Aqua-{µ-1,4-bis-[(1,4,7,10-tetra-aza-cyclo-dodecan-1-yl)meth-yl]benzene}(nitrato-κO)dicopper(II) tris-(nitrate) trihydrate.

In the title dinuclear CuII complex, [Cu2(NO3)(C24H46N8)(H2O)](NO3)3·3H2O, the two CuII mol-ecules both have a square-pyramidal geometry, but the ligands in the axial positions are different: a water mol-ecule and a nitrate ion. All nitrate ions, water mol-ecules, and N-H groups are involved in an inter-molecular hydrogen-bond network.

Epidemiology of bloodstream infections and surface swab cultures in burn patients.

Aim: For infection control in burn patients, it is essential to understand the epidemiology of bloodstream infection (BSI) and the local microbiological situation. There are few studies on blood and swab culture results among burn patients in Japan. The purpose of this study was to investigate the epidemiology of BSI and swab cultures in burn patients. Methods: Data from 355 burn patients over 13 years from 2008 were analyzed retrospectively. Bloodstream infection was defined as the isolation of bacteria or fungi from two or more blood cultures. The characteristics of burn patients and microorganisms detected from various cultures were analyzed. Results: The mortality rate among burn patients with BSI was 37.8%, which was more than twice that among burn patients without BSI. The univariate analysis showed that inhalation injury, total burn surface area (TBSA), and mortality were associated with BSI. The multivariate logistic analysis indicated that TBSA was an independent risk factor for BSI. The most frequently isolated organism from blood and swab cultures were Candida species and Pseudomonas aeruginosa, respectively. Seventy-five percent of the microorganisms isolated from blood were detected previously in swab cultures performed within 1 week from blood cultures. Conclusions: The prognosis of burn patients with BSI was poor, and TBSA was an independent risk factor for BSI. The predominant organisms isolated from blood and swab cultures were Candida species and P. aeruginosa, respectively. Surveillance wound swab cultures could be utilized for monitoring the local microbiological situation in burn patients.

Delayed tension gastrothorax caused necrosis of stomach and re-expansion pulmonary edema: a case report.

BACKGROUND: Traumatic tension gastrothorax is a rare and potentially fatal condition occurring in patients with congenital or acquired diaphragmatic defects. Traumatic tension gastrothorax leads to acute and severe respiratory distress. Delayed tension gastrothorax that develops late during injury can be more severe. CASE PRESENTATION: An 84-year-old woman was brought to our facility with cardiac arrest and returned to spontaneous circulation after 2 min of cardiopulmonary resuscitation. Computed tomography showed diaphragmatic injury and tension gastrothorax due to trauma because of a fall episode few days earlier. Emergency thoracotomy and laparotomy was performed, because nasogastric tube insertion failed. There was a partially necrotic stomach in the chest cavity. The stomach was retracted from the thoracic cavity into the abdominal cavity and placed in its proper position. There was a 5 cm tear of the diaphragm. The tear was sutured and closed and then the necrotic area of the stomach was resected. Although the surgery relieved the intrathoracic compression, it resulted in re-expansion pulmonary edema immediately after surgery and hypoxemia. The patient was unable to overcome the hypoxemic state and eventually died. CONCLUSIONS: Delayed tension gastrothorax can lead not only to obstructive shock due to intrathoracic compression but also to more severe organ ischemia and re-expansion pulmonary edema due to insufflation.

Radiation Emergency Medical Preparedness in Japan: A Survey of Nuclear Emergency Core Hospitals.

OBJECTIVE: Based on experiences following the Great East Japan Earthquake and nuclear power plant accident in 2011, Nuclear Emergency Core Hospitals (NECHs) were designated as centers for radiation disaster management in Japan. This study aimed to investigate their current status and identify areas for improvement. METHODS: This cross-sectional study was conducted in October 2018. Demographic data were collected by a questionnaire with free text responses about attitudes toward NECHs. Considerations regarding risk communications during a radiation disaster were analyzed using qualitative text mining analysis. RESULTS: A total of 36 hospitals participated in this study. Only 31% of NECHs anticipated a radiation disaster. The importance of business continuity plans and risk communications was shown. Text analysis identified 7 important categories for health care workers during a radiation disaster, including media response, communications to hospital staff, risk communications, radiation effects on children, planning for a radiation disaster in the region, rumors, and the role in the region. CONCLUSION: The radiation disaster medical system and NECHs in Japan were surveyed. The importance of risk communications, planning for a radiation disaster in each region, and the role in the region are identified as issues that need to be addressed.

In-hospital mortality among patients with invasive non-group A ß-hemolytic Streptococcus treated with clindamycin combination therapy: a nationwide cohort study.

AIM: Combination treatment with clindamycin is recommended in patients with invasive group A Streptococcus infection; however, whether the same treatment is effective in invasive group B Streptococcus and S. dysgalactiae subspecies equisimilis infections remains unknown. We aimed to investigate whether clindamycin added to standard of care therapy would be effective in patients with invasive non-group A ß-hemolytic Streptococcus infections. METHODS: This was a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database focusing on the period between 2010 and 2018. We extracted data on patients diagnosed with sepsis due to non-group A ß-hemolytic Streptococcus. One-to-four propensity score-matching was undertaken to compare patients who were treated with clindamycin within 2 days of admission (clindamycin group) and those who did not (control group). The primary outcome was in-hospital mortality. RESULTS: We identified 3754 eligible patients during the study period. The patients were divided into the clindamycin (n = 296) and control groups (n = 3458). After one-to-four propensity score matching, we compared 289 and 1156 patients with and without clindamycin, respectively. In-hospital mortality did not significantly differ between the two groups (9.7% versus 10.3%; risk difference 0.3%; 95% confidence interval, -3.5% to 4.2%). CONCLUSIONS: This nationwide database study showed that combination therapy involving the use of clindamycin was not associated with lower in-hospital mortality in patients with invasive non-group A ß-hemolytic Streptococcus.

DNA-cleavage activity of the iron(II) complex with optically active ligands, meta- and para-xylyl-linked N',N'-dipyridylmethyl-cyclohexane-1,2-diamine.

DNA-cleavage agents such as bleomycin have potential anticancer applications. The development of a DNA-cleavage reagent that recognizes specific sequences allows the development of cancer therapy with reduced side effects. In this study, to develop novel compounds with specific DNA-cleavage activities, we synthesized optically active binuclear ligands, (1R,1'R,2R,2'R)-N1,N1'-(meta/para-phenylenebis(methylene))bis(N2,N2-bis(pyridin-2-ylmethyl)cyclohexane-1,2-diamine) and their enantiomers. The DNA-cleavage activities of these compounds were investigated in the presence of Fe(II)SO4 and sodium ascorbate. The obtained results indicated that the Fe(II) complexes of those compounds efficiently cleave DNA and that their cleavage was subtle sequence-selective. Therefore, we succeeded in developing compounds that can be used as small-molecule drugs for cancer chemotherapy.

Design and synthesis of an anthranyl bridged optically active dinuclear iron(II)-ligand and evaluation of DNA-cleaving activity.

It is necessary to design a ligand that is compatible with the target molecule to optimally use the DNA-cleaving ability of metal complexes. In this study, we synthesized an optically active dinuclear ligand, (1R,1'R,2R,2'R)-N1,N1'-(anthracene-1,8-diylbis(methylene))bis(N2,N2-bis(pyridin-2-ylmethyl)cyclohexane-1,2-diamine) (R-ABDC, 4a) and its enantiomer (S-ABDC, 4b). We then prepared their Fe(II) complexes by mixing the ligand with FeSO4·7H2O in situ and investigated DNA-cleaving activities using plasmid DNA in the presence of excess sodium ascorbate at atmospheric conditions. The Fe(II) complexes efficiently cleaved DNA and selectively recognized two consecutive A and/or T sequences.

Two Cases of Post-intubation Laryngotracheal Stenosis Occurring after Severe COVID-19.

We experienced two cases of post-intubation laryngotracheal stenosis (PILS) occurring in patients after acute coronavirus disease (COVID)-19 in a relatively narrow time period. The patients required mechanical ventilation for 9 days in one and 28 days in the other. In both cases, the patients were discharged but later developed symptoms of cough and dyspnea, which were later diagnosed as PILS. Persistent cough and dyspnea are common symptoms in both PILS and the recovery phase of severe COVID-19. For this reason, PILS should be considered in the differential diagnosis post-COVID-19 patients. In addition, the prevalence of PILS may be greater than that of other critical diseases in severe COVID-19 patients.

Activation of Ligand Reaction on an Iron Complex: H/D Exchange Reaction of a Low-Spin Bis[2-(Pyridylmethylidene)-1-(2-pyridyl)methylamine]iron(II) Complex.

With the aim of shedding some light on the still scarcely investigated mechanism of transformation of imines in metal complexes, this study describes the investigation of the hydrogen-deuterium (H/D) exchange reaction of a bis[2-(pyridylmethylidene)-1-(2-pyridylmethylamine]iron(II) complex ([Fe(PMAP)2]2+), following our previous work on a low-spin iron(II) complex bearing two molecules of S-2-pyridylmethylidene-1-(2-pyridyl)ethylamine. This complex has been proven to undergo successive transiminations in acetonitrile, yielding a bis[1-(2-pyridyl)ethylidene-2-pyridylmethylamine]iron(II) complex. In the analogous [Fe(PMAP)2]2+ complex, a 1,3-hydrogen rearrangement occurs in a 10% deuterium oxide-acetonitrile-d3 (D2O-CD3CN) solution. The H/D exchange reaction of [Fe(PMAP)2]2+ was examined in the presence of various concentrations of 2,6-dimethylpyridine as a base in a 10% D2O-CD3CN solution at 45 °C, and the reaction mechanism was investigated.

Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational study.

AIM: Clinical guidelines for acute lower gastrointestinal bleeding (LGIB) recommend non-endoscopic treatment when endoscopic treatment is difficult or the patient is hemodynamically unstable. The aim of this study was to investigate whether angiography should be prioritized as initial treatment for severe LGIB patients over colonoscopy. METHODS: We undertook a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We compared adult patients who underwent colonoscopy or angiography within 1 day of admission for severe LGIB from 2010 to 2017. The primary outcome was in-hospital mortality. Secondary outcomes included surgery carried out within 1 day after admission and surgery carried out between 2 and 7 days of admission. Propensity score-matched analyses were undertaken to adjust for confounders. RESULTS: We identified 6,546 eligible patients. The patients were divided into the colonoscopy group (n = 5,737) and angiography group (n = 809). After one-to-four propensity score matching, we compared 3,220 and 805 patients who underwent colonoscopy and angiography, respectively. The angiography group was not significantly associated with reduced in-hospital mortality compared with the colonoscopy group. In contrast, the number of patients who underwent surgery within 1 day of admission was significantly lower in the angiography group than in the colonoscopy group. CONCLUSIONS: The present study revealed that in-hospital mortality did not significantly differ between colonoscopy and angiography, even in severe LGIB patients. Although this study was unable to identify which subgroups should undergo angiography for primary hemostasis, angiography might be a better option than colonoscopy for initial hemostasis in more severe cases of LGIB.

The relationship between neurosensory disturbance of the inferior alveolar nerve and the lingual split pattern after sagittal split osteotomy.

OBJECTIVE: The aim of this study was to evaluate the relationship between neurosensory disturbance (NSD) and the different types of bilateral sagittal split osteotomy (BSSO) lingual fracture created. STUDY DESIGN: The study group consisted of 45 patients with mandibular deformities (90 sides; 14 males and 31 females). Computed tomography (CT) scans were obtained preoperatively and 1 week postoperatively. All patients were divided into lingual fracture line groups on the basis of their postoperative scans. NSD was tested preoperatively and 1, 3, and 12 months postoperatively by using a sensory touch Semmes-Weinstein (SW) test and the 2-point discrimination (TPD) test. RESULTS: Patients were divided into 2 groups on the basis of their lingual fracture lines after mandibular BSSO; among the 45 patients, 39 sides (43.3%) had short-splits, and 51 sides (56.7%) had long-splits. The short-split group was less affected at all tested times, and the difference between the 2 groups was significant 1 month postoperatively on TPD test but not at other times on the both tests. CONCLUSIONS: The split type did not affect the NSD incidence at 3 and 12 months postoperatively.

The stability of HIV-2 Vpx and Vpr proteins is regulated by the presence or absence of zinc-binding sites and poly-proline motifs with distinct roles.

The Vpx and Vpr proteins of human immunodeficiency virus type 2 (HIV-2) are important for virus replication. Although these proteins are homologous, Vpx is expressed at much higher levels than Vpr. Previous studies demonstrated that this difference results from the presence of an HHCC zinc-binding site in Vpx that is absent in Vpr. Vpx has another unique region, a poly-proline motif (PPM) of seven consecutive prolines at the C-terminus. Using PPM point mutants of Vpx, this study demonstrated that these seven consecutive prolines are critical for suppressing proteasome degradation of Vpx in the absence of Gag. Both the PPM and the zinc-binding site stabilize Vpx but do so via different mechanisms. PPM and zinc-binding site mutants overexpressed in Escherichia coli aggregated readily, indicating that these motifs normally prevent exposure of the hydrophobic region outside the structure. Furthermore, introduction of the zinc-binding site and the PPM into Vpr increased the level of Vpr expression so that it was as high as that of Vpx. Intriguingly, HIV-2 has evolved to express Vpx at high levels and Vpr at low levels based on the presence and absence of these two motifs with distinct roles.

Reevaluation for prognostic value of prognostic burn index in severe burn patients.

AIM: The prognostic burn index (PBI), which consists of half partial-thickness burn surface area plus full-thickness burn surface area and age, has been widely used to predict mortality in Japan. However, the prognostic value of PBI has not been investigated sufficiently. The purpose of the present study is to clinically reevaluate the PBI in severe burn patients. METHODS: Data of 69 severe burn patients admitted to the burn center at Kyorin University Hospital (Tokyo, Japan) from January 2008 to December 2017 were analyzed retrospectively. The primary outcome in this study was in-hospital mortality. RESULTS: The overall in-hospital mortality rate was 34.8%. There were significant differences in age, the presence of inhalation injury, total burned surface area, full-thickness burn area, burn index, and PBI between survivors and non-survivors. In logistic regression analysis, PBI was independently associated with mortality, while the presence of inhalation injury was not. A PBI above the threshold of 105 was significantly associated with in-hospital mortality. The area under the receiver operating characteristic curve for PBI was 0.85 (95% confidence interval, 0.73-0.93). CONCLUSION: The PBI could be a good prognostic indicator. A PBI above the threshold of 105 was associated with mortality among severe burn patients treated in burn-care facilities.

The Accuracy of Maxillary Position Using a Computer-Aided Design/Computer-Aided Manufacturing Intermediate Splint Derived Via Surgical Simulation in Bimaxillary Orthognathic Surgery.

PURPOSE: The purpose of this study was to assess the clinical interventions and the accuracy of maxillary reposition using a computer-aided design/computer-aided manufacturing (CAD/CAM) splint derived via surgical simulation. MATERIALS AND METHODS: The retrospective study comprised 24 patients who underwent bimaxillary surgery. The patients were assigned to 1 of 2 groups by a way of maxillary repositioning. One group received conventional intermediate wafers and the other CAD/CAM wafers during Le Fort I osteotomy. We recorded operation time, blood loss, the operative accuracy. Accuracy was analyzed by 3-dimensional computed tomography images before and immediately after the operation. The evaluation points were the right maxillary first incisor (U1), the right maxillary second molar (M2-right), and the left maxillary second molar (M2-left). RESULTS: The 2 groups did not differ significantly in operation time and blood losses. The vertical axis of U1 data differed significantly between the 2 groups (P = 0.008). None of the horizontal, vertical, or anteroposterior axis of M2-right data differed significantly, and anteroposterior axis of M2-left data differed significantly (P = 0.0296). The CAD/CAM group 3-dimensional distance errors were less than those of the conventional group for all points. CONCLUSION: Placement of CAD/CAM splint allowed highly accurate repositioning; the accuracy exceeded that afforded by conventional model surgery using a facebow and articulator.

Diagnostic accuracy for drug detection using liquid chromatography/mass spectroscopy in overdose patients.

AIM: Information about the causative drugs is essential for appropriate treatment for drug overdose, but patients sometimes cannot provide information about overdosed drugs owing to disturbed consciousness or an unwillingness to cooperate with treatment. The purpose of this study was to decide whether liquid chromatography/mass spectroscopy (LC/MS) is useful as a detection method for overdosed drugs. METHODS: Overdose patients (n = 279) treated in our facility were retrospectively studied. Specimens from gastric lavage, blood serum, and urine were tested using LC/MS. The matching rates between drugs overdosed and those detected by LC/MS were evaluated; LC/MS and Triage DOAR were also compared. Data are shown as means. RESULTS: Patients overdosed on 3.2 kinds of drugs and were transferred to our hospital 4.6 h after. Overall 3.5 kinds of drugs were detected by LC/MS, and 2.4, 1.9, and 2.2 kinds were from the stomach, blood, and urine, respectively. Matching rate among the ingested drugs (kinds of drugs matched/ones ingested) was the highest in the gastric samples (0.56), and the lowest in the urine samples (0.46) (P < 0.01). In addition, the matching rates among the detected drugs (kinds of drugs matched/ones detected) were as high as 0.74 and 0.78 in the gastric and blood samples, respectively. Comparing the sensitivity and specificity of detection of benzodiazepines and tricyclic antidepressants between LC/MS and Triage DOAR, we found that these two methods were comparable. CONCLUSION: Liquid chromatography/mass spectroscopy was proven to be an effective method to detect overdosed drugs, especially when there was not enough information about the drugs ingested.

Pyramidal and posterior osseous release for maxillary superior/posterior mobilization using an ultrasonic bone-cutting device after Le Fort I osteotomy.

AIM: The purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy. MATERIALS AND METHODS: In total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed. RESULTS: The mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003). CONCLUSION: The PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.

Deletion of the Golgi Ca2+-ATPase PMR1 gene potentiates antifungal effects of dodecanol that depend on intracellular Ca2+ accumulation in budding yeast.

One strategy for overcoming infectious diseases caused by drug-resistant fungi involves combining drugs rendered inactive by resistance with agents targeting the drug resistance mechanism. The antifungal activity of n-dodecanol disappears as incubation time passes. In Saccharomyces cerevisiae, anethole, a principal component of anise oil, prolongs the transient antifungal effect of dodecanol by downregulating genes of multidrug efflux pumps, mainly PDR5. However, the detailed mechanisms of dodecanol's antifungal action and the anethole-induced prolonged antifungal action of dodecanol are unknown. Screening of S. cerevisiae strains lacking genes related to Ca2+ homeostasis and signaling identified a pmr1Δ strain lacking Golgi Ca2+-ATPase as more sensitive to dodecanol than the parental strain. Dodecanol and the dodecanol + anethole combination significantly increased intracellular Ca2+ levels in both strains, but the mutant failed to clear intracellular Ca2+ accumulation. Further, dodecanol and the drug combination reduced PMR1 expression and did not lead to specific localization of Pmr1p in the parental strain after 4-h treatment. By contrast with the parental strain, dodecanol did not stimulate PDR5 expression in pmr1Δ. Based on these observations, we propose that the antifungal activity of dodecanol is related to intracellular Ca2+ accumulation, possibly dependent on PMR1 function, with anethole enabling Ca2+ accumulation by restricting dodecanol efflux.

Critical Malperfusion Caused by Central Aortic Repair for Acute Aortic Dissection: A Case Report.

We encountered a case of hepatic malperfusion resulting from central repair for Stanford type A acute aortic dissection (AAD). A 78-year-old woman had AAD, for which ascending aortic repair was performed. Hepatic malperfusion developed 3 days postoperatively. The superior mesenteric and celiac arteries were occluded by a false lumen (FL). We believed that the surgery caused a change in the blood flow in FL. Percutaneous transluminal angioplasty and stenting of the superior mesenteric artery were performed, and the patient's condition improved. Thus, intervention for the branched artery should be performed prior to central repair, depending on the type of malperfusion.

Disaster-related carbon monoxide poisoning after the Great East Japan Earthquake, 2011: a nationwide observational study.

AIM: To investigate disaster-related carbon monoxide (CO) poisoning after the Great East Japan Earthquake using a nationwide inpatient database in Japan. METHODS: This was a retrospective cohort study. We identified adult patients with CO poisoning who were registered in the Japanese Diagnosis Procedure Combination inpatient database from 2010 to 2017. We evaluated trends in the numbers of patients with CO poisoning each month from disaster (Tohoku region) and non-disaster areas. In the disaster area, we compared the numbers of patients with CO poisoning during pre- and post-earthquake periods. We also compared the numbers of CO poisonings after the earthquake (<30 days) and 1 year later. RESULTS: Eligible patients (n = 7,814) were categorized into disaster area (n = 988) and non-disaster area (n = 6,826) groups. The numbers of CO-poisoned patients in the non-disaster area showed a seasonal variation, and there was a significant peak registered on March 11 in the disaster area. In the disaster area, the number of patients with CO poisoning in the post-earthquake period was significantly higher than that in the pre-earthquake period (135 versus 18; odds ratio, 7.50; 95% confidence interval, 4.59-12.3). The number of patients in the post-earthquake period was also significantly higher than that on April 9, 2012, which was one month after the annual follow-up (135 versus 10; odds ratio, 13.5; 95% confidence interval, 7.10-25.7). CONCLUSION: This study showed that CO poisoning significantly increased in the affected area after the Great East Japan Earthquake, underlining the importance of providing information regarding the hazard of earthquake-related CO poisoning.

Effect of "surgery first" orthognathic approach on temporomandibular symptoms and function: a comparison with "orthodontic first" approach.

OBJECTIVE: The aim of this study was to comparatively evaluate the effects of the surgery-first approach (SFA) and the orthodontics-first approach (OFA) on temporomandibular joint (TMJ) function and maximum mouth opening. STUDY DESIGN: This retrospective study investigated the outcomes of patients with diagnosed skeletal class III dentofacial deformities. Twenty-four patients were enrolled in the OFA group, and 23 patients were enrolled in the SFA group. All patients were examined in the same manner 4 times: before surgery and at 1, 3, 6, and 12 months after surgery. Range of mouth opening (ROM) was measured between the maxillary and mandibular central incisors. Symptoms were evaluated subjectively by using a questionnaire with items pertaining to pain on mandibular movements, TMJ sounds, and pain in masticatory muscles region. RESULTS: No severe complications or relapse occurred in either group during the 12-month follow-up period. Postoperative changes in ROM showed similar tendencies, but there was no significant difference in ROM during the follow-up period between the OFA and SFA groups (P < .05). The percentage reduction was nearly 45% at 1 month postoperatively and 20% at 3 months postoperatively compared with the preoperative situation. After 6 months postoperatively, the ROM was almost the same as before surgery. The number of patients with such sounds increased with time until 12-month postoperative examinations in the OFA group but increased slightly during this period in the SFA group. During the first 3 months postoperatively, less than 10% of patients in both groups had newly detected pain of TMJ and/or muscles. At 6 and 12 months postoperatively, only 1 patient in the SFA group had pain. CONCLUSIONS: No significant differences in TMJ symptoms or function were observed during a 12-month follow-up period between patients with skeletal class III malocclusion treated with the SFA and those treated with the OFA.