Orofacial myofunctional reeducation assisted by a prefabricated reeducation appliance: towards a necessary paradigm shift / Rééducation myofonctionnelle orofaciale assistée par gouttière de rééducation préfabriquée et orthodontie : vers un nécessaire changement de paradigme

Introduction: Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. Objective: The main objective of this article was to advocate the association of orofacial myofunctional reeducation (OFMR) with the use of prefabricated reeducation appliances (PRAs) in orthodontics. Material and Method: A summary of published data was carried out and the conclusions of a cross-sectional epidemiological study were reported. The aim of the study was to assess the current state of orofacial myofunctional rehabilitation in orthodontics in France. Consideration was given to the relevance of the arguments put forward by manufacturers regarding the specific features of their devices and their supposed effects. Results: Published data, albeit of uneven methodological quality, seem to show the superiority of orofacial myofunctional reeducation combined with the use of a prefabricated reeducation appliance (PRA), compared with the use of OFMR without PRA. A new, more effective, simpler and less time-consuming approach to PRA-assisted OFMR is proposed. The project for a new model of prefabricated reeducation appliance is presented. Ten clinical cases are presented to illustrate the clinical and administrative aspects of this PRA-assisted RMOF. Original clinical approaches are also presented: mandibular disocclusion and recentering wedges (MDRW), anti-retrusion wedges (ARW) and sequential multi-attachment bonding (SMB), mandibular then maxillary. Conclusion: PRA-assisted OFMR appears to be a necessary paradigm shift, which it would be useful to offer our patients.

Introduction: La rééducation myofonctionnelle orofaciale (RMOF) est la rééducation des muscles, des fonctions et des postures de repos du complexe orofacial. Elle est utilisée dans la prise en charge thérapeutique des dysfonctionnements orofaciaux chez des patients de tous âges et présentant un large éventail de troubles et de comorbidités. Objectif: L'objectif principal de cet article était de prôner l'association de la rééducation myofonctionnelle orofaciale (RMOF) avec le port d'une gouttière de rééducation préfabriquée (GRP) en orthodontie. Matériel et méthode: Une synthèse des données publiées a été effectuée et les conclusions d'une étude épidémiologique transversale ont été rapportées. Elle avait été menée pour dresser un état des lieux de la pratique de la rééducation myofonctionnelle orofaciale en orthodontie en France. Une réflexion a été conduite sur la pertinence des arguments avancés par les fabricants quant aux particularités de leurs dispositifs et leurs effets supposés. Résultats: Les données publiées, même de qualité méthodologique inégale, semblent montrer la supériorité d'une rééducation myofonctionnelle orofaciale associée au port d'une gouttière de rééducation préfabriquée (GRP) comparée à la mise en œuvre d'une RMOF sans GRP. Une nouvelle approche de la RMOF assistée par GRP, plus efficace, plus simple et moins chronophage est proposée. Le projet d'un nouveau modèle de gouttière de rééducation préfabriquée est exposé. Dix cas cliniques sont présentés pour illustrer les volets clinique et administratif de cette RMOF assistée par GRP. Des approches cliniques originales sont également exposées : cales de désocclusion et de recentrage mandibulaire (CDRM), cales anti-rétrusion (CAR) et collage multiattache séquentiel (CMS), mandibulaire puis maxillaire. Conclusion: La RMOF assistée par GRP apparaît comme un nécessaire changement de paradigme, dont il semble utile de faire bénéficier nos patients.

Trainee-therapists are not all equal: Examination of therapeutic efficiency, effectiveness and early client dropout after 12 months of clinical training.

OBJECTIVE: Contemporary research demonstrates the feasibility of assessing therapeutic performance of trainee-therapists through the use of objective measures of client treatment outcome. Further, significant variation between individual therapists based on their client treatment outcomes has been demonstrated. This study sets out to determine whether a reliable composite measure of therapeutic efficiency, effectiveness and early dropout can be developed and used to objectively compare trainee-therapists against each other. DESIGN AND METHODS: Treatment outcomes of 611 clients receiving treatment from 58 trainee-therapists enrolled in a professional training programme were tracked with the OQ-45.2 over a 6-year period to assess therapeutic efficiency, therapeutic effectiveness and early client dropout. RESULTS: Significant variation between trainee-therapists was observed for each index. Findings of a moderately strong correlation between therapeutic efficiency and effectiveness enabled the ranking of trainee-therapists based upon a composite measure of these indexes. A non-significant correlation was found between early client dropout and measures of therapeutic effectiveness and efficiency. CONCLUSIONS: The findings stress the importance of utilizing objective measures to track the treatment outcomes. Despite all trainee-therapists being enrolled in the same training programme, significant variation between trainee-therapists' therapeutic efficiency and effectiveness was found to exist. PRACTITIONER POINTS: Developing of potential benchmarking tools that enable trainee-therapists, supervisors and educational institutions to quickly assess therapeutic performance can become part of a holistic assessment of a trainee-therapist's clinical development. Despite an inherent optimistic belief that therapists do not cause harm, there appears to be a small and significant proportion of trainee-therapists who consistently evidence little therapeutic change. Considerable variability in trainee-therapists' therapeutic efficiency and effectiveness can exist in the one training programme. Early client dropout may not be associated with therapists' therapeutic effectiveness and efficiency.

Improved Hyperthermia Treatment of Tumors Under Consideration of Magnetic Nanoparticle Distribution Using Micro-CT Imaging.

PURPOSE: Heterogeneous magnetic nanoparticle (MNP) distributions within tumors can cause regions of temperature under dosage and reduce the therapeutic efficiency. Here, micro-computed tomography (CT) imaging was used as a tool to determine the MNP distribution in vivo. The therapeutic success was evaluated based on tumor volume and temperature distribution. PROCEDURES: Tumor-bearing mice were intratumorally injected with iron oxide particles. MNP distribution was assessed by micro-CT with a low radiation dose protocol. RESULTS: MNPs were clearly visible, and the exact distribution to nontumor structures was detected by micro-CT. Knowledge of the intratumoral MNP distribution allowed the generation of higher temperatures within the tumor and led to higher temperature values after exposure to an alternating magnetic field (AMF). Consequently, the tumor size after 28 days was reduced to 14 and 73 % of the initial tumor volume for the MNP/AMF/CT and MNP/AMF groups, respectively. CONCLUSIONS: The MNP distribution pattern mainly governed the generated temperature spots in the tumor. Knowing the MNP distribution enabled individualized hyperthermia treatment and improved the overall therapeutic efficiency.

"Application of Metabolomics in ""Disease-syndrome-efficacy"" Integration Research" / 世界科学技术-中医药现代化

As an important clinical mode, the disease-syndrome-efficacy integration is a development trend of traditional Chinese medicine (TCM) and western medicine combination. The mode combined comprehensive effica-cy evaluation based on disease-syndrome integration is able to highlight advantages of TCM clinical diagnosis and treatment. With the status of disease-syndrome and effects of Chinese herbal medicine treatments, the en-dogenous metabolites and metabolic network of body changed in the systemic level. According to the analysis of these metabolic changes by metabolomic technologies, it is helpful to investigate the essence of disease-syndrome and explain the mechanism of Chinese herbal medicine actions. This review summarized the current applications of metabolomics in the area of disease-syndrome-efficacy integration research . Metabolomics applied in the disease-syndrome-efficacy integration research is helpful to facilitate the development of TCM and western medicine combination .