Effect of Conventional Versus Passive Self-Ligating Vestibular Appliances on Torque, Tip and Transverse Dental Changes in Patients Affected by Class I Malocclusion: A Retrospective Study

ABSTRACT Objective: To evaluate the effects of passive self-ligating appliances (PSLAs) and conventional ligating appliances (CLAs) during orthodontic treatment regarding torque, tip, and transversal dental changes. Material and Methods: Dental parameters were digitally acquired from pre- and post-treatment models of each subject belonging to two groups of patients treated with PSLAs (23 patients; 11 females and 12 males with a mean age of 14.2 ± 1.6 years) and CLAs (18 patients; 10 females and 8 males with a mean age of 14.3 ± 1.9 years), respectively. All subjects had Class I or slight Class II malocclusion (= 2mm), permanent dentition and no previous orthodontic treatment. After normality of data was assumed, a paired sample t-test rejected any side differences at T0 and, therefore, the data were grouped by tooth group. Statistical analyses were performed using a linear mixed-effect framework, assuming the appliance, time, and interactions as fixed effects and the tooth type as random effects. Finally, post-hoc effect analysis was used to contrast modeled marginal effects (p<0.05). Results: For both appliances, there is a general increase of both torque and transverse values at T1, especially for PSLAs. Tip shows a general reduction in the lateral sectors for both appliances is registered. The only significant statistical difference referred to appliances' efficacy is located to mandibular intermolar width. Conclusion: Both appliances have an expansive potential for both torque and transverse dental changes. No evident differences are detectable between appliances except for the rate of the mandibular intermolar width increase.

Torsional Resistance of Two New Heat Treated Nickel Titanium Rotary Instruments: An in Vitro Evaluation

Abstract Objective: To evaluate the difference in torsional resistance, angular deflection and fragment length between two new rotary instruments: AF Blue S4 and S-One. These files share all features except cross-sectional design. Material and Methods: A total of 40 new Nickel-Titanium instruments of 25 mm in length were tested in this study and divided in two groups: 20 AF Blue S4, tip 25 and constant 6% taper and 20 AF-Blue S4 tip 25 and constant 6% taper. The torsional test was performed by the use of a torque recording endodontic motor (KaVo, Biberac, Germany). Torque to Fracture (TtF), Angular Deflection (AD) and Fragment Length (FL) was recorded for each instrument. To ensure an immovable block at 3mm of the instrument tip, an auto-polymerizing resin (DuraLay; Reliance Dental Mfg Co, Worth, IL) was used. Each file was rotated clockwise at a speed of 300 rpm until fracture occurred. Results: Group A (AF Blue S4) showed higher TtF and AD than Group B (S-One), and statistical analysis found significant differences between the two instruments (p<0.05). The mean values for FL showed no significant differences (p>0.05) between the two instruments. Conclusion: The AF Blue S4 seems to have a higher resistance to torsional stress in vitro. Clinically, the use of AF Blue S4 could be safer in narrow canals.

Global Longitudinal Strain Predicts Poor Functional Capacity in Patients with Systolic Heart Failure / Strain Longitudinal Global é Preditor de Baixa Capacidade Funcional em Pacientes com Insuficiência Cardíaca Sistólica

Abstract Background: Left ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF. Objetive: Correlate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria. Methods: Systolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO2, VE/VCO2 slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO2 in 50% after physical exercise (T1/2VO2). ROC curve analysis of GLS to predict VO2 < 14 mL/kg/min and VE/VCO2 slope > 35 (heart transplantation's criteria) was performed. Results: Twenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO2 and T1/2VO2. GLS correlated to all CPET variables (maxVO2: r = 0.671, p = 0.001; VE/VCO2 slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T1/2VO2: r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation's criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03. Conclusion: GLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation.

Resumo Fundamento: O strain longitudinal global (SLG) é capaz de predizer a capacidade funcional dos pacientes com insuficiência cardíaca (IC) e fração de ejeção do ventrículo esquerdo (FEVE) preservada, e avaliar o prognóstico na IC com FEVE reduzida. Objetivo: Correlacionar o SLG com parâmetros do teste de exercício cardiopulmonar (TECP), e avaliar se o SLG seria capaz de predizer quais pacientes com IC sistólica deveriam ser encaminhados ao transplante cardíaco de acordo com os critérios do TECP. Métodos: Os pacientes com IC sistólica com FEVE <45%, classe funcional NYHA II e III, submeteram-se prospectivamente ao TECP e à ecocardiografia com análise do strain. A FEVE e o SLG foram correlacionados com as seguintes variáveis do TECP: maxVO2, inclinação de VE/VCO2, redução da frequência cardíaca durante o primeiro minuto de recuperação (RFC), e tempo necessário para a redução do maxVO2 em 50% após o exercício físico (T1/2VO2). Foi realizada análise da curva ROC do SLG em predizer um VO2 < 14 mL/kg/min e uma inclinação de VE/VCO2 > 35 (critérios para transplante cardíaco). O nível de significância adotado na análise estatística foi de p < 0,05. Resultados: Vinte e seis pacientes foram selecionados para o estudo (idade, 47±12 anos, 58% homens, FEVE média LVEF = 28 ± 8%). A FEVE correlacionou-se somente com o maxVO2 e o T1/2VO2. O SLG correlacionou-se com todas as variáveis do TECP (maxVO2: r = 0,671; p = 0,001; inclinação de VE/VCO2: r = -0,513; p = 0,007; RFC: r = 0,466; p = 0,016; e T1/2VO2: r = -0,696, p = 0,001). A área sob a curva ROC para o SLG para predizer os critérios para transplante cardíaco foi de 0,88 (sensibilidade 75%, especificidade 83%) para um ponto de corte de -5,7%, p = 0,03. Conclusão: O SLG apresentou associação significativa com todos os parâmetros funcionais do TECP. O SLG foi capaz de classificar os pacientes com IC segundo capacidade funcional e possivelmente pode identificar quais pacientes têm um prognóstico ruim e, portanto, se beneficiariam de um tratamento diferenciado, tal como o transplante cardíaco.

Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study.

BACKGROUND: Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. METHODS AND RESULTS: Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49-0.87]; P=0.014). CONCLUSIONS: LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.

Global Longitudinal Strain or Left Ventricular Twist and Torsion? Which Correlates Best with Ejection Fraction? / Strain Longitudinal Global ou Twist do Ventrículo Esquerdo e Torção? Qual se Correlaciona Melhor com a Fração de Ejeção?

Abstract Background: Estimative of left ventricular ejection fraction (LVEF) is a major indication for echocardiography. Speckle tracking echocardiography (STE) allows analysis of LV contraction mechanics which includes global longitudinal strain (GLS) and twist/torsion, both the most widely used. Direct comparison of correlations between these novel parameters and LVEF has never been done before. Objective: This study aims to check which one has the highest correlation with LVEF. Methods: Patients with normal LVEF (> 0,55) and systolic dysfunction (LVEF <0,55) were prospectively enrolled, and underwent echocardiogram with STE analysis. Correlation of variables was performed by linear regression analysis. In addition, correlation among levels of LV systolic impairment was also tested. Results: A total of 131 patients were included (mean age, 46 ± 14y; 43%, men). LVEF and GLS showed a strong correlation (r = 0.95; r2 = 0.89; p < 0.001), more evident in groups with LV systolic dysfunction than those with preserved LVEF. Good correlation was also found with global longitudinal strain rate (r = 0.85; r2 = 0.73; p < 0.001). Comparing to GLS, correlation of LVEF and torsional mechanics was weaker: twist (r = 0.78; r2 = 0.60; p < 0.001); torsion (r = 0.75; r2 = 0.56; p < 0.001). Conclusion: GLS of the left ventricle have highly strong positive correlation with the classical parameter of ejection fraction, especially in cases with LV systolic impairment. Longitudinal strain rate also demonstrated a good correlation. GLS increments analysis of LV systolic function. On the other hand, although being a cornerstone of LV mechanics, twist and torsion have a weaker correlation with LV ejection, comparing to GLS.

Resumo Fundamento: A estimativa da fração de ejeção do ventrículo esquerdo (FEVE) é uma das pincipais indicações para a ecocardiografia. Speckle tracking (ST) permite a análise da mecânica de contração do VE que inclui a deformação (strain) longitudinal global (SLG) e o twist / torção, sendo ambos os mais utilizados. A comparação direta de correlações entre esses novos parâmetros e a FEVE nunca foi feita antes. Objetivo: Verificar qual delas tem a maior correlação com a FEVE. Métodos: Pacientes com FEVE normal (> 0,55) e disfunção sistólica (FEVE < 0,55) foram prospectivamente inscritos e submetidos a ecocardiograma com análise do ST. A correlação das variáveis foi realizada por análise de regressão linear. Além disso, também foi testada a correlação entre os níveis de comprometimento sistólico do VE. Resultados: Foram incluídos 131 pacientes (média de idade de 46 ± 14 anos e 43% de homens). A FEVE e SLG apresentaram forte correlação (r = 0,95; r2 = 0,89; p < 0,001), mais evidente em grupos com disfunção sistólica do VE do que naqueles com FEVE preservada. Também foi encontrada boa correlação com a taxa de deformação (strain rate) longitudinal (SRL) global (r = 0,85; r2 = 0,73; p < 0,001). Comparando-a à SLG, a correlação entre FEVE e mecânica de torção foi mais fraca: twist (r = 0,78; r2 = 0,60; p < 0,001); Torção (r = 0,75, r2 = 0,56, p < 0,001). Conclusão: A SLG do ventrículo esquerdo apresenta alta correlação positiva com o parâmetro clássico de fração de ejeção, principalmente nos casos de comprometimento sistólico do VE. O SRL também demonstrou uma boa correlação. A SLG incrementa a análise da função sistólica do VE. Por outro lado, apesar de ser a pedra angular da mecânica do VE, o twist e a torção têm uma correlação mais fraca com a ejeção do VE, quando comparados ao SLG.

Torsión anexial: presentación clínica y manejo en una serie retrospectiva de 17 años

Objetivos: Analizar y presentar la epidemiología descriptiva de pacientes con antecedente de torsión anexial. Diseño: Estudio observacional, descriptivo y retrospectivo. Institución: Hospital Universitario Doctor Peset, Valencia, España. Participantes: Mujeres diagnosticadas de torsión anexial. Intervenciones: Diagnóstico y tratamiento de 54 mujeres de entre 11 y 64 años entre el 1/02/1997 y 30/06/2014. Resultados: En las 54 pacientes incluidas, la edad media al diagnóstico fue 31,7 años; 6 (11 ,1 %) pacientes habían sido intervenidas quirúrgicamente por patología anexial previa. El anexo más afectado fue el derecho; 34 (62,9%) pacientes presentaban masas anexiales. El síntoma de presentación en todas las pacientes fue el dolor pélvico agudo, y el tiempo medio transcurrido desde la aparición de la clínica hasta el trata­ miento fue de 24 a 72 horas. En 14 (25,9%) pacientes se realizó laparotomía y en 40 (74,1%) laparoscopia; 3 (5,6%) pacientes presentaron recidiva de la torsión de forma posterior. Conclusiones: El cuadro de torsión anexial debe tenerse en cuenta en toda mujer que acude a urgencias con dolor abdominal agudo. Esta patología es considerada una urgencia quirúrgica, y un retraso en el diagnóstico y tratamiento puede dar lugar a la pérdida del anexo afecto. Hoy en día, la vía laparoscópica es la de elección para su tratamiento en estas pacientes.

Objectives: To present the descriptive epidemiology in a group of women with adnexal torsion. Design: Observational, descriptive and retrospective study. Setting: Hospital Universitario Doctor Peset, Valencia. Spain. Participants: Women diagnosed of adnexal torsion. Interventions: Between February 1997 and june 2014, 54 patients 11-64 years old with adnexal torsion were included. Results: The mean onset age was 31.7 years old. Previous adnexal surgerywas reported in 6 cases (11.1 %). The right adnexal region was the most affected; 34 (62.9%) patients were adnexal mass carriers. The most common presenting symptom was acute pelvic pain, and the mean lag time between onset of symptoms and confirmation of diagnosis was 24-72 hours. Fourteen (25.9%) patients were treated by laparotomy and 40 (74.1 %) by laparoscopy. Recurrence occurred in 3 patients (5.6%). Conclusions: Adnexal torsion should be considered in everywoman complaining of pelvic pain in emergency services. A prompt surgical intervention is required to avoid irreversible ovarian damage. Nowadays, conservative therapy by laparoscopy is preferred in these patients.

Torsion of the greater omentum secondary to omental lymphangioma in a child: a case report.

BACKGROUND: Omental cyst and omental torsion both are uncommon but important causes of acute abdomen with a difficult clinical diagnosis due to nonspecific features. Here we report a case of an eight year old child with acute abdominal pain referred for USG and CT scan which revealed two cysts in greater omentum leading to secondary omental torsion. CASE REPORT: An eight year old male child presented to casualty with severe pain abdomen since 1 day. There was no history of vomiting or altered bowel habits. The patient was febrile with tachycardia on arrival. On examination rigidity and tenderness all over abdomen were present. Serum amylase was within normal range. USG and CECT abdomen were done subsequently. USG showed two well defined cystic lesions in lower abdomen with presence of some internal echogenic debris and calcified foci in their dependent part. There was also presence of omentum with a whirl of blood vessels seen along anterior abdominal wall leading to these lesions suggesting torsion. On colour Doppler the presence of blood flow within the whirl of vessels was seen. Mild amount of free fluid was also seen in the peritoneal cavity. On CECT abdomen the findings of omental cysts and torsion of greater omentum with free fluid in abdomen were confirmed. The cysts measured 60×55 and 65×55mm on CT. The patient was taken for an emergency laparotomy for indication of acute generalized peritonitis. Two large omental cysts were found in the pelvic cavity along with torsed greater omentum along with 150 ml of hemorrhagic fluid in peritoneal cavity. The cysts and twisted necrotic part of the greater omentum were excised at surgery. No postoperative complications were observed. Histopathologic examination was suggestive of lymphangioma of omentum. CONCLUSIONS: Lymphangioma of the omentum is an not very uncommon however acute presentation with omental torsion and infarction is an unusual entity. Optimal utilization of preoperative imaging with USG, Doppler and contrast enhanced CT scan can provide correct diagnosis.

Two adult cases of extralobar pulmonary sequestration: A non-complicated case and a necrotic case with torsion.

BACKGROUND: This case report describes two cases of extralobar pulmonary sequestration in adults with and without torsion/necrosis. CASE REPORTS: Non-complicated extralobar pulmonary sequestration was found incidentally in a 50-year-old asymptomatic woman (Case 1), diagnosed with the presence of a branching structure in a mass lesion and blood supply from the right inferior phrenic artery. Another case of a 38-year-old woman presented with a sudden onset of back pain caused by extralobar pulmonary sequestration with torsion/necrosis (Case 2). A 4-cm fusiform mass in the paravertebral region showed enhancement in the peripheral rim only, and no feeding artery. These were the same as it had been reported typical findings in extralobar pulmonary sequestration with necrosis. On magnetic resonance imaging, the masses in both cases showed inhomogeneous low signal and branching high signal on T2-weighted images. That was characteristic for a stroma without dilated alveoli as a solid part and dilated alveoli as fluid regions. CONCLUSIONS: By comparing those two cases, we came to a conclusion that only T2-weighted imaging reflects the native structure, even after infarction. Although differentiation from a cystic tumor with hemorrhage or infection can be problematic, inhomogeneous low signal and branching high signal on T2-weighted images may help us distinguish extralobar pulmonary sequestration from other cystic lesions.

Torsional force applied to the tibia of living lambs in an attempt to change the bone rotational axis

To evaluate the effects of torsional force on the rotational axis of living lamb tibias. METHODS: An external fixator device was designed to apply rotation to the tibias of lambs. Once a week, the bone distal extremity was rotated 2º. After achieving ~20º of internal rotation, the turning was discontinued and the device was maintained in situ for one month and euthanasia occurred in group A (n=10) after this. In group B (n=9) euthanasia occurred three months after removing the device. Computed tomography scans evaluated the rotational angle; dual-energy X-ray absorptiometry assessed the bone mineral density, and conventional and polarized light microscopy studied the bone microstructure. RESULTS: In group A, the mean angle of the external rotation in the control tibias was 24º and 8º in the twisted tibias (p<0.0001); in group B, the angle was 23º (control) and 7º (twisted, p<0.0001), with no differences between groups A and B (p=0.9567). The BMD increased in the twisted tibias in group A (p<0.0001) and in group B (p=0.0023), with no between-group differences (p>0.05). Microscopically, the twisted tibias showed asymmetrical subperiosteal bone deposition on the lateral cortex surface. CONCLUSION: Gradual torsion applied to the immature tibia significantly modified its rotational axis.

Diagnóstico en Torsión de Pedículo de Quiste Anexial en Ginecología / Diagnosis in torsion of adnexal cyst in gynecology

Objetivos: Evaluar los signos clínicos, ecográficos y Doppler color en el diagnóstico de la torsión de pedículo. Métodos: Estudio observacional prospectivo de corte transversal, incluyó a 22 pacientes durante un período de tres años, que acudieron, con dolor abdominal agudo y presencia de quiste anexial. Las edades comprendidas fueron entre 22 y 58 años. Resultados: Cotejados con los hallazgos quirúrgicos y la evolución clínica: de 22 pacientes, 9 tenían torsión de pedículo; la tríada clásica mostró una sensibilidad de 55%, especificidad del 46%, valor predictivo positivo del 42%, valor predictivo negativo del 60%. El signo directo de torsión de pedículo mostró una sensibilidad de 78%, especificidad de 92%, valor predictivo positivo de 87%, valor predictivo negativo del 86%. El Doppler color mostró una sensibilidad de 100%, especificidad de 69%, valor predictivo positivo de 69%, valor predictivo negativo de 100%. El líquido libre abdominal mostró un resultado variable. Conclusiones: La sospecha clínica es el primer paso en el diagnóstico; el hallazgo del signo directo de torsión fue el de mayor valor diagnóstico; el hallazgo de señal Doppler color en la pared del quiste prácticamente, descartó la posibilidad de torsión.

Objectives: To evaluate the clinical, ultrasonography signs and Doppler color in the diagnosis of the torsión of pedicle. Methods: Prospective observational study of cross-section included 22 patients over a period of three years, who attended with acute abdominal pain and presence of anexial cyst. With an age range between 22 and 58 years. Results: 22 patients, 9 had torsión of pedicle; triad classic showed a 55% sensitivity, specificity 46%, positive predictive value 42%, negative predictive value 60%. The direct sign of torsión of pedicleshowed a sensitivity of 78%, specificity 92%, positive predictive value 87%,negative predictive value of 86%. The absence of Doppler signal colorshowed a sensitivity of 100%, specificity of 69%, positive predictive value 69%, negative predictive value of 100%. The abdominal free liquid showed a variable result. Conclusions: The clinical suspicion is the first passage in the diagnosis; the finding of the direct sign of torsión was the one of greater value diagnosis; the finding of color Doppler signal in the wall of the cyst practically, discarded any possibility of torsion.