Effect of orofacial myofunctional therapy along with preformed appliances on patients with mixed dentition and lip incompetence.

BACKGROUND: Various preformed early orthodontic appliances for correcting oral habits and training orofacial muscles have emerged on the market. However, there are few reports on the effectiveness of these appliances for orofacial myofunctional training. METHODS: This retrospective study evaluated children with lip incompetence and mixed dentition treated at the Pediatric Dentistry Department of Shanghai Ninth People's Hospital from 2016 to 2018. A total of 109 children (54 males, 55 females; age range: 7-10 years, mean age: 8.2 years) were selected from an overall sample of 870 patients. During the first visit, all patients were instructed to perform active lip and tongue training at home daily and were divided into two groups according to the kind of appliances worn. The first group consisted of 56 subjects (30 females; 26 males), with a mean age of 8.1 years (SD 1.1 years), treated with preformed appliances. The second group consisted of 53 subjects (25 females; 28 males), with a mean age of 8.2 years (SD 1.0 years), treated with conventional early orthodontic appliances (arch expansion devices along with "2*4" local fixed appliances). For each subject in the two groups, initial (pretreatment, T1) and final (posttreatment, T2) intraoral and external photos, dental casts, lateral cephalograms, and orthopantograms were taken, and lip strength was measured. SNA, SNB, ANB, APDI, FMA, U1SN, and IMPA before and after treatment were measured by The Dolphin Imaging Cephalometric Analysis Software. The hyoid bone position was also recorded. Differences between groups were identified with an independent sample t-test (P < 0.05). RESULTS: In the first group, a statistically significant forward movement of the mandible was detected by an increase in SNB of - 1.06 degrees (P < 0.01) and an increase in APDI of - 2.23 degrees (P < 0.01). The increase in IMPA (- 3.21 degrees, P < 0.01) demonstrated a statistically significant protrusion of the lower incisors. Lip strength significantly increased (- 2.44, P < 0.01). The increase in HC3 (- 1 mm, P < 0.01) and HFH (- 2.95 mm, P < 0.01) implied a forward and downward movement of the hyoid bone. In the second group, a statistically significant forward movement of the mandible was also detected by an increase in APDI of -1.96 degrees (P < 0.01). Lip strength also significantly increased (- 1.24, P < 0.01). The increase in HFH (- 2.55 mm, P < 0.01) implied a downward movement of the hyoid bone. Compared with the treatment in the second group, orofacial myofunctional therapy combined with the preformed appliances led to a statistically significant lip strength increase (- 2.30, P < 0.05). Significant differences were observed in SNB and IMPA between the two groups (P < 0.05). CONCLUSIONS: Orofacial myofunctional therapy effectively improved patient lip strength and was a good option for mixed dentition patients with lip incompetence. Preformed appliances could enhance the orofacial myofunctional therapy effect and result in significant improvements in lip strength and forward movement of the mandible, which can optimize the jaw relationship.

Identificación del biotipo facial mediante fotografía vs. radiografías laterales de cráneo. Revisión de literatura / Identification of the facial biotype by photography versus lateral skull radiography. Literature review

Objetivo: reconocer la eficacia de la identificación del biotipo facial mediante fotografía vs. radiografías laterales de cráneo. Materiales y métodos: se realizó un estudio de tipo descriptivo, retrospectivo de la literatura. Para ello se consultaron bases de datos electrónicas, como PubMed, ScienceDirect, Lilacs, Epistemonikos, Sage, Healey Library, Scielo y Google Scholar. Las palabras clave utilizadas fueron: photographs; extraoral photographs; cephalometry; lateral cephalograms; facial biotypes; brachyfacial; mesofacial; dolichofacial. La búsqueda se restringió a artículos en inglés, español y portugués publicados desde el año 2017 hasta el año 2022. Resultados: el biotipo facial permite determinar las características morfológicas y funcionales relacionadas con la dirección en la cual el macizo craneofacial crece y se desarrolla. Existen varios métodos que posibilitan la identificación del biotipo facial. En la actualidad hay diversos tipos de software que, mediante fotografías digitales de las dimensiones y proporciones faciales, permiten identificar el biotipo facial; no obstante, el estándar de oro para la determinación del biotipo facial son las radiografías laterales de cráneo, en las que, por medio de un sistema de trazos, se logra la identificación del biotipo. Este es un método que demanda mayores conocimientos teóricos-anatómicos, por lo que, en la mayoría de los casos, los resultados son más precisos. Sin embargo, al ser ambas técnicas "operador-dependiente", la veracidad de los resultados dependerá en gran medida de los conocimientos, las habilidades y las destrezas de cada profesional. Conclusión: tanto las fotografías digitales como las radiografías laterales del cráneo permiten la identificación del biotipo facial. La precisión de su resultado dependerá, en gran medida, de las habilidades, las destrezas y los conocimientos del profesional, tanto de la técnica como de sus conocimientos básicos de anatomía y radiología.

Objective: To recognize the efficacy of facial biotype identification by photography vs. lateral skull radiographs. Materials and methods:A descriptive, retrospective study of the literature was carried out, for which electronic databases such as PubMed, Science Direct, Lilacs, Epistemonikos, Sage, Healey Library, Scielo and Google Scholar were consulted. The keywords used were: photographs; extraoral photographs; cephalometry; lateral cephalograms; facial biotypes; brachyfacial; mesofacial; dolichofacial. The search was restricted to articles in English, Spanish, and Portuguese published from 2018 to 2022. Results: The facial biotype allows the determination of the morphological and functional characteristics related to the direction in which the craniofacial massif grows and develops. There are several methods that allow the identification of the facial biotype, currently there are different types of software that allow the analysis through digital photographs of the dimensions and facial proportions that allow the identification of the facial biotype; However, the gold standard for determining the facial biotype are lateral skull radiographs, in which biotype identification is achieved by means of a trace system, being a method that demands greater theoretical-anatomical knowledge, therefore that the results in most cases are more precise, however, as both techniques are "operator dependent", the veracity of the results found to a great extent on the knowledge, abilities and skills of each professional. Conclusion: Both digital photographs and lateral skull radiographs allow the identification of the facial biotype, the accuracy of the result will depend mainly on the skills, abilities, and knowledge of the professional, both the technique and of his basic understanding of anatomy and radiology.

Vitamin D supplementation during pregnancy to prevent vitamin D deficiency in newborns: a systematic review and meta-analysis / Suplementação de vitamina D durante a gravidez para a prevenção da deficiência de vitamina D em recém-nascidos: uma revisão sistemática e meta-análise

Abstract Objectives: to assess the effects of vitamin D supplementation during pregnancy on the outcomes of vitamin D concentration in newborns, length at birth, overall health (Apgar), birth weight and maternal vitamin D concentration after childbirth. Methods: this research was conducted in the electronic databases of MEDLINE, LILACS, EMBASE and Cochrane Library until December 2020, using the terms "vitamin D", "pregnancy", "vitamin D deficiency", "infant", "newborn" and their synonyms. Randomized controlled trials were searched by evaluating the effects of maternal vitamin D supplementation in neonates. The data was analyzed on RevMan 5.4 software and the quality of evidence on GRADE. Results: the newborn's overall health condition was presented as Apgar, with a mean difference (MD) of 0.15 (CI95%=0.06-0.25; p=0.002; I2=0%, two studies, 648 participants, moderate quality evidence) at the first minute and 0.11 (CI95%=0.04-0.17; p=0.001; I2=0%, two studies, 648 participants, moderate quality evidence) at the fifth minute. Significant effects were also presented at the length at birth considering any supplemented dose (MD=0.19; CI95%=0.08-0.30; p=0.0010; I2=0%, 1452 participants, low quality evidence) and birth weight in doses higher than 4000IU/day (MD=257.05 (CI95%=137.81-376.29; p<0.0001; I2=14%, 176 participants, moderate quality evidence). Conclusion: vitamin D supplementation during pregnancy improves serum 25 (OH) D concentration and suggests positive effects on overall health condition, length at birth and birth weight. PROSPERO CRD42017073292.

Resumo Objetivos: avaliar os efeitos da suplementação materna de vitamina D durante a gravidez nos desfechos concentração de vitamina D no recém-nascido, comprimento ao nascer, estado geral de saúde (Apgar), peso ao nascer e concentração de vitamina D materna após o nascimento. Métodos: a pesquisa foi conduzida nas bases de dados eletrônicas MEDLINE, LILACS, EMBASE e Cochrane Library até dezembro de 2020, utilizando os termos "vitamin D", "pregnancy", "vitamin D deficiency", "infant", "newborn" e seus sinônimos. Pesquisou-se por ensaios clínicos randomizados avaliando os efeitos da suplementação materna de vitamina D no neonato. Os dados foram analisados pelo software RevMan 5.4 e a avaliação da qualidade das evidências pelo GRADE. Resultados: o estado geral de saúde do recém-nascido foi apresentado como Apgar, com uma diferença de média (DM) de 0,15 (IC95%=0,06-0,25; p=0,002; I2=0%, dois estudos, 648 participantes, evidência de qualidade moderada) para o teste no primeiro minuto e 0,11 (IC95%=0,04-0,17; p=0,001; I2=0%, dois estudos, 648 participantes, evidência de qualidade moderada) para quinto minuto. Efeitos significativos também foram apresentados para o comprimento ao nascer em qualquer dose suplementada (DM=0,19 (IC95%=0,08-0,30; p=0,0010; I2=0%, 1452 participantes, evidência de baixa qualidade) e peso ao nascer em doses maiores que 4000UI/dia (DM=257,05 (IC95%=137,81-376,29; p<0,0001; I2=14%, 176 participantes, evidência de qualidade moderada). Conclusão: a suplementação de vitamina D durante a gravidez melhora a concentração sérica de 25 (OH)D e sugere apresentar efeitos positivos no estado geral de saúde, comprimento ao nascer e peso ao nascer. PROSPERO CRD42017073292.

Bio-Exercise (BioEx) - A biocreative orofacial myofunctional therapy: preliminary cephalometric study and clinical application.

OBJECTIVE: To introduce newly structured and developed orofacial myofunctional therapy (OFMFT) protocols named Bio-Exercise (BioEx), and evaluate the treatment effect of this method, using lateral cephalometric analysis on malocclusion with low tongue posture in young patients. METHODS: A retrospective preliminary study was performed using orthodontic records from 28 patients (mean age of 8.41±1.45-year-old, 13 males, 15 females) treated with BioEx therapy using tongue elevators for 18.14±9.04 months (range: 6 to 37 months). Pretreatment (T0) and post-BioEx therapy (T1) lateral cephalograms were subsequently analyzed for tongue posture changes by linear, anteroposterior and vertical measurements. The data were analyzed by paired t-test, considering a 5% significance level. RESULTS: The tongue length (TGL) and tongue height (TGH) increased statistically significant between T0 and T1. The decrease of the dorsum of the tongue perpendicular to the palatal plane (Td-PP value) was statistically significant. The increase of the tip of the tongue perpendicular to the pterygomaxillary vertical line (TT-PMV) was not statistically significant. CONCLUSIONS: These preliminary cephalometric results indicate that BioEx can be an effective OFMFT modality in increasing the tonicity of the tongue muscles to establish more normalized tongue position at rest.

Determinación de la maduración ósea según la morfología de las vértebras cervicales, sexo y biotipo facial de niños y adolescentes de Córdoba, Argentina / Determination of bonematurationaccording to the cervical vertebrae morphology, sex, and facial biotype of children and adolescents from Córdoba, Argentina

Introducción: Durante el proceso de crecimiento y desarrollo una serie de hechos se suceden con mayor o menor regularidad y similitud en todos los niños desde el nacimiento hasta la adultez. Mediante la radiografía carpal se observaban un gran número de centros secundarios de osificación, considerados "indicadores de madurez", ubicados en la mano, muñeca y epífisis distales del cúbito y radio. Actualmente, los cambios morfológicos de las vértebras cervicales son considerados indicadores de la maduración ósea. Objetivo:Con el objeto de minimizar las radiaciones en pacientes niños y adolescentes al momento de determinar el grado de maduración ósea, se reemplazó la radiografía carpal por la telerradiografía lateral de cráneo, utilizada rutinariamente. Corroborando, además la edad de maduración en nuestra población. Este estudio nos permite, al momento de decidir el plan de tratamiento, el método a utilizar para la resolución del caso clínico: ortopedia, ortodoncia o ambos a la vez.Materiales y métodos: estudiotransversal sin seguimiento del paciente. Se analizaron radiografías laterales del cráneo, ortopantomografías y carpo de 318 niños y adolescentes de ambos sexos de 10 a 16 años con dentición permanente en ambos arcos dentales, con/sin la presencia del 2° molar. El biotipo facial se determinó por el cefalograma de Björk-Jarabak.Resultados: Las edades promedio en los diferentes biotipos faciales no variaron significativamente, observándose valores medios menores en varones, con biotipo dólico y meso con tendencia a braquifacial. En niñas, se observa que la mayoría están relacionadas significativamente (p<0,05) con excepción del biotipo mesofacial entre edades cronológicas con edades óseas vertebrales y edades óseas vertebrales con óseas carpales y dentarias.Mientras que en varones la excepción se da en el biotipo dólicofacial en todas las variables siendo, solamente significativo entre las variables: edades cronológicas con óseas carpales y edades óseas vertebrales con óseas carpales. Por lo tanto, podemos concluir que existe una alta correlación entre las edades óseas vertebral, carpal y dentaria en ambos sexos y biotipos faciales excepto en niñas con biotipo mesofacial

Evaluation of the acceleration, skeletal and dentoalveolar effects of low-level laser therapy combined with fixed posterior bite blocks in children with skeletal anterior open bite: A three-arm randomised controlled trial.

OBJECTIVES: To evaluate the effectiveness of the low-level laser therapy (LLLT) in accelerating the early treatment of the skeletal anterior open bite (AOB) and to evaluate the associated skeletal and dentoalveolar changes. MATERIALS AND METHODS: A three-arm, parallel-group, randomized controlled trial was conducted on 42 patients aged 8-10 years with skeletal AOB. Patients were randomly allocated to three groups: the fixed posterior bite block+low-level laser therapy (FPBB+LLLT) group; the fixed posterior bite block (FPBB) group; and the untreated control group (UCG) in a 1:1:1 allocation ratio. The LLLT dose in the FPBB+LLLT group was applied using 808-nm wavelength Ga-Al-As semiconductor laser device with the energy of 4-joules/point and irradiation time of 16 seconds/point. LLLT was applied in the first visit; then, it was applied on day 3, 7 and 14 of the first month. Afterwards, it was applied every 15 days until the end of the treatment. Lateral cephalometric images were taken at the beginning of the treatment (T0) and at the end of the active phase (T1). The primary outcome measures were the overall time needed to correct the AOB and the skeletal and dentoalveolar changes. RESULTS: The correction of the AOB required significantly less mean time in the FPBB+LLLT group compared to the FPBB group (x̅=7.07, x̅=9.42 months, respectively; P=0.001). The mean upper first molar intrusion in the FPBB+LLLT group was 1.21mm and significantly greater than that of the FPBB group (0.82mm; P=0.018). However, there was a slight mean extrusion of the upper first molar in the UCG (0.32mm). CONCLUSIONS: The overall time needed to correct the AOB was shorter in the FPBB+LLLT group. The LLLT appeared to be effective in accelerating orthodontic tooth movement. FPBB alone or LLLT were effective in the early treatment of anterior open bite (AOB). The two interventional groups produced similar dentoalveolar and skeletal changes; most of which were dentoalveolar in the correction of the anterior open bite.

Evaluation of fetal and neonatal outcomes after ingestion of Cnidium root (Cnidium officinale Makino) during pregnancy.

Cnidium officinale Makino is a perennial plant, a member of the Umbelliferae family. Cnidium root has traditionally been used as a medicinal herb. It has analgesic, antiinflammatory, antipyretic, antibacterial, antispasmodic, vasodilatory, hypertensive, and sedative effects. However, there are no studies of reproductive toxicity in humans. Therefore, this study aimed to prospectively evaluate the fetal and neonatal outcomes in the children of women who inadvertently used Cnidium root during pregnancy. In a prospective cohort study design, 111 singleton pregnant women taking Cnidium root for various reasons, and 219 age-matched singleton pregnant women unexposed to any herbal agent (unexposed group), were followed up until delivery. In the exposed group, Cnidium root was indicated as controlling cough and cold in 54.1% of patients, at the maximal dose of 12,000 mg/day between 1 day to 12.4 weeks of gestation. Fetal outcomes, including birth weight and 1- and 5-min Apgar score, were similar for the two groups. There were four babies born with major malformations in the exposed group vs. 14 in the unexposed group (OR = 0.5; 95% CI 0.2-1.6; p = 0.190). The gestational age, length, and head circumference were relatively shorter among babies born in the exposed group. Even after adjusting for gender, there was a tenfold increase in the frequency of shorter newborns (<2SD) in the exposed group (OR = 10.1; 95% CI 1.2-87.6; p = 0.019). Our study suggests that Cnidium root is not a major human teratogen. Whether lesser gestational ages at birth and shorter birth lengths are clinically relevant after exposure to Cnidium remains to be elucidated in further studies.

Efficacy of pediatric integrative manual therapy in positional plagiocephaly: a randomized controlled trial.

BACKGROUND: Positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. METHODS: Thirty-four neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (- 10 cm to + 10 cm). RESULTS: CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40% compared with 0.34 ± 1.72% in the control group (p = 0.000). CI did not present significant differences between groups. Manual therapy led to a more positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p = 0.004). CONCLUSION: Manual therapy plus a caregiver education program improved CVAI and led to parental satisfaction more effectively than solely a caregiver education program. TRIAL REGISTRATION: Trial registration number: NCT03659032 ; registration date: September 1, 2018. Retrospectively registered.

Fetal cranial growth trajectories are associated with growth and neurodevelopment at 2 years of age: INTERBIO-21st Fetal Study.

Many observational studies and some randomized trials demonstrate how fetal growth can be influenced by environmental insults (for example, maternal infections)1 and preventive interventions (for example, multiple-micronutrient supplementation)2 that can have a long-lasting effect on health, growth, neurodevelopment and even educational attainment and income in adulthood3. In a cohort of pregnant women (n = 3,598), followed-up between 2012 and 2019 at six sites worldwide4, we studied the associations between ultrasound-derived fetal cranial growth trajectories, measured longitudinally from <14 weeks' gestation, against international standards5,6, and growth and neurodevelopment up to 2 years of age7,8. We identified five trajectories associated with specific neurodevelopmental, behavioral, visual and growth outcomes, independent of fetal abdominal growth, postnatal morbidity and anthropometric measures at birth and age 2. The trajectories, which changed within a 20-25-week gestational age window, were associated with brain development at 2 years of age according to a mirror (positive/negative) pattern, mostly focused on maturation of cognitive, language and visual skills. Further research should explore the potential for preventive interventions in pregnancy to improve infant neurodevelopmental outcomes before the critical window of opportunity that precedes the divergence of growth at 20-25 weeks' gestation.

Clinical Radiographic Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.

OBJECTIVE: To determine if clinically acquired cephalometric measurements, specifically soft palate size, can predict hypoglossal nerve stimulation outcomes. STUDY DESIGN: Combined prospective cohort study and retrospective review. SETTING: US sleep otolaryngology training program. METHODS: Adults with obstructive sleep apnea and apneahypopnea index greater than 15 events/h who underwent hypoglossal nerve stimulation. Eligible subjects had diagnostic preoperative sleep studies and full-night efficacy postoperative studies for analysis. Lateral neck x-rays were obtained as part of routine clinical care and measured for key cephalometric variables by trained head and neck radiologists. Continuous variables were compared using the Student t test, while χ2 testing was used for categorical variables. RESULTS: Fifty-one patients met all study criteria. On average, patients were white, middle aged, and overweight. Following hypoglossal nerve stimulation, the overall cohort achieved a significant apnea-hypopnea index reduction from 36.7 events/h to 20.6 events/h (P < .01) and a response rate of 47% (defined as apnea-hypopnea index reduction >50% and apnea-hypopnea index <20 events/h). On average, therapy responders had significantly thinner soft palates than nonresponders (13.4 ± 3.8 mm vs 16.0 ± 3.4 mm, P = .045). CONCLUSIONS: Patient-specific anatomic factors, specifically soft palate thickness, may help identify optimal candidates for hypoglossal nerve stimulation. A larger, prospective study including both anatomic and physiologic variables is required to validate these findings.

Análisis de diferentes protocolos cefalométricos laterales. Parte II: consideraciones sobre diferentes aplicaciones / Analysis of different lateral cephalometric protocols. Part II: consideratios on different applications

El objetivo de esta segunda parte es relacionar el protocolo utilizado en el Ateneo Argentino de Odontología (A.A.O.) expuesto en la Parte I, con los cefalogramas laterales diseñados por los Dres. Arne Björk, Joseph Jarabak, James McNamara y Robert Ricketts y proponer las visiones complementarias en la búsqueda de un diagnóstico y un plan de tratamiento de mayor precisión. La aplicación de una secuencia lógica en el diagnóstico de una maloclusión permite establecer una categoría de análisis jerarquizada en función de los condicionantes y de las posibilidades de intervención terapéutica (AU)

The objective of this second part is to relate the protocol used in the Ateneo Argentino de Odontología (A.A.O.) exposed in Part I, with the lateral cephalograms designed by the Drs. Arne Bjork, Joseph Jarabak, James McNamara and Robert Ricketts and propose complementary visions in the search for a more accurate diagnosis and treatment plan. The application of a logical sequence in the diagnosis of malocclusion, allows to establish a category of hierarchical analysis according to the conditions and the possibilities of therapeutic intervention (AU)

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants.

The variable macronutrient content of human milk may contribute to growth deficits among preterm infants in the neonatal intensive care unit (NICU). In a longitudinal study of 37 infants < 32 weeks gestation, we aimed to (1) determine the between-infant variation in macronutrient intake from human milk and (2) examine associations of macronutrient intake with growth outcomes. We analyzed 1626 human milk samples (median, 43 samples/infant) with mid infrared spectroscopy. Outcomes at term equivalent age were weight, length, head circumference, fat mass, and fat-free mass. Median (range) intakes from human milk were: protein 1.37 (0.88, 2.43) g/kg/day; fat 4.20 (3.19, 5.82) g/kg/day; carbohydrate 8.94 (7.72, 9.85) g/kg/day; and energy 82.5 (68.7, 99.3) kcal/kg/day. In median regression models adjusted for birth size and gestational age, and other covariates, greater intakes of fat and energy were associated with higher weight (0.61 z-scores per g/kg/day fat, 95% CI 0.21, 1.01; 0.69 z-scores per 10 kcal/kg/day, 95% CI 0.28, 1.10), whereas greater protein intake was associated with greater body length (0.84 z-scores per g/kg/day protein, 95% CI 0.09, 1.58). Higher fat intake was also associated with higher fat mass and fat-free mass. Macronutrient intakes from human milk were highly variable and associated with growth outcomes despite routine fortification.

Treatment of a twice-relapsed anterior open bite using temporary anchorage devices, myofunctional therapy, and fixed passive self-ligating appliances.

Maxillary LeFort impaction surgery can lead to improvements in facial proportions, smile esthetics, and improved function for patients with long lower facial height and anterior open bite. Sometimes, because of patient wishes, corrective jaw surgery might not be the most appropriate choice for treatment. This report describes the orthodontic retreatment of a 25-year-old woman with a history of 2 orthodontic treatments and 1 corrective jaw surgery, each with anterior open bite relapse. This third orthodontic treatment plan addressed her chief concern and focused on maximizing esthetics, function, and long-term stability. A problem list was used to design a treatment plan that incorporated myofunctional therapy, fixed appliances, and temporary anchorage devices to intrude her maxillary teeth and correct her orthodontic problems. Molar intrusion lasted 8.5 months, and total treatment time in fixed appliances lasted 22 months. The treatment was successful in addressing her chief concerns by shortening her lower facial third, relieving her lip strain, closing her anterior open bite, and achieving a Class I molar and canine occlusion. Overall, posttreatment stability was excellent at approximately 1-year follow-up, and the patient stated that she was very happy with the result.

Factores morfofuncionales de interés en prostodoncia que dependen de los biotipos craneofaciales / Morphofunctional factors of interest in prosthodontics depending on the craniofacial biotypes

El presente es un trabajo de investigación bibliográfica que busca establecer la posibilidad de utilizar las cefalometrías como elementos de diagnóstico pronóstico y elaboración de prótesis. Centra su objeto de estudio en encontrar y clasificar los factores morfológicos y funcionales que varían con los biotipos craneofaciales y que son de interés en la prostodoncia. La metodología empleada fue la revisión de la literatura histórica hasta la actualidad en la que se relacionan temas de prostodoncia a los biotipos craneofaciales. Si bien solo dos autores relacionaron la prostodoncia con los biotipos cráneo faciales, sí se encontraron varios temas de interés asociados directamente a la prostodoncia. Se clasificaron en temas de oclusión: Curva de Spee, plano de oclusión, movimientos mandibulares, dimensión vertical oclusiva y de especio libre interoclusal. Tema de maloclusiones. Tema de fuerza muscular. Tema variaciones morfológicas de procesos alveolares, corticales ósea y de la forma dentaría. Encontrándose para cada uno de ellos alguna correlación positiva con los distintos tipos faciales. De este estudio, se concluye que es necesario sistematizar el estudio de los conocimientos que puede aportar la cefalometría como una importante herramienta de diagnóstico al prostodoncista a partir de haberse encontrado variaciones muy importantes en los aspectos mencionados que hacen al interés de la rehabilitación prostodóncica (AU)

This Work is a bibliographic research that seeks to establish the use of cephalometries as elements of diagnosis prognostic and prosthesis elaboration. Its focus is to find and classify morphological and functional factors that vary with facial types which are of interest in prosthodontics. This was a review of the historical literature to date, in which prosthodontics are related to facial types. Although only two authors related prosthodontics to facial ypes, they did find several topics of interest directly associated with prosthodontics. They were classified into occlusion themes: Spee curve, occlusion plane, mandibular movements, occlusive vertical dimension and interocclusal free space. Malocclusion issue. Muscle strength theme. Morphological variations of alveolar processes, cortical bone and dental morphology. They found some positive correlation with the different facial types for each of them. From this study, it is concluded that it is necessary to systematize the study of cephalometries because they can provide to be an important diagnostic tool to the prosthodontist because there were found very important variations in the mentioned aspects that are of interest in prosthodontic rehabilitation (AU)

What factors impact the clinical outcome of magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor?

OBJECTIVE: Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a novel and useful treatment for essential tremor (ET); however, the factors impacting treatment outcome are unknown. The authors conducted this study to determine the factors affecting the outcome of MRgFUS. METHODS: From May 2016 through August 2017, 15 patients with ET were admitted to Ohnishi Neurological Center and treated with MRgFUS. To determine the factors impacting treatment outcome, the authors retrospectively studied correlations between the Clinical Rating Scale for Tremor (CRST) improvement rate and age, disease duration, baseline CRST score, skull density ratio (SDR), skull volume, maximum delivered energy, or maximum temperature. RESULTS: The mean CRST score was 18.5 ± 5.8 at baseline and 4.6 ± 5.7 at 1 year. The rate of improvement in the CRST score was 80% ± 22%. Younger age and lower baseline CRST score were correlated with a higher CRST improvement rate (p = 0.025 and 0.007, respectively). To obtain a CRST improvement rate ≥ 50%, a maximum temperature ≥ 55°C was necessary. There was no correlation between SDR and CRST improvement rate (p = 0.658). A lower SDR and higher skull volume required significantly higher maximum delivered energy (p = 0.014 and 0.016, respectively). A higher maximum temperature was associated with a significantly larger lesion volume (p = 0.026). CONCLUSIONS: Younger age and lower baseline CRST score were favorable outcome factors. It is important to assess predictive factors when applying MRgFUS.

Child Head Circumference and Placental MFSD2a Expression Are Associated to the Level of MFSD2a in Maternal Blood During Pregnancy.

Gestational diabetes mellitus (GDM) is a world-wide health challenge, which prevalence is expected to increase in parallel to the epidemic of obesity. Children born from GDM mothers have lower levels of docosahexaenoic acid (DHA) in cord blood, which might influence their neurodevelopment. Recently, the membrane transporter Major Family Super Domain 2a (MFSD2a) was associated with the selective transportation of DHA as lysophospholipids. The expression of the DHA membrane transporter MFSD2a is lower in GDM placentas, which could affect materno-fetal DHA transport. Humans with homozygous inactivating mutations in the MFSD2a gene present severe microcephaly and intellectual impairments. Herein, we intended to identify early blood biomarkers that may be of use during pregnancy to monitor the offspring development and the adequate nutritional interventions, such as nutritional supplementation, that may be selected to improve it. We evaluated MFSD2a expression in maternal blood at the third trimester of pregnancy, and its potential relationship with the expression of placental MFSD2a at delivery and child outcomes. Three groups of pregnant women were recruited: 25 controls, 23 GDM with dietary treatment, and 20 GDM with insulin treatment. Maternal and neonatal anthropometric and biochemical parameters were evaluated. MFSD2a was analyzed in placenta, blood and serum. MFSD2a protein expression in maternal blood was significantly lower in GDM groups and correlated with placental MFSD2a and Z-score neonatal head circumference during the first 6 months of life. The cord/maternal serum ratio of DHA, a solid indicator of materno-fetal DHA transport, was reduced in GDM groups and correlated with MFSD2a in maternal blood at the third trimester and in placenta at delivery. This indicates that altered MFSD2a levels in maternal blood during pregnancy might influence placental nutrient transport and fetal neurodevelopment. Furthermore, MFSD2a levels in maternal blood on the third trimester were inversely correlated to DHA in maternal serum lyso-PL. Thus, the level of MFSD2a in maternal blood could be used as a potential biomarker for the early detection of disturbances of MFSD2a expression during pregnancy and the subsequent consequences for the neurodevelopment of the child, as well as it may help to choose the optimal treatment approach for the affected subjects.

Relationships between Neonatal Nutrition and Growth to 36 Weeks' Corrected Age in ELBW Babies-Secondary Cohort Analysis from the Provide Trial.

A key modifiable factor for improving neurodevelopment in extremely low birthweight (ELBW) babies may be improving growth, especially head growth, by optimising nutrition in the early neonatal period. We aimed to investigate relationships between nutrient intakes in the 4 weeks after birth, and growth from birth to 36 weeks' corrected age (CA) in ELBW babies. We undertook a prospective cohort study of 434 participants enrolled in a randomised controlled trial (ProVIDe) in eight New Zealand and Australian neonatal intensive care units. Macronutrient intakes from birth to 4 weeks and weight, length and head circumference measurements from birth to 36 weeks' CA were collected. From birth to 36 weeks' CA, the median (IQR) z-score changes were: weight -0.48 (-1.09, 0.05); length -1.16 (-1.86, -0.43), and head circumference -0.82 (-1.51, -0.19). Changes in z-score to 4 weeks and 36 weeks' CA were correlated with protein intake. Each 1 g·Kg-1·d-1 total protein intake in week 2 was associated with 0.26 z-score increase in head circumference at 36 weeks' CA. Both nutritional intake and change in z-scores to 36 weeks' CA differed widely amongst sites. Correlations between nutrition and growth, and differences in these amongst sites, indicate there may be potential to improve growth with enhanced nutrition practices.

Head Circumference Growth Is Enhanced by SMOFlipid in Preterm Neonates.

BACKGROUND: Suboptimal fat intake during the early postnatal weeks significantly affects brain growth and maturation. Studies to date have focused on the quantity rather than the quality of fat intake. OBJECTIVE: We hypothesized that early nutrition of premature neonates should also include optimization of the type of fat intake, and thus those receiving SMOFlipid, a balanced multicomponent lipid emulsion, would have improved head growth as measured by head circumference (HC) at discharge. STUDY DESIGN: We retrospectively reviewed HC in infants weighing <1,500 g who were hospitalized for two or more weeks during a 20-month period, in which all preterm infants received fat as Lipofundin, and the following 20-month period, in which all such infants received SMOFlipid.Lipids were dosed up to 3 g/kg/day and reduced as enteral nutrition progressed. Parenteral fish oil (Omegaven) was permitted as rescue therapy during both periods. RESULTS: Period 2 infants had better head growth (0.79 [0.69,0.90] vs. 0.75 [0.64,0.86] cm/week; p = 0.0158). More infants reached discharge with an HC of ≥50 percentile (51 vs. 31%; p = 0.0007), and fewer infants had an HC of ≤3 percentile (11 vs. 14%; p = 0.023). Median length of stay was reduced by more than 1 week.A multivariable regression was performed using the weekly increase in HC as the dependent variable, and the time epoch, birth weight, gestational age, hospitalization days, and gender as independent variables. Only the time epoch and days of hospitalization were significant (both p < 0.0001). CONCLUSION: Our data offer preliminary evidence of improved brain growth in those receiving a balanced lipid emulsion as compared with a soybean oil emulsion.

La ortodoncia y la cirugía ortognática como aliadas en el tratamiento / Orthodontics and orthognathic surgery as treatment allied

¿Qué es la estética? Es más que un concepto frívolo. Tiene que ver con la armonía facial, la autoestima, la autoimagen, la percepción de belleza. Es un concepto que involucra al individuo en su totalidad, en su ser, que va más allá de frivolidad estética. Muchos pacientes que vienen a la consulta no expresan inicialmente su real demanda. Expresan problemas funcionales, pero su real preocupación, en la mayor parte de los casos, es estética. Pueden manifestar que no pueden comer bien, masticar un alimento o que no respiran bien o sesean, pero su motivación principal es estética y tiene que ver con su propia autoestima. Las funciones de respiración, deglución, fonación, masticación, oclusión deben estar entre los objetivos a conservarse o restituirse por parte del especialista, pero el tratamiento sería un fracaso si no atendemos la demanda, a veces no bien explicitada, por el paciente y que responde a su profunda necesidad real. Para la OMS, la salud puede definirse como el estado completo de bienestar físico, mental y social. Nuestro objetivo, como agentes de salud, será poder satisfacer la demanda explícita o encubierta con la mayor estética y la mayor funcionalidad (AU)

What is aesthetics? It is more than a frivolous concept. It has to do with facial harmony, self-esteem, self-image, the perception of beauty. It is a concept, which involves the individual as a whole, in his being, which goes beyond aesthetic frivolity. Many patients who come to the office do not initially express their real demand. They express functional problems, but their real concern, in most cases, is aesthetic. They may state that they cannot eat well, chew a food or that they do not breathe well or sedate, but their main motivation is aesthetic and has to do with their own self-esteem. The functions of breathing, swallowing, phonation, chewing, occlusion should be among the objectives to be retained or restored by the specialist, but the treatment would be a failure if we do not meet the demand sometimes not well explained by the patient and responding to their Deep real need. For WHO, health can be defined as the complete state of physical, mental and social well-being. Our goal, as health agents, will be to be able to meet the explicit or covert demand with the greatest aesthetics and functionality (AU)