Algorithm for pediatric orbital blowout fractures: a 20-year retrospective cohort study

Abstract Objective Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. Methods This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. Results There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p= 0.0046). There were no differences in Hess area ratio by age group. Conclusion Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures. Level of evidence 4.

Algorithm for pediatric orbital blowout fractures: a 20-year retrospective cohort study.

OBJECTIVE: Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. METHODS: This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. RESULTS: There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p = 0.0046). There were no differences in Hess area ratio by age group. CONCLUSION: Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures.

The impact of nasal surgery on sleep quality.

OBJECTIVE: Nasal obstruction is considered to be one of the risk factors for obstructive sleep apnea, together with a high arched narrow palate, elongated uvula, malocclusion, and tongue and tonsil size. The impact of nasal obstruction on sleep apnea is controversial, however, and its relation to sleep quality is rarely discussed. The purpose of this study was to investigate the independent effect of nasal obstruction on sleep quality. METHODS: Sixty-nine patients with nasal obstructive symptoms and without sleep apnea episodes were enrolled from September 2018 to August 2019, and compared before and after surgery with thirty-four patients who had benign diseases of the thyroid or parathyroid as a control group, to investigate effects of surgery. Sleep quality was evaluated using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). All cases were reassessed at three months after surgery. RESULTS: The postoperative PSQI scores in the nasal surgery group were significantly lower than the preoperative scores (p < 0.001). In contrast, there was no statistically significance difference between the pre- and postoperative PSQI scores in the neck surgery group. Difference of PSQI scores before and after surgery in the nasal surgery group was significantly higher than the neck surgery group. CONCLUSIONS: This double-arm study suggests that reduction of nasal disfunction with nasal surgery contributes significantly to sleep quality, in patients who may not have noticed their impaired quality of sleep previously because of their long-term nasal symptoms.

Structural changes of layered alkylsiloxanes during the reversible melting-solidification process.

Through various in situ analyses, we have revealed the structural changes that occur during the reversible melting-solidification process of layered alkylsiloxanes (CnLSiloxanes) with carbon numbers (n) of 18 and 16. In situ high-resolution solid-state (13)C nuclear magnetic resonance (NMR) analysis at controlled temperatures indicates drastic conformational changes of the long alkyl chains during the melting-solidification process. A (13)C NMR signal at 33 ppm, which shows the highest intensity at room temperature (RT), is assigned to an inner methylene group with an all-trans conformation. As the temperature increases, the 33-ppm signal intensity decreases while the signal intensity at 30.5 ppm simultaneously increases. The 30.5 ppm signal is assigned to an inner methylene group with a trans-gauche conformation. Subsequently, upon cooling, the signal at 33 ppm recovers, even after CnLSiloxanes have melted. In situ X-ray diffraction measurements at controlled temperatures reveal that the ordered arrangement of the long alkyl chains becomes disordered with elevating temperatures and reordered upon cooling to RT. In situ high-resolution solid-state (29)Si NMR analysis shows that the melting-solidification process progresses without any structural change in siloxane sheets of the CnLSiloxanes. Thus, the in situ analyses show that disordering of the long alkyl chains causes the CnLSiloxanes to melt. Because the majority of long alkyl chains are packed again in the ordered arrangement with the all-trans conformation upon cooling, the CnLSiloxanes are reversibly solidified and the CnLSiloxane structure is recovered.

Nanoporous carbons through direct carbonization of a zeolitic imidazolate framework for supercapacitor electrodes.

Nanoporous carbons with high surface area are achieved through direct carbonization of a commercially available zeolitic imidazolate framework (ZIF-8) without any additional carbon sources. The resultant nanoporous carbons exhibit high electrochemical capacitances in an acidic aqueous electrolyte.

Effect of layer charge density on orientation and aggregation of a cationic laser dye incorporated in the interlayer space of montmorillonites.

Effect of layer charge density of clay on the orientation and aggregation state of a laser dye, oxazine 4, in dye/clay complexes was investigated using a series of layer-charge-controlled montmorillonites as host materials. By the combination of polarized UV-vis spectroscopy and powder X-ray diffraction methods, it was revealed that the higher layer charge caused the formation of higher-order H-aggregates with the molecular axis nearly perpendicular to the silicate layer, and that the basal spacing was mostly governed by the degree of dye aggregation.

Luminescence properties of rhodamine 6G intercalated in surfactant/clay hybrid thin solid films.

To develop the solid-state laser oscillator based on laser dye compounds, the incorporation of rhodamine 6G (R6G, a laser dye) in cetyltrimethylammonium (CTA+) cationic surfactant/montmorillonite clay hybrid (HpC) thin solid films was investigated. The R6G/HpC samples were prepared by immersing the HpC films into a R6G aqueous solution with various concentration. X-ray diffraction patterns of the films of HpC, measured before and after the intercalation of R6G, proved the coexistence of both the dye and surfactant in clay interlayer spaces. All prepared thin films exhibited luminescence. It indicates that CTA+ molecules play a role as a partial suppressor of the aggregation of R6G molecules which prevents fluorescence. Moreover, the luminescence property of the present thin films was observed to be dependent on the co-intercalated degree of R6G molecules, indicating that the R6G intercalating in HpC interlayer space molecules exist as two or more luminescence species in the clay interlayer space.

Isomerization of cationic azobenzene derivatives in dispersions and films of layered silicates.

Photoisomerization reactions of cationic azobenzene dyes in solutions, dispersions, and films of layered silicates were studied by visible (Vis) spectroscopy. The dyes isomerized reversibly from thermodynamically more stable trans-isomers to cis-isomers when irradiated with ultraviolet (UV) light. Observed trends were compared with the optical changes of the dyes that occurred as a consequence of their adsorption at the silicate surface. Small fractions of the dyes are likely to have isomerized during the adsorption process, even without the UV-light irradiation. The aggregation of the dyes was another reaction taking place at the surface of the silicates. The extent of the UV-light-induced isomerization reactions was reduced for the adsorbed dye cations. The reaction proceeded readily for a dye with monovalent cations. However, the photoisomerization was practically negligible in both dispersions and films of layered silicates for a dye with bivalent cations, whereas the isomerization proceeded in solution. This phenomenon was interpreted in terms of the attractive electrostatic forces between the substrate and the dye cations, which hindered the isomerization reaction. The layer charge of silicates affected the orientation of the dye cations as observed by X-ray diffraction (XRD) measurements. However, the choice of silicate did not significantly affect the fundamental aspects and the described basic trends of the UV-light-induced isomerization reaction.

Aggregation and decomposition of a pseudoisocyanine dye in dispersions of layered silicates.

The optical properties of reaction systems composed from a pseudoisocyanine (PIC) solution and dispersed layered silicates were studied using visible spectroscopy. Two series of reduced-charge montmorillonites were used as the silicate materials. Each series consisted of eight samples with different layer charges, which were prepared from one parent material. Observed trends were verified with another series of dioctahedral and trioctahedral smectites of different layer charges, structure, and origin. The layer charge density of the silicates significantly affected the aggregation of PIC cations. In addition to the formation of J-aggregates, dye spectral bleaching was also observed. Silicates with very low charge densities induced neither significant aggregation nor spectral bleaching of the dye. The highest levels of PIC J-aggregate formation were found in dispersions of the layered silicates with a medium surface charge. However, reversible spectral bleaching was also observed in some cases. PIC dye cations probably change their conformations during the adsorption process, due to the tension resulting from the large size of the cations and the relatively high charge density at the silicate surface. The bleached dye recovers, at least partially, with the rearrangement and redistribution of the dye cations over the time. In contrast, the presence of silicates with very high charge densities (synthetic taeniolite and fluorohectorite) led to the very fast and irreversible decomposition of the PIC. Perhaps, the tension in adsorbed dye cations, induced by the high charge density at the silicate surface, resulted in significant destabilization and a decomposition reaction of the chromophore.