Does 2 years’ nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible?

The aim of this pilot study was to investigate the effects of 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and obstructive sleep apnea syndrome with respect to possible development of a forward position of the mandible or other dentofacial changes. Thirty snoring and sleep apnea patients, mean age 55.3 years (SD, 8.61; range, 46.5 to 79.8 years), referred from the Ear, Nose, and Throat Department, were treated with an acrylic splint with full tooth coverage that advanced the mandible 5 to 8 mm (70% of maximal protrusion) and used 5 mm opening vertically. The splint was used 6 to 8 hours per night and 5 to 7 nights per week. Two lateral head radiographs were taken in centric occlusion, 1 before and 1 after 2 years of treatment. A small but statistically significant forward and downward change in mandibular position was found after treatment; mean was 0.4 mm (SD, 0.53; range, 0.0 to 2.0 mm; P <.001) and 0.3 mm (SD, 0.43; range, 0. 0 to 1.5 mm; P <.001), respectively. The forward and downward movement of the mandible was accomplished by a statistically significant increase in mandibular length-mean was 0.4 mm (SD, 0.62; range, 0.0 to 2.5 mm; P <.01)-and a significant decrease in overjet (P <.001) and overbite (P <.05). However, none of the patients reported any permanent sense of altered occlusion, and the anteroposterior distance between habitual occlusion (intercuspal position) and centric relation (retruded position) did not exceed 1. 0 mm in any of the patients either before or after the treatment. The change in mandibular position might be a result of a condylar and/or glenoid fossa remodeling or condylar position changes within the fossa as a compensatory reaction to the advancement of the mandible (bite jumping). However, to visualize and analyze such possible changes in detail, additional studies using lateral tomography of the temporomandibular joints or magnetic resonance imaging are required. Furthermore, because the treatment of snoring and OSAS patients is considered to be lifelong, long-term studies are needed to analyze if the small change in mandibular position will continue with further treatment.     

Molecular structure and chromosome distribution of three repetitive DNA families in Anemone hortensis L. (Ranunculaceae)

The structure, abundance and location of repetitive DNA sequences on chromosomes can characterize the nature of higher plant genomes. Here we report on three new repeat DNA families isolated from Anemone hortensis L.; (i) AhTR1, a family of satellite DNA (stDNA) composed of a 554–561 bp long EcoRV monomer; (ii) AhTR2, a stDNA family composed of a 743 bp long HindIII monomer and; (iii) AhDR, a repeat family composed of a 945 bp long HindIII fragment that exhibits some sequence similarity to Ty3/gypsy-like retroelements. Fluorescence in-situ hybridization (FISH) to metaphase chromosomes of A. hortensis (2n = 16) revealed that both AhTR1 and AhTR2 sequences co-localized with DAPI-positive AT-rich heterochromatic regions. AhTR1 sequences occur at intercalary DAPI bands while AhTR2 sequences occur at 8–10 terminally located heterochromatic blocks. In contrast AhDR sequences are dispersed over all chromosomes as expected of a Ty3/gypsy-like element. AhTR2 and AhTR1 repeat families include polyA- and polyT-tracks, AT/TA-motifs and a pentanucleotide sequence (CAAAA) that may have consequences for chromatin packing and sequence homogeneity. AhTR2 repeats also contain TTTAGGG motifs and degenerate variants. We suggest that they arose by interspersion of telomeric repeats with subtelomeric repeats, before hybrid unit(s) amplified through the heterochromatic domain. The three repetitive DNA families together occupy ∼10% of the A. hortensis genome. Comparative analyses of eight Anemone species revealed that the divergence of the A. hortensis genome was accompanied by considerable modification and/or amplification of repeats. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Ambulatory oral surgery: 1-year experience with 11?680 patients from Zagreb district,Croatia

Aim

To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia.

Methods

Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age.

Results

The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P < 0.001) and intraoral incisions (P < 0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas.

Conclusion

The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health.Oral health is essential to general health and well-being, and tooth loss is an important indicator of oral health status. Reduction of tooth loss is one of the targets for achieving global goals for oral health (1).Croatian dental health system, along with general health care, is regulated by the Health Care Law and divided into three levels of care: primary, secondary, and tertiary. Primary dental health care is performed by doctors of dental medicine with the help of dental assistants; it includes prevention, detection, and treatment of oral diseases, as well as rehabilitation of the masticatory system. Secondary or specialist outpatient dental health care treats patients in need of expert opinion, advice, or treatment. Tertiary care provides care only for patients requiring hospitalization.In order for the system to work properly and without overload, levels of health care must cooperate. Most patients with oral needs visit a primary health care system dentist, so further education of these professionals is essential for a better system of specialist referrals and a more efficient health care system. In Croatia, there are no data about the types and frequencies of oral surgery treatment so the aim of this study was to gain insight into the types and frequencies of diagnoses and ambulatory surgical treatments at the Department of Oral Surgery at University Hospital Dubrava in Zagreb, Croatia. We also investigated whether there was a significant difference in clinical diagnoses and procedures according to sex, age, and place of residence.     

Prevalence of Endocrine Disorders in Morbidly Obese Patients and the Effects of Bariatric Surgery on Endocrine and Metabolic Parameters

Background

Several endocrine abnormalities, including hypothyroidism and Cushing??s syndrome (CS), are considered as causative factors of obesity. The aim of this study was to evaluate the prevalence of endocrine disorders and obesity-associated co-morbidities, as well as the impact of substantial weight loss.

Methods

Screening was performed in 433 consecutive morbidly obese patients (age 41?±?12?years; BMI 47?±?6.9?kg/m²; women 76%). A 1-mg dexamethasone suppression test (1-mg DST) was conducted to exclude CS, and thyrotropin (TSH) was measured to exclude hypothyroidism. Insulin sensitivity was estimated from oral glucose tolerance tests employing the Clamp-like index. Examinations were carried out at baseline, as well as at 6 and 12?months postoperatively.

Results

The prevalence of CS was below 0.6%. Before surgery, TSH was elevated compared to an age- and sex-matched normal weight control group (2.4?±?1.2 vs. 1.5?±?0.7???U/ml; p?2; p?p?+-group compared to the MetS^--group (15.0?±?6.3 vs. 13.5?±?6.3???g/dl; p?=?0.003).

Conclusions

CS appears to be a rare cause of morbid obesity. Normalization of slightly elevated thyrotropin after weight loss suggests that obesity causes TSH elevation rather than the reverse.     

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

Background

The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection.

Methods

Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux.

Results

A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery.

Conclusion

Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate.     

Active Iron Sites of Disordered Mesoporous Silica Catalyst FeKIL-2 in the Oxidation of Volatile Organic Compounds (VOC)

Iron-functionalized disordered mesoporous silica (FeKIL-2) is a promising, environmentally friendly, cost-effective and highly efficient catalyst for the elimination of volatile organic compounds (VOCs) from polluted air via catalytic oxidation. In this study, we investigated the type of catalytically active iron sites for different iron concentrations in FeKIL-2 catalysts using advanced characterization of the local environment of iron atoms by a combination of X-ray Absorption Spectroscopy Techniques (XANES, EXAFS) and Atomic-Resolution Scanning Transmission Electron Microscopy (AR STEM). We found that the molar ratio Fe/Si ≤ 0.01 leads to the formation of stable, mostly isolated Fe³⁺ sites in the silica matrix, while higher iron content Fe/Si > 0.01 leads to the formation of oligonuclear iron clusters. STEM imaging and EELS techniques confirmed the existence of these clusters. Their size ranges from one to a few nanometers, and they are unevenly distributed throughout the material. The size of the clusters was also found to be similar, regardless of the nominal concentration of iron (Fe/Si = 0.02 and Fe/Si = 0.05). From the results obtained from sample characterization and model catalytic tests, we established that the enhanced activity of FeKIL-2 with the optimal Fe/Si = 0.01 ratio can be attributed to: (1) the optimal concentration of stable isolated Fe³⁺ in the silica support; and (2) accelerated diffusion of the reactants in disordered mesoporous silica (FeKIL-2) when compared to ordered mesoporous silica materials (FeSBA-15, FeMCM-41).     

Simple vibroacoustic foetal stimulator

Primary objective: To build and test a simple vibroacoustic foetal stimulator. Research design: A vibroacoustic foetal stimulator was constructed and subjected to bench testing. Clinical trial was carried out in comparison to an electro larynx. Main outcomes and results: Screening specificity of 98% and 100% sensitivity was achieved, with no decrease in specificity due to user's maladjustments. The device was characterized by simple use, maintenance and disinfection. Conclusions: The device is a good screening instrument for foetal health in prenatal care, despite its simplicity and low price.