Can the Upper Vermilion and the Nasolabial Fold Be Changed With Orthognathic Surgery?

BACKGROUND: Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support. PURPOSE: A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles. STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded. PREDICTOR VARIABLE: The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up). MAIN OUTCOME VARIABLE: The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL. COVARIATES: The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements. ANALYSES: Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson's linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P < .05. RESULTS: The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P < .001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P = .019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P < .001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P < .001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P = .001), indicating a more projected and everted upper vermilion. CONCLUSIONS AND RELEVANCE: When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted.

Barcelona line. A multicentre validation study of a facial projection reference in orthognathic surgery.

The purpose of this study was to validate an already published facial anteroposterior reference: upper incisor (UI) to soft tissue plane or so-called Barcelona line (BL) to trace the most aesthetic sagittal position of the maxilla. A cross-sectional multicentre evaluation of Caucasian patients from Spain and Brazil with different anteroposterior maxillary positions was designed. Sagittal images in natural head orientation of grouped patients according to the horizontal distance from the UI to BL were ranked by healthcare professionals and non-professional Caucasian raters according to the aesthetic perception of each profile, using a digital survey. Seventy-four raters (50 laypeople, 12 orthodontists, and 12 maxillofacial surgeons) rated 40 profiles. The best-rated profile corresponded to group 3 (0-4 mm UI-BL) with 61.8% of positive evaluations, followed by group 4 (≥ 4 mm UI-BL): with 61.1%. On the other hand, group 1 (≤-4 mm UI-BL) was the worst-ranked profile with 71.8% of negative evaluations, followed by group 2 (-4-0 mm UI-BL): with 59.6% of negative evaluations. The correlation between the mean assessment score and UI-BL showed a moderately-strong association (r = 0.68, p < 0.001). The inter-rater reliability of assessment (74 evaluators) was moderate (k = 0.49, 95% CI: 0.39 to 0.59). The results suggest that protrusive middle-third facial profiles are preferable. The BL is proposed as a simple, individualised, and reproducible tool to trace an aesthetic sagittal position of the maxilla in orthognathic surgery.

Modifications of the Protein Characteristics of Pacaya Caused by Thermal Treatment: A Spectroscopic, Electrophoretic and Morphological Study.

The inflorescences of Chamaedorea tepejilote Liebm. are consumed as food in Central America and southern Mexico but is an underutilized food because of its sensory characteristics, principally due to its bitter taste. However, the inflorescences of Chamaedorea tepejilote Liebm. are nutritionally promising due to their high protein content (approximately 25%). Protein isolates from pacaya were modified via three different thermal treatments to determine the effect of the treatments on the protein structures. Scanning electron microscopy indicated that the pacaya protein isolate particles had less rough and irregular surfaces with larger particle sizes due to an aggregation process when a thermal treatment was used compared to those when no thermal treatment was used. An increase in the intensity of the low molecular weight protein fractions (≤20 kDa) in the electrophoretic pattern of the proteins was observed, which was generated by the hydrolysis of the proteins by heat treatment. The modifications in the FT-IR spectra showed that thermal treatment of pacaya affected the secondary structure of its proteins, mainly when microwave treatment was used. Raman spectroscopy revealed that the α-helical structure was dominant in the proteins of pacaya and that thermal treatment increased the fraction of the ß-sheet structure at the expense of the α-helical structure.

Foreign-Born Individuals with HIV in King County, WA: A Glimpse of the Future of HIV?

To better understand country of birth-related shifts in the demography of people newly diagnosed with HIV infection, we compared demographic and clinical characteristics of foreign-born and U.S.-born residents of King County, WA diagnosed with HIV from 2006 to 2015. The proportion of cases that were foreign-born increased from 23 to 34% during this time. Most foreign-born cases were born in Africa (34%), Latin America (32%), Asia (22%), or Europe (7%). Latin Americans and Asians were similar to U.S.-born individuals by HIV risk factor and gender, while Africans were more likely to be female and less often men who have sex with men. In 2015, approximately 15% of cases presumptively newly diagnosed in King County were foreign-born individuals who self-reported a pre-immigration HIV diagnosis. Increases in foreign-born individuals previously diagnosed out of country may lead to inaccuracy in the count of new diagnoses, including an over-estimate of community-acquired HIV in King County.