Noninvasive respiratory support following extubation in preterm infants.

The use of noninvasive respiratory support is widespread in newborn infants with respiratory distress. As the use of noninvasive respiratory support has increased, so too have the number of modes available. Among these modes, low-flow nasal cannula and nasal continuous positive airway pressure (NCPAP) have been used for a long time and have known efficacy and safety in newborn infants needing respiratory support. High-flow nasal cannula (HFNC) has been newly introduced, and its efficacy and safety are currently being investigated. Bilevel nasal continuous positive airway pressure and nasal intermittent positive-pressure ventilation are often used when NCPAP or HFNC therapy fails. More recently, noninvasive neurally adjusted ventilatory assist and noninvasive high-frequency oscillatory ventilation have been introduced, and their efficacy and safety are currently under evaluation. Comparison of the efficacy and safety among various modes of noninvasive respiratory support after extubation in preterm infants is helping to clarify the position of each mode. The clarification of the strength and characteristics of each device within the same mode will become important as a future direction of noninvasive respiratory support after extubation in such subjects. However, no research has yet reported on long-term outcomes in preterm infants receiving noninvasive respiratory support after extubation. Therefore, further research is needed to evaluate the long-term outcomes.

Anti-cyclic Citrullinated Peptide Antibody-positive Girl with Chronic Polyarthritis Later Diagnosed with Juvenile Systemic Lupus Erythematosus: A Case Report.

BACKGROUND: Arthritis is one of the earliest symptoms of juvenile systemic lupus erythematosus (SLE) but is unusual in cases presenting with chronic arthritis or deforming/erosive arthritis. Overlap of juvenile idiopathic arthritis (JIA) and juvenile SLE is a rare clinical condition known as "rhupus" syndrome. The clinical and serological characteristics of rhupus syndrome in children remain to be established. In addition, no studies regarding anti-cyclic citrullinated peptide (CCP) antibody in juvenile SLE or juvenile rhupus syndrome have been reported. CASE REPORT: A 12-year-old girl suffered from polyarthralgia lasting for one week. She was tentatively diagnosed with polyarticular JIA because of her symptom of chronic arthritis and a positive result for anti-CCP antibody. After six months of follow-up for JIA, she presented with a fever, malar rash, and worsening of arthralgia. Laboratory examinations revealed hypocomplementemia and a positive result for anti-double-stranded DNA antibody. She was diagnosed with juvenile SLE. CONCLUSIONS: It is important to note that patients with chronic arthritis, as well as those with anti-CCP antibody-positive polyarthritis, should be carefully followed for their clinical and serological condition, considering the possibility of them developing juvenile SLE.

A Family Case of COVID-19 Pneumonia with Different Chest CT Features and Duration of SARS-CoV-2 Shedding: a Case Report from Japan.

Coronavirus disease 2019 (COVID-19) pneumonia in children characteristically has a milder clinical presentation, with milder inflammatory biomarkers and radiological findings. Accumulating evidence indicates a difference in chest computed tomography (CT) features and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding between children and adults. Here, we report a family case of COVID-19 pneumonia in which 2 brothers (aged 14 years and 2 years) had different findings. On admission, the 2-year-old brother had few symptoms with no signs of pneumonia, whereas the older brother had presented with pneumonia on admission. Both were positive for SARS-CoV-2 infection on polymerase chain reaction and showed obvious characteristic signs of COVID-19 pneumonia on chest CT. However, CT findings in the younger brother were nonspecific and similar to those of other pneumonias. The older brother required longer treatment because of the longer shedding period of SARS-CoV-2 detected in nasopharyngeal samples. Both boys were discharged without complications. This family case suggests that the clinical features of COVID-19 pneumonia might differ between younger and older children.

Intuitive Facial Imaging Method for Evaluation of Postoperative Swelling: A Combination of 3-Dimensional Computed Tomography and Laser Surface Scanning in Orthognathic Surgery.

PURPOSE: Postoperative facial swelling after orthognathic surgery may be prolonged and of concern in some patients. In recent years, there have been several reports of analysis of postoperative facial swelling by volume data; however, such evaluations cannot exclude the possibility of error in the measured point because there are no clear anatomic landmarks on the cheek. Three-dimensional laser scanning is a noninvasive tool that can be used to measure surface changes in soft tissue over time. The aim of this study was to quantify postoperative swelling in orthognathic surgery by fusing surface scanned images with skin images reconstructed from 3-dimensional computed tomography data and identifying a set of reference points on the bone. MATERIALS AND METHODS: The study comprised 30 patients undergoing bilateral sagittal split osteotomy. Facial scans were obtained with the Artec Eva Scan imaging system (Data Design, Aichi, Japan) at 9 time points from before surgery to 6 months postoperatively. Postoperative scan images were compared with the baseline facial scan obtained 6 months postoperatively. RESULTS: On average, 66% of the initial postoperative edema subsided in 1 month. After 3 months, only 5% of the swelling remained. There were statistically significant correlations between subcutaneous tissue thickness and swelling (P < .0001). CONCLUSIONS: We were able to monitor facial swelling after orthognathic surgery with very high precision using the described method. Subcutaneous tissue thickness is an important determinant of facial swelling.

Factors predictive of pterygoid process fractures after pterygomaxillary separation without using an osteotome in Le Fort I osteotomy.

OBJECTIVE: This study demonstrated pterygomaxillary disjunction patterns and elucidated factors related to unfavorable pterygomaxillary junction fractures in Le Fort I osteotomy without using an osteotome. STUDY DESIGN: Clinical and anatomical data obtained from computed tomography images (100 sides) were analyzed for their ability to predict patterns of pterygomaxillary disjunction. RESULTS: Separation of the pterygomaxillary junction was most frequently performed at the maxillary tuberosity (48.0%). Twenty-eight pterygoid plates were fractured. Male gender, increased age, thickness of the pterygomaxillary junction, and length of the maxillary tuberosity were significant risk factors for pterygoid process fractures. We also identified that a pterygomaxillary junction thickness less than 2.6 mm and a maxillary tuberosity length of more than 11.5 mm indicated a statistically significant risk of pterygoid process fractures. CONCLUSIONS: Prediction of frangible pterygoid plates by preoperative quantitative evaluation of morphometric values provides useful information for selecting safe procedures.

Endoscopic-assisted resection of peripheral osteoma using piezosurgery.

Endoscopic-assisted surgery has gained widespread popularity as a minimally invasive procedure, particularly in the field of maxillofacial surgery. Because the surgical field around the mandibular angle is extremely narrow, the surrounding tissues may get caught in sharp rotary cutting instruments. In piezosurgery, bone tissues are selectively cut. This technique has various applications because minimal damage is caused by the rotary cutting instruments when they briefly come in contact with soft tissues. We report the case of a 33-year-old man who underwent resection of an osteoma in the region of the mandibular angle region via an intraoral approach. During surgery, the complete surgical field was within the view of the endoscope, thereby enabling the surgeon to easily resection the osteoma with the piezosurgery device. Considering that piezosurgery limits the extent of surgical invasion, this is an excellent low-risk technique that can be used in the field of maxillofacial surgery.