Prediction of surgery-first approach orthognathic surgery using deep learning models.

The surgery-first approach (SFA) orthognathic surgery can be beneficial due to reduced overall treatment time and earlier profile improvement. The objective of this study was to utilize deep learning to predict the treatment modality of SFA or the orthodontics-first approach (OFA) in orthognathic surgery patients and assess its clinical accuracy. A supervised deep learning model using three convolutional neural networks (CNNs) was trained based on lateral cephalograms and occlusal views of 3D dental model scans from 228 skeletal Class III malocclusion patients (114 treated by SFA and 114 by OFA). An ablation study of five groups (lateral cephalogram only, mandible image only, maxilla image only, maxilla and mandible images, and all data combined) was conducted to assess the influence of each input type. The results showed the average validation accuracy, precision, recall, F1 score, and AUROC for the five folds were 0.978, 0.980, 0.980, 0.980, and 0.998 ; the average testing results for the five folds were 0.906, 0.986, 0.828, 0.892, and 0.952. The lateral cephalogram only group had the least accuracy, while the maxilla image only group had the best accuracy. Deep learning provides a novel method for an accelerated workflow, automated assisted decision-making, and personalized treatment planning.

An optimized scheme for detecting magneto-optic effects in ultrathin films with Sagnac interferometry.

Sagnac interferometry is advantageous in measuring time-reversal-symmetry breaking effects in ferromagnetic and antiferromagnetic materials as it suppresses time-reversal symmetric birefringent effects that are ubiquitous and often overwhelming in optical detection systems. When its sensitivity is limited only by the amplifier noise in the photo-detector, one needs to optimize the optical power that returns to the detector. We demonstrate an experimental scheme that maximizes the returning optical power in a Sagnac interferometry when detecting the magneto-optic effect in ultrathin films. In this scheme, the optical beam bearing the Faraday effect on a thin film is reflected at a second surface coated with a highly reflective gold film. The gold film increases the returned optical power by a factor of 4-5. For a normal-incidence Sagnac interferometer, this scheme yields an increase in the signal-to-noise ratio by the same factor. For an oblique-incidence Sagnac interferometer, this scheme should yield an increase in the signal-to-noise ratio by a factor of 20-25. For illustration, this scheme is used to measure magnetization curves and Kerr rotation images of 4.5-unit-cell thick SrRuO3(001) grown on SrTiO3(001).

Relapse patterns of two-jaw surgical correction in patients with skeletal Class III malocclusion and different vertical facial types.

The aim of this study was to evaluate postoperative relapse after the surgical correction of skeletal Class III deformities of various facial patterns as a guide to surgical planning. A retrospective cohort study of 90 consecutive patients with skeletal Class III malocclusion who underwent bimaxillary surgery was performed. The surgical outcomes and postoperative stability were compared. The primary predictor variable was vertical facial type, which was classified into three groups according to the Frankfort mandibular plane angle (FMA). The primary outcome of angular and linear measurements was obtained using serial cone beam computed tomography scans obtained at time points of preoperative, 1 week after surgery, and orthodontic debonding. No significant difference in skeletal relapse was observed in patients with the different vertical facial types. The mandible displayed a forward and upward relapse in all three groups postoperatively. The patients with a low FMA exhibited a more consistent mandibular relapse pattern than those with a normal or high FMA. These findings suggest that bimaxillary surgery is clinically stable for mandibular prognathism regardless of the vertical facial pattern. However, 1-1.5 mm of overcorrection in the mandible setback should be considered in patients with a low FMA, because of the greater facial depth and consistent forward and upward mandibular relapse pattern.

Penetration of inferior alveolar nerve canal increased by bicortical fixation after bilateral sagittal split osteotomy in mandibular prognathism.

The purpose of this three-dimensional cone beam computed tomography (CBCT) study was to identify the difference between monocortical fixation (MCF) and bicortical fixation (BCF) in mandibular canal penetration after bilateral sagittal split osteotomy (BSSO) to correct mandibular prognathism, where interosseous fixation was done by BCF or MCF. CBCT was performed 1 week postoperatively and Dolphin 3D software was used to assess direct penetration of the mandibular canal by either type of screw. The primary outcome variable was the presence or absence of mandibular canal penetration and was categorized as a binary coded variable. The BCF and MCF groups were compared by χ2 test, and the odds ratio for canal penetration was estimated. Multiple logistic regression was performed to identify factors related to canal penetration. A total of 118 patients were included. The MCF group had only 6% canal penetrations (3/50 patients) and the BCF group had 58.8% canal penetrations (40/68 patients). The regression model showed that BCF was the only factor causing mandibular canal penetration, with an adjusted odds ratio of 52.5. Awareness of the increased risk of canal penetration with BCF and potential nerve injury might influence case selection.

Outcome of surgical-orthodontic treatment in hemifacial microsomia with and without early mandibular distraction osteogenesis.

The aim of this study was to compare the outcomes of surgical-orthodontic treatment between hemifacial microsomia (HFM) patients who had and had not undergone early mandibular distraction osteogenesis (DO). Twenty adult unilateral HFM patients were included, seven who had undergone early mandibular DO (DO group) and 13 who had not (NDO group). All patients were type IIB, except for one type IIA patient in the NDO group. Mean age at definitive surgery was 20.72±2.96 years. Linear, cross-sectional, and volumetric measurements were obtained from serial cone beam computed tomography scans. Data were obtained pre-surgery (T0), 1 week after surgery (T1), and at treatment completion (T2) to determine surgical movement, post-surgical stability, and net gain movement. Surgical and ultimate outcomes did not differ significantly between the groups. The overall surgical movement among all patients was as follows (mean values): maxillomandibular complex (MMC) symmetry was achieved by Le Fort I differential roll movement (3.78mm extrusion on the affected side, 4.28mm impaction on the non-affected side), a combination of medial movement and yaw rotation of MMC, and genioplasty. Upper and lower dental midlines and deviated menton were shifted by 5.73mm, 5.08mm, and 12.38mm, respectively. Anterior impaction and advancement with counterclockwise rotation of MMC were also performed. Menton was advanced by 6.14mm and lower facial height was increased by 3.55mm. Neither group exhibited a significant difference in stability. Relapse at the maxilla was <1mm and relapse at the mandible was <1.5mm. The results suggest that early DO had limited beneficial effects on the definitive correction outcome. HFM patients achieved acceptable symmetry and a stable surgical outcome, regardless of early DO, following surgical-orthodontic correction at skeletal maturity with three-dimensional surgical simulation.

Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care services among gynecologic oncology patients: A randomized controlled trial.

OBJECTIVES: A randomized control trial (RCT) to estimate the effect of an interventional video on improving palliative care knowledge, acceptability and attendance to outpatient services in gynecologic oncology patients. METHODS: Women receiving treatment for gynecologic malignancy recruited at an academic tertiary care center were randomized to: palliative care educational video or non-directive cancer center video. The primary outcome was referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy and the Palliative Care Knowledge Scale. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher's exact tests with significance level of α = 0.05. RESULTS: 111 women were enrolled. Demographic characteristics were equally distributed between groups with respect to age, race, cancer, and stage. There was no statistical difference in knowledge scores or in referral to palliative care between the patients that watched the educational versus control video (29% vs. 27%; p = .79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 31.5%; p ≤.001). Further, those referred had significantly worse baseline functional scores. CONCLUSIONS: Use of a palliative care educational video did not increase knowledge or acceptability of palliative services within this RCT. However, the rate of patients referred to palliative care tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services.

Correlation between changes in the gonial area and postoperative stability in the treatment of mandibular prognathism.

INTRODUCTION: The present study was to investigate the relationship between the post-operative area of the gonial region (lateral and frontal) and post-operative relapse. MATERIAL AND METHODS: Thirty-seven patients, treated for mandibular prognathism were followed with serial lateral cephalograms [pre-operatively (T1), immediately after surgery (T2), and at least 2 years post-operatively (T3)]. The surgical changes (T21), post-operative stability (T32) and 2-year surgical change (T31) were evaluated by the Student's t-test. Pearson's correlation coefficient analysis was used to determine the correlations between the cephalometric parameters. Multiple linear regression analysis was used to assess the association between the risk factors and post-operative relapse. RESULTS: The immediate post-operative changes (T21), mean setback of the Me was 12.3 mm and the frontal gonial area (T2) was increased by 138.7 mm2. The final post-operative changes (T31), lateral gonial area was significantly reduced by 190.5 mm2. CONCLUSION: Relapse was significantly correlated with the amount of setback. However, changes in the area of the gonial region (lateral and frontal) showed weak correlation with relapse. Multiple regression analysis also showed poor predictability of relapse. In conclusion, the results of this study showed that significant changes in the area of the gonial region (lateral and frontal) did not affect the maintenance of post-operative stability.

Chronopharmacological Characteristics of the Effect of Hepatoprotectors in Experiment?

We studied circadian rhythms of activity of hepatoprotectors (Antral, Carsil, and glutargin) under conditions of acute paracetamol-induced hepatitis simulated in the morning, afternoon, evening, and at night (09.00, 15.00, 21.00, and 03.00). Antral and Carsil exhibited similar chronoprofiles with the maximum hepatoprotective activity at 09.00 and 21.00, while glutargin exhibited circadian pattern opposite and its activity was maximum at 15.00 and 03.00.

Does two-dimensional vs. three-dimensional surgical simulation produce better surgical outcomes among patients with class III facial asymmetry?

The aim of this study was to compare the outcomes of traditional two-dimensional planning (2DP) and three-dimensional surgical simulation (3DS) in the surgical correction of skeletal class III with facial asymmetry. This retrospective cohort study included 37 consecutive adult Taiwanese patients. Preoperative and postoperative three-dimensional cephalometric measurements were obtained from cone beam computed tomography scans. The outcome variables were the differences in preoperative and postoperative linear and angular measurements and the differences between the two groups after surgery. When the surgical result was compared between the 2DP and 3DS groups, significant differences were found for four cephalometric variables: the distance from gonion on the non-deviated side to the midsagittal plane (MSP), mid-gonion to the MSP, upper first molar on the non-deviated side to the Frankfort horizontal plane, and the yaw angle. In the 3DS group, mandibular symmetry was achieved because the centre between the bilateral gonions was improved, and because there was no significant difference in the horizontal gonion (Go to the MSP) between the deviated and non-deviated sides after surgery. 3DS provides all the necessary information for planned surgical movements for the correction of facial asymmetry; it should be considered during surgical planning to improve surgical outcomes, particularly the achievement of bilateral mandibular contour symmetry.

Dentoskeletal parameters related to visual perception of facial asymmetry in patients with skeletal class III malocclusion after orthognathic surgery.

The purpose of the study is to explore the critical parameters determining the visual perception of postoperative facial symmetry. This study retrospectively included 24 patients with skeletal class III malocclusion and double-jaw orthognathic surgery (OgS). The patients were classified according to the outcome of subjective visual perception scores (SVPS) based on the postoperative frontal images by 10 orthodontists: symmetrical surgical outcome (S group, n=12) and facial asymmetry after surgery (A group, n=12). The 3D dentofacial measurements from cone beam computed tomography, were compared between the S and A groups. The relationship of all variables in all patients with the SVPS was explored by Spearman correlation coefficient. Significant differences were observed in the midline parameters in the mandible, the B point, gnathion and menton, and the mandibular border axis as well as in the discrepancy of the chin morphology between the two groups (P<0.05). The findings demonstrated that the midline parameter deviation, shape of the mandibular border, and the contour of menton morphology play the major role in the visual perceptions of postoperative asymmetry.

The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit.

The aim of this study was to evaluate nutritional care and outcomes in a medical intensive care unit (ICU) following multidisciplinary nutritional team (MNT) involvement. The authors retrospectively reviewed the data of all patients admitted to a medical ICU from April to October 2013 (pre-MNT period) and from April to October 2014 (post-MNT period). In total, 140 patients were included and allocated to the pre-MNT group (n=70) or the post-MNT group (n=70). The post-MNT group was more likely to use enteral nutrition (61.4 vs 37.1%, P=0.002). In terms of total calories and protein provided, the number of nutritional goal-achieved days during stays in ICU was significantly greater in the post-MNT group than in the pre-MNT group (63.7% vs 47.6%, P<0.05 and 44.3% vs 29.9%, respectively, P<0.05). The MNT activities resulted in significant improvements in terms of nutritional provision and adequacy in a medical ICU.

Efficacy and safety of non-invasive body tightening with high-intensity focused ultrasound (HIFU).

BACKGROUND: Noninvasive skin-tightening devices have become increasingly popular in response to increasing demand for improvements in skin laxity and tightening with minimal risk and recovery time. OBJECTIVE: We evaluated the efficacy and safety of HIFU for skin tightening in the face and body. METHODS: A total of 32 Korean subjects enrolled in this prospective clinical trial. The subjects were treated with HIFU to both cheeks, lower abdomen, and thigh. Skin elasticity was measured before and after treatment using a Cutometer (CT575, Courage and Khazaka® , Cologne, Germany). Three blinded, experienced dermatologists evaluated paired pre- and post-treatment (week 4 and 12) photographs according to the Global Aesthetic Improvement Scale (GAIS). Participants also completed self-assessments using GAIS. Subjects rated their pain on a numeric rating scale (NRS) immediately, 7 days, 4 weeks, and 12 weeks after treatment. RESULTS: Skin elasticity measured via a Cutometer was significantly improved 12 weeks after treatment at all treated sites (P<.05). Both IGAIS and SGAIS showed significant improvements 12 weeks after treatment. Immediately after treatment the mean NRS score was 3.00±1.586, but no pain was reported at 4 and 12 weeks post-treatment. No serious adverse effects were observed during the follow-up period. CONCLUSION: HIFU safely and effectively improves skin elasticity and clinical contouring of the face and body.

Comparison of the adult three-dimensional craniofacial features of patients with unilateral craniofacial microsomia with and without early mandible distraction.

This study was conducted to analyze the long-term facial growth of patients with craniofacial microsomia (CFM) after early mandible distraction osteogenesis (DO), and compared adult three-dimensional (3D) craniofacial features of patients with and without early mandibular DO for Pruzansky grade II deformities. The study included 20 patients: 9 with early mandible DO (the DO group) and 11 without previous treatment (the NDO group). Longitudinal radiographs were measured for growth changes after DO. The 3D craniofacial images were constructed to compare the craniofacial forms between the two groups. The patients with early DO presented 8 to 9mm forward and downward maxillary growth and 4.6mm limited forward and 17.3mm substantial downward mandibular growth. The ramus length ratio (affected/nonaffected) was 90.8% at DO completion and decreased to 69.5% at growth completion during 13 years of follow-up. Both groups showed obvious craniofacial asymmetry, as indicated by occlusal plane canting, chin deviation, transverse and vertical condyle positions, and mandibular contours. Although all the bilateral differences were higher in the NDO group than in the DO group, no statistical differences were found. Early mandible distraction could not alter the inherent facial growth pattern in patients with grade II CFM. Limited changes are derived for definitive facial correction with early DO.

Referred symptom from myofascial pain syndrome: One of the most important causes of sensory disturbance in breast cancer patients using taxanes.

The aim of this retrospective study was to evaluate common causes of upper extremity sensory disturbance in breast cancer patients. Breast cancer patients who received surgery and taxane chemotherapy (CTx) with upper extremity sensory disturbance that began after CTx were included. With comprehensive clinical history, physical examination and electrodiagnostic results, diagnosis for each patient was made. Fifty-two patients were included: 23 (44.2%) were diagnosed with chemotherapy-induced peripheral neuropathy (CIPN), 7 (13.5%) with myofascial pain syndrome (MPS), six (11.5%) with carpal tunnel syndrome (CTS), four (7.7%) with CIPN and MPS, and three (5.8%) with CIPN and CTS. CIPN was more correlated with sensory symptoms at upper and lower extremities, a shorter time from CTx start, and adriamycin and cytoxan (AC) plus paclitaxel, than with AC plus docetaxel and fluorouracil, epirubicin and cyclophosphamide plus taxanes. MPS was correlated with longer duration of CTx and use of hormone therapy. CTS was correlated with wrist trauma history. Patients with CIPN showed similar degrees of pain even after 3 months of treatment, in comparison to the patients with MPS and CTS. When breast cancer patients complain of upper extremity sensory disturbance, various causes, especially referred symptom from MPS, should be considered for effective treatment.

Gut microbiota-associated bile acid deconjugation accelerates hepatic steatosis in ob/ob mice.

AIM: Nonalcoholic hepatic fat accumulation has been hypothesized to be associated with alterations in gut microbiota composition, although mechanistic explanations for this link are largely insufficient. The aim of this study was to elucidate the microbiota-driven mechanisms involved in the development of nonalcoholic hepatic steatosis. METHODS AND RESULTS: Ob/ob mice and their wild-type lean control mice were fed an AIN-93G diet for 12 weeks. Faecal microbiota composition, faecal bile acid (BA) profile and intestinal and hepatic markers of BA metabolism were analysed. Ob/ob mice had significantly less faecal taurine-conjugated BAs compared to their lean controls. The proportions of butyrate-producing bacteria were lower in ob/ob mice compared to those in lean mice. Intestinal expression of farnesoid X receptor (FXR) mRNA was significantly higher, whereas hepatic expression of cholesterol-7α-hydroxylase 1 (CYP7A1) and small heterodimer partner (SHP) were significantly lower in ob/ob mice compared to those in control mice. CONCLUSION: Microbiota-associated BAs deconjugation may induce nonalcoholic fatty liver disease (NAFLD) by activating intestinal FXR signalling and blocking hepatic FXR-SHP pathway, thereby accelerating fat synthesis. SIGNIFICANCE AND IMPACT OF THE STUDY: We provided evidences that changes in the gut microbiota and their metabolites can alter the profile of BAs, thereby providing a mechanism by which an altered microbiota profile contributes to the development of NAFLD.