Sizes of Dental Arches in Children with the Pierre Robin Syndrome and Isolated Cleft Palate Aged from 0.2 to Six Years

Abstract

Development of the dental arches and length and weight at birth were studied from 0.2 to 6 years of age in 78 children with Pierre Robin syndrome and 58 with isolated cleft palate. The growth of the maxillary dental arches was similar in both groups before palatal closure. The anterior width of the maxillary arch did not differ between the groups during the six year follow up period, but the depths of the maxillary and mandibular arches were significantly less (< 0.001) in the group with Pierre Robin syndrome compared with those with isolated cleft palates at the age of 3 and 6 years. The mandibular width at the first and second deciduous molars in the group with Pierre Robin syndrome was also significantly smaller (<0.01) than in the other group at the age of 6 years. The weight and length at birth were similar in both groups, and they were slightly lower than among the normal Finnish population.     

甲颏高度对喉镜暴露困难的评估

目的 评价甲颏高度对评估国人喉镜暴露困难的准确性.方法 选取拟择期行气管插管全身麻醉的患者120例,术前分别采用改良Mallampati分级、甲颏间距、身高/甲颏距离、甲颏高度对所有患者气道分级进行评估.再根据插管时实际声门暴露情况按照Cormack' s-Lehane法对气道进行分级.计算4种方法的敏感性、特异性、阳性预测值及阴性预测值.结果 喉镜暴露困难率4.2％,困难插管率1.7％,无插管失败患者.4种方法的特异性由高到低依次是身高/甲颏距离(91.3％)、甲颏间距(85.2％)、甲颏高度(89.6％)、改良Mallampati分级(48.7％).与改良Mal-lampati分级比较,甲颏间距、身高/甲颏距离、甲颏高度的特异性明显增高(P＜0.01);4种评估方法的敏感性、阳性预测值和阴性预测值的差异均无统计学意义.结论 甲颏高度在评估国人困难气道方面与甲颏距离及身高/甲颏距离有相近的敏感性、特异性、阳性预测值和阴性预测值,可作为独立危险因素应用于喉镜暴露困难的评估.     

Metabolic clues regarding the enhanced performance of elite endurance athletes from orchiectomy-induced hormonal changes

This article examines the metabolic performance of an elite cyclist, Lance Armstrong, before and after his diagnosis with testicular cancer. Although a champion cyclist in 1-day events prior to his diagnosis of testicular cancer at age 25, he was not a contender in multi-day endurance cycle races such as the 3-week Tour de France. His genetic makeup and physiology (high VO2max, long femur, strong heavy build) coupled with his ambition and motivation enabled him at an early age to become one of the best 1-day cyclists in the world. Following his cancer diagnosis, he underwent a unilateral orchiectomy, brain surgery and four cycles of chemotherapy. After recovering, he returned to cycling and surprisingly excelled in the Tour de France, winning this hardest of endurance events 7 years running. This dramatic transformation from a 1-day to a 3-week endurance champion has led many to query how this is possible, and under the current climate, has led to suggestions of doping as to the answer to this metamorphosis. Physiological tests following his recovery indicated that physiological parameters such as VO2max were not affected by the unilateral orchiectomy and chemotherapy. We propose that his dramatic improvement in recovery between stages, the most important factor in winning multi-day stage races, is due to his unilateral orchiectomy, a procedure that results in permanent changes in serum hormones. These hormonal changes, specifically an increase in gonadotropins (and prolactin) required to maintain serum testosterone levels, alter fuel metabolism; increasing hormone sensitive lipase expression and activity, promoting increased free fatty acid (FFA) mobilization to, and utilization by, muscles, thereby decreasing the requirement to expend limiting glycogen stores before, during and after exercise. Such hormonal changes also have been associated with ketone body production, improvements in muscle repair and haematocrit levels and may facilitate the loss of body weight, thereby increasing power to weight ratio. Taken together, these hormonal changes act to limit glycogen utilization, delay fatigue and enhance recovery thereby allowing for optimal performances on a day-to-day basis. These insights provide the foundation for future studies on the endocrinology of exercise metabolism, and suggest that Lance Armstrong's athletic advantage was not due to drug use.     

The relationship of actual height loss with health-seeking behaviors and risk factors in perimenopausal and menopausal women

PURPOSE: To explore whether there is a difference in the perceived height and actual height in the perimenopausal or menopausal woman and discover the difference's effect on osteoporosis health-seeking preventive behaviors and risk factor awareness. DATA SOURCES: Sixty-three perimenopausal and menopausal women, aged 45-70 years, who presented at three Midwestern clinics for their annual physical exam. Data were collected with The Osteoporosis Questionnaire, which included the Osteoporosis Risk Questionnaire, Health-O-Meter height measuring stick, tape measure with inch-rule for arm span measurements, and balance scale for weight. CONCLUSIONS: There were a significant relationship between actual height loss and osteoporosis risk factors (r = 0.41595, p = 0.0007) and a trend for a relationship between adjusted height loss and osteoporosis risk factors (r = 0.2407, p = 0.0574). IMPLICATIONS FOR PRACTICE: Due to the great expense of current testing for bone mass density loss, the results of this study may help clinicians more readily identify markers for increased risk of osteoporosis through simple height measurements and osteoporosis risk factor assessments during annual visits.     

Molar bite force and its correlation with signs of temporomandibular dysfunction in mixed and permanent dentition

The aim of the study was to evaluate molar bite force (BF) magnitude and its correlation to the signs of temporomandibular dysfunction (TMD), gender, weight, height and age in 101 students ranging in age from 6 to 18 years (32 boys/21 girls with mixed dentition and 23 boys/25 girls with permanent dentition). TMD clinical signs were evaluated using the Craniomandibular Index (CMI), and two subscales, the Dysfunction Index (DI) and the Palpation Index (PI). BF was determined with a pressurized tube connected to a sensor (MPX5700-Motorola SPS). anova, Tukey's test, and Pearson's and Spearman's coefficients were evaluated. BF was higher in the permanent dentition (P < 0.05). There was no difference in BF between genders within the groups, but boys with permanent dentition had higher values than children with mixed dentition (P < 0.05). The girls with permanent dentition presented negative correlation in BF with PI and CMI (P < 0.05). BF was positively correlated with weight, height and age in the permanent dentition group (P < 0.05). It was concluded that BF increased from mixed to permanent dentition, with an assumed enhancing influence of body variables and ageing. The TMD signs in older girls were correlated to decreasing BF, suggesting an influence of muscle tenderness preventing subjects from exerting maximum BF.     

HIFU治疗骨肉瘤对患儿身高影响的探讨

骨肉瘤的发病率虽然很低,但是患者多为成长期的少儿,尤其是多年来骨肉瘤保肢治疗的5年以上生存率显著提高,因此,患儿骨骺端功能在治疗中的受影响程度直接关系到患儿的生活质量和心理状态,应该重视。本文着重观察骨肉瘤经局部高强聚焦超声(HIFU)治疗后对患儿骨骺生长及身高的影响,现将相关病例总结分析如下:随访统计的所有病例均为2001年至2005年之间系统保肢治疗的少儿患者,所有病例均为本院门诊患者,男患儿3例,女患儿1例,共4例。年龄9~14岁之间,发病部位均在股骨和胫骨,患儿瘤体大小和全身症状无显著差异,全部病例均未手术截肢治疗,而是接受HIFU治疗结合全身综合治疗。HIFU治疗的输出功率和次数均使用临床常规肿瘤消融治疗标准。对所有病例进行HIFU治疗后身高跟踪测量,每年测量1次,对存活3年以上的患儿身高追踪测量,跟踪测量时间均为3年。以首次测量身高为基数,把接受HIFU治疗的患儿与正常同龄儿童年增高身高作比对,其计算方法为:年均身高增长值=3年身高增长总数&#247;3(单位:cm)。观察3年生存期以上的患儿经HIFU合并系统综合治疗者4例。HIFU治疗组患者的身高年增长数值为2.6~5.1cm,平均值为3.9cm。讨论骨...     

Axis vertebral dimensions for safe screw placement: A CT normative data analysis

IntroductionMorphometric evaluation of the pedicle and isthmus of second cervical vertebra (C2) (Axis) is extremely vital before contemplating any surgical stabilization involving the Craniovertebral region, in view of its proximity to the vertebral artery and the cervical nerve root. The dimensions of pedicles and isthmuses in C2 vary between individuals and there is paucity of data in the Indian population. This study strives to measure the average pedicle and isthmus dimensions in a sample of population, which would enable selection of screws with safest diameters to be used in C2; thereby avoiding injury to adjacent neurovascular structures.Materials and methodsOne Hundred patients in the age group between 18 and 70 years who underwent CT scan of head and neck region were included in the study. The aim of this study was to assess the anatomic suitability of transarticular and pedicle screw placement in Axis vertebrae of Indian population and determine the maximum safe diameter for screw placement. The following parameters were measured in millimeters: Pedicle width, Pedicle angle, Internal height and Isthmic height.ResultsThe Mean maximum diameter of potential pedicle screw was 4.99 ± 1.1 mm for the right side with the left side being slightly wider at 5.20 ± 1.16 mm. Twenty eight (28%; 56 out of 200 pedicles) had a measurement < 4.5 mm. The internal height in sagittal images representing the pedicle height was found to be 4.79 ± 0.96 mm on the right side and 4.75 ± 1.04 mm on the left side. Sixty five (65) out of 200 pedicles (32.5%) had measurements < 4.5 mm in sagittal plane. The Mean maximum diameter of potential Transarticular screw (outer diameter of isthmus) was 5.05 ± 0.78 mm for the right side and 5.18 ± 0.84 mm on the left side.DiscussionIsthmic height < 4.5 mm could potentially violate the vertebral foramen when a 3.5 mm screw is used. In our study 22.5% isthmuses were narrow (<4.5 mm). The mean maximum safe diameter for a potential transarticular screw in the present study was 5.11 mm. Though our patients had smaller isthmus dimensions compared with literature, 77.5% of C2 could take a 4 mm transarticular screw quite comfortably considering the 0.5 mm margin on either side. In the present study, 28% of pedicles were found to be inappropriately sized (<4.5 mm) to accommodate the standard 3.5 mm screw. The mean maximum diameter of a potential pedicle screw in our study was 5.09 mm; and in 72% of patients a 4 mm screw could be placed with confidence. Though our patients on an average can accommodate a 4 mm screw comfortably, we suggest a protocol of obtaining CT measurements of C2 prior to operative intervention for identifying those individuals at risk of neurovascular injury; 22.5% for transarticular screw and 28% for pedicle screw.     

Important Tools for Use by Pediatric Endocrinologists in the Assessment of Short Stature

Assessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360° European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches.     

曲普瑞林治疗特发性中枢性性早熟女孩疗效观察

目的　观察促性腺素释放激素类似物 (GnRHa)曲普瑞林 (达菲林 )治疗女孩特发性中枢性性早熟 (ICPP)的作用。方法　在多个中心 (6所医院 )采用曲普瑞林治疗 2 8例ICPP女童 6个月 (4例 )和12个月 (2 4例 ) ,观察乳房及其他第二性征和生长速率变化 ,观察治疗前后B超子宫、卵巢、X线片骨龄(BA)、血清E2 、LHRH激发试验 ,部分病人随访GH激发试验及血清IGF Ⅰ变化。用国际统一标准Greulich Pyle图谱方法评估骨龄 ,Bayley Pinneau方法预测成人终身高。结果　经治疗乳房、子宫、卵巢容积均缩小 ,LHRH激发试验显示LH、FSH峰值显著降低 ,骨龄成熟延缓 ,BA/CA(生活年龄 )比值随疗程而下降。治疗 6个月、12个月按BA的身高标准差分值 (HtSDSBA)从治疗前 -1.46± 0 .16分别增加至 -1.3 0± 0 .15和 -1.0 2± 0 .17(P <0 .0 0 1)。按CA的身高标准差分值 (HtSDSCA)亦随疗程下降 ,治疗前、治疗后6个月、12个月分别为 1.0 5± 0 .2 0、0 .99± 0 .18和 0 .95± 0 .2 0 (P <0 .0 0 1)。预测成人终身高 ,治疗前为(153 .8± 1.1)cm ,治疗后 6个月、12个月各为 (155.0± 1.1)cm和 (157.0± 1.2 )cm。结论　曲普瑞林治疗ICPP可有效抑制性腺轴及性征发育 ,延缓BA成熟和改善预测成人终身高     

Bioimpedance-Guided Hydration for the Prevention of Contrast-Induced Kidney Injury: The HYDRA Study

Background

Intravascular volume expansion plays a major role in the prevention of contrast-induced acute kidney injury (CI-AKI). Recommended standard amounts of fluid infusion before procedures do not produce homogeneous responses in subjects with different initial hydration status.