Correlations between sleep architecture and sleep-related masseter muscle activity in children with sleep bruxism.

BACKGROUND: Sleep bruxism (SB) occurring during No-REM (nREM) sleep and increase in microarousals per hour have been described in adults, but not in children. OBJECTIVE: To assess the correlation between sleep architecture and masseter muscle activity related to sleep bruxism (SB/MMA) in children. MATERIALS AND METHODS: Forty-three children aged 7-12 years (mean age: 9.4 ± 1.3) with confirmed SB underwent a two-night polysomnographic (PSG) study in a sleep laboratory, for accommodation (first night) and data collection (second night). Data on sleep architecture (total sleep duration (TSD), sleep efficiency (SE), sleep onset latency (SOL), REM and nREM sleep duration and proportion and microarousals/hour during REM and nREM sleep) and episodes/hour of SB/MMA were recorded. Single and multiple-variable linear regression analyses were performed to assess the correlation between data on sleep architecture (predictors) and SB/MMA (dependent variable). RESULTS: Shorter TSD, REM and nREM stage 1 sleep duration, longer SOL and more microarousals/hour during REM and nREM sleep were found to be positive predictors of SB/MMA in children in the multiple-variable regression analysis (R2  = 0.511). CONCLUSION: Within the limitations of this study, it can be concluded that SB/MMA is correlated with altered sleep architecture in children (shorter total sleep duration (TSD), shorter nREM and REM sleep and higher microarousals during REM and nREM sleep). Nevertheless, the clinical significance of these findings need to be demonstrated in future studies.

Rare variants found in clinical gene panels illuminate the genetic and allelic architecture of orofacial clefting.

PURPOSE: Orofacial clefts (OFCs) are common birth defects including cleft lip, cleft lip and palate, and cleft palate. OFCs have heterogeneous etiologies, complicating clinical diagnostics because it is not always apparent if the cause is Mendelian, environmental, or multifactorial. Sequencing is not currently performed for isolated or sporadic OFCs; therefore, we estimated the diagnostic yield for 418 genes in 841 cases and 294 controls. METHODS: We evaluated 418 genes using genome sequencing and curated variants to assess their pathogenicity using American College of Medical Genetics criteria. RESULTS: 9.04% of cases and 1.02% of controls had "likely pathogenic" variants (P < .0001), which was almost exclusively driven by heterozygous variants in autosomal genes. Cleft palate (17.6%) and cleft lip and palate (9.09%) cases had the highest yield, whereas cleft lip cases had a 2.80% yield. Out of 39 genes with likely pathogenic variants, 9 genes, including CTNND1 and IRF6, accounted for more than half of the yield (4.64% of cases). Most variants (61.8%) were "variants of uncertain significance", occurring more frequently in cases (P = .004), but no individual gene showed a significant excess of variants of uncertain significance. CONCLUSION: These results underscore the etiological heterogeneity of OFCs and suggest sequencing could reduce the diagnostic gap in OFCs.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed. OBJECTIVE: To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings. METHODS: International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents. RESULTS: The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents. CONCLUSION: The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children.

BACKGROUND: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. OBJECTIVE: The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings. METHODS: Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children. RESULTS: The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children. CONCLUSION: The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Diagnostic criteria for temporomandibular disorders in children and adolescents: An international Delphi study-Part 2-Development of Axis II.

BACKGROUND: Unlike the psychosocial assessment established for adults in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), a standardised psychosocial assessment for children and adolescents with TMD complaints has not yet been established. OBJECTIVES: To develop a new standardised instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments. METHODS: A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2 and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophising, sleep problems and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritise the suggested instruments from most to least recommended. RESULTS: The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophising, stress and resilience. CONCLUSION: Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

Microbial Shift in the Enteric Bacteriome of Coral Reef Fish Following Climate-Driven Regime Shifts.

Replacement of coral by macroalgae in post-disturbance reefs, also called a "coral-macroalgal regime shift", is increasing in response to climate-driven ocean warming. Such ecosystem change is known to impact planktonic and benthic reef microbial communities but few studies have examined the effect on animal microbiota. In order to understand the consequence of coral-macroalgal shifts on the coral reef fish enteric bacteriome, we used a metabarcoding approach to examine the gut bacteriomes of 99 individual fish representing 36 species collected on reefs of the Inner Seychelles islands that, following bleaching, had either recovered to coral domination, or shifted to macroalgae. While the coral-macroalgal shift did not influence the diversity, richness or variability of fish gut bacteriomes, we observed a significant effect on the composition (R2 = 0.02; p = 0.001), especially in herbivorous fishes (R2 = 0.07; p = 0.001). This change is accompanied by a significant increase in the proportion of fermentative bacteria (Rikenella, Akkermensia, Desulfovibrio, Brachyspira) and associated metabolisms (carbohydrates metabolism, DNA replication, and nitrogen metabolism) in relation to the strong turnover of Scarinae and Siganidae fishes. Predominance of fermentative metabolisms in fish found on macroalgal dominated reefs indicates that regime shifts not only affect the taxonomic composition of fish bacteriomes, but also have the potential to affect ecosystem functioning through microbial functions.

Sleep bruxism in children: relationship with screen-time and sugar consumption.

OBJECTIVE/BACKGROUND: Consumption of added sugar and excessive screen-time is increasing worldwide and is associated with sleeping and behavior disorders, which are related with possible Sleep Bruxism (SB) in children. Therefore, the objective of this investigation was to examine the relationship between screen-time and sugar-consumption and possible SB in children. PATIENTS/METHODS: A cross-sectional study, including parents of 460 4- to 8-year-old children, was performed. Frequency of possible SB was assessed with the Children's Sleep Habits Questionnaire; sugar consumption with the Health Behaviour in School-Aged Children Food-Frequency Questionnaire. Comprehensive measures of screen-time (including cell phones, computers, electronic devices, electronic games, and TV) were taken. The time was recorded in hour/day. All data were analyzed with STATA© data analysis and statistical software version 13.0 (Copyright 1996-2016; Stata-Corp LP, College Station, TX, USA). Spearman correlation test and ordinal-multiple-variable regression analyses were used. RESULTS: Data of 440 subjects Mean age 6.2 years (S.D. 1.8) were analyzed. Prevalence of possible SB was 35% and screen-time was available for 92.9% of the children. Mean screen-time was 2.1 h/day. Parents reported 73% of the children (n = 319) to consume added sugar once a day every day and 20% more than once every day. Correlations of possible SB were statistically significant with screen-time (Rho = 0.8; p = 0.002) and sugar-consumption (Rho = 0.7; p = 0.03). Associations were found between possible SB and increase-to-increase screen-time and sugar-consumption (OR > 2). CONCLUSION: The results of this study demonstrated that as screen-time and sugar consumption increased, the frequency of bruxism in children increased.

Diagnostic criteria for temporomandibular disorders (DC/TMD) for children and adolescents: An international Delphi study-Part 1-Development of Axis I.

BACKGROUND: Since in children and adolescence prevalence is assessed mainly on self-reported or proxy-reported signs and symptoms; there is a need to develop a more comprehensive standardised process for the collection of clinical information and the diagnosis of TMD in these populations. OBJECTIVE: To develop new instruments and to adapt the diagnostic criteria for temporomandibular disorders (DC/TMD) for the evaluation of TMD in children and adolescents. METHOD: A modified Delphi method was used to seek international consensus among TMD experts. Fourteen clinicians and researchers in the field of oro-facial pain and TMD worldwide were invited to participate in a workshop initiated by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM scientific network) at the General Session of the International Association for Dental Research (IADR, London 2018), as the first step in the Delphi process. Participants discussed the protocols required to make physical diagnoses included in the Axis I of the DC/TMD. Thereafter, nine experts in the field were added, and the first Delphi round was created. This survey included 60 statements for Axis I, and the experts were asked to respond to each statement on a five-item Likert scale ranging from 'Strongly disagree' to 'Strongly agree'. Consensus level was set at 80% agreement for the first round, and at 70% for the next. RESULTS: After three rounds of the Delphi process, a consensus among TMD experts was achieved and two adapted DC/TMD protocols for Axis I physical diagnoses for children and adolescents were developed. CONCLUSION: Through international consensus among TMD experts, this study adapted the Axis I of the DC/TMD for use in evaluating TMD in children and adolescents.

Association between psychological factors and temporomandibular disorders in adolescents of rural and urban zones.

BACKGROUND: Temporomandibular disorders (TMD) are related to psychological factors. Adolescence is one of the stages in life with more psychosocial vulnerability, which is dissimilar in rural and urban zones. Thus, the aim of this investigation was to evaluate the association between psychological factors (symptoms of anxiety, depression and somatization) and TMD in adolescents between 12 and 15 years, belonging to urban and rural zones of Colombia. METHODS: 180 subjects aged 12-15 years (mean 13.8, SD 1.2), enrolled in public schools in the rural (n = 90) and urban (n = 90) zones were included. All subjects were evaluated using the DC/TMD instrument; the Axis I was applied for the clinical examination and the Axis II for the psychological evaluation. Data were analyzed by means of T-student, Mann-Whitney, Kruskall-Wallis tests, Pearson Chi square and multiple-variable analysis with logistic regression. RESULTS: Forty percent of the included subjects presented some type of TMD. TMD related to pain were the most common (25.5% of the studied adolescents), being myalgia the most common (20% of the adolescents in urban zone and 31.1% of the adolescents in the rural zone). There was no difference between the TMD present in males and females, but there were differences in the symptoms of Anxiety, and Somatization (p < 0.05). TMD and psychological factors were more prevalent in children with 13 years of age. A statistically significant association between TMD and symptoms of Anxiety (Pearson Chi squared 25.57, p = 0.04), depression (Pearson Chi squared 33.28, p = 0.03) and somatization (Pearson Chi squared 25.79, p = 0.04) was found in subjects from rural zones. No associations between psychological aspects and TMD were found in subjects from urban zones, but overall all psychological factors significantly influenced TMD. CONCLUSION: This study indicates Myalgia to be the most prevalent TMD in studied Colombian adolescents. Pain-related TMDs are associated with psychological factors in the adolescent population of rural Colombia. Symptoms of anxiety, depression and somatization were found to be associated to TMD, even when the frequency was not necessarily severe.

Multivariate GWAS of Structural Dental Anomalies and Dental Caries in a Multi-Ethnic Cohort.

Odontogenesis is a complex process, where disruption can result in dental anomalies and/or increase the risk of developing dental caries. Based on previous studies, certain dental anomalies tend to co-occur in patients, suggesting that these traits may share common genetic and etiological components. The main goal of this study was to implement a multivariate genome-wide association study approach to identify genetic variants shared between correlated structural dental anomalies and dental caries. Our cohort (N = 3,579) was derived from the Pittsburgh Orofacial Clefts Study, where multiple dental traits were assessed in both the unaffected relatives of orofacial cleft (OFC) cases (n = 2,187) and unaffected controls (n = 1,392). We identified four multivariate patterns of correlated traits in this data: tooth agenesis, impaction, and rotation (AIR); enamel hypoplasia, displacement, and rotation (HDR); displacement, rotation, and mamelon (DRM); and dental caries, tooth agenesis and enamel hypoplasia (CAH). We analyzed each of these four models using genome-wide multivariate tests of association. No genome-wide statistically significant results were found, but we identified multiple suggestive association signals (P < 10-5) near genes with known biological roles during tooth development, including ADAMTS9 and PRICKLE2 associated with AIR; GLIS3, WDR72, and ROR2 associated with HDR and DRM; ROBO2 associated with DRM; BMP7 associated with HDR; and ROBO1, SMAD2, and MSX2 associated with CAH. This is the first study to investigate genetic associations for multivariate patterns of correlated dental anomalies and dental caries. Further studies are needed to replicate these results in independent cohorts.

Brain Cortex Activity in Children With Anterior Open Bite: A Pilot Study.

Anterior open bite (AOB) is related to functional alterations of the stomatognathic system. There are no studies concerning brain activation of the cortex comparing children with and without AOB during rest and activities such as deglutition and phonation. The aim of this study was to determine the activity of the brain cortex of children with AOB at rest and during phonation and deglutition and to evaluate the association of intelligence quotient (IQ), attention (Test of Variables of Attention, known as TOVA), beats per minute (BPM), and oxygen saturation measurement (SpO2) with brain activity in subjects with AOB. Fourteen children (seven with AOB and seven without AOB) with mixed dentition, aged 10-13 years, underwent an IQ test, TOVA, SpO2, and quantitative electroencephalography (QEEG). Electrodes were set in the scalp, according to the 10-20 protocol. Data were analyzed using statistical tests to assess comparisons between children with and without AOB. The results showed that IQ, TOVA, SpO2, or BPM did not show any statistically significant differences between the groups, except for the response time (contained in TOVA) (p = 0.03). Significant differences were found for the brain activity during rest (Condition 1) of the tongue, between children with and without AOB (p < 0.05 for alpha/theta and alpha peaks), whereas there were no differences during function (Condition 2). The findings of this investigation provide insights about the cortex activity of the brain while the tongue is in the resting position in children with AOB. This may imply an altered activity of the brain cortex, which should be considered when diagnosing and treating AOB. Other diagnostic techniques derived from investigations based on neuroscience could develop new diagnostic and therapeutic techniques to give better solutions to children with malocclusions. Treatments should be focused not only on the teeth but also on the brain cortex.

Content and construct validity of the Diagnostic Criteria for Temporomandibular Disorders Axis I for children.

OBJECTIVE: To perform the content and construct validation of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I, for children 7-11 years old. MATERIALS AND METHODS: A Delphi process was used to perform the content validity of the DC/TMD Axis I. One hundred eighty-nine 7- to 11-year-old children were assessed with the adapted instrument. Confirmatory factor analysis (CFA) was used to investigate construct validity of the DC/TMD for children. A baseline one-factor model was compared against a two-factor (Model 2) and a seven-factor (Model 3) models based on the original DC/TMD. Root mean squared error of approximation (RMSEA), comparative fit index (CFI), chi-square, change in chi-square and Cronbach's α were used to analyse the data. All analyses were performed in STATA© version 13.0. RESULTS: Items of the DC/TMD were reduced, "history time" was changed to 2 weeks, pain intensity was assessed through a face scale, and language was adapted to be better understood by children. The amount of muscle pressure was maintained as in the original DC/TMD Axis I. The CFA led to a two- and a seven-factor model, with good fit. The internal consistency of Model 2 was .91 and of Model 3, .94. CONCLUSION: The results of this study provide evidence to support a seven-factor representation of the DC/TMD Axis I for 7- to 11-year-old children, as well as a two-factor structure. Such findings will begin to provide researchers with confidence in the properties of this instrument when considering its inclusion in clinical research.

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP]).

Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified-that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

Whole genome sequencing of orofacial cleft trios from the Gabriella Miller Kids First Pediatric Research Consortium identifies a new locus on chromosome 21.

Orofacial clefts (OFCs) are among the most prevalent craniofacial birth defects worldwide and create a significant public health burden. The majority of OFCs are non-syndromic, and the genetic etiology of non-syndromic OFCs is only partially determined. Here, we analyze whole genome sequence (WGS) data for association with risk of OFCs in European and Colombian families selected from a multicenter family-based OFC study. This is the first large-scale WGS study of OFC in parent-offspring trios, and a part of the Gabriella Miller Kids First Pediatric Research Program created for the study of childhood cancers and structural birth defects. WGS provides deeper and more specific genetic data than using imputation on present-day single nucleotide polymorphic (SNP) marker panels. Genotypes of case-parent trios at single nucleotide variants (SNV) and short insertions and deletions (indels) spanning the entire genome were called from their sequences using human GRCh38 genome assembly, and analyzed for association using the transmission disequilibrium test. Among genome-wide significant associations, we identified a new locus on chromosome 21 in Colombian families, not previously observed in other larger OFC samples of Latin American ancestry. This locus is situated within a region known to be expressed during craniofacial development. Based on deeper investigation of this locus, we concluded that it contributed risk for OFCs exclusively in the Colombians. This study reinforces the ancestry differences seen in the genetic etiology of OFCs, and underscores the need for larger samples when studying for OFCs and other birth defects in populations with diverse ancestry.

Tiempo y eficacia de diferentes sistemas y dinámicas para penetrar la obturación de GuttaCore en el retratamiento en conductos curvos simulados de EndoTraining Block / Time and efficacy of different systems and dynamics to penetrate the GuttaCore obturation in the retreatment of simulated curves canals in EndoTraining Blocks

Objetivo: Evaluar el tiempo y la eficacia de diferentes instrumentos y dirección de movimiento para perforar el GuttaCore y alcanzar la longitud de trabajo en conductos simulados curvos. Material y métodos: Treinta EndoTraining Blocks, fueron instrumentados hasta la longitud de trabajo, con el sistema de instrumentación reciprocante WaveOne Gold Primary y obturados con GuttaCore Primary y cemento sellador AH Plus. Las muestras fueron divididas en 3 grupos de 10 especímenes. Grupo 1: Des-obturados con ProTaper Gold F2 en giro rotatorio horario. Grupo 2: Desobturados con WaveOne Gold Primary en giro rotatorio antihorario. Grupo 3: Desobturados con WaveOne Gold Primary en movimiento recíproco. El tiempo de penetración del instrumento hasta la longitud de trabajo fue registrado con un cronómetro digital. Posteriormente, cada EndoTraining Block fue evaluado en un microscopio óptico para observar el trayecto de penetración del instrumento dentro del bloque de GuttaCore. Los instrumentos fueron descartados tras dos usos y observados al microscopio óp-tico para analizar su superficie. El tiempo registrado se evaluó por medio del análisis de variancia y prueba de Tamhane para comparaciones múltiples. Para las variables morfología del conducto y estado del instrumento se utilizó la prueba de chi-cuadrado o la prueba exacta de Fisher. Resultados: Los grupos 1 y 2 mostraron un tiempo significativamente menor en la penetración del material obturador (P<0,05) que el grupo 3. Los transportes de la morfología de los conductos simulados no mostraron diferencias significativas entre grupos (P>0,05). En relación al estado de los instrumentos, los grupos 1 y 2 mostraron diferencias significativas respecto al grupo 3 (P= 0,02). Conclusiones: Los sistemas ProTaper Gold en giro horario y WaveOne Gold en giro antihorario fueron más eficientes que el WaveOne Gold en movimiento recíproco

Objective: The aim of this study was to evaluate the time and efficacy to penetrate the GuttaCore and reach the working length in simulated curved canal using different instruments and kinematics. Material and methods: Thirty Endo training Blocks were instrumen-ted with WaveOne Gold Primary and obturated with GuttaCore Primary and AH Plus sealer. Blocks were divided into 3 groups of 10 samples each. Group 1: Desobturated with ProTaper Gold F2 in clockwise rotation. Group 2: Desobturated with WaveOne Gold Primary in counterclockwise rotation. Grupo 3: Desobturated with WaveOne Gold Primary reciprocating motion. Time to reach the working length was recorded by a digital chronometer. After this procedure all the Endo Training Block were evaluated under an optic microscope in order to analyze the canal morphology. Instrument were used twice and then were discarded and observed under an optic microscope to determine the file condition. Registered time was evaluated by the analysis of variance and Tamhane test for multiple comparisons. Regarding to the variables of canal morphology and the final instrument condition, chi square test or Fisher exact test were used grouping data when necessary. Results: Groups 1 and 2 showed significantly shorter time (P<0,05) than group 3 in penetrating the filling material. Alteration of the canal morphology in simulated canals was not significant between groups (P>0,05). Regarding to the final instrument condition, groups 1 and 2 showed statistical difference respect of group 3 (P=0,02). Conclusions: ProTaper Gold in clockwise rotation and WaveOne Gold in counterclockwise rotation were more efficient than Wa-veOne Gold in reciprocation motion

Flight over the Proto-Caribbean seaway: Phylogeny and macroevolution of Neotropical Anaeini leafwing butterflies.

Our understanding of the origin and evolution of the astonishing Neotropical biodiversity remains somewhat limited. In particular, decoupling the respective impacts of biotic and abiotic factors on the macroevolution of clades is paramount to understand biodiversity assemblage in this region. We present the first comprehensive molecular phylogeny for the Neotropical Anaeini leafwing butterflies (Nymphalidae, Charaxinae) and, applying likelihood-based methods, we test the impact of major abiotic (Andean orogeny, Central American highland orogeny, Proto-Caribbean seaway closure, Quaternary glaciations) and biotic (host plant association) factors on their macroevolution. We infer a robust phylogenetic hypothesis for the tribe despite moderate support in some derived clades. Our phylogenetic inference recovers the genus Polygrapha Staudinger, [1887] as polyphyletic, rendering the genera FountaineaRydon, 1971 and Memphis Hübner, [1819] paraphyletic. Consequently, we transfer Polygrapha tyrianthina (Salvin & Godman, 1868) comb. nov. to Fountainea and Polygrapha xenocrates (Westwood, 1850) comb. nov. to Memphis. We infer an origin of the group in the late Eocene ca. 40 million years ago in Central American lowlands which at the time were separated from South America by the Proto-Caribbean seaway. The biogeographical history of the group is very dynamic, with several oversea colonization events from Central America into the Chocó and Andean regions during intense stages of Andean orogeny. These events coincide with the emergence of an archipelagic setting between Central America and northern South America in the mid-Miocene that likely facilitated dispersal across the now-vanished Proto-Caribbean seaway. The Amazonian region also played a central role in the diversification of the Anaeini, acting both as a museum and a cradle of diversity. We recover a diversification rate shift in the Miocene within the species-rich genus Memphis. State speciation and extinction models recover a significant relationship between this rate shift and host plant association, indicating a positive role on speciation rates of a switch between Malpighiales and new plant orders. We find less support for a role of abiotic factors including the progressive Andean orogeny, Proto-Caribbean seaway closure and Quaternary glaciations. Miocene host plant shifts possibly acted in concert with abiotic and/or biotic factors to shape the diversification of Anaeini butterflies.

The Evolving Concept of Damage Control in Neurotrauma: Application of Military Protocols in Civilian Settings with Limited Resources.

OBJECTIVE: The aim of the present review was to describe the evolution of the damage control concept in neurotrauma, including the surgical technique and medical postoperative care, from the lessons learned from civilian and military neurosurgeons who have applied the concept regularly in practice at military hospitals and civilian institutions in areas with limited resources. METHODS: The present narrative review was based on the experience of a group of neurosurgeons who participated in the development of the concept from their practice working in military theaters and low-resources settings with an important burden of blunt and penetrating cranial neurotrauma. RESULTS: Damage control surgery in neurotrauma has been described as a sequential therapeutic strategy that supports physiological restoration before anatomical repair in patients with critical injuries. The application of the concept has evolved since the early definitions in 1998. Current strategies have been supported by military neurosurgery experience, and the concept has been applied in civilian settings with limited resources. CONCLUSION: Damage control in neurotrauma is a therapeutic option for severe traumatic brain injury management in austere environments. To apply the concept while using an appropriate approach, lessons must be learned from experienced neurosurgeons who use this technique regularly.

Recurrent Pituicytoma in a Pediatric Patient: A Case Report

Pituicytoma is a rare tumor that arises from the glial cells of the neurohypophysis. For a long time, it was believed that pituicytomas only appeared in adults. Currently, at least three cases of this entity occurring in children have been reported in the literature. The aim of the present report is to describe the case of a 5-year-old girl who presented to the emergency department with visual disturbances, and the diagnosis was a recurrent pituicytoma. Therefore, the clinical presentation, the radiological features of the tumor, and the corresponding surgical management are described. Additionally, a brief review of the management of this unusual entity was performed.

O pituicitoma é um tumor raro que surge das células gliais da neurohipófise. Durante muito tempo, acreditou-se que os pituicitomas só aparecessem em adultos. Atualmente, pelo menos três casos desta entidade ocorrendo em crianças foram relatados na literatura. O objetivo do presente artigo é descrever o caso de uma menina de 5 anos que chegou à emergência com distúrbios visuais, e o diagnóstico foi um pituicitoma recorrente. A apresentação clínica, as características radiológicas do tumor, e o correspondente manejo cirúrgico foram, portanto, descritos. Além disso, foi realizada uma breve revisão do tratamento desta entidade incomum.

Agreement between jaw-muscle activity measurement with portable single-channel electromyography and polysomnography in children.

BACKGROUND: Polysomnography (PSG) is the gold standard for sleep bruxism (SB) assessment. High economical costs, complex technical equipment, and unfamiliar laboratory setting limit its use in children. AIM: To determine the night-to-night variability of electromyography (EMG) episodes during a five-night recording with the GrindCare Measure (GCM), and the agreement in the assessment of masticatory muscle activity (MMA) between GCM and PSG in children. DESIGN: Forty-seven children from clinics of Universidad CES participated. Each participant was assessed with GCM for five consecutive nights. The last night, children underwent a single-night PSG study, together with the GCM. Spearman correlation coefficients were used to analyze data. RESULTS: The frequency of SB occurrence was 'sometimes' in 12 (25.5%) and 'usually' in 19 (40.4%) children. Simultaneous measurements with GCM and PSG obtained during the fifth night of measurement were not significantly correlated. Correlation between GCM total EMG episodes and EMG episodes/h and PSG total SB episodes, SB episodes/h, total bursts and burst/h measured with PSG was also not significant. CONCLUSION: EMG measurement with GCM was not accurate to detect PSG/SB in children. There was not advantage of multiple assessment for five nights with GCM, reducing the impact of night-to-night EMG episodes' variability on the GCM/PSG correlation.

Association of dietary habits and parental-reported sleep tooth grinding with tooth wear in children with mixed dentition.

BACKGROUND: Tooth wear has a multifactorial etiology, thus it should be assessed within a multiple-variable framework. The objective of this investigation was to assess the association of dietary habits and parental-reported sleep tooth grinding (STG) with tooth wear in children with mixed dentition. METHODS: One hundred twenty-one (N = 121) subjects (mean age 9.6 years) participated in a cross-sectional study. Wear of 1637 teeth was evaluated using the screening module of the Tooth Wear Evaluation System (TWES). Parental-report of STG was evaluated by means of the Children's Sleep Habits Questionnaire (CSHQ), whilst dietary habits were investigated by means of the Health Behaviour in School-Aged Children Food-Frequency Questionnaire (HBSC-FFQ). Data were analyzed with the Spearman correlation test and ordinal-multiple-variable regression analyses. Odds Ratio (OR) and ordinal OR were obtained for the independent variables included in the models. RESULTS: Parental-report of STG is not associated with tooth wear in the mixed dentition; some dietary habits were found to be correlated with specific tooth wear patterns, but the correlation values were weak. Associations were found between dietary habits and the increase-to-increase severity of occlusal/incisal and non-occlusal/non-incisal tooth wear of some teeth (OR > 2). CONCLUSIONS: A strong correlation of dietary habits and sleep tooth grinding with tooth wear in the mixed dentition was not demonstrated. However, dietary habits showed to have effects in terms of increase-to-increase severity.