioned the participants' real knowledge of the subject. RESULTS: Out of a maximum score of 5, the average score of 4.25 for Part 1 indicated that the participants had frequent contact with e-cigarettes. The score of 3.65 for Part 2 showed that adolescents have both right and wrong beliefs on the subject. Part 3 was completed by 1224 participants (76.5%) while 376 (23.5%) reported a lack of any specific knowledge about vaping. The average score of 3.33 demonstrated that adolescents who completed Part 3 of the survey have incomplete knowledge about e-cigarettes. For the whole cohort of 1600 participants, the average score was 2.80. No significant sex differences were detected. The Ukranian participants had poor knowledge about the dangers of vaping in comparison with the participants in the USA and Australia (p = 0.03). CONCLUSION: While the contact of adolescents with e-cigarettes users is extensive, their actual knowledge remains inadequate. Various school-based smoking risk campaigns face a necessity for further adjustments and improvements.

Screening Procedure for Hemihypertrophy: Preliminary Results of International Multicenter Prospective Study.

INTRODUCTION: Isolated or congenital hemihypertrophy is a rare disorder characterized by asymmetric overgrowth of one side of the body. This article describes the protocol and preliminary results of a lateral body asymmetry (hemihypertrophy) screening procedure performed in healthy adolescents in a multicenter study. The reported incidence of hemihypertrophy varies between different publications and standardized protocols are needed to improve research in this area. METHODS: Our screening program is taking place in Australia, Israel, Mexico, Ukraine and USA. Procedure includes two steps: (1) "three measurements - three questions" screening, or assessment of face, palms, and shins; (2) in-depth assessment of selected cases in order to exclude localized, lesional, and syndrome-related cases as well as body asymmetry within normative range and to select suspected cases of isolated hemihypertrophy. This step includes measurements of various anatomical regions and a detailed questionnaire. RESULTS: At this stage, the screening procedure is completed and the selected participants are advised to refer to medical institutions for further clinical and genetic follow up to exclude possible tumors and other accompanying disorders. CONCLUSION: We present an easy-to-use selection tool to identify children with suspected IH, which results in the selection of the risk group that may benefit from referral to a pediatrician and a clinical geneticist.

The range of normative surface skin temperature changes in adolescents: prospective multicenter study.

AIM: We aimed to establish a normative range of surface skin temperature (SST) changes due to blood redistribution in adolescents and to register the time needed for complete postural change-related blood redistribution. METHODS: The healthy volunteers (age 15-18, n = 500, M 217, F 283) were recruited for this prospective multicenter study. The volunteers were asked to keep one extremity down and another extremity up in supine rest, sitting with straight legs, and upright rest. We obtained temperature readings being taken from the tips of the middle fingers and temperature readings from the tips of the first toes at the ambient temperature of 25 °C and 30 °C. The control group consisted of a 100 of adult volunteers. RESULTS: The resting temperature of the middle fingers for a sitting participant was 28.6 ± 0.8 °C. The physiological change of this temperature during body position changes was 4.5 ± 1.1 °C and for most of the participants remained within the 26.5-31.5 °C range at 25 °C. For the toe, physiological skin temperature range was 25.5-33 °C. At 30 °C, these ranges were 27-33 °C for the fingers and 27-34 °C for the toes. On average, 2-3 min were needed for such temperature changes. CONCLUSION: At normal room temperature, the SST of thermoneutral adolescents may vary within a range of approximately 5 °C only due to the blood redistribution in the body. This range is specific for each person due to individual peculiarities of the vasomotor activity. This normative range of SSTs should be taken into account during investigations of thermoregulation.

Normative surface skin temperature changes due to blood redistribution: A prospective study.

The continuing development and manufacture of infrared devices, together with improvements in thermal body mapping techniques have simplified surface skin thermography which is being used more extensively than ever before. Normative thermography data, however, remains incomplete. A normative blood redistribution range of skin temperatures was established for use as a reference for laboratory infrared thermography (IT), thermal body mapping, and mass fever screenings. 500 healthy volunteers participated in this prospective study. To determine the maximum range of the skin temperature changes due to the posture-related physiological blood redistribution, the volunteers were asked to keep one extremity up and another extremity down whilst lying, sitting, and standing. We obtained 6000 hand and 400 foot temperature readings. The normal temperature was 29.1 ±â€¯0.6 °C for the middle fingers and 27.8 ±â€¯0.7 °C for the toes. The physiological temperature change during body position changes ranged from 4 to 6 °C (fingers: 27-31 °C; toes: 26-32 °C). At normal room temperature, the surface skin temperature may vary within this range due to blood redistribution. These changes reflect the individual variability of vasomotor activity. This physiological range of temperatures should be taken into account during IT and other thermography-involved investigations.

Hemihyperplasia/hemihypertrophy in adolescents: prospective international study.

AIM: The reported incidence of isolated hemihyperplasia (IH) has a very wide range (from 1:13,000 to 1:86,000 live births) and further clarification is needed. We hypothesized that a survey of the birth prevalence of IH among newborn infants may underestimate the incidence of IH by overlooking late-onset cases. METHODS: The prospective international multicenter study utilized the two-steps selection tool for an anonymous survey of volunteers of 15-18 years old. The initial step was "three measurements-three questions" screening, or "face-palms-calves survey". The subsequent step was an in-depth assessment of selected cases to exclude localized, lesional and syndrome-related cases as well as body asymmetry within normative range and to select suspected cases of IH. This step included measurements of various anatomical regions and a subsequent questionnaire. The participants that were selected in a risk group were advised to refer to medical institutions for clinical, genetic and instrumental investigation. RESULTS: Out of 6000 of selected participants (male, M 3452, female, F 2548), 229 (3.82%) were selected for detailed investigation and 57 (0.95%) were assigned to the risk group. Only 36 of them were actually referred to medical institutions and in two cases the diagnosis of IH was confirmed. CONCLUSION: Our survey indicated the prevalence of IH at the age of adolescence as approximately 1:3000. While IH is a hereditary genetic disorder, it may not be detected in newborns and infants and the true prevalence of the disease can be estimated if older age children are screened.

The 11p15.5 chromosomal region: When did the instability occur?

The disturbances of the 11p15.5 chromosomal region are associated with Beckwith-Wiedemann syndrome, Russell-Silver syndrome, Wilms tumor, IMAGe syndrome, and idiopathic hemihyperplasia. The aim of this research was to examine the hypothesis that 11p15.5 initially became unstable in the European population about 200 years ago. The medical literature from 1557 onwards, especially treatises on teratology, body asymmetry, and books of normal and pathologic anatomy, was searched for any mentioning of lateral body asymmetry, macroglossia and other possible visually detectable symptoms associated with the above-mentioned syndromes. The results indicate that lateral body asymmetry was not described before the first half of the 19th century, it was mentioned in the 1820s, and the first description of a true case was published in 1850. All first cases of hemihyperplasia were reported in continental Europe. Historical data suggest that the 11p15.5 chromosomal region became unstable in the first half of the 19th century. Our preliminary hypothesis is that de novo mutation occurred in continental Europe. Additional genetic research is needed to investigate the development of 11p15.5 instability during this period.

Hemihyperplasia: History of medicine assists medical genetics.

This paper examines the role of the history of medicine in case of congenital isolated hemihyperplasia. Isolated hemihyperplasia is a genetic disorder in which one side of the body grows more than the other, causing visible lateral asymmetry of the human body. The date of the occurrence of the genetic mutation that leads to hemihyperplasia is not known yet. The aim of the current research was to confirm or to disprove the fact that isolated hemihyperplasia was first described in the first half of the 19th century. Using the case of hemihyperplasia we aimed to demonstrate how historical analysis may assist medical genetics in cases when estimating a mutation date is necessary. Medical literature from 1573 onwards was searched for any mention of hemihypertrophy, hemihyperplasia, hemi-gigantism, partial gigantism, hemi-macrosomia and other possible descriptions for pathological lateral body overgrowth. Historical analysis suggests that the mutation in question occurred in the first half of the 19th century, approximately 200 years ago. This led to the appearance of hemihyperplasia and subsequent hemihyperplasia-including syndromes. An additional genetic research is needed for investigation of the development of the involved chromosomal region instability since this period. Such research may use the timeline orientation provided by the history of medicine.

Assessment of anxiety in adolescents involved in a study abroad program: a prospective study.

Objective The aim of the study was to measure the effects on levels of anxiety in healthy teenagers caused by a temporary change of country and school during a study abroad program. Methods In a prospective study we gathered the data from six anxiety level related tests on high school participants in a study abroad program (age 15-17, n = 364, M 172, F 192). These volunteer participants were divided into two separate groups: with self-reported elevated levels of anxiety (n = 111; YES-group) and with self-reported normal levels of anxiety (n = 253; NO-group). Two control groups of schoolchildren drawn from two local schools were used for comparison (n = 100 each). Three tests were subjective, i.e. self-fill-out tests. The next three tests were objective psychological or neurophysiological tests designed to estimate reflex control, concentration and a feeling for the passage of time. Results The initial mean anxiety level score among the 364 participants was 41.5 ± 16.7 (min 16, max 80) on 5-110 scale. For the YES-group the score was 56.5 ± 15.9, and for the NO-group the score was 34.7 ± 17.4 (p = 0.05). The retesting after they had been in the same place for 7 weeks revealed that the mean anxiety level score of the participants decreased to 37.4 ± 16.9 (min 15, max 72). For the YES-group the score significantly decreased to 39.3 ± 15.5, and for the NO-group the score slightly elevated to 36.7 ± 16.4 producing similar results for both groups (p = 0.81). Conclusion A temporary change of country and school at first results in a rise in anxiety levels in about one third of participants. However, after an extended stay it falls to normal levels.