Positional Plagiocephaly and Craniosynostosis.

Along with the decrease in sudden infant death syndrome due to the successful "Back to Sleep" Campaign, there was a reciprocal increase in cases of positional plagiocephaly (PP). The prevalence of PP significantly rose from approximately 5% to upward of 46% at age 7 months. Consequently, clinicians have seen a surge in the number of patients presenting with head shape abnormalities. Not only does this increase in patient volume pose a logistical problem to clinics, but it also poses a potential risk to patients with craniosynostosis, whose head shape anomalies are similar to a "needle in a haystack" of patients with more common PP. This review explores the causes, risk factors, and treatment options of PP and craniosynostosis, along with the differential of head shape anomalies based on phenotypic presentation. In doing so, we hope to provide pediatric care clinicians with the tools necessary to effectively evaluate and manage patients with head shape abnormalities. [Pediatr Ann. 2023;52(1):e10-e17.].

Differences in Practice in Alveolar Bone Grafting Among American Cleft Palate-Craniofacial Association Members.

The purpose of this study is to determine areas of agreement and disagreement among American Cleft Palate-Craniofacial Association (ACPA)members in the clinical practice of alveolar bone grafting (ABG), to guide further research to optimize ABG practices.A cross-sectional survey was conducted.The respondents were in an academic, combination, or private practice.The respondents were either plastic or oral and maxillofacial surgeons (OMFS) from various countries.A de-identified 24-question online survey was distributed to ACPA surgeon members utilizing the Research Electronic Data Capture (REDCap) tool.Data collected included surgeon specialty, use of various alveolar bone graft surgical techniques, as well as protocols.There was more variability than consensus between specialties with regards to the preoperative workup, timing of surgery, materials used for bone graft, surgical techniques, perioperative management, and postoperative evaluation. There was consensus on grafting during mixed dentition, not staging soft and hard tissue closure, and using iliac crest for primary and secondary grafting. Disagreements involved factors used to time the procedure and type of imaging used to assess viability. Technical differences involved incision type, part of bone grafted, use of minimally invasive technique, and material used for revisions.Aside from areas of consensus among surgeons on ABG, several areas, including use of bone substitutes in revision grafting, incision and type of iliac crest graft used during initial grafting, and postoperative protocols, had no consensus. These areas should be targets of further research to determine if there truly is an optimal method to perform ABG.The study was approved by the University of Illinois at Chicago Institutional Review Board. A de-identified 24-question online survey was distributed to surgeon members of the ACPA utilizing the REDCap tool on August 7, 2020. The survey questions consisted of multiple choice and multiple selection questions including an option to select "other" and specify the information in a blank space. Data collected included surgeon specialty, use of various alveolar bone graft surgical techniques, as well as pre and postoperative protocols. The full survey is included in online Supplemental material. Data analysis was performed in SPSS Statistics 27 (IBM Corp.). Descriptive statistics were performed, and chi-square was used to test for significant differences in survey responses between groups.

Body weight perception and body weight control behaviors in adolescents / Percepção do peso corporal e comportamentos para controle de peso em adolescentes

Abstract Objective: To investigate the association between the perception of body weight (as above or below the desired) and behaviors for body weight control in adolescents. Methods: This was a cross-sectional study that included 1051 adolescents (aged 15-19 years) who were high school students attending public schools. The authors collected information on the perception of body weight (dependent variable), weight control behaviors (initiative to change the weight, physical exercise, eating less or cutting calories, fasting for 24 h, taking medications, vomiting, or taking laxatives), and measured body weight and height to calculate the body mass index and then classify the weight status. Associations were tested by multinomial logistic regression analysis. Results: Adolescents of both sexes who perceived their body weight as below the expected weight took more initiatives to gain weight, and those who perceived themselves as overweight made more efforts to lose weight. In adolescents who perceived themselves as overweight, the behavior of not taking medication was associated with the outcome only in boys (Odds Ratio = 8.12), whereas in girls, an association was observed with the variables eating less, cutting calories, or avoiding fatty foods aiming to lose or avoid increasing body weight (Odds Ratio = 3.39). Adolescents of both sexes who practiced exercises were more likely to perceive themselves as overweight (male Odds Ratio = 2.00; Odds Ratio = 1.93 female). Conclusion: The perception of the body weight as above and below one's expected weight was associated with weight control behaviors, which were more likely to result in initiatives to lose and gain weight, respectively.

Resumo Objetivo: Verificar a associação da percepção (acima ou abaixo) do peso corporal esperado com os comportamentos para controle de peso em adolescentes. Métodos: Estudo transversal, feito com 1.051 adolescentes (15 a 19 anos) do ensino médio de escolas públicas estaduais. Foram coletadas informações sobre a percepção do peso corporal (variável dependente), comportamentos de controle de peso (iniciativa para mudar o peso, prática de exercícios físicos, comer menos ou cortar calorias, ficar 24 h sem comer, tomar medicamentos, vomitar ou tomar laxantes) e aferidas as medidas de massa corporal e estatura para cálculo do índice de massa corporal e classificação do status do peso. As associações foram testadas por meio da regressão logística multinomial. Resultados: Adolescentes de ambos os sexos com percepção do peso corporal abaixo do peso esperado apresentaram mais iniciativas para ganhar peso e aqueles que se percebiam acima do peso tiveram mais iniciativas para perder peso. Nos adolescentes que se percebiam acima do peso, o comportamento de não tomar medicamento esteve associado ao desfecho apenas nos rapazes (OR = 8,12), enquanto nas moças observou-se associação com comer menos, cortar calorias ou evitar alimentos gordurosos para perder ou para não aumentar o peso corporal (OR = 3,39). Adolescentes de ambos os sexos que faziam exercício físico tiveram maior chance de se perceber acima do peso (masculino OR = 2,00; feminino OR = 1,93). Conclusão: A percepção do peso acima e abaixo do peso esperado esteve associada aos comportamentos de controle de peso, nos quais, respectivamente, tinham mais chances de tomar iniciativas para perder e para ganhar peso.

Body weight perception and body weight control behaviors in adolescents.

OBJECTIVE: To investigate the association between the perception of body weight (as above or below the desired) and behaviors for body weight control in adolescents. METHODS: This was a cross-sectional study that included 1051 adolescents (aged 15-19 years) who were high school students attending public schools. The authors collected information on the perception of body weight (dependent variable), weight control behaviors (initiative to change the weight, physical exercise, eating less or cutting calories, fasting for 24h, taking medications, vomiting, or taking laxatives), and measured body weight and height to calculate the body mass index and then classify the weight status. Associations were tested by multinomial logistic regression analysis. RESULTS: Adolescents of both sexes who perceived their body weight as below the expected weight took more initiatives to gain weight, and those who perceived themselves as overweight made more efforts to lose weight. In adolescents who perceived themselves as overweight, the behavior of not taking medication was associated with the outcome only in boys (Odds Ratio=8.12), whereas in girls, an association was observed with the variables eating less, cutting calories, or avoiding fatty foods aiming to lose or avoid increasing body weight (Odds Ratio=3.39). Adolescents of both sexes who practiced exercises were more likely to perceive themselves as overweight (male Odds Ratio=2.00; Odds Ratio=1.93 female). CONCLUSION: The perception of the body weight as above and below one's expected weight was associated with weight control behaviors, which were more likely to result in initiatives to lose and gain weight, respectively.

The third suture in MACS-lifting: making midface-lifting simple and safe.

BACKGROUND: The minimal access cranial suspension (MACS)-lift is a short scar rhytidectomy with vertical purse string suture suspension of the facial tissues. It exists in a simple and extended version. The simple MACS-lift achieves a vertical lifting of neck and lower half of the face with two purse string sutures. The action of a third, malar suture gives additional correction of the middle third of the face, and results in the extended MACS-lift. OBJECTIVE: To draw attention to the power and advantages of the 'third' malar suture in the extended MACS-lift in achieving volumetric restoration of the midface, softening of the nasolabial fold and enhancing support of the lower eyelid. METHODS: The core principle of this technique is the use of strong purse string sutures in a pure antigravitational direction for correction of the ageing neck and lower two-thirds of the face. In a simple MACS-lift the neck is corrected by a first narrow vertical purse-string suture. The volume of jowls and cheeks is repositioned in a cranial direction with a second, slightly oblique purse string suture. To achieve better control over the midface an extended MACS-lift is performed by adding a third malar vertical purse string suture between the paracanthal area and the malar fat pad. RESULTS: 557 MACS-lift procedures have been performed by the two senior authors, of which 183 were simple and 374 extended. A retrospective review of this technique revealed high patient satisfaction, only one major complication and a minor complication rate of 6%. Both versions of the technique deliver a vertical vector correction of sagged facial features. The third suture restores the volume of the midface and malar mound and provides strong support of the lower eyelid. CONCLUSIONS: The third suture in the MACS-lift short scar rhytidectomy produces a natural midface lifting through a short scar, with adequate softening of the nasolabial fold and good support of the lower eyelid.

Performance of sequence analysis, INNO-LiPA line probe assays and AFFIGENE assays in the detection of hepatitis B virus polymerase and precore/core promoter mutations.

In this study, we compare results obtained by sequences analysis and commercial kits in the detection of hepatitis B virus (HBV) polymerase and precore (PC) and core promoter mutations. A total of 23 serum samples from lamivudine treated patients were tested for polymerase mutations by direct sequencing, INNO-LiPA HBV DR and AFFIGENE HBV DE/3TC. Full concordance among the three assays was observed in 63% of the total analysed codons. Concordant results were obtained between sequencing and LiPA in 80%, between sequencing and AFFIGENE in 73% and between LiPA and AFFIGENE in 74% of all tested codons. All discrepancies were observed in mixed population samples in which AFFIGENE and LiPA detected additional viral variants not revealed by sequence. In two patients, with serial samples, LiPA detected earlier than sequence and AFFIGENE an emerging mutate strain. PC and core promoter viral variants were detected in 28 serum samples collected from 14 HBV inactive carriers and from 14 hepatitis B patients with chronic liver disease. Direct sequencing, INNO-LiPA HBV PreCore and AFFIGENE HBV MUTANT VL 19 showed fully coincident results in 88% of tested positions. These findings showed that all assays evaluated were sensitive and accurate tools to analyse HBV genomic variability. Sequence analysis is essential to study new emerging mutations as LiPA and AFFIGENE assays are more easily useful in clinical laboratories to detect the appearance of well-characterized HBV variants.

Four years of treatment with lamivudine: clinical and virological evaluations in HBe antigen-negative chronic hepatitis B.

AIM: To evaluate the clinical and virological impact of the prolonged use of lamivudine in 94 patients with HBe antigen-negative chronic hepatitis B. METHODS: Initial virological and biochemical responses were obtained in 84 (89%) and in 83 (88%) patients respectively. RESULTS: The virological response peaked within the first 12 months, but diminished to 39% at 48 months because of drug resistance. Overall a virological breakthrough developed in 44 patients (52.4%). After virological breakthrough, the actuarial probability of maintaining biochemical remission diminished to 15% at 24 months and 0% at 29 months. There was no response in 10.6%. Polymerase gene mutations were observed in 82.5% of virological breakthroughs but also in 75% of the non-responders. Overall 7.4% of patients developed a hepatocellular carcinoma. CONCLUSION: Almost 90% of patients responded initially to lamivudine but the emergence of drug resistance progressively reduced the rate of virological remission to 39% at the fourth year of therapy. YMDD mutants explained the 75% of lamivudine resistances and were also selected very early in non-responders. Although the biochemical response is invariably lost within 29 months of the YMDD mutant's duration, the clinical outcome was benign despite severe postvirological breakthrough hepatitic flares in about 12% of cases.

Síndrome de Pai: características clínicas e relato de caso / Pai Syndrome: Clinical Characteristics and case report

A síndrome de Pai é uma desordem congênita rara primeiramente descrita em 1987. As principais características clínicas são a presença de fissura mediana do lábio superior, lipoma intracranial de corpo caloso e pólipos cutâneos, principalmente em asa nasal. Na literatura médica somente seis casos desta síndrome foram descritos. Apresenta-se o relato de mais um caso completo da síndrome, enfocando-se a reparação labial e nasal.

Pai syndrome is a rare congenital disorder first described in 1987. The main clinical features are median cleft of the upper lip, intra-cranial lipoma and cutaneous polyps. In literature only six cases of this syndrome have been described. We present the report of another complete case of syndorme, foccusing the lip and nose repair.

Reconstrução de orelha pós condrite por piercing: relato de caso / Ear reconstruction after perichondritis by piercing: case report

A prática do uso do piercing auricular transcartilaginoso por razões de vaidade tem aumentado em popularidade. Não muito raramente, uma complicação pode acontecer, com infecção do pertuito resultando em pericondrite e abscesso subpericondral. Isto pode evoluir para a perda da cartilagem e a deformidade conhecida como orelha em couve-flor, semelhante a de lutadores de Jiu Jitsu, sendo casos de difícil reconstrução. Apresentamos o relato de um caso de reconstrução auricular pós condrite com o uso de cartilagem costal devido ao piercing.

The practice of transcartilagenous auricular piercing for vanity purposes has been increasing in popularity. However, a infection in this site results in auricular perichondritis. A subperiostal abscess associated with perichondritis often leads to loss of cartilage and to a deformity known as “cauliflower ear”, which has a poor chance of good reconstruction. We present a case report of an auricular reconstruction after chondritis due to ear piercing using a rip cartilage.

Rinoseptoplastia aberta para tratamento de deformidade nasal na fissura unilateral / Open rhinoseptoplasty for the treatment of nasal deformity in the unilateral cleft lip

A correção das deformidades nasais associadas à fissura unilateral tem-se demonstrado de difícil solução cirúrgica. As características do nariz fissurado são bem conhecidas com mais de vinte alterações anatômicas. Nos últimos vinte anos, muitas técnicas e táticas foram desenvolvidas para corrigir a deformidade nasal associada à fissura unilateral. Apresentamos nossa experiência na correção da deformidade nasal em fissurados labiais unilaterais com rinoseptoplastia aberta tardia em 69 pacientes e os resultados estético e funcional.

The correction of nasal deformities in unilateral cleft lip has been demonstrated of hard surgery solution. The characteristics features of cleft lip nose are wellknown with more than 20 abnormal anatomical components. Within the last twenty years, many techniques had been developed to correct the associated nasal deformity associated with unilateral cleft lip. We present our experience in the correction of unilateral cleft lip nasal deformity with delayed open rhinoseptoplasty in 69 patients and the cosmetic and functional results.

Characterization of Toxoplasma gondii surface antigen 1 (SAG1) secreted from Pichia pastoris: evidence of hyper O-glycosylation.

A truncated form of surface antigen 1 (SAG1t), the immunodominant surface antigen of Toxoplasma gondii, was expressed in the methylotrophic yeast, Pichia pastoris. The truncated protein lacked the C-terminal residues which, in native SAG1, encompass a glycosylphosphatidylinositol anchorage site. The single potential N-glycosylation site was mutated and a sequence encoding a hexahistidine tag was introduced at the C-terminal of the construction to aid purification by immobilized metal-chelate chromatography. Recombinant SAG1t was efficiently secreted into the culture medium as three protein species having molecular masses of 29, 38/45 and 50/60 kDa. This heterogeneity was dependent upon the composition of the medium used to grow the yeast transformants. Mass spectrometric analyses, chemical deglycosylation, lectin recognition and sensitivity to mannosidase treatments showed that SAG1t heterogeneity was related to the presence of O-linked oligosaccharides containing alpha1-2-, alpha1-3- or alpha1-6-linked mannoses. The glycosylated and deglycosylated recombinant SAG1t were recognized by monoclonal and human-serum-derived antibodies, specific for the native SAG1, which suggested that the O-glycosylations had no major effect on the protein conformation. However, ELISA and Western-blot analysis with human sera showed that the O-carbohydrates added by P. pastoris could be recognized as antigenic structures. As a consequence, purification of the unglycosylated 29 kDa recombinant SAG1t species or deglycosylation is required in order to use recombinant SAG1t as a diagnostic reagent. Moreover, the presence of carbohydrates, not found on the native protein, suggests that addition of unnatural glycan structures by P. pastoris is a potential drawback that should be considered when using this expression system.