Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis

Orthodontic treatment is suggested in growing individuals to correct transverse maxillary deficiency and mandibular retrusion. Since, as a secondary effect, these orthodontic procedures may improve pediatric obstructive sleep apnea (OSA), this systematic review assessed their effects on apnea-hypopnea index (AHI) and oxygen saturation (SaO2). Twenty-five (25) manuscripts were included for qualitative synthesis, 19 were selected for quantitative synthesis. Five interventions were analyzed: rapid maxillary expansion (RME, 15 studies), mandibular advancement (MAA, five studies), myofunctional therapy (MT, four studies), and RME combined with MAA (one study). RME produced a significant AHI reduction and minimum SaO2 increase immediately after active treatment, at six and 12 months from baseline. A significant AHI reduction was also observed six and 12 months after the beginning of MAA treatment. MT showed positive effects, with different protocols. In this systematic review and meta-analysis of data from mainly uncontrolled studies, interceptive orthodontic treatments showed overall favorable effects on respiratory outcomes in pediatric OSA. However, due to the low to very low level of the body evidence, this treatment cannot be suggested as elective for OSA treatment. An orthodontic indication is needed to support this therapy and a careful monitoring is required to ensure positive improvement in OSA parameters.

"Growing fibroadenoma": Are there clinical and pathological features predicting a phyllodes tumor on surgical excision?

In cases of growth of FA on imaging, core needle biopsies (CNB) are often performed to rule out phyllodes tumor (PT). We aim to focus on "growing FAs" and to identify clinical and histopathologic features that are likely to predict a PT on excision. Thirty-four FAs with radiologic documentation of growth were included. Various clinical and pathological features such as age, body mass index (BMI), lesion size, and growth rate were recorded. On excision, 17 cases (50 %) were FAs, whereas 16 (47 %) were re-classified as benign PT despite only 19 % being suspicious for PT on CNB. PT patients were older (mean age 42.6) than those with FAs (mean age 28.2), p = 0.0002. All false negative cases demonstrated intracanalicular growth. Mitotic rate was the most significant histologic feature in PT on excision compared to others, such as lesion circumscription and stromal cellularity. Recognition and careful counting of mitotic rate, especially with intracanalicular patterns in growing FAs, can potentially prevent missing a PT on CNB. In patients with "growing FAs" who are ≥40 years of age, excision may be recommended due to the high likelihood of PT diagnosis on excision and high false negative rate on CNB.

Prediction of calcium and phosphorus requirements for pigs in different bodyweight ranges using a meta-analysis

Several studies have focused on Ca and P requirements for pigs. These requirements are estimated from their retention and bone formation. However, modern pig breeds have different responses to dietary Ca and P than traditional breeds, and their requirements are expected to change on an annual basis. Besides individual Ca and P needs, the Ca to P ratio (Ca/P) is an important factor in determining requirements. This study aimed to implement a linear and quadratic regression analysis to estimate Ca and P requirements based on average daily gain (ADG), apparent total tract digestibility (ATTD) of Ca (ATTD-Ca), ATTD of P (ATTD-P), and crude protein (CP) digestibility. Results show that Ca/P had linear and quadratic effects on ADG in the phytase-supplemented (PS) group in both the 6–11 kg and 11–25 kg categories. In the latter category, the CP digestibility was linearly increased in response to increasing Ca/P in the without-phytase (WP) group. In the 25–50 kg category, there was a linear response of ADG and linear and quadratic responses of CP digestibility to Ca/P in the PS group, while a linear and quadratic increase in CP digestibility and a quadratic effect on ATTD-Ca were observed in the WP group. In the 50–75 kg category, Ca/P had significant quadratic effects on ADG in the PS and WP groups, along with significant linear and quadratic effects on ATTD-Ca. In addition, Ca/P had significant quadratic effects on ATTD-P and led to a significant linear and quadratic increase in the CP digestibility in the WP group. In the 75–100 kg category, analysis showed a significant decrease in ATTD-Ca and ATTD-P in the PS and WP groups; in the latter, ATTD-P and ATTD-Ca were linearly decreased by increasing Ca/P. In conclusion, our equations predicted a higher Ca/P in the 6–25 kg bodyweight categories and a lower Ca/P in the 50-100 kg category than that recommended in the literature.

Hindlimb torsional alignment changes in growing rabbits after patellar dislocation

BACKGROUND

Torsional malalignment has been considered as a risk factor for patellar dislocation. But the influence of patellar dislocation for torsional alignment development remains unknown. The present study aims to investigate whether the torsional alteration of the hindlimb occurs after patellar dislocation in growing rabbits.

METHODS

In the present study, 30 one-month-old rabbits were included. The experimental group consisted of 30 left knees of rabbits which underwent patellar lateral dislocation. The control group consisted of 30 right knees of the rabbits which no surgical procedure was performed. The Computed Tomography (CT) scan was performed after the surgery and at the point the rabbits were skeletal mature (5 months post-surgery). The angles of femoral version and tibial torsion were measured using a three-dimensional method and analyzed between the experimental group and the control group.

RESULTS

After the surgery, the femoral version and tibial torsion in the experimental and control group were not significantly different. However, 5 months after surgery, the angle of femoral version in the experimental group (-5.50 ± 6.13°) was significantly different from that in the control group (-10.90 ± 4.74°) (P < 0.05). But the angle of tibial torsion in the experimental group (7.17 ± 7.25°) and control group (4.47 ± 6.34°) were not significantly different (P = 0.144).

CONCLUSIONS

From this study, patellar dislocation can lead to alteration of femoral version in growing rabbits. So patellar dislocation may affect on lower extremity alignment. These findings may develop pathology and etiology of patellar dislocation.

Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects

OBJECTIVES

To evaluate the use of the Forsus Fatigue Resistant Device (FFRD), supported with bimaxillary splints, in treatment of skeletal Class II malocclusion.

MATERIALS AND METHODS

Data from 46 skeletal Class II females who received either conventional Forsus alone (FFRD group) (15 patients, 12.54 ± 0.90 years), FFRD and bimaxillary splints (splint-FFRD group) (15 patients, 12.29 ± 0.82 years), or were untreated controls (16 subjects, 12.1 ± 0.9 years) were retrieved from previous clinical trials. FFRD was inserted onto the mandibular archwire in the FFRD group after leveling and alignment with multibracket appliances. In the splint-FFRD group, Forsus was inserted between fixed maxillary and mandibular splints. Treatment continued until reaching an edge-to-edge incisor relationship.

RESULTS

Both treatment groups failed to induce significant mandibular skeletal effects compared to the normal growth exhibited by untreated controls. The splint-FFRD group showed significant reduction of SNA (-0.88° ± 0.51°) and ANB (-1.36° ± 0.87°). The mandibular incisors showed significant proclination in the FFRD (9.17° ± 2.42°) and splint-FFRD groups (7.06° ± 3.34°).

CONCLUSIONS

The newly proposed splint-supported FFRD was equally effective as the conventional FFRD in treatment of Class II malocclusion with dento-alveolar changes and additional maxillary restricting effect. It has an additional advantage of immediate initiation of the Class II correction.

Dynamic Change of Free Serum L-carnitine Concentration in Relation to Age, Sex, and Exercise in Anglo-Arabian Thoroughbred Horses

The physiological role of L-carnitine in equine species is worthy of investigation; however, the systemic content of free L-carnitine and its dynamic change in growing foals as well as in exercising horses are still poorly investigated. In this study, the influence of age and exercise on free serum L-carnitine levels was evaluated in equine species. Ten foals were monitored from 6 up to 18 months of age (group 1), whereas 60 horses were divided in six groups in accordance with their age: group 2, 2-year-old; group 3, 3-year-old; group 4, 4-year-old; group 5, 5-year-old; group 6, 6-year-old; group 7, 7-year-old. To assess the age and sex effect on free serum L-carnitine values, blood samples were collected from foals and horses. Adult horses (groups 2-7) were subjected to a simulate 1,660-m race, and blood samples were collected before the simulate race (T_PRE), within 10 minutes (T_POST10) from the end of race, and after 30 minutes (T_POST30) from the end of race. The amino acid levels were influenced by age (P < .0001) in foals and horses. Decreased levels of amino acid were observed at T_POST10 with respect to T_PRE and T_POST30. (P < .001). The findings suggest that the biosynthetic pathway of L-carnitine is organizing and adapting to the metabolic needs of skeletal and cardiac muscle tissue in the course of growth. L-carnitine could play a role for the provision of energy to the exercising muscles. Further studies are needed to evaluate possible beneficial effects of L-carnitine during growing phase and on parameters of equine physical performance.

Exercise prevents high fat diet-induced bone loss, marrow adiposity and dysbiosis in male mice

High fat diets can have detrimental effects on the skeleton as well as cause intestinal dysbiosis. Exercise prevents high fat (HF) diet-induced obesity and also improves bone density and prevents the intestinal dysbiosis that promotes energy storage. Previous studies indicate a link between intestinal microbial balance and bone health. Therefore, we examined whether exercise could prevent HF-induced bone pathology in male mice and determined whether benefits correlate to changes in host intestinal microbiota. Male C57Bl/6 mice were fed either a low fat diet (LF; 10 kcal% fat) or a HF diet (60 kcal% fat) and put under sedentary or voluntary exercise conditions for 14 weeks. Our results indicated that HF diet reduced trabecular bone volume, when corrected for differences in body weight, of both the tibia (40% reduction) and vertebrae (25% reduction) as well and increased marrow adiposity (44% increase). More importantly, these effects were prevented by exercise. Exercise also had a significant effect on several cortical bone parameters and enhanced bone mechanical properties in LF but not HF fed mice. Microbiome analyses indicated that exercise altered the HF induced changes in microbial composition by reducing the Firmicutes/Bacteriodetes ratio. This ratio negatively correlated with bone volume as did levels of Clostridia and Lachnospiraceae. In contrast, the abundance of several Actinobacteria phylum members (i.e., Bifidobacteriaceae) were positively correlated with bone volume. Taken together, exercise can prevent many of the negative effects of a high fat diet on male skeletal health. Exercise induced changes in microbiota composition could represent a novel mechanism that contributes to exercise induced benefits to bone health.

growing, processing and storage

Because of the increase of people's attention to food safety, monitoring the residue of pesticide in rice is becoming more and more important. Commercial and home processing techniques have been used to transform paddy rice into rice products for human or animal consumption, which may reduce the pesticide content in rice. The degradation of tricyclazole during different stages of commercial and home processing and storage was assessed in this paper. Many researches studying the occurrence and distribution of pesticide residues during rice cropping and processing have been reported. Rice samples were extracted with acetonitrile, the extracts were enriched, and then residues were analyzed by liquid chromatography/tandem mass spectrometry method. The dissipation dynamics of tricyclazole in rice plant, soil, and paddy water fitted the first-order kinetic equations. The dissipation half-lives of tricyclazole in the rice plant, water, and soil at dosage of 300~450 g a.i. hm ^-2 were 4.84~5.16, 4.64~4.85, and 3.57~3.82 days, respectively. The residue levels of tricyclazole gradually reduced with different processing procedures. What is more, decladding process could effectively remove the residues of tricyclazole in raw rice, and washing process could further remove the residues of tricyclazole in polished rice. Degradation dynamic equations of tricyclazole in the raw rice and polished rice were based on the first-order reaction dynamic equations, and the half-lives of the degradation of tricyclazole was 43.32~58.24 days and 46.83~56.35 days in raw rice and polished rice. These results provide information regarding the fate of tricyclazole in the rice food chain, while it provides a theoretical basis for systematic evaluation of the potential residual risk of tricyclazole.

Multiscale investigation on the effects of additional weight bearing in combination with low-magnitude high-frequency vibration on bone quality of growing female rats

This study aimed to explore the effects of additional weight bearing in combination with low-magnitude high-frequency vibration (LMHFV; 45 Hz, 0.3 g) on bone quality. One hundred twenty rats were randomly divided into ten groups; namely, sedentary (SED), additional weight bearing in which the rat wears a backpack whose weight is x% of the body weight (WBx; x = 5, 12, 19, 26), basic vibration (V), and additional weight bearing in combination with LMHFV in which the rat wears a backpack whose weight is x% of the body weight (Vx; x = 5, 12, 19, 26). The experiment was conducted for 12 weeks, 7 days per week, and 15 min per day. A three-point bending mechanical test, micro computed tomography, and a nanoindentation test were used. Serum samples were analyzed chemically. Failure load in V19 rats was significantly lower than that in SED rats (P < 0.05). Vx (x = 5, 12, 19, 26) rats showed poor microarchitectures. The content of tartrate-resistant acid phosphatase 5b was significantly higher in Vx (x = 5, 12, 19, 26) rats than that in SED rats (P < 0.05). V26 rats demonstrated comparatively better nanomechanical properties of materials than the other vibrational groups. Additional weight bearing in combination with LMHFV negatively affected the macromechanical properties and microarchitecture of bone. Heavy additional weight bearing, such as 26% of body weight, in combination with LMHFV was able to improve the nanomechanical properties of growing bone material compared with LMHFV. A combined mechanical stimulation was used, which may provide useful information to understand the mechanism of this mechanical stimulation on bone.

The use of a non-invasive extendable prosthesis at the time of revision arthroplasty

Aims

The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses.

Patients and Methods

All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140).

Results

The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years.

Conclusion

Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370-7.

Clinical utility of ultrasound to prospectively monitor distraction of magnetically controlled growing rods

BACKGROUND CONTEXT

Growing rods are commonly used for surgical treatment of skeletally immature patients with scoliosis, but require repeated surgeries for distractions and are fraught with complications. As an alternative, the use of magnetically controlled growing rods (MCGR) allows for more frequent non-invasive distractions to mimic normal growth. However, more plain radiographs are needed to monitor increased distraction frequency, thereby increasing ionizing radiation exposure to the developing child. The use of ultrasound, which emits no radiation, has been found in a cross-sectional study to be reliable in measuring MCGR distractions.

PURPOSE

The study aims to address the prospective clinical utility of ultrasound compared with plain radiographs for assessing MCGR distractions.

STUDY DESIGN

This is a prospective study.

PATIENT SAMPLE

The study includes patients with early-onset scoliosis undergoing distractions after MCGR implant.

OUTCOME MEASURES

The distraction length on plain radiographs and ultrasound was measured.

METHODS

This is a prospective study of patients treated with MCGR. Patients with both single- and dual-rod systems were included. Outpatient distractions were performed at monthly intervals, targeting 2 mm of distraction on each occasion. Assessment of distraction length was monitored by ultrasound at each visit; plain radiographs were taken every 6 months and were compared with ultrasound measurements.

RESULTS

Nine patients (5 female, 4 male), with a mean of 29 distractions (standard deviation [SD] ±14.3), were recruited. The mean distracted length per 6 months was 5.7 mm (SD ±3.6 mm) on plain radiographs and 5.2 mm (SD ±3.9 mm) on ultrasound for the concave rod, and 6.1 mm (SD ±3.6 mm) on plain radiographs and 5.9 mm (SD ±3.8 mm) on ultrasound for the convex rod. Excellent inter- and intra-rater reliabilities were observed for radiographic and ultrasound measurements. An excellent correlation was noted between the two imaging modalities (r=0.93; p<.0001).

CONCLUSIONS

This is the first prospective study to validate that ultrasound assessment of MCGR distraction lengths was highly comparable with that of plain radiographs. The present study has verified that ultrasound can be used to document length changes by distraction over time and that it had high clinical utility. Ultrasound can be a reliable alternative to plain radiographs, thereby avoiding radiation exposure and its potential detrimental sequelae in the developing child.

Scientific Research: What it Means to Me

This article gives a personal perception of the author, of what scientific research means. Citing examples from the lives of all time greats like Newton, Kelvin and Maxwell he stresses the agonies of thinking up new ideas, the urge for creativity and the pleasure one derives from the process when it is completed. He then narrates instances from his own life that proved inspirational towards his research career. In his early studenthood, his parents and maternal uncle had widened his intellectual horizons while in later life his interaction with Fred Hoyle made him take up research challenges away from the beaten path. He concludes that taking up an anti-Establishment stand in research can create many logistical difficulties, but the rewards of success are all the more pleasing.