Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis

ABSTRACT Introduction: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. Objective: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. Material and Methods: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. Results: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). Conclusions: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

RESUMO Introdução: A expansão rápida da maxila assistida cirurgicamente (ERMAC) tem sido o tratamento de escolha em indivíduos que apresentam suturas esqueleticamente maduras. Objetivo: O objetivo deste estudo foi avaliar, utilizando uma análise não linear com elementos finitos, a distribuição de tensões e os deslocamentos das estruturas craniofaciais e dentoalveolares gerados por três tipos de expansores palatinos usados na ERMAC. Material e Métodos: Três tipos de expansores palatinos foram projetados: Modelo I (dento-osseossuportado com quatro mini-implantes), Modelo II (dento-osseossuportado com dois mini-implantes) e Modelo III (osseossuportado com quatro mini-implantes). Uma osteotomia Le Fort I foi realizada e foi simulada uma expansão palatina total de 5,0 mm. Um método de análise não linear (três teorias - teoria da não-linearidade geométrica, teoria do contato não linear e métodos para materiais não lineares) foi utilizado para avaliar a tensão e o deslocamento de diversas estruturas craniofaciais e dentoalveolares. Resultados: Independentemente do tipo de aparelho expansor palatino, a ERMAC produziu maior expansão anterior da maxila do que posterior (ENA variou de 2,675 mm a 3,444 mm e ENP variou de 0,522 mm a 1,721 mm); o Modelo I apresentou padrão de abertura mais paralela da sutura palatina mediana, com ENP/ENA igual a 54%. Com relação à ENA, o Modelo II (1,159 mm) e o Modelo III (1,000 mm) apresentaram maior deslocamento para baixo do que o Modelo I (0,343 mm). A ENP deslocou-se mais para anterior do que a ENA com todos os aparelhos; o Modelo III apresentou o maior deslocamento para anterior da ENP (1,147 mm) e da ENA (1,064 mm). Os três tipos de expansores apresentaram deslocamento dentário semelhante e separação mínima das suturas craniofaciais. Como esperado, diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensões (o expansor osseossuportado apresentou tensão mínima nos dentes, e o expansor dento-osseossuportado com dois mini-implantes apresentou o maior). Conclusões: Com base nesse estudo de elementos finitos, os resultados mostraram que diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensão, com deslocamento mínimo das suturas craniofaciais e diferentes expansões esqueléticas em forma de V.

Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite

Abstract Objective: Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. Methods: A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. Results: There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. Conclusion: Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.

Validity of the Maturation Stage Method in the Individual Assessment of Midpalatal Suture Ossification Before Maxillary Expansion: A Systematic Review / Validez del Método de la Etapa de Maduración en la Evaluación Individual de la Osificación de la Sutura Palatina Mediana Previo a la Expansión Maxilar: Una Revisión Sistemática

In 2013, midpalatal suture maturation stage assessment was proposed for the evaluation of patients before performing maxillary expansion. In this study, we aimed to analyze the association between the midpalatal suture maturation stages assessed by CBCT, according to the method described by Angelieri et al., and other objective methods used to assess skeletal maturation or bone fusion. A computerized database search was conducted using PubMed, Cochrane Library, SciELO, LILACS, Web of Science, and Scopus, without language restriction. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Search terms included midpalatal suture, maturation, correlation, diagnostic performance, classification, evaluation, assessment, and relationship. Quality assessment was performed using the Observational Cohort and Cross-Sectional Studies tool developed by the National Heart, Lung, and Blood Institute. Eleven studies met the inclusion criteria. Of all the studies included, 81.9% had fair qualit y and 18.1% good quality, respectively. Eight out of eleven studies assessed the correlation between the midpalatal suture maturation method and the skeletal maturity evaluated by CVM method (Spearman's correlation coefficient: 0.244-0.908). Two out of eleven studies evaluated the correlation between midpalatal suture maturation method and the skeletal maturity assessed by HWM method (Spearman's correlation coefficient: 0.904-0.905) Even though midpalatal suture maturation stage assessment needs an exhaustive training and calibration process, it is a valid method to evaluate skeletal maturation or bone fusion. From a clinical perspective, for patients at CS4, CS5 and CS6, an assessment of the midpalatal suture on CBCT is indicated. A similar assessment should be done in patients at SMI 7-9.

En 2013, se propuso un nuevo método para la evaluación del estadio de maduración de la sutura palatina mediana para la evaluación de los pacientes antes de realizar la expansión maxilar. En este estudio, nuestro objetivo fue analizar la asociación entre las etapas de maduración de la sutura palatina mediana evaluada en CBCT, según el método descrito por Angelieri et al., y otros métodos objetivos utilizados para evaluar la maduración esquelética o la fusión ósea. Se realizó una búsqueda en las bases de datos PubMed, Cochrane Library, SciELO, LILACS, Web of Science y Scopus, sin restricción de idioma. Se buscó literatura no publicada en ClinicalTrials.gov, el Registro Nacional de Investigación y la base de datos Pro-Quest Dissertation Abstracts and Thesis. Se estableció contacto con los autores cuando fue necesario y se revisaron las listas de referencias de los estudios incluidos. Los términos de búsqueda incluyeron sutura palatina mediana, maduración, correlación, rendimiento diagnóstico, clasificación, evaluación, valoración y relación. La evaluación de la calidad se realizó mediante la herramienta de Estudios transversales y de cohortes observacionales desarrollada por el Instituto Nacional del Corazón, los Pulmones y la Sangre. Once estudios cumplieron con los criterios de inclusión. Del total de estudios incluidos, el 81.9% tuvo calidad regular y el 18.1% calidad buena, respectivamente. Ocho de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método CVM (coeficiente de correlación de Spearman: 0.244-0.908). Dos de once estudios evaluaron la correlación entre el método de maduración de la sutura palatina mediana y la madurez esquelética evaluada por el método HWM (coeficiente de correlación de Spearman: 0.904-0.905). Aunque la evaluación del estado de maduración de la sutura palatina mediana necesita un proceso exhaustivo de entrenamiento y calibración, es un método válido para evaluar la maduración esquelética o la fusión ósea. Desde una perspectiva clínica, para pacientes en CS4, CS5 y CS6, está indicada una evaluación de la sutura palatina mediana en CBCT. Se debe realizar una evaluación similar en pacientes con SMI 7-9.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review

Abstract Objective To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. Methods The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. Results We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. Conclusion Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.

Proposal for the Modification of the Method to Evaluate the Midpalatal Suture Maturation Status / Proposta de Modificação do Método para Avaliação do Status da Sutura Palatina Mediana

The objective of present research was to propose a new definition for the midpalatal suture (MPS) maturational stages through reevaluation of intermediate stages B, C and D. The sample was composed by 158 cone-beam computed tomography (CBCT) of individuals between 11 and 20 years of age (±15.4 years, 86 females and 71 males), divided into two groups: 74 individuals aged 11-15 years and 84 individuals aged 16-20 years. The CBCT scans were applied to evaluate midpalatal suture maturation status and comprised stages previously classified as B (29), C (92) and D (37). Each axial image was subdivided into six parts in the anteroposterior direction, and each portion was classified according to MPS maturational evaluation methodology. New definitions of stages were proposed. The reliability of the method was tested by two examiners and the intra- and inter-examiner concordances were defined for each evaluation through weighted kappa coefficients and 95% confidence intervals. The chi-square test was used to compare the groups. In all statistical tests, a significance level of 5% was adopted. Two new maturational stages were defined: sub-stage C- and sub-stage C+, with prevalence of 12% and 8.9%, respectively, in 11 to 20-year-olds. The redefinition and validation of the maturational stages of MPS, considering the sub-stages C- and C+, may allow to elucidate the difference in the prognosis of Rapid Maxillary Expansion among individuals aged 11 to 20 years. This data should be confirmed through a clinical study.(AU)

O objetivo da presente pesquisa foi propor uma nova definição para os estágios maturacionais da sutura palatina média (MPS) por meio da reavaliação dos estágios intermediários B, C e D. A amostra foi composta por 158 tomografias computadorizadas de feixe cônico (TCFC) de indivíduos entre 11 e 20 anos de idade (±15,4 anos, 86 do sexo feminino e 71 do sexo masculino), divididos em dois grupos: 74 indivíduos de 11 a 15 anos e 84 indivíduos de 16 a 20 anos. Os exames de TCFC foram aplicados para avaliar o estado de maturação da sutura palatina média e compreenderam os estágios previamente classificados como B (29), C (92) e D (37). Cada imagem axial foi subdividida em seis partes no sentido anteroposterior, e cada porção foi classificada de acordo com a metodologia de avaliação maturacional MPS. Novas definições de estágios foram propostas. A confiabilidade do método foi testada por dois examinadores e as concordâncias intra e interexaminadores foram definidas para cada avaliação por meio de coeficientes kappa ponderados e intervalos de confiança de 95%. O teste do qui-quadrado foi utilizado para comparar os grupos. Em todos os testes estatísticos adotou-se o nível de significância de 5%. Dois novos estágios maturacionais foram definidos: subestágio C- e subestágio C+, com prevalência de 12% e 8,9%, respectivamente, em jovens de 11 a 20 anos. A redefinição e validação dos estágios maturacionais da MPS, considerando os subestágios C- e C+, podem permitir elucidar a diferença no prognóstico da Expansão Rápida da Maxila entre indivíduos de 11 a 20 anos. Esses dados devem ser confirmados por meio de um estudo clínico.(AU)

Split crest con colocación simultánea de implantes en sector anterior: reporte de un caso / Split crest with simultaneous placement of implants in the anterior sector: a case report

La pérdida ósea en el sector anterior, ya sea por un defecto horizontal, vertical o combinado, actualmente es un desafío, no sólo por la integración del implante, sino por la estética involucrada. Entre las técnicas de regeneración ósea que permiten solucionar estos defectos, cabe destacar la técnica de expansión de crestas. Se presenta el caso de una paciente de 58 años con reborde atrófico, que se sometió a la expansión de crestas con colocación simultánea de implantes en sector anterior, con xenoinjerto previo a técnica de expansión de crestas con piezoeléctrico, colocación simultánea de implantes Narrow Connection SLActive Straumann. Se logró ganancia ósea y estabilidad primaria de los implantes, sin complicaciones. En escenarios seleccionados, la técnica de expansión de crestas de manera predecible permite ganancia de hueso horizontal adecuada, el éxito de los implantes con tasa de supervivencia y mínimas complicaciones intra y postoperatorias (AU)

Bone loss in the anterior sector, both a horizontal, vertical or combined defect is a challenge today; not only for the integration of the implant but also the aesthetic involved. There are techniques of bone regeneration that help us to solve this type of defects, among them we should highlight the crest expansion technique. We present the case of a 58-year-old patient with atrophic flange, who underwent the expansion of crests with simultaneous placement of implants in the anterior sector, with xenograft prior to the piezoelectric crest expansion technique, Simultaneous placement of Narrow Connection SLActive Straumann implants, bone gain and primary stability of the implants were obtained, without complications. In selected scenarios, the crest expansion technique could be considered a predictable approach that demonstrates a high implant survival rate, adequate horizontal bone gain, and minimal intra- and postoperative complications (AU)

Unicystic Ameloblastoma ? A Case Series

Ameloblastoma is a benign, locally aggressive neoplasm that constitutes about 1–3% of the tumors of the jaw. Wide surgical excision with adequate safe margin is the most common treatment of choice. The study aimed to manage cases with unicystic ameloblastoma while preserving the continuity of the mandible (without resection). This article presents a series of cases ranging from 18 to 40 years old patients of both sexes with unicystic ameloblastoma, especially in the mandible showing more male predilection than female. All the cases presented in this article were treated by enucleation and curettage. None of the patients presented post?operative paresthesia. None of the cases went in for resection. Post?operative recovery was uneventful in all the patients. All the patients were followed up for a period of 3.5–5 years. None of the cases reported recurrence at the date of publication.

Evaluación de Cambios Dimensionales en Ancho y Altura del Reborde Óseo Alveolar Mediante la Técnica de Oseodensificación en Zonas Posteriores del Maxilar. Reporte de Serie de Casos

Con el objetivo de tratar mediante implantes dentales zonas de tejido óseo incipiente y minimizar el uso de técnicas más invasivas, surge la oseodensificación (OD), una técnica realizada mediante la utilización de fresas Densah®, diseñadas para aumentar la densidad ósea, desplazando y condensando el tejido óseo circundante al fresado. El objetivo del estudio fue determinar los cambios dimensionales en ancho y altura del reborde óseo alveolar (ROA) en zonas posteriores del maxilar utilizando la técnica de OD, 3 meses posterior a realizada la cirugía. Se realizaron evaluaciones imagenológicas mediante Cone-Beam-CT (preoperatorio y mínimo 3 meses postoperatorio) a 9 pacientes, en los que se instalaron 10 implantes, divididos según instalación mediata e inmediata. En ambos grupos, se midió el ancho del ROA tanto a nivel marginal, utilizando como referencia el plano de la cresta ósea vestibular (COV), como 4 mm apical al plano COV. También se midió la altura del ROA con relación al plano COV y al piso del seno maxilar (PSM). Las comparaciones se realizaron mediante el análisis estadístico prueba t student-muestras pareadas. Los datos imagenológicos mostraron un valor de p<0,05 para la expansión ósea, tanto en ancho (solo implantes mediatos, media 2,11 ± 1,66 mm) como en altura con relación a PSM (implantes mediatos e inmediatos, medias de 2,28 ± 2,21 y 1,88 ± 1,82 respectivamente). La técnica de OD resultó ser efectiva en generar un aumento, tanto en ancho de implantes mediatos a nivel del plano COV como en altura del ROA en implantes mediatos e inmediatos.

In order to treat areas of incipient bone tissue with dental implants and minimize the use of more invasive techniques, osseodensification (OD) is a technique performed using Densah® drills, designed to increase bone density by displacing and condensing the bone tissue surrounding the drill. To determine the dimensional changes in width and height of the alveolar bone ridge (ABR) in posterior regions of the maxilla using the OD technique, 3 months after surgery. Imaging evaluations were performed by Cone- Beam-CT (preoperative and at least 3 months postoperative) in 9 patients, in whom 10 implants were installed, divided according to mediate and immediate installation. In both groups, the width of the ABR was measured both at the marginal level, using the vestibular osseous ridge plane (VOR) as a reference, and 4 mm apical to the VOR plane. The height of the ROA was also measuredin relation to the VOR plane and the maxillary sinus floor (MSF). Comparisons were performed by student t-test paired-samples statistical analysis. Imaging data showed a value of p<0.05 for bone expansion, both in width (mediated implants only, mean 2.11±1.66 mm) and height in relation to PSM (mediated and immediate implants, means of 2.28±2.21 and 1.88±1.82 respectively). The OD technique proved to be effective in generating an increase in width of dental implants mediated at the level of the VOR plane and in height of the ABR (mediated and immediate implants).

DYRK1-mediated phosphorylation of endocytic components is required for extracellular lumen expansion in ascidian notochord

BACKGROUND: The biological tube is a basal biology structure distributed in all multicellular animals, from worms to humans, and has diverse biological functions. Formation of tubular system is crucial for embryogenesis and adult metabolism. Ascidian Ciona notochord lumen is an excellent in vivo model for tubulogenesis. Exocytosis has been known to be essential for tubular lumen formation and expansion. The roles of endocytosis in tubular lumen expansion remain largely unclear. RESULTS: In this study, we first identified a dual specificity tyrosine-phosphorylation-regulated kinase 1 (DYRK1), the protein kinase, which was upregulated and required for ascidian notochord extracellular lumen expansion. We demonstrated that DYRK1 interacted with and phosphorylated one of the endocytic components endophilin at Ser263 that was essential for notochord lumen expansion. Moreover, through phosphoproteomic sequencing, we revealed that in addition to endophilin, the phosphorylation of other endocytic components was also regulated by DYRK1. The loss of function of DYRK1 disturbed endocytosis. Then, we demonstrated that clathrin-mediated endocytosis existed and was required for notochord lumen expansion. In the meantime, the results showed that the secretion of noto-chord cells is vigorous in the apical membrane. CONCLUSIONS: We found the co-existence of endocytosis and exocytosis activities in apical membrane during lumen formation and expansion in Ciona notochord. A novel signaling pathway is revealed that DYRK1 regulates the endocytosis by phosphorylation that is required for lumen expansion. Our finding thus indicates a dynamic balance between endocytosis and exocytosis is crucial to maintain apical membrane homeostasis that is essential for lumen growth and expansion in tubular organogenesis.

O escorpionismo no Estado de Goiás (2003-2019) / Scorpionism in the State of Goiás (2003-2019)

Objetivo: realizar uma avaliação dos acidentes com escorpiões no Estado de Goiás no período de 2003 a 2019. Métodos: trata-se de um estudo epidemiológico descritivo, onde a coleta de dados se baseou nas Fichas de Notificações Compulsórias, mantidas no Centro de Informações e Assistência Toxicológica de Goiás. Foram utilizados formulários simplificados para a coleta de 23 variáveis que foram analisadas e tabuladas. Resultados: foram notificados 18.720 casos, sendo o município de Goiânia com o maior número de ocorrências do estado, com um predomínio dos acidentes na zona urbana, sendo a população economicamente ativa a mais vulnerável. A sazonalidade dos acidentes possui características pouco evidentes em relação à precipitação e à temperatura anual do Estado de Goiás, com uma discreta menor prevalência nos meses de junho e julho. O tempo de atendimento está associado a um prognóstico mais favorável e à classificação do caso. O aumento do número de acidentes é crescente a partir de 2012, ano em que a notificação compulsória passou a ser obrigatória. A distribuição geográfica dos acidentes é influenciada pelo processo de urbanização desorganizado. Os óbitos estão associados, principalmente, à faixa etária pediátrica. Conclusões: a sazonalidade dos acidentes escorpiônicos no Estado de Goiás tem um padrão pouco evidente em relação às condições ambientais. A faixa etária produtiva é a mais acometida. Existe uma necessidade de melhora na capacitação dos profissionais de saúde quanto ao diagnóstico, à quantidade de soro a ser utilizada e ao preenchimento e encaminhamento das fichas de notificação

Objective: to carry out an evaluation of accidents with scorpions in the State of Goiás from 2003 to 2019. Methods: this is a descriptive epidemiological study, where data collection was based on the Compulsory Notification Forms, kept at the Information and Toxicological Assistance in Goiás. A simplified form was used to collect 23 variables that were analyzed and tabulated. Results: 18,720 cases were notified, with the municipality of Goiânia having the highest number of occurrences in the state, with a predominance of accidents in the urban area, with the economically active population being the most vulnera-ble. The seasonality of the accidents has little evident characteristics in relation to annual precipitation and temperature in the State of Goiás, with a slight lower prevalence in the months of June and July. The length of service is associated with a better prognosis and case classification. The increase in the number of accidents has been increasing since 2012, when compulsory notification became mandatory. The geographic distribution of accidents is influenced by the disorganized urbanization process. Deaths are mainly associated with the pediatric age group. Conclusions: the seasonality of scorpion accidents in the State of Goiás has an unclear pattern with respect to environmental conditions. The productive age group is the most affected. There is a need to improve the training of health professionals regarding the diagnosis, the amount of serum to be used and the completion and forwarding of notification forms

Three-dimensional printed 316L stainless steel cardiovascular stent's electrolytic polishing and its mechanical properties / 生物医学工程学杂志

The interventional therapy of vascular stent implantation is a popular treatment method for cardiovascular stenosis and blockage. However, traditional stent manufacturing methods such as laser cutting are complex and cannot easily manufacture complex structures such as bifurcated stents, while three-dimensional (3D) printing technology provides a new method for manufacturing stents with complex structure and personalized designs. In this paper, a cardiovascular stent was designed, and printed using selective laser melting technology and 316L stainless steel powder of 0-10 µm size. Electrolytic polishing was performed to improve the surface quality of the printed vascular stent, and the expansion behavior of the polished stent was assessed by balloon inflation. The results showed that the newly designed cardiovascular stent could be manufactured by 3D printing technology. Electrolytic polishing removed the attached powder and reduced the surface roughness Ra from 1.36 µm to 0.82 µm. The axial shortening rate of the polished bracket was 4.23% when the outside diameter was expanded from 2.42 mm to 3.63 mm under the pressure of the balloon, and the radial rebound rate was 2.48% after unloading. The radial force of polished stent was 8.32 N. The 3D printed vascular stent can remove the surface powder through electrolytic polishing to improve the surface quality, and show good dilatation performance and radial support performance, which provides a reference for the practical application of 3D printed vascular stent.

Effect of miniscrew-assisted rapid palatal expansion on mandibular position / 口腔医学

Objective@#To explore the effect of miniscrew-assisted rapid palatal expansion (MARPE) on mandible position in the treatment of adult skeletal Class Ⅰ malocclusion with maxillary transverse deficiency. @*Methods@#In this retrospective study, 20 cases of adult skeletal Class Ⅰ malocclusion with maxillary transverse deficiency treated with MARPE in our hospital from July 2019 to March 2022 were selected as research objects. CBCT data of three time points before treatment (T0), immediately after expansion (T1) and six months after retention (T2) were collected. The head position was standardized and calibrated by Dolphin software, and then mandible landmarks (left and right Condylion, left and right Gonion, Menton) were positioned. The linear distance changes of each landmark relative to the reference plane of coronal plane, axial plane and sagittal plane were measured, which represented the sagittal, vertical and horizontal displacement of mandible respectively. Repeated measurement ANOVA and LSD multiple comparison were used to evaluate the position change of each landmark.@*Results @#The Menton and right Gonion rotated clockwise at T1, and relapsed to the initial position at T2. No lateral displacement of Menton was found.@*Conclusion@#When MARPE is used to treat skeletal Class Ⅰ malocclusion with maxillary transverse deficiency, it causes a transient clockwise rotation of the mandiblar. The mandible does not show sagittal, vertical and horizontal position changes in long-term evaluation.

Periosteum: Functional Anatomy and Clinical Application

@#Periosteum is a connective tissue that envelopes the outer surface of bones and is tightly bound to the underlying bone by Sharpey’s fibers. It is composed of two layers, the outer fibrous layer and the inner cambium layer. The periosteum is densely vascularised and contains an osteoprogenitor niche that serves as a repository for bone-forming cells, which makes it an essential bone-regenerating tissue and has immensely contributed to fracture healing. Due to the high vascularity of inner cambium layer of the periosteum, periosteal transplantation has been widely used in the management of bone defects and fracture by orthopedic surgeons. Nevertheless, the use of periosteal graft in the management of bone defect is limited due to its contracted nature after being harvested. This review summarizes the current state of knowledge about the structure of periosteum, and how periosteal transplantation have been used in clinical practices, with special reference on its expansion.

De novo Huntington′s disease due to paternal intermediate alleles: a case report and literature review / 中华神经科杂志

Objective:To report the clinical manifestation and genetic characteristics of a case of de novo Huntington′s disease due to paternal intermediate alleles. Methods:Clinical data and imaging features of a middle-aged female, who complained of unstable walking without positive family history and was admitted to Xuanwu Hospital, Capital Medical University on September 20, 2022, were retrospectively analyzed. The serum samples of the patient and her parents were used to screen HTT gene dynamic mutation in accordance with the principle of informed consent and voluntary. And the relevant literatures were reviewed. Results:This is a 38-year-old female with progressive course, who presented as ataxia, involuntary movement at the end of extremities, dystonia, and cognitive impairment. Imaging results showed atrophy of bilateral caudate nuclei, as well as decreased glucose metabolism of bilateral caudate nuclei, putamen and partial cortex. Genetic testing showed the abnormal expansion of polymorphic trinucleotide (CAG) repeats in HTT gene and confirmed the diagnosis of Huntington′s disease. The CAG repeat length of the patient was 17/47 (pathopoiesis), of the father was 17/35 (intermediate alleles), and of the mother was 17/17 (normal). Conclusions:Paternal intermediate alleles may cause the first case of Huntington′s disease in a family. Importantly, HTT gene screening should be performed for the patient and parents when the diagnosis of Huntington′s disease is clinically possible despite negative family history, to prevent the misdiagnosis.

Application of self-developed rapid tracheotomy apparatus for acute tracheotomy / 中国基层医药

Objective:To investigate the application effects of self-developed rapid tracheotomy apparatus for acute tracheotomy.Methods:A total of 120 patients who underwent an acute tracheotomy in the Weihai Branch of The 970 Hospital of PLA Joint Logistics Support Force from January 2019 to December 2020 were included in this study. These patients were randomly divided into a rapid group and a conventional group, with 60 patients in each group. Patients in the rapid group underwent tracheotomy with a self-developed rapid tracheotomy apparatus. Patients in the conventional group underwent the standard steps of traditional tracheostomy. The operation time, incision length, amount of bleeding, and incidence of postoperative complications were compared between the two groups.Results:The operation time in the rapid group was significantly shorter than that in the conventional group [(4.5 ± 0.9) minutes vs. (19.3 ± 4.7) minutes, t = 23.86, P < 0.001]. The length of incision in the rapid group was significantly shorter than that in the conventional group [(2.8 ± 0.3) cm vs. (4.2 ± 1.3) cm, t = 8.68, P < 0.001]. The amount of bleeding during the surgery in the rapid group was significantly less than that in the conventional group [(4.4 ± 1.6) mL vs. (11.8 ± 4.1) mL, t = 12.99, P < 0.001]. The incidence of postoperative complications in the rapid group was significantly lower than that in the conventional group ( χ2 = 4.66, P = 0.031). Conclusion:The self-developed rapid tracheotomy apparatus for acute tracheotomy can be used to establish an artificial airway quickly and minimally invasively by simplifying the operational steps. It is remarkably innovative to increase safety with open-view operations and decrease the incidence of complications. It can be repeatedly sterilized and reused, which is worthy of clinical application and popularization.

Effect of fluorescence method on cardiopulmonary function, immune function and safety during pulmonary segmental resection / 中国医师进修杂志

Objective:To explore the effects of fluorescence method and improved expansion and collapse method on cardiopulmonary function, immune function and safety during segmental pneumonectomy.Methods:One hundred and fifty-six patients with lung segmental resection operation in Yucheng People′s Hospital from March 2018 to August 2020 were enrolled. They were divided into two groups according to the random number table method, each group with 78 patients. The patients in the observation group were treated with fluorescence method and the patients in the control group were treated with modified expansion collapse method. The operation indexes, immune function and cardiopulmonary function of the two groups were compared, and the incidence of postoperative complications were counted.Results:The intraoperative time and the appearance time of intersegmental plane in the observation group were shorter than those in the control group: (105.33 ± 10.62) min vs. (139.46 ± 12.58) min, (15.46 ± 1.13) s vs. (724.56 ± 65.65) s, there were statistical differences ( P<0.05). After operative for 1, 7 d, the levels of 6 min walking distance, peak expiratory flow rate, percentage of forced vital capacity and percentage forced expiratory volume in 1 second in the observation group were higher than those in the control group: after operative for 1 d: (475.36 ± 10.29) m vs. (412.11 ± 13.33) m, (284.52 ± 10.33) L/min vs. (251.13 ± 12.89) L/min, (85.65 ± 3.21)% vs. (81.13 ± 1.43)%, (83.25 ± 2.55)% vs. (74.49 ± 2.53)%; after operative for 7 d: (510.23 ± 16.66) m vs. (488.33 ± 15.42) m, (302.13 ± 15.58) L/min vs. (285.12 ± 10.22) L/min, (93.46 ± 5.79)% vs. (88.44 ± 5.44)%, (92.25 ± 2.32)% vs. (85.54 ± 2.13)%, there were statistical differences ( P<0.05). After operative for 1, 7 d, the levels of CD 4+/CD 8+, CD 8+, CD 4+ in the observation group were higher than those in the control group: after operative for 1 d: 0.85 ± 0.10 vs. 0.52 ± 0.04, 0.305 ± 0.025 vs. 0.285 ± 0.012, 0.325 ± 0.021 vs. 0.304 ± 0.025; after operative for 7 d: 1.13 ± 0.10 vs. 1.02 ± 0.07, 0.324 ± 0.029 vs. 0.306 ± 0.023, 0.359 ± 0.024 vs. 0.332 ± 0.025, there were statistical differences ( P<0.05). The rate of postoperative complications in the observation group was lower than that in the control group: 2.56%(2/78) vs. 11.54%(9/78), there was statistical difference ( χ2 = 4.79; P = 0.029). Conclusions:Both the fluorescence method and the modified inflation-collapse method have certain therapeutic effects, but the combination of fluorescence method in segmentectomy can provide reliable technical support and reduce the impact on cardiopulmonary function.

Effect of pursed lip breathing on respiratory function and respiratory muscle strength while using a spine mat / 体力科学

It has been reported that using of the spine mat increases chest expansion, inspiratory capacity (IC) and maximum inspiratory mouth pressure (PImax). However, no changes were observed in other respiratory functions and the respiratory muscle strength. The purpose of this study was to clarify the effects of pursed-lip breathing lying on the spine mat to the respiratory function and respiratory muscle strength. Forty-two adult male participants were assigned to two groups; an intervention group (IG group) of 21 participants who performed pursed-lip breathing on top of a spine mat and a control group (CG group) of 21 participants who performed pursed-lip breathing only. The intervention period was 5 days, and the respiratory features evaluated were chest expansion, respiratory function, respiratory muscle strength, and spinal alignment. A significant increase between the Pretest and the Posttest in chest expansion at the circumference of the axilla level, of the xiphoid process level and of the 10th rib level was observed only in IG group. For the respiratory function and the respiratory muscle strength, intervention group showed significant increases in percentage of vital capacity (%VC), tidal volume (TV), PImax, and maximum expiratory mouth pressure (PEmax). In the control group, only the TV indicated a significant increase. Regarding changes before and after the intervention, the intervention group showed significantly higher PImax and PEmax than the control group. No significant difference in spinal alignment was observed between the two groups. These results showed that pursed-lip breathing lying on the spine mat would increase the PImax, PEmax and the chest expansion.

Applications of genetic code expansion in the study of lysine acylation / 中国药科大学学报

@#Lysine acylation is a ubiquitous protein modification that controls various aspects of protein function. However, it can be challenging to decipher the biological function of site-specific acylation modifications in living cells.The recently developed genetic code expansion (GCE) technology has enabled site-specific incorporation of unnatural amino acids (UAAs) that are structurally consistent with the natural acylation modifications in vivo through orthogonal aminoacyl-tRNA synthetase/tRNA pairs, thus facilitating the study of physicochemical properties and biological behaviors of homogeneously acylated proteins.Besides, GCE technology allows for the targeted introduction of UAAs that mimic acylation modifications but cannot be recognized by deacylases, which improves the stability of lysine acylation modification products.Moreover, the insertion of photo-crosslinked UAAs at specific sites of the target protein has been used to elucidate the reciprocal proteome of acylated modified proteins.Based on the introduction of different structural and functional acylation modifications, we described the novel design of GCE technology combined with three types of UAAs, and their application in studying the functional effects of protein acylation modifications on the enzyme activity, protein stability, cellular localization, protein-DNA interactions and protein-protein interactions of target proteins, with a description of the limitations and prospects of GCE technology in studying protein acylation modification.

Effect of maxillary expansion combined with orofacial myofunctional therapy on the position of the tongue of children with mouth breathing / 临床耳鼻咽喉头颈外科杂志

Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.