Cortical thickness at the time of the initial attack in two patients with paediatric relapsing–remitting multiple sclerosis

BackgroundMultiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with a low incidence in the paediatric population; cortical atrophy is often striking, even in the early stages of the disease. Evidence of cortical thinning in childhood MS is scant.AimsThis study aimed to assess cortical thickness in paediatric patients during the initial attack of remitting–relapsing MS.MethodsWe report two cases of remitting–relapsing MS, with initial attacks at 12 and 16 years of age. We analysed brain cortical thickness (CTh) in these patients and compared these data to the CTh of a control group comprised of six 12-year-old females and six 16-year-old males.ResultsBoth cases exhibited a total brain CTh significantly below that of the control group. This difference was also observed when analysing the CTh of all lobes except the left parietal lobe in one of the cases.ConclusionsCortical atrophy is already present at the time of onset of MS. Studies with larger patient populations that have a more homogenous clinical presentation could identify the time of onset of cortical atrophy and use this parameter as a prognostic and/or treatment marker of MS.     

Success with plasmapheresis treatment for recurrent focal segmental glomerulosclerosis in pediatric renal transplant recipients

FSGS recurs in approximately 30% of transplanted kidneys and may lead to graft loss. We retrospectively examined the efficacy of early and intensive PP without additional IS in pediatric kidney transplant patients with recurrent FSGS at our center. Seven of 24 patients (29%) had nephrotic proteinuria and histologic evidence of FSGS recurrence within 1–5 days post‐transplantation. PP was initiated early after transplantation and initially performed daily until sustained decline in proteinuria. PP frequency was then individually tapered according to proteinuria. Recurrent FSGS in all seven patients responded to a four‐ to 32‐wk course of PP. Two of seven patients had a second recurrence of FSGS, and both recurrences remitted after an additional 3–6 wk of PP. Median observation period was 4.5 yr (0.8–16.3 yr). Complete remission of recurrent FSGS has been sustained in all seven patients, and all patients have stable graft function with recent plasma creatinine <1.5 mg/dL in six of seven patients. Most recent urine protein/creatinine is 0.13–0.61 mg/mg in six of seven patients. One patient has heavy proteinuria secondary to chronic allograft nephropathy 16 yr post‐transplant. Intensive and prolonged PP, when initiated early in the post‐operative period, is effective in treating recurrent FSGS and preventing graft loss without the use of additional immunosuppressants.     

儿童多发性硬化生活能力、神经心理和眼科预后长期随访观察

目的通过对儿童多发性硬化（MS）系统随访,总结其躯体、心理预后及视力特点。方法回顾性收集首都医科大学附属北京儿童医院近10年来经McDonald诊断标准评估确诊的MS病历,对病程3年以上的MS病例进行系统的随访,随访内容包括日常生活活动能力评估（ADL）,扩展的功能障碍量表评分（EDSS）,神经心理评估（抑郁、焦虑、注意力、社会生活能力）和智力检测,眼科检查［最佳矫正视力、光学相干断层扫描(OCT)测量视神经纤维层(RNFL)厚度、图形视觉诱发电位(P-VEP)］等,对预后进行综合分析。 结果23例MS患儿进入分析。男10例,女13例,平均起病年龄7.7岁;复发缓解型20例,进展复发型2例,继发进展型1例。23例均复发,次数1～10次。平均随访7.7（3.6～14）年,均行ADL评分,完全依赖和中度依赖各1例,均为进展复发型;16例行EDSS评分,EDSS 0分 11例,EDSS≤2.5分4例,EDSS 4.0分1例（为进展复发型）;15例完成神经心理检查,韦氏智力测验2例低于平常,2例边界,1例社会适应能力临界,6例存在注意力缺陷,4例存在轻度焦虑情绪,均无抑郁情绪。16例患儿32眼完善眼科检查,30眼矫正视敏度0.5～1.5,视野无异常,余2眼仅存光感;合并视神经炎MS患儿眼底均提示视神经萎缩,OCT检查结果显示视神经眼在各个象限的RNFL厚度与无视神经炎眼相比明显变薄（P＜0.001）;P-VEP检查中视神经炎眼较无视神经炎眼P100潜伏期明显延长,振幅明显减低（P＜0.05） 结论儿童MS复发缓解型预后尚好,多合并视神经萎缩,但无视力严重受损;其他类型预后差,多遗留躯体残疾及视力残疾,OCT检查可对视神经受累程度定量测定。儿童MS可出现认知损害、焦虑和注意力缺陷等多种神经心理问题。     

Sealer Penetration into Dentinal Tubules in the Presence or Absence of Smear Layer: A Confocal Laser Scanning Microscopic Study

Introduction

The aim of this study was to test the dentinal tubule penetration of AH26 (Dentsply DeTrey, Konstanz, Germany) and MTA Fillapex (Angelus, Londrina, PR, Brazil) in instrumented root canals obturated by using cold lateral compaction or warm vertical compaction techniques in either the presence or absence of the smear layer.

Methods

Forty-five extracted single-rooted human mandibular premolar teeth were used. The crowns were removed, and the root canals were instrumented by using the Self-Adjusting File (ReDent-Nova, Ra'anana, Israel) with continuous sodium hypochlorite (2.6%) irrigation. Final irrigation was either with 5% EDTA or with sodium hypochlorite. The canals were dried and obturated by using rhodamine B–labeled AH26 or MTA Fillapex in combination with the cold lateral compaction or the warm vertical compaction technique. After setting, the roots were sectioned horizontally at 4-, 8-, and 12-mm distances from the apical tip. On each section, sealer penetration in the dentinal tubules was measured by using confocal laser scanning microscopy.

Results

Regardless of the usage of EDTA, MTA Fillapex, compared with AH26, was associated with greater sealer penetration when used with the cold lateral compaction technique, and, conversely, AH26, compared with MTA Fillapex, was associated with greater sealer penetration when used with the warm vertical compaction technique (P < .05). Removal of the smear layer increased the penetration depth of MTA Fillapex used with the cold lateral compaction technique (P < .05); however, it had no significant effect on the penetration depth of AH26.

Conclusions

Greater sealer penetration could be achieved with either the MTA Fillapex–cold lateral compaction combination or with the AH26–warm vertical compaction combination. Smear layer removal was critical for the penetration of MTA Fillapex; however, the same did not hold for AH26.     

不同锥度牙胶尖冷侧压充填根尖封闭性能的比较研究

目的：对比研究0.02锥度和0.06锥度牙胶尖冷侧压充填后根尖封闭效果.方法：收集离体单根管前牙53颗,经根管清理、机用ProTaper预备成型后随机分为2个实验组和1个阳性对照组,实验组每组26个样本,对照组1个样本.实验组分别用0.02锥度牙胶尖和0.06锥度牙胶尖作主尖冷侧方加压进行充填,阳性对照组不进行充填.用透明标本法配合染料渗透技术测量根尖染料的线性渗透长度,评价各组标本的根尖封闭效果.结果：阳性对照组标本染料全部进入根管.0.02锥度组染料渗透长度（0.761 ±0.457） mm,0.06锥度组（0.906±0.490） mm,差异无统计学意义（P＞0.05）.结论：机用ProTaper预备根管后,冷牙胶侧方加压充填时0.06锥度牙胶尖和0.02锥度牙胶尖的根尖封闭效果差异无统计学意义.     

连续波热牙胶垂直充填技术的临床评价

目的 通过连续波热牙胶垂直充填方法与冷牙胶侧压根管充填方法在充填时间、根管充填质量、术后疼痛的比较,对连续波热牙胶充填技术进行临床评价.方法 选择需要做根管治疗的患牙140颗,随机分为2组,其中冷牙胶组76颗,热牙胶组64颗,比较2组患牙根管充填时间、充填质量、侧支根管充填情况、术后疼痛情况等.结果 冷牙胶组充填时间为切牙（6.51 ±0.26） min/根管、前磨牙（4.13 ±0.26） min/根管、磨牙（4.17 ±0.27） min/根管,热牙胶组则分别为（3.07 ±0.16） rmin/根管、（2.79 ±0.31） rmin/根管、（2.91±0.24） min/根管,差异均具有统计学意义（P＜0.05）;2组根管充填质量差异无统计学意义（P＞0.05）,根管超填与根管充填方法无关;热牙胶组侧支根管充填率高于冷牙胶组;2组根管充填术后疼痛差异无统计学意义（P＞0.05）.结论 连续波热牙胶垂直充填方法可以快速、高质量地完成根管充填,提高侧支根管充填率,不会增加根管超填以及术后疼痛的风险.     

Treatment Strategies for Missing Maxillary Central Incisor—An Orthodontist's Perspective

The loss of maxillary central incisors at an early age has psychological, esthetic, and functional implications. Multiple treatment options are available for replacing missing central incisors. The management demands a multidisciplinary approach involving the orthodontist, prosthodontist, and periodontist. Treatment planning requires consideration of a variety of clinical and nonclinical factors. This clinical report attempts to demonstrate different strategies for the management of unilaterally and bilaterally missing central incisors.     

Double anterior (anterolateral and anteromedial) thigh flap for oral perforated defect reconstruction

ObjectiveThe purpose of this study was to assess the therapeutic efficacy of oral perforated defect reconstruction with a double anterior (anterolateral and anteromedial) thigh flap through the modified lateral lip-submandibular approach.Materials and methodsFrom July 2010 to August 2013, eight patients with oral perforated defects secondary to oral cancer ablation involving the superior partial mandible or the posterior partial maxilla, with immediate reconstruction by double anterior (anterolateral and anteromedial) thigh flaps, were retrospectively enrolled into this study.ResultsAll double anterior flaps were musculocutaneous flaps. Seven double flaps resulted in good functional and aesthetic outcomes with complete flap survival. One patient required operative exploration in the postoperative period due to thrombosis in the external jugular vein. After the salvage, one of the double flaps in the intraoral region resulted in partial failure of the superficial skin of the flap. No functional impairment at the donor sites occurred in any of the cases.ConclusionThe double anterior (anterolateral and anteromedial) thigh flap is a feasible and acceptable technique for reconstruction of an oral perforated defect involving the mandible or the maxilla through the modified lateral lip-submandibular approach. It presents a very acceptable aesthetic and functional result with the additional advantage of low morbidity at the donor site.     

Temporary replacement of missing maxillary lateral incisors with orthodontic miniscrew implants in growing patients: rationale,clinical technique,and long-term results

Abstract

The missing maxillary lateral incisor in adolescent patients presents an orthodontic challenge. Historically, there have been three treatment options to address this clinical problem: (1) canine substitution, (2) tooth auto-transplantation, and (3) dental restoration. Unfortunately, these methods are not without limitation. A novel treatment concept, originating in 2003 and utilizing orthodontic miniscrew implants, is presented along with the rationale, clinical technique and 8 years of follow-up.