Screening of fluorescent bacteria for growth promotion and biocontrol potential against Pyricularia oryzae on aerobic rice (MARDI Aerob 1)

Aims@#This study aimed to screen the plant growth-promoting fluorescent bacteria (FLB) which isolated from the healthy rice rhizophere and to evaluate its biocontrol and growth promotion properties against Pyricularia oryzae on aerobic rice seedling of MARDI Aerob 1. @*Methodology and results@#King’s B agar with glycerol was used as the selective medium to isolate FLB from the healthy rice rhizosphere soil. All FLB obtained were in vitro screened for antagonistic activities against P. oryzae using dual culture, volatile substances and hydrogen cyanide productions. The potential FLB isolates were further evaluated on rice seedling early growth promotion before identified using 16S rRNA gene sequencing. A total of 24 FLB were isolated from the healthy rice rhizosphere soil in Setiu, Terengganu, Malaysia. Isolates: FLB4, FLB5, FLB7 and FLB10 scored the total of percentage inhibition radial growth (PIRG) values ranged 99.5-105.0%. Further seedling growth promotion screening revealed that FLB4, FLB7 and FLB10 were significantly improved seedling growth with vigor index of 378.32%, 461.53% and 335.60% over control (133.31%). 16S rRNA sequencing identified that FLB7 as Bacillus subtilis and the FLB4 and FLB10 as Pseudomonas putida.@*Conclusion, significance and impact of study@#The selected FLB isolates (FLB4, FLB7 and FLB10) are potential to be developed as biological control agents against P. oryzae with growth promoting property on aerobic rice seedling.

Determinants of Postoperative Spinal Height Change among Adult Spinal Deformity Patients with Long Construct Circumferential Fusion

Methods@#We retrospectively reviewed the clinical and imaging data of ASD patients who underwent lumbar corrective circumferential fusion of ≥3 levels (n=106). SH was defined as the vertical distance between C2 and S1 on a standing lateral image. As potential predictors of postoperative height change, the number of lateral lumbar interbody fusion (LLIF) levels, change in spino-pelvic parameters, total number of levels fused, and pedicle subtraction osteotomies (PSO) were documented. Univariate and multivariate linear regression analyses were performed to identify the predictors of postoperative height change. @*Results@#The mean SH change was −2.39±50.8 mm (range, −160 to 172 mm). The univariate analyses showed that the number of LLIF levels (coefficient=10.9, p=0.03), the absolute coronal vertical axis change (coefficient=0.6, p=0.01), and the absolute Cobb angle change (coefficient=−0.9, p=0.03) were significant predictors for height change. Patients with PSOs (n=14) tended to have a shorter height postoperatively (coefficient=−26.1); however, this difference was not significant (p=0.07). Multivariate analyses conducted with variables of pp=0.04, R2=0.11). @*Conclusions@#Utilizing a modified definition of SH used in previous AIS studies, we demonstrated that patients with ASD lose SH postoperatively and that PT change was an independent contributor of SH change.

Determinants of Postoperative Spinal Height Change among Adult Spinal Deformity Patients with Long Construct Circumferential Fusion

Methods@#We retrospectively reviewed the clinical and imaging data of ASD patients who underwent lumbar corrective circumferential fusion of ≥3 levels (n=106). SH was defined as the vertical distance between C2 and S1 on a standing lateral image. As potential predictors of postoperative height change, the number of lateral lumbar interbody fusion (LLIF) levels, change in spino-pelvic parameters, total number of levels fused, and pedicle subtraction osteotomies (PSO) were documented. Univariate and multivariate linear regression analyses were performed to identify the predictors of postoperative height change. @*Results@#The mean SH change was −2.39±50.8 mm (range, −160 to 172 mm). The univariate analyses showed that the number of LLIF levels (coefficient=10.9, p=0.03), the absolute coronal vertical axis change (coefficient=0.6, p=0.01), and the absolute Cobb angle change (coefficient=−0.9, p=0.03) were significant predictors for height change. Patients with PSOs (n=14) tended to have a shorter height postoperatively (coefficient=−26.1); however, this difference was not significant (p=0.07). Multivariate analyses conducted with variables of pp=0.04, R2=0.11). @*Conclusions@#Utilizing a modified definition of SH used in previous AIS studies, we demonstrated that patients with ASD lose SH postoperatively and that PT change was an independent contributor of SH change.

Extrahepatic Manifestations of Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and encompasses a spectrum of pathology from simple steatosis to inflammation and significant fibrosis that leads to cirrhosis. NAFLD and its comorbid conditions extend well beyond the liver. It is a multisystemic clinical disease entity with extrahepatic manifestations such as cardiovascular disease, type 2 diabetes, chronic kidney disease, hypothyroidism, polycystic ovarian syndrome, and psoriasis. Indeed, the most common causes of mortality in subjects with NAFLD are cardiovascular disease, followed by malignancies and then liver-related complications as a distant third. This review focuses on several of the key extrahepatic manifestations of NAFLD and areas for future investigation. Clinicians should learn to screen and initiate treatment for these extrahepatic manifestations in a prompt and timely fashion before they progress to end-organ damage.

Clinical Correlates of False Positive Assignment in Bipolar Screening Measures Across Psychiatric Diagnoses among Patients without Bipolar Disorder

Objective@#In this study, we aimed to determine clinical correlates of false positive assignment (FPA) on commonly used bipolar screening questionnaires. @*Methods@#A retrospective chart review was conducted to a total of 3885 psychiatric outpatients. After excluding patients who have bipolar spectrum illnesses, patients who were assigned as having hypomania on the mood disorder questionnaire (MDQ) or the hypomania checklist-32 (HCL-32) were identified as patients who had FPA. Psychiatric diagnoses and severity of emotional symptoms were compared between patients with and without FPA. @*Results@#Patients with FPA on the MDQ showed significant associations with presence of major depressive disorder, generalized anxiety disorder, and alcohol-use disorder, while patients with FPA on the HCL-32 showed associations with presence of panic disorder and agoraphobia. FPA on the MDQ was also associated with greater emotional symptoms and lifetime history of suicide attempts. Logistic regression analysis showed that male sex, younger age, presence of alcohol-use disorder, and severity of depression and obsessive-compulsive symptoms were significantly associated with FPA on the MDQ. @*Conclusion@#The FPA for the MDQ was associated with clinical factors linked to trait impulsivity, and the FPA for both the MDQ and the HCL-32 could be related to increased anxiety.

Comparing the Efficacy of Alvogyl and Zinc Oxide Eugenol Dressing For the Treatment of Dry Socket: A Double Blind Randomised Study

Background: The most common unpleasant post operative complication following extraction of permanent teeth is Dry socket. The primary goal of treatment for dry socket is pain relief. Local dressings will do better pain relief and faster healing. Aim: To compare the effectiveness of Alvogyl and Zinc oxide eugenol dressings placed intra alveolar for the management of dry socket. Methods:All the patient who underwent extraction of teeth and who satisfied the inclusion and exclusion criteria were included in the study. Patients who were diagnosed to suffer from dry socket were randomly allocated to two groups name Group A (Zinc oxide Eugenol) and Group B (Alvogyl). Pain relief was compared between the two groups. Results: In all the level of time assessed Alvogyl showed the statistically significant difference in relieving pain than Zinc oxide eugenol dressings. Alvogyl required less number of dressings when compared to zinc oxide eugenol. Conclusion: Alvogyl is far better than the Zinc oxide eugenol dressing for providing pain relief in dry socket.

Comparison of Anesthetic Efficacy of IANB - Classical and Gow-Gates Technique during Surgical Removal of Impacted Mandibular Third Molar

Background: The most frequently used mandibular injection technique is inferior alveolar nerve (IANB) block for achieving local anesthesia for dental treatment. The IANB block does not always give success. The interruption of sensory transmission to its best, by depositing anesthetic solution at lingula has not been proved. Aim: To compare the degree of patient acceptability and clinical efficacy of IANB and GG techniques in patients undergoing surgical removal of impacted mandibular third molar under local anesthesia. Methods: The split-mouth design was conducted on 20 healthy and ambulatory individuals (10 male and 10 female) aged between 40 and 50 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar reporting. Results: VAS of IANB was 4.60±1.82 and GG was 1.95±1.64 with GG more comfortable and no difference in case of aspiration. Onset of Anesthesia was better in IANB than GG with no difference in duration of anesthesia in both groups. Conclusion: To conclude GG is considered better than IANB in Mandibular block anesthesia

Serotonergic Antidepressants Are Associated with Increased Blood Loss and Risk for Transfusion in Single-Level Lumbar Fusion Surgery

STUDY DESIGN: Retrospective case-control study. PURPOSE: The purpose of this study was to examine the effect of antidepressants on blood loss and transfusion requirements in spinal surgery patients. OVERVIEW OF LITERATURE: Several studies have shown an increase in perioperative bleeding in orthopedic surgery patients on antidepressant drug therapy, yet no study has examined the impact of these agents on spinal surgery patients. METHODS: Charts of patients who underwent single-level spinal fusion (posterior lumbar interbody fusion with posterior instrumentation) performed by five fellowship-trained surgeons at a tertiary spine center between 2008 and 2013, were retrospectively reviewed. Exclusion criteria included select medical comorbidities, select drug therapy, and Amercian Society of Anesthesiologists Physical Status Classification score of greater than 2. Serotonergic antidepressants were examined in multivariate analysis to assess their predictive value on estimated blood loss and risk of transfusion. RESULTS: A total of 235 patients, of which 52% were female, were included. Allogeneic blood was transfused in 7% of patients. The average estimated blood loss was 682±463 mL. Selective serotonin reuptake inhibitors were taken by 10% of all patients. Multivariable regression analysis showed that intake of selective serotonin reuptake inhibitors was a significant predictor for blood loss (average increase of 34%, p=0.015) and for the need of allogeneic blood transfusion (odds ratio, 4.550; p=0.029). CONCLUSIONS: There was a statistically significant association between selective serotonin reuptake inhibitors and both increased blood loss and risk of allogeneic red blood cell transfusion. Surgeons and perioperative providers should take these findings into account when assessing patients' preoperative risk for blood loss and transfusion.

Human immunodeficiency virus, Hepatitis B virus and syphilis infections among longdistance truck drivers in, a Port City in Ghana

Although the high prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis infections among longdistance truck drivers has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study carried out between the months of January and June 2013 sought to determine the sero-prevalence and risk factors of HIV, HBV and syphilis infections among long distance truck drivers at the Tema sea port, Ghana. Materials and Methods: Of a total of 800 eligible drivers, 106 (13.25%) drivers consented to take part in the study. Subjects voluntarily completed a risk factor questionnaire and provided blood specimen for testing for HIV, syphilis and the surface antigen of HBV (HBsAg). Results: The mean age of the drivers was 40.56 ± 11.56 years. The sero-prevalence of HIV was 0.94%, 14.2% had HBsAg and reactive syphilis serology was 3.8%. On multivariate analysis, the main determinants of HBV infection were; multiple sexual partnership (OR, 6.36; 95% CI: 1.35­29.79), patronage of commercial sex workers (OR, 6.85; 95% CI: 0.88 ­ 52.89), cross-border travelers (OR: 6.89-fold, 95% CI: 0.86 - 55.55) and prolonged duration of trips for more than two weeks (OR: 4.76; 95% CI: 0.59 ­ 38.02). The main determinant of syphilis infection on multivariate analysis was being a Muslim (OR, 2.19; 95% CI: 0.22 ­ 21.74). Conclusion: The data indicate a lower sero-prevalence of HIV but a higher sero-prevalence of syphilis. However, the sero-prevalence of HBV infection is comparable to that of the general population

Cryptosporidial Diarrhoea in Children at a Paediatric Hospital in Accra, Ghana.

Background: Diarrhoeal diseases are common among children in developing countries, and are caused by several aetiological agents including Cryptosporidium sp. Several species of this parasite exist which may belong to either anthroponotic or zoonotic forms. With recent application of molecular tools, species involved in human transmission in any locality and sources of infection can now be determined. Aim: We screened children with acute diarrhoea at a paediatric hospital in Accra, Ghana for enteric parasites to determine frequency of cryptosporidial diarrhoea. Cryptosporidium isolates were then characterized by molecular methods to determine the genetic species in transmission. Methodology: A total of 365 diarrhoeic children of age ≤ 5 years were used in this cross-sectional study. Stool samples were collected and tested for enteric parasites by microscopy and ELISA. Cryptosporidium isolates were subsequently genotyped by PCR-RFLP and confirmed by sequencing of the 18S rRNA gene. Demographic and clinical data were obtained by a structured questionnaire and data analysed for possible association with cryptosporidial diarrhoea. Results: Enteric parasites detected were Cryptosporidium sp. (22.2%), G. lamblia (5.8%) and E. histolytica (0.8%). Neither gender nor breastfeeding habits, presence of domestic animals, source of children’s food, seasons (dry or rainy) appeared to be associated with infection of Cryptosporidium sp. However, age of children, source of drinking water, and education level of mother seems to have association with infection of the parasite. Genotyping results show that C. parvum is the only species involved in transmission. Conclusion: Cryptosporidium parvum is the commonest enteric parasite causing diarrhoea among children with acute diarrhoea. Children ≤ 3 years and those who drank sachet water were most affected. A carefully planned health education among illiterate mothers and improved sanitary conditions could reduce rate of infections. Further sub-genotyping of C. parvum is needed to determine whether source of infection is zoonotic or anthroponotic.

XELOX ± Bevacizumab compared to FOLFOX4 ± Bevacizumab in first line metastatic colorectal cancer in a non-reimbursed health care system: A cost analysis

INTRODUCTION: XELOX is non-inferior to FOLFOX-4 as a first-line treatment for metastatic colorectal cancer. This study compares the costs associated with XEL0X+/-bevacizumab versus FOLFOX4+/-bevacizumab in a non-reimbursed, out of pocket Philippine health care system.METHODS: This is a cost-minimization analysis using Philippine General Hospital as base case and a typical Filipino patient of 60 kg with BSA 1.66. The outcome data were derived from the N016966 trial. These included the drugs capecitabine, 5-fluorouracil, oxaliplatin, and bevacizumab (BEV); chemotherapy cycles and corresponding hospital admission for each regimen; resources associated with treatment of adverse events such hospital days, ambulatory consultations, concomitantmedication, and central venous line insertion/removal, with costs and charges based on the local setting.RESULTS: Highest cost (direct and/or indirect) was for FOLFOX4+BEV, followed by XEL0X+BEV, FOLFOX4, and then XELOX. The use of XELOX resulted in a cost saving of PhP 158,642 per patient compared with FOLFOX4. The use of XEL0X+BEV resulted in a cost saving of PhP 186,144 per patient compared with FOLFOX4+BEV.CONCLUSION: XEL0X+/-BEV is less costly than FOLFOX4-F/-BEV in an out-of-pocket Philippine tertiary hospital setting from the patient's perspective.

A Comparative Study of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spondylolisthesis

STUDY DESIGN: Level 4 retrospective review. PURPOSE: To compare the radiographic and clinical outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) with posterior segmental spinal instrumentation (SSI) for degenerative lumbar spondylolisthesis. OVERVIEW OF LITERATURE: Both PLIF and LLIF have been performed for degenerative spondylolisthesis with good results, but no study has directly compared these two techniques so far. METHODS: The electronic medical and radiographic records of 78 matched patients were analyzed. In one group, 39 patients underwent PLIF with SSI at 41 levels (L3-4/L4-5), while in the other group, 39 patients underwent the LLIF procedure at 48 levels (L3-4/L4-5). Radiological outcomes such as restoration of disc height and neuroforaminal height, segmental lumbar lordosis, total lumbar lordosis, incidence of endplate fracture, and subsidence were measured. Perioperative parameters were also recorded in each group. Clinical outcome in both groups was assessed by the short form-12, Oswestry disability index and visual analogue scale scores. The average follow-up period was 16.1 months in the LLIF group and 21 months in the PLIF group. RESULTS: The restoration of disc height, foraminal height, and segmental lumbar lordosis was significantly better in the LLIF group (p<0.001). The duration of the operation was similar in both groups, but the average blood loss was significantly lower in the LLIF group (p<0.001). However, clinical outcome scores were similar in both groups. CONCLUSIONS: Safe, effective interbody fusion can be achieved at multiple levels with neuromonitoring by the lateral approach. LLIF is a viable treatment option in patients with new onset symptoms due to degenerative spondylolisthesis who have had previous lumbar spine surgery, and it results in improved sagittal alignment and indirect foraminal decompression.

Gender Disparity in HIV Prevalence: A National-Level Analysis of the Association between Gender Inequality and the Feminisation of HIV/AIDS in sub-Saharan Africa

The HIV pandemic in sub-Saharan Africa is often described as undergoing a 'feminisation' in which female HIV prevalence exceeds that of male in most age groups and countries. However; much of the variation between countries in the female-to-male (FTM) ratio of HIV prevalence remains unexplained. This paper uses information from DHS; World Bank; UNDP and UNAIDS to identify correlates of the FTM ratio at the country level; with a focus on gender inequality. The FTM ratio is investigated overall and for two age groups. Divergent results by age suggest that the influence of particular mechanisms depend on the age group in question; with epidemiological and demographic variables in particular demonstrating strong associations with the FTM ratio for 25-49 year olds. The mechanisms influencing gender disparity in HIV prevalence between younger adults remain unclear; with few significant correlates observed for the 15-24 age group

Acetazolamide for Cystoid Macular Oedema in Bietti Crystalline Retinal Dystrophy

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.

Radiological changes in renal cell carcinomaafter extracorporeal CyberKnife® radiosurgical ablation:a case report / Alterações radiológicas no carcinoma de células renais após radiocirurgia estereotáticacom CyberKnife®: relato de caso

Small asymptomatic renal masses are more commonly discovered in elderly patients; however, multiple comorbidities in this population may preclude definitive surgical treatment. In this context, treatment options include active surveillance and ablative techniques. Stereotactic radiosurgery is a relatively innovative method of delivering ablative energy to abdominal organs, with very few human or animal experiences published. We describe our experience treating a patient with a large centrally located renal mass using CyberKnife® stereotactic radiosurgery.

Pequenas massas renais assintomáticas são mais frequentemente encontradas em pacientes idosos; contudo, comorbidades múltiplas nesses pacientes podem contraindicar um tratamento cirúrgico definitivo. Em tal contexto, as opções terapêuticas incluem vigilância ativa e técnicas ablativas. A radiocirurgia estereotáxica é um método inovador que aplica energia ablativa em órgãos abdominais, mas há pouca experiência nesse campo tanto em seres humanos como em animais. Descrevemos nossa experiência com o tratamento de um paciente com uma grande massa renal de localização central, utilizando-se a radiocirurgia esterotáxica com CyberKnife®.

Hiperinsulinismo na infância: quando apenas uma dosagem de insulina não é suficiente / Hyperinsulinism in infancy and childhood: when an insulin level is not always enough

INTRODUÇÃO: A hipoglicemia em bebês e crianças pode causar convulsões, atraso de desenvolvimento e dano cerebral permanente. O hiperinsulinismo (HI) é a causa mais comum de hipoglicemia, seja transitória ou permanente. A HI é caracterizada pela secreção inadequada de insulina, o que resulta em hipoglicemia persistente, de leve a grave. As diferentes formas de HI representam um grupo de doenças clínica, genética e morfologicamente heterogêneo. CONTEÚDO: Hiperinsulinismo congênito está associado às mutações de SUR-1 e Kir6.2, glucoquinase, glutamato desidrogenase, 3-hidroxiacil-CoA desidrogenase de cadeia curta e expressão ectópica de SLC16A1 na membrana plasmática das células beta. O HI pode estar associado ao estresse perinatal, como asfixia do nascimento, toxemia materna, prematuridade ou retardo do crescimento intra-uterino, resultando em hipoglicemia neonatal prolongada. Mimetismo de HI neonatal inclui pan-hipopituitarismo, hipoglicemia induzida por fármaco, insulinoma, anticorpos antiinsulina e estimuladores do receptor de insulina, síndrome de Beckwith-Wiedemann e distúrbios congênitos de glicosilação. Exames laboratoriais para HI podem incluir quantificação de glicose, insulina, β-hidroxibutirato, ácidos graxos, amônia e perfil de acilcarnitinas plasmáticos, além de ácidos orgânicos urinários. Os exames genéticos estão disponíveis em laboratórios comerciais para os genes sabidamente associados à hiperinsulinemia. Testes de resposta insulínica aguda (RIA) são úteis na caracterização fenotípica. Exames de imagem e histológicos também estão disponíveis para diagnosticar e classificar o HI. O objetivo do tratamento de crianças com HI é prevenir os danos cerebrais da hipoglicemia, mantendo níveis de glicose plasmática acima de 70mg/dl por terapia farmacológica ou cirúrgica. CONCLUSÃO:A terapêutica do HI requer abordagem multidisciplinar que inclui endocrinologistas pediátricos, radiologistas, cirurgiões e patologistas, os quais são treinados para diagnosticar..

BACKGROUND: Hypoglycemia in infants and children can lead to seizures, developmental delay, and permanent brain damage. Hyperinsulinism (HI) is the most common cause of both transient and permanent disorders of hypoglycemia. HI is characterized by dysregulated insulin secretion, which results in persistent mild to severe hypoglycemia. The various forms of HI represent a group of clinically, genetically, and morphologically heterogeneous disorders. CONTENT: Congenital hyperinsulinism is associated with mutations of SUR-1 and Kir6.2, glucokinase, glutamate dehydrogenase, short-chain 3-hydroxyacyl-CoA dehydrogenase, and ectopic expression of SLC16A1 on β-cell plasma membrane. Hyperinsulinism may be associated with perinatal stress such as birth asphyxia, maternal toxemia, prematurity or intrauterine growth retardation, resulting in prolonged neonatal hypoglycemia. Mimickers of hyperinsulinism include neonatal panhypopituitarism, drug-induced hypoglycemia, insulinoma, antiinsulin and insulin-receptor stimulating antibodies, Beckwith-Wiedemann Syndrome, and congenital glycosylation disorders. Laboratory testing for hyperinsulinism may include quantification of blood glucose, plasma insulin, plasma β-hydroxybutyrate, plasma fatty acids, plasma ammonia, plasma acylcarnitine profile and urine organic acids. Genetic testing is available at commercial laboratories for genes known to be associated with hyperinsulinism. Acute insulin response (AIR) tests are useful in phenotypic characterization. Imaging and histological tools are also available to diagnose and classify hyperinsulinism. The goal of treatment in infants with hyperinsulinism is to prevent brain damage from hypoglycemia by maintaining plasma glucose levels above 700 mg/l (70 mg/dl) through pharmacologic or surgical therapy. SUMMARY: The treatment of hyperinsulinism requires a multidisciplinary approach that includes pediatric endocrinologists, radiologists, surgeons, and pathologists who trained to diagnose...

Arterial ischemic stroke in children--recent advances.

Childhood stroke syndromes are an important cause of mortality and morbidity. This paper focuses on the recent advances in arterial ischaemic stroke beyond the neonatal period. Vascular risk factors are identified in the majority of children and guide both acute and longer term treatments, as well as determining prognosis. Contrary to popular belief many children have residual impairments encompassing a wide range of domains. National and international collaborations are facilitating an increase in the understanding of childhood stroke and have the eventual aim of conducting trials of potential therapeutic interventions.

Distraction osteogenesis in patients with syndromic midface retrusion--a primary experience / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the feasibility of midface distraction for correction of severe syndromic Four consecutive patients with severe syndromic midface retrusion underwent midface retrusion.</p><p><b>METHODS</b>distraction osteogenesis. The patients(three girls and one boy) aged from 4 to 12 years. Two were with Crouzon syndrome, one with Apert and one with Marfan syndrome. One was treated with Le Fort III external distraction, two with Le Fort III internal distraction, and the other with monobloc internal distraction. The distraction devices were activated on the fourth postoperative day at 1 mm per day.</p><p><b>RESULTS</b>All patients completed the distraction as activated on the fourth postoperative day at 1 mm per day. Results was planned. Successful advancement of 8 to 20 mm was obtained at the occlusal level in all patients as measured by cephalograms. The facial appearance was significantly improved,especially in the orbits and the upper part of the nose. Follow-up from 4 months to one year demonstrated that the face was symmetrical. All patients obtained This study shows that although midface distraction osteogenesis needs to be satisfactory results.</p><p><b>CONCLUSIONS</b>This study shows that although midface distraction osteogenesis needs to be improved to increase its controllability, it has obvious advantages over the traditional way of bone graft and rigid fixation. Midface distraction avoids bone grafts and alleviates the restriction of the soft tissue to midfacial bone advancement. Midface distraction osteogenesis is an effective and practical way to correct severe syndromic midfacial hypoplasia.</p>

Mandibular distraction osteogenesis in the treatment of obstructive sleep apnea syndrome in children with micrognathia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the treatment of obstructive sleep apnea syndrome (OSAS) in children with congenital micrognathia using mandibular distraction osteogenesis and to discuss the advantages and disadvantages of this approach.</p><p><b>METHODS</b>6 patients (4 males, 2 females) had undergone mandibular distraction osteogenesis, 12 distraction devices were placed through extraoral incision for bilateral distraction. The mean age of treatment was 1 year and 9 months (range 4 months to 9 years). Every patient had been evaluated pre and postoperatively with cephalometry. The period of consolidation was 4 - 11 weeks. The period of follow-up was from 2 to 10 months.</p><p><b>RESULTS</b>The average distraction distance was 19.2 mm (range 15 to 25 mm). The osteotomy and distraction processes were smooth in all the cases, the osteogenesis was good, without infection and other complications. The posterior airway space was increased from averaged 4.5 mm preoperatively to 10. 1mm after surgery. Five children had normal respiration and sleep restored with naso-pharyngeal airway removal or tracheostomy decannulation. One patient is to receive a planned second stage of distraction with a horizontal vector. The results were stable without relapse during a follow-up period of 2 to 10 months.</p><p><b>CONCLUSIONS</b>Application of mandibular distraction osteogenesis is an important component and effective in the treatment of OSAS and permits mandibular advancement in the younger child. As more experience is gained with distraction osteogenesis in the treatment of children with OSAS, the role of distraction will become better defined.</p>