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1.
Eat Disord ; 32(3): 325-339, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38291724

RESUMO

Research has identified trait sensitivity as a potential risk factor and treatment target of eating disorders. Conceptualizations of trait sensitivity have depicted individuals with high and low trait sensitivity metaphorically as orchids and dandelions, highlighting their responsiveness to environmental conditions and associated outcomes. While orchids require careful tending to survive, with such care, they emerge extraordinary. In contrast, dandelions can survive a broad range of environmental conditions. Within a scientific framework, trait sensitivity can be conceptualized as neurobiologically-based, with heightened sensory, interoceptive, interpersonal, and emotional processing. While trait sensitivity may increase susceptibility to eating disorders, when therapists view these traits through the lens of environmental responsiveness, they can facilitate their client's inherent resilience and potential. Incorporating a model of trait sensitivity into eating disorders treatment using psychoeducation, modifying environmental stimuli, and selecting optimal interventions has the potential to increase treatment engagement, deepen therapeutic collaboration, and improve outcomes.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Humanos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Personalidade/fisiologia
2.
Cells ; 11(24)2022 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-36552861

RESUMO

Medication-related osteonecrosis of the jaw (MRONJ) is a complication caused by anti-resorptive agents and anti-angiogenesis drugs. Since we wanted to write a protocol for a randomized clinical trial (RCT), we reviewed the literature for the essential information needed to estimate the size of the active patient population and measure the effects of therapeutics. At the same time, we designed a questionnaire intended for clinicians to collect detailed information about their practices. Twelve essential criteria and seven additional items were identified and compiled from 43 selected articles. Some of these criteria were incorporated in the questionnaire coupled with data on clinical practices. Our review found extensive missing data and a lack of consensus. For example, the success rate often combined MRONJ stages, diseases, and drug treatments. The occurrence date and evaluation methods were not harmonized or quantitative enough. The primary and secondary endpoints, failure definition, and date coupled to bone measurements were not well established. This information is critical for writing a RCT protocol. With this review article, we aim to encourage authors to contribute all their findings in the field to bridge the current knowledge gap and provide a stronger database for the coming years.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Humanos , Difosfonatos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico , Conservadores da Densidade Óssea/efeitos adversos , Inibidores da Angiogênese , Conhecimento , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Front Bioeng Biotechnol ; 10: 968346, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36353738

RESUMO

Objectives: The purpose of this pilot porcine study was to explore and illustrate the surgical application of human amniotic membrane (hAM) in an ex vivo model of medication-related osteonecrosis of the jaw (MRONJ). Material and methods: Five oral and maxillofacial surgeons participated to this study. MRONJ was simulated on porcine mandible specimens. hAM was applied using four different techniques: implantation with complete coverage, implantation with partial coverage, apposition and covering graft material. At the same time, the surgeons evaluated how well the hAM handled and its physical properties during the surgery. Results: Surgeons found that hAM had suitable mechanical properties, as it was easy to detach from the support, handle, bind to the defect and bury. hAM was also found to be strong and stable. The "implantation with complete coverage" and "implantation with partial coverage" techniques were the preferred choices for the MRONJ indication. Conclusion: This study shows that hAM is a graft material with suitable properties for oral surgery. It is preferable to use it buried under the gingiva with sutures above it, which increases its stability. This technical note aims to educate surgeons and provide them with details about the handling of hAM in oral surgery. Clinical relevance: Two surgical techniques for hAM application in MRONJ were identified and illustrated. hAM handling and physical properties during surgery were reported.

4.
J Clin Med ; 11(19)2022 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-36233424

RESUMO

This study aimed to demonstrate an association between the occurrence of surgical site infection (SSI) after orthognathic surgery and penicillin allergy and to assess whether other factors could be associated with the occurrence of SSI. A 10-year monocentric retrospective study was conducted to identify possible risk factors for SSI in orthognathic surgery. Bivariate analyses were performed using Fisher, Student, or Wilcoxon tests and multivariate analyses using logistic regression. Two hundred and sixty-six patients were included, and 3.5% had SSI. Bivariate analyses revealed a significant association between SSI and age at surgery (p = 0.01), penicillin allergy (p = 0.02), and postoperative antibiotic therapy by Clindamycin (Dalacine®) (p = 0.02). Multivariate analyses confirmed the association between the occurrence of SSI and treatment with Clindamycin (Dalacine®) or Clindamycin (Dalacine®) and Metronidazole (Flagyl®) postoperatively (p = 0.04). Antibiotic therapy with Clindamycin (Dalacine®) seems to be associated with a higher rate of SSI, and the mandible was the only site affected by SSI.

5.
Eat Behav ; 47: 101673, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36206618

RESUMO

INTRODUCTION: Eating disorders (EDs) are deadly illnesses with high relapse rates, highlighting need for better interventions. Animal-assisted therapy (AAT) has been implemented supplementally for EDs, with horses utilized at many residential facilities. AAT shows promise with meta-analyses of randomized control trials (RCTs) showing significant decreases in depression, anxiety, and negative affect; however, no review to date has evaluated efficacy for EDs. Therefore, this study conducted a systematic review of primary literature to investigate the efficacy of AAT for EDs. METHOD: A systematic review was conducted via PubMed, PsycInfo, and Google Scholar, up to and including September 2021, yielding 10 studies. Therapy animals included horses (n = 8), dogs (n = 1), and dolphins (n = 1). Populations included AAT ED therapists and patients (ages 11 to adult). The PRISMA methodology was used (registration PROSPERO CRD42021256239). Risk of bias assessment used Cochrane method for quantitative studies, Critical Appraisal Skills Programme checklist for qualitative studies, and JBI Critical Appraisal Checklist for Case Reports. Given study type heterogeneity, neither synthesis nor certainty assessments were conducted. RESULTS: Case and qualitative studies reported improvement in cognitive flexibility, ability to relinquish control, and confidence. Quantitative studies demonstrated an inverse relationship between AAT utilization and ED symptoms post-treatment. Effect sizes, when reported, were mostly moderate. All but one study had low, or unclear, risk of bias. Limited randomization and a lack of RCTs measuring ED symptomology directly makes drawing conclusions difficult. CONCLUSION: While preliminary research indicates possible benefits of AAT as a complement to traditional ED treatment, more research is needed to establish efficacy. Future studies should employ randomized control trials and examine key mechanisms of change.


Assuntos
Transtornos de Ansiedade , Transtornos da Alimentação e da Ingestão de Alimentos , Humanos , Cães , Cavalos , Animais , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Doença Crônica
6.
Front Bioeng Biotechnol ; 10: 936074, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35935507

RESUMO

Medication-related osteonecrosis of the jaw (MRONJ) is a complication of certain pharmacological treatments such as bisphosphonates, denosumab, and angiogenesis inhibitors. There are currently no guidelines on its management, particularly in advanced stages. The human amniotic membrane (hAM) has low immunogenicity and exerts anti-inflammatory, antifibrotic, antimicrobial, antiviral, and analgesic effects. It is a source of stem cells and growth factors promoting tissue regeneration. hAM acts as an anatomical barrier with suitable mechanical properties (permeability, stability, elasticity, flexibility, and resorbability) to prevent the proliferation of fibrous tissue and promote early neovascularization at the surgical site. In oral surgery, hAM stimulates healing and facilitates the proliferation and differentiation of epithelial cells in the oral mucosa and therefore its regeneration. We proposed using cryopreserved hAM to eight patients suffering from cancer (11 lesions) with stage 2-3 MRONJ on a compassionate use basis. A collagen sponge was added in some cases to facilitate hAM grafting. One or three hAMs were applied and one patient had a reapplication. Three patients had complete closure of the surgical site with proper epithelialization at 2 weeks, and two of them maintained it until the last follow-up. At 1 week after surgery, three patients had partial wound dehiscence with partial healing 3 months later and two patients had complete wound dehiscence. hAM reapplication led to complete healing. All patients remained asymptomatic with excellent immediate significant pain relief, no infections, and a truly positive impact on the patients' quality of life. No adverse events occurred. At 6 months of follow-up, 80% of lesions had complete or partial wound healing (30 and 50%, respectively), while 62.5% of patients were in stage 3. Radiological evaluations found that 85.7% of patients had stable bone lesions (n = 5) or new bone formation (n = 1). One patient had a worsening MRONJ but remained asymptomatic. One patient did not attend his follow-up radiological examination. For the first time, this prospective pilot study extensively illustrates both the handling and surgical application of hAM in MRONJ, its possible association with a collagen sponge scaffold, its outcome at the site, the application of multiple hAM patches at the same time, and its reapplication.

8.
J Prim Care Community Health ; 12: 2150132721996888, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33618558

RESUMO

BACKGROUND: This study aimed to explore clinicians' perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. METHODS: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. RESULTS: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. CONCLUSIONS: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.


Assuntos
Transtornos de Ansiedade , Ansiedade , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Assistência Perinatal , Gravidez , Encaminhamento e Consulta , Estados Unidos
9.
J Stomatol Oral Maxillofac Surg ; 122(4): 349-354, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33248293

RESUMO

AIM: To evaluate the impact of intraoperative cone beam computed tomography (CBCT) assessment for the surgical management of zygomatic bone fracture (ZF). METHODS: A prospective study was conducted on patients operated on for unilateral ZF during a two-year period. Repositioning of the fractured zygoma was assessed intraoperatively by measuring the position of malar eminences in three dimensions on CBCT. A difference of more than 2 mm between both sides was considered significant and the reduction was judged inadequate. Surgical procedure was adapted to intraoperative imaging findings. RESULTS: The surgical procedures of 47 patients treated for ZF were analyzed. In 15% of the cases (7 patients), the intraoperative CBCT showed an inadequate reduction while the morphological results seemed correct. Those patients benefited from an immediate correction of the reduction. From these 7 patients, reduction was optimized further without the need of osteosynthesis in one case, additional osteosynthesis was performed in 4 cases and 2 patients required both reduction and osteosynthesis revision. CONCLUSION: Intraoperative CBCT control helps to achieve anatomic repositioning in case of ZF. It may reduce the risk of under-treatment and possible reoperation, and of over-treatment meaning systematic ORIF in all fractures.


Assuntos
Fraturas Orbitárias , Fraturas Zigomáticas , Tomografia Computadorizada de Feixe Cônico , Humanos , Sobretratamento , Estudos Prospectivos , Fraturas Zigomáticas/diagnóstico por imagem , Fraturas Zigomáticas/cirurgia
10.
J Craniomaxillofac Surg ; 46(9): 1504-1510, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30041992

RESUMO

INTRODUCTION: Unilateral coronal synostosis (UCS) is a complex craniosynostosis, combining malformations of the upper (frontal bone, orbito-naso-frontal bandeau (ONFB) ) and the middle thirds of the face. In our centre, the surgical correction consists in the repositioning of the ONFB in front of the zygomaticofrontal suture on the affected side. Defects in the corrections have been observed post-operatively for some patients with a persistent asymmetry in the side walls of the orbits. The purposes of our study were to perform an analysis of the frontal process of zygoma (FPZ) in children affected by UCS using preoperative CT-scans and to consider the modification of surgical techniques in order to achieve a better ONFB repositioning and thus, better symmetry. MATERIAL AND METHOD: The preoperative CT-scans of 13 children with UCS who underwent corrective surgery in our department from 2005 to 2016, were analyzed. After the selection of 6 morphological points in 2 and 3 dimensions using planning software, the sutures constituting the coronal arch and the sagittal distances between the coronal plane and the zygomaticofrontal sutures were analyzed. We compared the measurements on the pathological side to the healthy side, the non-affected side being the reference side. The patients included were those for whom the lack of symmetry between the healthy side and the affected side was more than 2 mm. Statistical analyses were carried out using a Student t-test. RESULTS: Of the 13 children, 10 (1 day to 42 months old) met the inclusion criteria. The mean sagittal distance between the coronal plane and the healthy zygomaticofrontal suture was 33.8 mm ± 5.43 mm [range: 25.9: 40.9] [median: 34.3]. On the pathological side, the distance was 28.75 mm ± 4.76 mm [range: 20.8: 36.3] [median: 29.55], (p = 0.04). DISCUSSION: There is a significant asymmetry between the FPZ on the healthy and the pathological sides in children affected by UCS. This asymmetry is variable, therefore justifying a personalized surgical correction whichtakes into account not only the shape of the ONFB but also the degree of asymmetry of the FPZ. A prospective study with immediate preoperative CBCT image acquisition and long-term clinical and radiological follow-up, will be our next step.


Assuntos
Craniossinostoses/diagnóstico por imagem , Craniossinostoses/cirurgia , Assimetria Facial/diagnóstico por imagem , Assimetria Facial/cirurgia , Cirurgia Assistida por Computador/métodos , Zigoma/anormalidades , Zigoma/diagnóstico por imagem , Zigoma/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
11.
J Craniomaxillofac Surg ; 44(10): 1561-1566, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27618720

RESUMO

INTRODUCTION: Craniosynostoses affecting the forehead sutures can not only cause brain damage, but can also have an esthetic impact, because of the associated orbito-naso-frontal deformations. Reshaping the orbito-naso-frontal bandeau (ONFB) is difficult to appreciate perioperatively and should ideally be customized to each child. The aim of this study was to develop a template to guide the surgeon preoperatively towards an ideal customized remodelling of the ONFB. MATERIALS AND METHODS: A previous study conducted on computed tomography scans obtained from healthy children allowed us to conclude that the whole ONFB shape could be accurately described just by the distance measured between the fronto-zygomatic sutures (FZD), independently of age and gender. Our customizable template relies on this measurement. RESULTS: A re-usable template, built around three supports adjustable to a wide range of FZD, was designed using the CAD 3D Rhinoceros® software and machined in stainless steel 316L. The prototype was used for three children with good preliminary results. DISCUSSION AND CONCLUSION: The use of a customizable surgical template allows the surgeon to perform accurate and ideal perioperative remodeling of the ONFB in children suffering from craniosynostosis affecting the forehead sutures. Our prototype is currently the only one to be adjustable according to the FZD. The utility of this device will be assessed in a future prospective clinical study.


Assuntos
Craniossinostoses/cirurgia , Osso Frontal/cirurgia , Nariz/cirurgia , Órbita/cirurgia , Desenho Assistido por Computador , Suturas Cranianas/cirurgia , Craniossinostoses/diagnóstico por imagem , Craniotomia/instrumentação , Craniotomia/métodos , Ossos Faciais/diagnóstico por imagem , Feminino , Humanos , Masculino , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X
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