MRI analysis of neurodevelopmental anatomy in myelomeningocele: prenatal vs postnatal repair.

OBJECTIVE: Compared with postnatal repair, prenatal myelomeningocele (MMC) repair is associated with improved motor function and decreased need for cerebrospinal fluid (CSF) diversion. It is unknown how prenatal surgery alters neuroanatomic structures identifiable on magnetic resonance imaging (MRI). The purpose of this study was to use MRI to compare neurodevelopmental anatomy in patients undergoing fetal MMC repair compared with those undergoing postnatal repair. METHODS: This was a retrospective review of neonates who underwent prenatal or postnatal MMC repair at our institution between 2016 and 2021. Imaging data, including prenatal ultrasound and pre- and postnatal MRI examinations, if available, were retrieved. We analyzed anatomical findings characteristically seen on MRI of the neuroaxis in patients with MMC and compared imaging findings between patients with prenatal vs postnatal MMC repair. RESULTS: The study population included 61 patients who underwent surgical repair for MMC during the 6-year study period, of whom 25 underwent prenatal repair and 36 postnatal repair. CSF diversion was required in 24% of the prenatally repaired cohort vs 67% of the postnatally repaired cohort (P = 0.001). On postnatal MRI, a syrinx was present in 13% of the prenatally repaired cohort vs 42% in the postnatally repaired cohort (P = 0.02). Postnatal corpus callosal (CC) morphology was abnormal in 54% of the prenatally repaired cohort vs 53% of the postnatally repaired cohort (P = 0.92), while falx morphology was normal in 92% of the prenatally repaired cohort vs 34% of the postnatally repaired cohort (P < 0.001). On postnatal MRI, patients in the prenatally repaired cohort had a shorter tentorium-to-foramen-magnum distance compared with those in the postnatally repaired cohort (mean, 18.43 mm vs 22.42 mm; P = 0.01), a larger foramen magnum diameter (mean, 22.87 mm vs 18.94 mm; P < 0.001) and a smaller degree of hindbrain herniation (mean, 1.53 mm vs 8.72 mm; P < 0.001). The cerebral aqueduct was patent in 79% of the prenatally repaired cohort vs 100% of the postnatally repaired cohort on postnatal MRI (P = 0.008). Between the two cohorts, at postnatal MRI there was no significant difference in the presence of gray-matter heterotopia, presence of the septum pellucidum or size of the massa intermedia. CONCLUSIONS: We report variations in developmental neuroanatomy in patients with MMC, including rates of CC dysgenesis, gray-matter heterotopia and additional cranial and spinal MRI findings. Compared to postnatal surgery, prenatal surgery is associated with changes to infratentorial anatomy, with minimal effect on supratentorial brain development. This information will be useful in counseling parents affected by fetal MMC and in understanding how prenatal repair of MMC affects brain development. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Axenfeld-Rieger syndrome: a case report.

Axenfeld-Rieger syndrome (ARS) is a rare autosomal dominant condition manifesting as a heterogeneous group of features. Of particular note are the ocular and craniofacial anomalies and dental features such as hypodontia, microdontia, taurodontism, enamel hypoplasia, conical-shaped teeth, shortened roots and delayed eruption. To treat cases with ARS effectively, a multidisciplinary approach is required, and this report describes the complex and long-term management of a case with input from Paediatric Dentistry, Orthodontics, Restorative Dentistry, Speech and Language Therapy, Oral and Maxillofacial Surgery and Radiology.

Stopping antibiotic therapy after 72 h in patients with febrile neutropenia following intensive chemotherapy for AML/MDS (safe study): A retrospective comparative cohort study.

BACKGROUND: Induction chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) is almost universally complicated by febrile neutropenia(FN). Empirical broad-spectrum antibiotic therapy (EBAT) strategies advocated by guidelines result in long periods of broad-spectrum antibiotic therapy. We compared the outcome of AML/MDS patients treated with a 3-day versus a prolonged (until neutrophil recovery) regimen. METHODS: This is a retrospective comparative cohort study in AML or MDS patients undergoing remission-induction chemotherapy from 2011 to 2019, comparing 2 tertiary care hospitals with different strategies regarding antibiotic treatment for FN. At Erasmus University medical center(EMC), EBAT was stopped after 3 days of FN, in absence of a clinically or microbiologically documented infection. In the University Hospitals Leuven(UZL), a prolonged strategy was used, where EBAT was given until neutrophil recovery. The primary endpoint was a serious medical complication(SMC) defined as death or ICU admission in the 30 days after the start of chemotherapy. FINDINGS: 305 and 270 AML or MDS patients received chemotherapy at EMC and UZL, respectively. Broad-spectrum antibiotic treatment was given for a median of 19 days (IQR13-25) at UZL versus 9 days at EMC (IQR5-13) (p <0·001). With the 3-day EBAT strategy, an SMC was observed in 12·5% versus 8·9% with the prolonged strategy (p = 0·17). The hazard ratio for an SMC was not significantly higher with the 3-day strategy (HR 1·357,95%CI 0·765-2·409). INTERPRETATION: This study suggests that during remission induction chemotherapy it is safe to stop antibiotics after 3 days of FN in absence of infection. A comparison of both strategies in a prospective trial should be pursued.

A solution concentration dependent transition from self-stratification to lateral phase separation in spin-cast PS:d-PMMA thin films.

Thin films with a rich variety of different nano-scale morphologies have been produced by spin casting solutions of various concentrations of PS:d-PMMA blends from toluene solutions. During the spin casting process specular reflectivity and off-specular scattering data were recorded and ex situ optical and atomic force microscopy, neutron reflectivity and ellipsometry have all been used to characterise the film morphologies. We show that it is possible to selectively control the film morphology by altering the solution concentration used. Low polymer concentration solutions favour the formation of flat in-plane phase-separated bi-layers, with a d-PMMA-rich layer underneath a PS-rich layer. At intermediate concentrations the films formed consist of an in-plane phase-separated bi-layer with an undulating interface and also have some secondary phase-separated pockets rich in d-PMMA in the PS-rich layer and vice versa. Using high concentration solutions results in laterally phase-separated regions with sharp interfaces. As with the intermediate concentrations, secondary phase separation was also observed, especially at the top surface.

Invasive fungal infections in patients treated with Bruton's tyrosine kinase inhibitors.

Bruton's tyrosine kinase (BTK) inhibitors are increasingly used in untreated and previously treated chronic lymphocytic leukaemia (CLL) patients. Invasive fungal infections (IFI) were rarely observed in patients treated for CLL in the pre-BTK era. In this article, we describe two patients with CLL who developed an IFI during treatment with the BTK inhibitor ibrutinib. The atypical presentation and the serious course of this complication are described.

Central diabetes insipidus: A rare complication of IVH in a very low birth weight preterm infant.

A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant's initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted. The combination of persistent hypernatremia (150-160 mmol/l), polyuria (8.4 ml/kg/hr), high plasma osmolality (323 mosm/kg), hyposthenuria (75 mosm/kg) and an undetectable serum ADH (<0.8 pg/ml) confirmed the diagnosis of central diabetes insipidus (CDI). Serum sodium and urine output decreased and urine osmolality increased after subcutaneous DDAVP administration.CDI is an uncommon cause of hypernatremia in the neonatal period. The diagnosis can be difficult as excessive urine output and high serum sodium can often be attributed to high insensible water loss in the extremely premature newborn. CDI in our patient was thought to be due to grade III-IV IVH complicated by post-hemorrhagic hydrocephalus.In conclusion, the diagnosis of central DI should be considered as a complication of severe IVH in the extremely premature neonate who demonstrates persistent hypernatremia, polyuria, decreased urine osmolality, and increased plasma osmolality. Serum ADH levels can be helpful in confirming the central origin of DI and subcutaneous desmopressin can be an effective treatment in the preterm infant.

Double-negative regulatory T cells induce allotolerance when expanded after allogeneic haematopoietic stem cell transplantation.

Double-negative (DN) regulatory T cells (Tregs) are specialized T lymphocytes involved in the down-modulation of immune responses, resulting in allotolerance after allogeneic haematopoietic stem cell transplantation (HSCT). Most of the properties of DN Tregs were identified in murine models, including the unique ability to suppress alloreactive syngeneic effector T cells in an antigen-specific manner via Fas/Fas-ligand interactions. We investigated the behaviour of DN Tregs following human allogeneic HSCT with regard to occurrence of graft-versus-host disease (GvHD) and restoration of T-cell receptor repertoire in a cohort of 40 patients. The frequency of DN Tregs and CD4/CD8 TCR repertoire was measured serially and at the time of diagnosis of GvHD by flow cytometry. Analysis demonstrated a positive correlation between degree of alloreactivity, as measured by grade of GvHD, and the number of variable beta chain (Vbeta) family expansions in both T-cell populations. We also found that a deficiency of DN Tregs was associated with an increased number of Vbeta family expansions, and most importantly, with the occurrence of GvHD. All individuals who demonstrated more than 1% DN Tregs did not develop GvHD, providing evidence that DN Tregs participate in peripheral tolerance to prevent GvHD when expanded after allogeneic HSCT.

Alkylamine sensing using langmuir-blodgett films of n-alkyl-N-phenylamide-substituted zinc porphyrins.

Two porphyrin compounds, zinc(II) 5,10,15,20-tetrakis(3,5,5-trimethyl- N-phenylhexanamide)porphyrin and zinc(II) 5,10,15,20-tetrakis(2,2-dimethyl- N-phenylpropanamide)porphyrin, have been investigated as possible candidates for the detection of alkylamines. UV-visible spectroscopy has shown that their solution absorption spectra are significantly modified upon interaction with a range of organic analytes, including acetic acid, butanone, ethylacetate, hexanethiol, octanal, octanol, alkylamines, and trimethylphosphite. Large spectral changes are observed for the family of alkylamines as a result of the specific affinity between zinc and the amine moiety. Langmuir-Blodgett (LB) films of the porphyrins have been fabricated in order to assess their solid-state sensing capability toward amines. The surface pressure-area (Pi- A) isotherms reveal a clear three-phase Langmuir film behavior and show that these monolayer films may be compressed to a relatively high surface pressure ( approximately 40-50 mN m (-1)). The isotherm data alongside molecular modeling suggest a relatively flat orientation of the porphyrin rings of both compounds: that is, a mutually parallel alignment of the plane of the porphyrin ring and that of the water surface. LB films deposited at 15 mN m (-1) have been exposed to alkylamine vapor (carried by N 2). A red shift and increase in intensity of the Soret band absorbance is observed which can be reversed by flowing pure N 2 over the gently heated sample (60 degrees C) after exposure. Primary amines were expected to invoke the greatest sensing response due to (i) their larger association constants with these porphyrins compared to secondary and tertiary amines and (ii) the ease of diffusion of amines which is expected to follow the order primary > secondary > tertiary due to the steric hindrance arising from the bulky secondary and tertiary amines. However, the magnitude of the absorbance change is largest for exposure to the secondary amines, dipropylamine and dibutylamine, for both porphyrins, compared to primary and tertiary amines. This trend follows that observed when the amines were added to solutions of the porphyrins. The rate of response of the porphyrin LB films falls as the molecular weight of the diffusing alkylamine increases. Furthermore, a greater rate of response is observed for the phenylhexanamide porphyrin compared to the phenylpropanamide porphyrin due to its lower molecular density within the LB film and therefore more porous structure.

Experimental and simulational study of the operation conditions for a high transmission mass filter.

The operation conditions of a double pulsed field mass filter were studied using both experiment and simulation. The mass filter consists of two pairs of parallel plates and operates on the time-of-flight principle. The study showed that the ions' beam deflection angle is a critical factor in optimizing the mass filter transmission efficiency. This angle is dependent on the accelerating voltage, ion mass, and horizontal velocity of the ions. The optimum operating conditions for the mass filter were found and used to study the mass distribution of palladium ions produced by a magnetron sputtering source. The study shows that this mass filter is suitable for technological applications because of its high transmission and wide mass range.

Structure-function and biological role of betacellulin.

Betacellulin (BTC) belongs to the epidermal growth factor (EGF) family of peptide ligands that are characterised by a six-cysteine consensus motif that forms three intra-molecular disulfide bonds crucial for binding the ErbB receptor family. BTC was initially described, purified and cloned from a mouse insulinoma cell line. BTC is proteolytically processed from a larger membrane-anchored precursor and is a potent mitogen for a wide variety of cell types. BTC binds and activates ErbB-1 and ErbB-4 homodimers and is further characterised by its unique ability to activate all possible heterodimeric ErbB receptors. BTC is widely expressed in most tissues and various body fluids, including milk. Expression is particularly high in the pancreas where it is thought to play a role in the differentiation of pancreatic beta cells. While much is known about the ErbB receptor binding characteristics of BTC and its effect on a variety of cultured cells under different conditions, the challenge that lies ahead is to determine the role of BTC in vivo. This review will focus on the structure of BTC and the various biological effects ascribed to this member of the EGF family.

An assessment of pain responses to thermal stimuli during stages of pregnancy.

A study utilizing visual analogue scale (VAS) responses to 43-51 degrees C nociceptive thermal stimuli was carried out to determine whether women demonstrate a change in pain responsiveness across stages of pregnancy. Fifteen women tested in late pregnancy, labor, and post partum showed no significant differences in VAS responses to thermal stimuli across these stages. The results indicate that no central pain inhibitory system is active during late pregnancy or labor.

Purification and molecular characterization of recombinant rat betacellulin.

A method for the large scale expression and purification of rat betacellulin (BTC) from Escherichia coli has been developed using a cleavable fusion protein strategy. Insoluble fusion protein collected as inclusion bodies was dissolved in urea under reducing conditions, re-folded, and purified by gel filtration chromatography and C(4) RP-HPLC. Authentic rat BTC was obtained after proteolytic cleavage of the fusion protein with Factor Xa. Factor Xa cleaved an additional site within the BTC protein, generating a truncated isoform separable from full-length BTC by heparin-affinity chromatography. Recombinant rat BTC stimulated the proliferation of mouse Balb/c 3T3 fibroblasts and competed for binding to the ErbB1 receptor in a dose-dependent manner analogous to that of BTC purified from natural sources.

Measurement of betacellulin levels in bovine serum, colostrum and milk.

Betacellulin, a member of the epidermal growth factor (EGF) family, was originally isolated and identified from the conditioned medium from a murine pancreatic beta-cell carcinoma cell line. Recently, we isolated bovine betacellulin from a growth factor enriched cheese whey extract, but there is no information on the presence of betacellulin in other biological fluids. We have cloned the cDNA for bovine betacellulin, produced recombinant betacellulin and shown that it has a similar potency to the purified native molecule in stimulating the proliferation of Balb/c3T3 fibroblasts. We have produced a polyclonal antiserum to bovine betacellulin which did not cross-react with EGF or transforming growth factor-alpha (TGF-alpha). The antibody was used in a homologous RIA that was able to detect betacellulin in pooled bovine colostrum sampled during the first 3 days after calving (2.30+/-0.11 ng/ml mean+/-s.e.m.; n=6), in bovine milk soluble fraction (1.93+/-0.64 ng/ml mean+/-s.e.m.; n=5) and in bovine cheese whey (2.59+/-0.16 ng/ml mean+/-s.e.m.; n=3). The betacellulin concentration in foetal bovine serum (FBS) (3.68+/-0.59 ng/ml mean+/-s.e.m.; n=6) greatly exceeded that of betacellulin in serum from male calves 1 and 5 weeks of age (0.53+/-0.15 ng/ml and 0.70+/- 0.09 ng/ml respectively; mean+/-s.e.m.; n=9). Betacellulin measured in the serum of these same animals when aged between 27 and 43 weeks was below the detection limits of the RIA. Sera from 10 out of 36 unmated heifers contained betacellulin levels within the detection limits of the assay (0.433+/-0.06 ng/ml mean+/-s.e.m.; n=10). The presence of betacellulin in bovine colostrum and milk suggests that it plays a role in the growth and development of the neonate and/or mammary gland function. The results also show that betacellulin is undetectable in the castrated adult male circulation. Additionally, although present in very low amounts, serum betacellulin could be under hormonal regulation in the female, since betacellulin was detected in sera from 27% of the unmated heifers examined in this study. The high levels of betacellulin detected in FBS relative to newborn and adult serum suggests a possible endocrine role for this growth factor in the bovine foetus.

Effect of the glutamine synthetase inhibitor, methionine sulfoximine, on the growth and differentiation of Dictyostelium discoideum.

To examine further the role of the enzyme glutamine synthetase in Dictyostelium discoideum we report here the effects of a specific glutamine synthetase inhibitor, methionine sulfoximine, on the growth and differentiation of this organism. Vegetative AX3 cells grown in the presence of methionine sulfoximine did not complete culmination in the normal time but were blocked at the finger stage. In these cells glutamine synthetase activity was almost completely abolished. However, methionine sulfoximine did not affect the level of glutamine synthetase mRNA, suggesting that there is no link between glutamine synthetase activity and mRNA transcription. Eventually glutamine synthetase activity reappeared and at the time culmination occurred. These results suggest that glutamine synthetase plays an important role in the assimilation of ammonia during the later stages of development in D. discoideum and that this assimilation is necessary for the completion of culmination.

A calcium and calmodulin-dependent protein kinase present in differentiating Dictyostelium discoideum.

A protein kinase from Dictyostelium discoideum which phosphorylates the synthetic peptide, calmodulin-dependent protein kinase substrate (CDPKS, amino acid sequence: PLRRTLSVAA) and is stimulated by Ca2+/calmodulin is described. This is the first report of a protein kinase with these characteristics in D. discoideum. The enzyme was partially purified by Q-Sepharose chromatography. The protein kinase is very labile, and rapidly loses Ca2+/calmodulin-dependence upon standing at 4 degrees C, even in the presence of protease inhibitors, making further purification and characterisation difficult. In the active fractions, a 55 kDa polypeptide is labelled with [gamma-32P]ATP in vitro under conditions in which intramolecular rather than intermolecular reactions are favoured. The phosphorylation of this peptide is stimulated in the presence of Ca2+ and calmodulin but not Ca2+ alone. Ca2+/calmodulin-dependent stimulation is inhibited in the presence of the calmodulin antagonist, trifluoperazine (TFP). It is proposed that the 55 kDa polypeptide may represent the autophosphorylated form of the enzyme.

American Academy of Dermatology guidelines of care. Development and process.

Medical practice guidelines are being developed at an accelerating pace, in all areas of medicine, for a wide range of uses. The field of practice guideline development is not new, but a number of important economic and health care issues have renewed interest in their creation. In 1987, in response to many of these issues, the American Academy of Dermatology took a leadership role and began a process designed to develop guidelines for disease entities treated by dermatologists. The result was a set of clinical practice guidelines and the most comprehensive dermatology guideline development processes to date. Herein we describe the guideline development process in its current, refined form and discuss some of its unique and important characteristics. New applications of guidelines, outside of clinical practice improvement, have made their development controversial. Nevertheless, it is important for the medical profession to lead in this effort, and the American Academy of Dermatology continues to explore ways to refine and update its guidelines to reflect the latest medical science and technology.

The effects of partial and total interosseous membrane transection on load sharing in the cadaver forearm.

This study was performed to examine the effects of partial and total transection of the interosseous membrane (IOM) on load transfer in the forearm. Twenty fresh frozen forearms were instrumented with custom designed load cells placed in the proximal radius and distal ulna. Simultaneous measurements of load cell forces, radial head displacement relative to the capitellum, and local tension within the central band of the IOM were made as the wrist was loaded to 134 N with the forearm at 90 degrees of elbow flexion and in neutral pronation supination. For valgus elbow alignment (radial head contacting the capitellum), mean force carried by the distal ulna was 7.1% of the applied wrist force and mean force transferred from radius to ulna through the IOM was 4.4%. For varus elbow alignment (mean 2.0 mm gap between the radial head and capitellum), mean distal ulna force was 28% and mean IOM force was 51%. Section of the proximal and distal one-thirds of the IOM had no significant effect upon mean distal ulnar force or mean IOM force. Total IOM section significantly increased mean distal ulnar force for varus elbow alignment in all wrist positions tested. The mean level of applied wrist force necessary to close the varus gap (89 N) decreased significantly after both partial IOM section (71 N) and total IOM section (25 N). The IOM became loaded only when the radius displaced proximally relative to the ulna, closing the gap between the radius and capitellum. As the radius displaced proximally, the wrist becomes increasingly ulnar positive, which in turn leads to direct loading of the distal ulna. This shift of force to the distal ulna could present clinically as ulnar sided wrist pain or as ulnar impaction after IOM injury.

Effects of radial head excision and distal radial shortening on load-sharing in cadaver forearms.

BACKGROUND: The present study was performed to measure changes in radioulnar load-sharing in the cadaveric forearm following two orthopaedic surgical procedures that often have varying results: radial head excision and distal radial shortening. A better understanding of the biomechanical consequences of those procedures could aid surgeons in obtaining a more satisfactory clinical outcome. METHODS: Miniature load-cells were inserted into the proximal part of the radius and the distal part of the ulna in twenty fresh-frozen cadaveric forearms. Load-cell forces, radial head displacement relative to the capitellum, and local tension within the central band of the interosseous membrane were measured simultaneously as the wrist was loaded to 133.5 N in neutral pronation-supination and neutral radioulnar deviation. Testing was repeated after incremental distal radial shortening and after removal of the radial head. RESULTS: With the elbow flexed to 90 degrees and in valgus alignment (the radial head in contact with the capitellum), the mean force in the distal part of the ulna was 7.1% of the applied wrist force and the mean force in the interosseous membrane was 4.0%. With the elbow in varus alignment (a mean initial gap of 1.97 mm between the radial head and the capitellum), the respective mean values were 27.9% and 51.2%. After excision of the radial head, the mean force in the distal part of the ulna increased to 42.4% of the applied wrist force and the mean force in the interosseous membrane increased to 58.8%, in both varus and valgus elbow alignment. The mean distal ulnar force increased with progressive distal radial shortening in both varus and valgus elbow alignment; after 6 mm of radial shortening, the distal ulnar force averaged 92.4% (in varus alignment) and 60.9% (in valgus alignment). Equal distal load-sharing between the radius and ulna occurred after approximately 5 mm of radial shortening with the elbow in valgus alignment and after approximately 2 mm of radial shortening with the elbow in varus alignment. In valgus alignment, the force in the interosseous membrane was negligible after all degrees of radial shortening; in varus alignment, the mean force in the interosseous membrane decreased from 51.2% (0 mm of distal radial shortening) to 0% (6 mm of distal radial shortening) because of progressive slackening of the interosseous membrane. CONCLUSIONS: Radial head excision shifted the applied wrist force that normally would be transmitted to the elbow, through radial head-capitellar contact, to the interosseous membrane. The resulting proximal radial displacement created an ulnar-positive wrist and increased distal ulnar loading. Radial shortening and ulnar lengthening procedures have been designed to shift the applied wrist force from the distal part of the radius to the distal part of the ulna; it is commonly assumed that these procedures have equivalent biomechanical effects. We found that radial shortening resulted in slackening of the interosseous membrane, thereby negating its ability to transmit load through the forearm. Slackening of the interosseous membrane would not be expected with distal ulnar lengthening procedures. CLINICAL RELEVANCE: When the radial head has been fractured or excised, the mechanical status of the interosseous membrane is critical to the load-sharing process. If the interosseous membrane remains intact, distal ulnar loads will be limited to less than half of the applied wrist force; if the interosseous membrane has been damaged, nearly the entire applied wrist force will be shifted to the ulna. The amount of radial shortening or ulnar lengthening performed at the time of surgery during joint-leveling procedures has been largely empirical. We found that distal ulnar load increased by approximately 10% for each millimeter of radial shortening.

Implementing the North Karelia Project in Scotland.

A comprehensive, determined and theory-based community programme can have a meaningful and positive effect on risk factors and life styles. In much the same way as the North Karelia Project was rolled out to cover the whole of Finland, there is no reason why our intervention schemes could not be rolled out to cover the whole of Scotland. The North Karelia Project proved that a major national demonstration programme can be a strong tool for favourable national development in chronic disease prevention and health promotion.

The influence of using digital diagnostic information on orthodontic treatment planning - a pilot study.

The purpose of this pilot study was to assess whether orthodontic treatment planning is reproducible when carried out using digital records compared with clinical examinations or using standard records. The study also assessed patients' opinion of face-to-face consultations and potential use of teleorthodontics. The study was designed as a prospective observational cross-sectional pilot study and carried out in a UK dental teaching hospital involving 27 subjects. Four consultant Orthodontists carried out treatment planning, firstly following a clinical examination, then using standard records, and then using digital records. Each subject completed a questionnaire. Cohen's kappa coefficient and Fleiss' kappa coefficient were used to assess intra-observer reproducibility and inter-observer reproducibility of treatment planning decisions, respectively. A change in the diagnostic information format affected treatment planning reproducibility for half of the observers. Inter-observer reproducibility was greater when using hard copy records in comparison to digital records. No subjects were unsatisfied with their face-to-face consultation.