The effectiveness of alternating rapid maxillary expansion and constriction combined with maxillary protraction in the treatment of patients with a class III malocclusion: a systematic review and meta-analysis

ABSTRACT

Objectives: To establish the effectiveness of Alternate Rapid Maxillary Expansion and Constriction combined with Protraction Facial Mask (Alt-RAMEC/PFM) approach in treating Class III growing patients compared with PFM combined with conventional Rapid Maxillary Expansion (RME/PFM).

Search sources: Unrestricted search in five electronic databases and manual searching were undertaken up to February 2018.

Data selection: Randomised clinical trials (RCTs) evaluating the effectiveness of Alt-RAMEC/PFM were selected.

Data extraction: Screening of references, data extraction and assessment of bias risk were evaluated independently by two reviewers.

Results: Five RCTs comparing the Alt-RAMEC/PFM with RME/PFM met the inclusion criteria. Small but statistically significant mean differences favouring Alt-RAMEC/PFM protocol as measured by SNA angle (1.16°; 95% CI 0.65 to 1.66), SNB angle (0.67°; 95% CI 0.32 to 1.02) and ANB angle (0.66°; 95% CI 0.08 to 1.25) were noted. Alt-RAMEC/PFM exhibited a more favourable overjet correction when compared to RME/PFM, however, differences in other dental changes were insignificant.

Conclusion: There is limited evidence with high risk of bias that Alt-RAMEC/PFM can result in a statistically significant increase in maxillary protraction compared with RME/PFM in Chinese subjects over the short-term. High-quality long-term RCTs with inclusion of patient-reported outcomes are required.     

On the coherence of information highlighted by narrators with aphasia

Background: A central purpose of narration is to convey one's point of view about a narrated event. One's expressed evaluation of a narrated event (modalising language) is often differentiated from one's expression of the time, place, person, and event proper (referential language). Use of narrative evaluative devices highlights information in narratives. Previous findings provide evidence that the frequency of use, co-occurrence and distribution of evaluative devices are similar for narratives of speakers with and without aphasia, suggesting a preservation of evaluative or modalising language in aphasia.

Aims: This study complements prior research on structural aspects of evaluative devices by examining the distribution and overall coherence of the content emphasised by evaluative devices in the personal narratives of speakers with aphasia, as compared to that of narratives produced by demographically similar speakers without aphasia.

Methods & Procedures: Participants were 33 demographically matched, English-speaking, middle-aged adults. Of these, 17 had aphasia, and 16 had no neurological disorder. Each group included similar proportions of three demographic subgroups: African-American males, African-American females, and Caucasian females. Each participant told a personal narrative of a frightening experience. Narrative evaluative content was analysed for its proportion of use on and off the main event line, and for its overall coherence.

Outcomes & Results: The distribution and coherence of highlighted/evaluated semantic content were similar for narratives of individuals with and without aphasia. Notably, some aphasic participants produced coherent evaluative/modalising content with incoherent referential content.

Conclusions: The relatively intact ability of individuals with aphasia to assign prominence to information in narratives sheds light on the neurological underpinnings of modalising language, and suggests possible skills associated with the ability of aphasic persons to “communicate better than they talk” (Holland, 1977 Holland, A. 1977. “Some practical considerations in aphasia rehabilitation”. In Rationale for adult aphasia therapy, Edited by: Sullivan, M. and Kommers, M. S. 167–180. Lincoln, NE: University of Nebraska Medical Center Print Shop.  [Google Scholar]). The clinical potential for assessment and treatment that incorporates narrative evaluative devices and modalising language needs to be further explored.     

Motor cortex stimulation modulates defective central beta rhythms in patients with neuropathic pain

ObjectiveMotor cortex stimulation therapy (MCS) is increasingly used to control refractory neuropathic pain. Post-movement beta synchronization (PMBS) is defined as a sharp increase in beta-frequency electroencephalographic power following movement offset and may reflect sensorimotor cortex inhibition induced, at least in part, by cortical processing of movement-related sensory afferent inputs. PMBS pattern is then often altered in case of neuropathic pain. The main objective of the present study was to test the hypothesis that implanted MCS modulates PMBS in patients presenting with neuropathic pain.MethodsUsing a high-resolution, 128-electrode electroencephalographic system, we recorded and compared, before and during MCS, PMBS patterns during brisk, unilateral right and left index finger extension in 8 patients presenting with neuropathic pain.ResultsThe pre-operative PMBS patterns were altered in all cases. MCS increased the spatial distribution and amplitude of PMBS in most of cases and restored maximum-intensity of PMBS contralateral to the painful body side. These modifications appeared significantly correlated with the analgesic effect of MCS.ConclusionThis study provides evidence of central beta rhythms neuromodulation induced by MCS.SignificanceThe restoration by MCS of defective cortical inhibition in patients with neuropathic pain is evoked.     

Conscious and unconscious processing of fear after right amygdala damage: A single case ERP-study

In this study, we describe a 58-year-old male patient (FZ) with a right-amygdala lesion after temporal lobe infarction. FZ is unable to recognize fearful facial expressions. Instead, he consistently misinterprets expressions of fear for expressions of surprise. Employing EEG/ERP measures, we investigated whether presentation of fearful and surprised facial expressions would lead to different response patterns. We also measured ERPs to aversively conditioned and unconditioned fearful faces.

We compared ERPs elicited by supraliminally and subliminally presented conditioned fearful faces (CS+), unconditioned fearful faces (CS–) and surprised faces. Despite FZ's inability to recognize fearful facial expressions in emotion recognition tasks, ERP components showed different response patterns to pictures of surprised and fearful facial expressions, indicating that covert or implicit recognition of fear is still intact.

Differences between ERPs to CS+ and CS– were only found when these stimuli were presented subliminally. This indicates that intact right amygdala function is not necessary for aversive conditioning.

Previous studies have stressed the importance of the right amygdala for discriminating facial emotional expressions and for classical conditioning. Our study suggests that the right amygdala is necessary for explicit recognition of fear, while implicit recognition of fear and classical conditioning may still occur following lesion of the right amygdala.     

Vertebroplasty using bisphosphonate-loaded calcium phosphate cement in a standardized vertebral body bone defect in an osteoporotic sheep model

In the context of bone regeneration in an osteoporotic environment, the present study describes the development of an approach based on the use of calcium phosphate (CaP) bone substitutes that can promote new bone formation and locally deliver in situ bisphosphonate (BP) directly at the implantation site. The formulation of a CaP material has been optimized by designing an injectable apatitic cement that (i) hardens in situ despite the presence of BP and (ii) provides immediate mechanical properties adapted to clinical applications in an osteoporotic environment. We developed a large animal model for simulating lumbar vertebroplasty through a two-level lateral corpectomy on L3 and L4 vertebrae presenting a standardized osteopenic bone defect that was filled with cements. Both 2-D and 3-D analysis of microarchitectural parameters demonstrated that implantation of BP-loaded cement in such vertebral defects positively influenced the microarchitecture of the adjacent trabecular bone. This biological effect was dependent on the distance from the implant, emphasizing the in situ effect of the BP and its release from the cement. As a drug device combination, this BP-containing apatitic cement shows good promise as a local approach for the prevention of osteoporotic vertebral fractures through percutaneous vertebroplasty procedures.     

Sulfur mustard exposure presenting to a community emergency department

We report dermal exposure to a chemical warfare agent, sulfur mustard, in a 28-year-old commercial fisherman. Chemical warfare agents such as sulfur mustard are considered potential terrorist weapons, and suspected exposure requires notification of federal authorities. We address potential pitfalls when alerting authorities and methods to avoid such obstacles, and we describe the clinical management of sulfur mustard toxicity.     

Does the addition of clonidine to opioid therapy improve outcomes in infants with Neonatal Abstinence Syndrome?

To undertake a literature search and critical appraisal of best available evidence to answer the clinical question: Does the addition of clonidine (I) to standard treatment with an opioid (C) improve outcomes (O) in infants with Neonatal Abstinence Syndrome? A search of both comprehensive (MedLine and Embase) and pre‐filtered databases (Dynamed, UpToDate and TRIP), utilising Boolean Operators to combine search terms appropriately. Three relevant studies were identified. One paper describing the outcomes of a randomised controlled trial by Agthe et al. (2009) most accurately answered the clinical question posed. This paper was critically appraised, and evidence applied to the clinical scenario. The use of clonidine as an adjunct to opioid in the management of infants with NAS reduces the total number of treatment days and dose of opioid required to control symptoms. However, there is a higher risk of rebound in symptoms post‐cessation of opioid and clinicians need to account for this in their discharge planning. More large scale, multi‐centre high‐quality research is needed to clarify the role of clonidine in the treatment of NAS: as monotherapy versus adjunct, the optimal dose and longer‐term impact on neurodevelopment.