Low booster uptake in cancer patients despite health benefits.

Patients with cancer are at increased risk of death from COVID-19 and have reduced immune responses to SARS-CoV2 vaccines, necessitating regular boosters. We performed comprehensive chart reviews, surveys of patients attitudes, serology for SARS-CoV-2 antibodies and T-cell receptor (TCR) ß sequencing for cellular responses on a cohort of 982 cancer patients receiving active cancer therapy accrued between November-3-2020 and Mar-31-2023. We found that 92·3% of patients received the primer vaccine, 70·8% received one monovalent booster, but only 30·1% received a bivalent booster. Booster uptake was lower under age 50, and among African American or Hispanic patients. Nearly all patients seroconverted after 2+ booster vaccinations (>99%) and improved cellular responses, demonstrating that repeated boosters could overcome poor response to vaccination. Receipt of booster vaccinations was associated with a lower risk of all-cause mortality (HR=0·61, P=0·024). Booster uptake in high-risk cancer patients remains low and strategies to encourage booster uptake are needed. Highlights: COVID-19 booster vaccinations increase antibody levels and maintain T-cell responses against SARS-CoV-2 in patients receiving various anti-cancer therapiesBooster vaccinations reduced all-cause mortality in patientsA significant proportion of patients remain unboosted and strategies are needed to encourage patients to be up-to-date with vaccinations.

Real-World Experience With CPX-351 Treatment for Acute Myeloid Leukemia in England: An Analysis From the National Cancer Registration and Analysis Service.

BACKGROUND: CPX-351 demonstrated improved overall survival (OS) versus conventional 3 + 7 daunorubicin/cytarabine chemotherapy in a registrational phase III study in older patients with newly diagnosed, high-risk secondary acute myeloid leukemia (AML). This retrospective, population-based cohort study aimed to describe and compare the characteristics and survival outcomes of younger (<60 years) versus older (≥60 years) patients with AML treated with CPX-351 in England. PATIENTS AND METHODS: The study included adults aged ≥18 years diagnosed with AML in England between January 2013 and March 2022, and treated with CPX-351 in routine clinical practice (patients who received CPX-351 in a clinical trial were excluded). Patient records were sourced from the population-level cancer analysis system database available through the National Cancer Registration and Analysis Service. RESULTS: Of 353 included patients, 104 (29.5%) were <60 years. With a median follow-up of 10.9 months from diagnosis, the estimated median OS was 12.9 months overall, 17.3 months for adults <60 years and 11.7 months for those ≥60 years. All-cause mortality by Day 30 from diagnosis was 6% overall, 4% for adults <60 years and 6% for those ≥60 years. Hematopoietic cell transplantation (HCT) was received by 54% of adults <60 years and 38% of those ≥60 years after CPX-351, with median OS landmarked from the HCT date not yet reached for either age subgroup. CONCLUSION: This study provides real-world survival outcomes data suggesting that CPX-351 is an effective treatment for both younger (<60 years) and older (≥60 years) adults with AML.

The influence of obstructive sleep apnea syndrome on the orthodontic treatment decision in children and adolescents. Part 2 : Which orthodontic treatments for children with apnea? / L'influence du syndrome d'apnées obstructives du sommeil sur la décision thérapeutique orthodontique chez l'enfant et l'adolescent. Partie 2 : Quels traitements orthodontiques chez l'enfant apnéique ?

Introduction: Sleep-disordered breathing could affect 10% of an orthodontic population. The integration of obstructive sleep apnea syndrome (OSAS) diagnosis could influence the choice of orthodontic techniques or their implementation, with the aim of improving ventilatory function. Material and Method: The author summarizes the clinical studies using dentofacial orthopedics, alone or in combination with other interventions, in pediatric OSAS or the repercussions of orthodontic interventions on upper airways. Results: For the same orthodontic anomaly, in particular, transverse maxillary deficiency, the temporality and the modality of treatment could be modified by a diagnosis of OSAS. It could be recommended to propose early orthopedic maxillary expansion, seeking to potentiate its skeletal effect, to reduce the severity of OSAS. Class II orthopedic devices have shown interesting results but the evidence value of the studies is not yet sufficient to recommend them widely and as an early treatment. Extractions of permanent teeth do not significantly reduce the upper airway. Discussion: OSAS in children and adolescents includes several endotypes and phenotypes for which orthodontics may or may not be indicated. It is not recommended to orthodontically treat an apneic patient with no significant malocclusion, for the sole purpose of having an effect on the respiratory tract. Conclusion: The orthodontic therapeutic decision is likely to be modified by a diagnosis of sleep-disordered breathing underlining the interest in systematic screening.

Introduction: Les troubles respiratoires obstructifs du sommeil concerneraient 10 % d'une population orthodontique générale. Un diagnostic de syndrome d'apnée obstructive du sommeil (SAOS) pourrait influencer le choix des techniques orthodontiques ou leur mise en œuvre, dans le but d'améliorer la fonction ventilatoire. Matériel et méthode: L'auteur fait la synthèse des études cliniques utilisant l'orthopédie dento-faciale, seule ou en association avec d'autres interventions, dans l'apnée du sommeil de l'enfant et l'adolescent ; les répercussions des traitements orthodontiques sur les voies aériennes supérieures sont discutées. Résultats: Pour une même anomalie orthodontique, notamment l'insuffisance transversale du maxillaire, la temporalité et la modalité de traitement pourraient être modifiées par un diagnostic de SAOS. Il pourrait être recommandé de proposer une expansion maxillaire précoce, cherchant à potentialiser l'effet squelettique, pour tenter de réduire la sévérité du SAOS. Les appareils orthopédiques de classe II ont montré des résultats intéressants mais la valeur de preuve des études n'est pas encore suffisante pour les recommander largement et précocement. Les extractions de dents permanentes ne réduisent pas significativement les voies respiratoires supérieures. Discussion: Le SAOS de l'enfant et de l'adolescent comprend plusieurs endotypes et phénotypes pour lesquels l'orthodontie peut être indiquée ou non. Il n'est pas recommandé de traiter orthopédiquement un patient apnéique qui ne présenterait pas de malocclusion significative, dans le seul but d'avoir un effet sur les voies respiratoires. Conclusion: La décision thérapeutique orthodontique est susceptible d'être modifiée par un diagnostic de trouble respiratoire obstructif, soulignant l'intérêt d'un dépistage systématique.

The influence of obstructive sleep apnea syndrome on orthodontic treatment decisions in children and adolescents. Part 1: OSA phenotypes, treatment temporality and reciprocal effects on growth / L'influence du syndrome d'apnées obstructives du sommeil sur la décision thérapeutique orthodontique chez l'enfant et l'adolescent. Partie 1 : Phénotypes du SAOS, temporalité des traitements et effets réciproques sur la croissance

Introduction: Pediatric OSAS is a complex condition, comprising a plurality of clinical signs, complicated by the phenomena of growth. Its etiology is dominated by the hypertrophy of lymphoid organs, but obesity and certain craniofacial and neuromuscular tone abnormalities also contribute. Material and Method: The authors summarize the interrelations between pediatric OSAS endotypes, phenotypes and orthodontic anomalies. They report clinical practice recommendations on the multidisciplinary management of pediatric OSAS and define the place and timing of orthodontics. Results: There is an indication for treatment of pediatric OSAS for an OAHI greater than 5/h, regardless of comorbidity, as well as for symptomatic children, whose OAHI is between 1-5/h. The first line of treatment is adenotonsillectomy, but it does not always normalize the OAHI. Complementary treatments are often necessary: early orthodontics (rapid maxillary expansion, myofunctional appliances), oral reeducation, as well as the management of obesity and allergies. Careful watching, without treatment is possible for mild cases with few symptoms, as pediatric OSAS tends to resolve naturally with growth. Discussion: The therapeutic approach is stratified, depending on the severity of OSAS and the child's age. In terms of orthodontic repercussions, obesity is associated with earlier maturation and some facial morphological differences, while oral hypotonia and nasal obstruction can alter facial growth, promoting mandibular hyperdivergence and maxillary deficiency. Conclusion: Orthodontists are in a privileged position for the detection, follow-up and certain treatments of OSAS.

Introduction: Le syndrome d'apnées obstructives du sommeil (SAOS) pédiatrique est une pathologie complexe, comportant une pluralité de signes cliniques, compliqués par les phénomènes de croissance. Son étiologie est dominée par l'hypertrophie des organes lymphoïdes, mais l'obésité, certaines anomalies cranio-faciales ou du tonus neuromusculaire y contribuent. Matériel et méthode: Les auteurs font la synthèse des interrelations entre endotypes, phénotypes du SAOS pédiatrique et anomalies orthodontiques. Ils résument les recommandations sur la prise en charge pluridisciplinaire du SAOS, définissant la place des traitements orthodontiques. Résultats: Une indication de traitement du SAOS pédiatrique existe pour un indice d'apnées/hypopnées obstructives (IAHO) supérieur à 5/h, indépendamment de comorbidité, ainsi que pour les enfants symptomatiques, avec un IAHO entre 1 et 5/h. La première ligne de traitement est l'adéno-amygdalectomie, qui ne permet pas toujours de normaliser l'IAHO. Des traitements complémentaires sont souvent nécessaires : orthodontie précoce (expansion maxillaire rapide, appareils myofonctionnels), rééducation orale/hygiène nasale, ainsi que la prise en charge de l'obésité et des allergies. Une surveillance attentive sans traitement est possible pour les cas peu sévères et peu symptomatiques, car le SAOS a tendance à se résoudre naturellement avec la croissance. Discussion: L'approche thérapeutique est stratifiée, en fonction de la sévérité du SAOS et de l'âge de l'enfant. Au niveau des répercussions orthodontiques, l'obésité est associée à une maturation plus précoce et à des différences morphologiques faciales, alors que l'hypotonie orale et l'obstruction nasale peuvent favoriser l'hyperdivergence mandibulaire et la déficience maxillaire. Conclusion: Les orthodontistes sont dans une position privilégiée pour le dépistage, le suivi et certains traitements du SAOS.

Do nasal and nasopharyngeal obstruction and their medical-surgical deobstruction significantly influence facial divergence? A concise review of major clinical studies with meta-analysis / L'obstruction du nez et du nasopharynx et leur désobstruction médico-chirurgicale influencent-elles significativement la divergence faciale ? Une revue concise des études cliniques majeures avec méta-analyse

Introduction: The term « adenoid facies ¼ suggests a causal relationship between nasopharyngeal obstruction and facial hyperdivergence in growing subjects. The strength of this association is controversial and few « quantified ¼ values exist. Materials and methods: A rapid electronic search was conducted on PubMed and Embase to find the main cephalometric studies involving patients with nasal/nasopharyngeal obstruction compared to a control sample. A meta-analysis was carried out to quantify the effect of obstruction (1) and intervention to relieve the obstruction (2) on mandibular divergence (SN/Pmand angle), maxillo-mandibular divergence (PP/Pmand angle), inclination of the occlusal plane (SN/Poccl) and the gonial angle (ArGoMe). Results: Qualitatively, the studies' bias level ranged from moderate to high. Results were concordant about the significant effect of the obstruction on facial divergence (1) with an increase in SN/Pmand (+3.6° on average, +4.1° in children <6 years), PP/Pmand (+5.4° on average, +7.7° <6 years), ArGoMe (+3.3°) and SN/Pocc (+1.9°). Surgical interventions to remove the respiratory obstacle in children (2) generally did not normalize the direction of growth, with the exception, with a very low level of evidence, of adenoidectomies/adeno-tonsillectomies, performed at an age less than 6-8 years. Conclusion: Early detection of respiratory obstacles and postural abnormalities associated with oral breathing appears to be decisive in order to hope for management at a young age and normalization of the direction of growth. However, the effects on mandibular divergence remain limited, requiring caution, and cannot be considered a surgical indication.

Introduction: Le terme « faciès adénoïdien ¼ suggère une relation de causalité entre l'obstruction nasopharyngée et l'hyperdivergence chez le sujet en croissance. La force de cette association est controversée et peu de valeurs « chiffrées ¼ existent. Matériels et méthodes: Une recherche électronique rapide a été menée sur PubMed et Embase pour retrouver les principales études céphalométriques impliquant des patients avec obstruction nasale/nasopharyngée comparés à une population témoin. Une métanalyse a été réalisée pour quantifier l'effet de l'obstruction (1) et de la désobstruction (2) sur la divergence mandibulaire (angle SN/Pmand), la divergence maxillo-mandibulaire (angle PP/Pmand), l'inclinaison du plan occlusal (SN/Poccl) et l'angle goniaque (ArGoMe). Résultats: Qualitativement, le niveau de biais des études allait de modéré à élevé. Les résultats étaient concordants sur l'effet significatif de l'obstruction sur la divergence faciale (1) avec une augmentation de SN/Pmand (+3,6° en moyenne, +4,1° chez les enfants < 6 ans), PP/Pmand (+5,4° en moyenne, +7,7° < 6 ans), ArGoMe (+3,3°) et SN/Pocc (+1,9°). Les interventions chirurgicales pour lever l'obstacle respiratoire chez l'enfant (2) ne permettaient généralement pas une normalisation de la direction de croissance, à l'exception, avec un très faible niveau de preuve, des adénoïdectomies/adéno-amygdalectomies, réalisées à un âge inférieur à 6-8 ans. Conclusion: Le dépistage précoce des obstacles respiratoires et des anomalies posturales associées à la ventilation orale apparaît déterminant pour espérer une prise en charge en jeune âge et une normalisation de la direction de croissance. Les effets sur la divergence mandibulaire restent cependant limités, imposant la prudence et ne constituant pas une indication chirurgicale.

Pilot study of a European oncology regimen reference library and matching algorithm.

OBJECTIVES: As yet, there is no European data standard for naming and describing oncology regimens. To enable real-world cancer treatment data comparisons, the Oncology Data Network created a unified reference database for systemic anti-cancer regimens used in practice across Europe. Data are extracted from clinical systems and mapped to a single standard called the "Core Regimen Reference Library (CRRL)". An automated matching algorithm has been designed based on: drug combinations; administration schedule; and dosing and route of administration. Incomplete matches are flagged for expert review. The aim of this pilot study is to have an expert pharmacist panel test the algorithm's feasibility by comparing computerised and manual matching of regimens that are currently in use in different European countries. METHODS: The combined team pooled a diverse sample of 47 reference regimens used in Europe for solid and haematological cancers. These were then codified to the developed common data standard and the algorithm was used to match them to the CRRL. The expert pharmacist panel from the European Society of Oncology Pharmacy (ESOP) selected 12 regimens from the sample set, ranging from simple to complex, and performed a single-blind test of the algorithm, by systematically matching each original regimen to the CRRL. RESULTS: ESOP validated the algorithm's feasibility based on full concurrence between manual and computer matches thereby validating the algorithm rules and logic with regard to what defines the core characteristics of a regimen and how to compare similarities and differences. CONCLUSIONS: ESOP's validation of the matching algorithm and approach to curating a master library provides confidence in their utility for reliable comparison of real-world regimen usage across Europe.

Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana.

Objectives: Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana. Methods: A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18 years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system. Results: Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus. Conclusion: Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.

Factors influencing the initiation of adjuvant endocrine therapy in patients with estrogen receptor-positive ductal carcinoma in situ: a single institution experience.

PURPOSE: This study evaluates whether race, socioeconomic status, insurance type, oncological provider type, and prior cancer treatment are associated with the suggestion and acceptance of hormonal therapy in patients with estrogen receptor (ER)-positive Ductal carcinoma in situ (DCIS). This study also assesses whether disparities exist pertaining to prescription of such medications. METHODS: This single-center retrospective study included 111 patients diagnosed with DCIS between 2020 and 2021. Data collected included race, type of insurance, prescribing providers, and socioeconomic status. We used zip codes to identify the poverty levels in these areas as published in the United States Census Bureau and stratified the patients into quartiles accordingly. Chi-Square statistics were used to calculate significance levels. RESULTS: There was no significant correlation between the intake of hormonal therapy and race (p = 0.60), insurance (p = 0.50), socioeconomic (p = 0.58), or providers (p = 0.99). 79.3% of women were offered endocrine therapy. Of those who were offered endocrine therapy, 70.8% accepted. Of patients not on hormonal therapy, 45.8% were not recommended the medications by their provider, and 54.2% declined treatment when offered. CONCLUSION: In this study, patients' demographics and providers were not associated with adjuvant hormonal therapy initiation in DCIS. Our results show that abstaining from endocrine therapy in DCIS patients is both due to lack of provider recommendation and patient rejection of these medications. The wide variation in hormonal therapy treatment among ER-positive DCIS patients suggests a need for improved provider-patient communication regarding the risks and benefits of endocrine therapy in order to ensure a shared decision-making process.

Is the quality of occlusal contacts comparable after aligner and fixed orthodontic therapy? A non-randomized cohort comparison using computerized occlusal analysis during 6 months of retention.

OBJECTIVE: Less than ideal contacts have been reported following aligner therapy, but it is considered a transitory problem, spontaneously resolving with the phenomenon of settling. Methods: Thirty-nine orthodontic patients (14 treated with aligners; 25 with fixed appliances) were evaluated with a digital occlusal analysis system (T-scan™10), assessing Maximum Intercuspation contact simultaneity, symmetry, and relative force distribution at treatment completion and after 3 and 6 months. RESULTS: No significant differences in occlusal contact quality were found between groups at treatment completion or follow-up. The center of force moved posteriorly and remained stable after 3 months but was located more anteriorly in females (p = 0.01). One-third of patients (both groups combined) had marked contact force asymmetry even after 6 months' retention. Conclusion: Occlusal contacts were comparable at completion of treatment with aligners or brackets and after 3-6 months of retention. Settling did not improve marked asymmetry in all patients.

Very-High Dynamic Range, 10,000 Frames/Second Pixel Array Detector for Electron Microscopy.

Precision and accuracy of quantitative scanning transmission electron microscopy (STEM) methods such as ptychography, and the mapping of electric, magnetic, and strain fields depend on the dose. Reasonable acquisition time requires high beam current and the ability to quantitatively detect both large and minute changes in signal. A new hybrid pixel array detector (PAD), the second-generation Electron Microscope Pixel Array Detector (EMPAD-G2), addresses this challenge by advancing the technology of a previous generation PAD, the EMPAD. The EMPAD-G2 images continuously at a frame-rates up to 10 kHz with a dynamic range that spans from low-noise detection of single electrons to electron beam currents exceeding 180 pA per pixel, even at electron energies of 300 keV. The EMPAD-G2 enables rapid collection of high-quality STEM data that simultaneously contain full diffraction information from unsaturated bright-field disks to usable Kikuchi bands and higher-order Laue zones. Test results from 80 to 300 keV are presented, as are first experimental results demonstrating ptychographic reconstructions, strain and polarization maps. We introduce a new information metric, the maximum usable imaging speed (MUIS), to identify when a detector becomes electron-starved, saturated or its pixel count is mismatched with the beam current.

Prevalence of malocclusions and oral dysfunctions in children with persistent sleep-disordered breathing after adenotonsillectomy in the long term.

STUDY OBJECTIVES: To evaluate the prevalence of craniofacial/orthodontic abnormalities and oral dysfunctions in a population of children with persistent sleep-disordered breathing despite adenotonsillectomy. METHODS: Medical charts of 4,000 children with sleep-disordered breathing operated on in a tertiary hospital were retrospectively reviewed. Patients reporting persistent sleep-disordered breathing symptoms were invited to an orthodontic/myofunctional evaluation following the Sleep Clinical Score), followed by a 1-night ambulatory type III sleep study. RESULTS: One hundred nonsyndromic symptomatic patients were examined (mean age 8.8 ± 3.5 years), from 1 to 12 years after surgery (mean 4.6 ± 3.1 years); 24% were overweight/obese; 69 had a sleep study. Although prevalent, oronasal abnormalities and malocclusions were not specifically associated with pathological sleep parameters (cartilage hypotonia 18%, septal deviation 5%, short lingual frenulum 40%). Malocclusions were associated with a higher respiratory event index in children under 8 years only, whereas an impaired nasal dilator reflex and tongue immaturity were associated with an increased obstructive respiratory event index in all patients (1.72 ± 2.29 vs 0.72 ± 1.22 events/h, P = .011) and Respiratory Event Index, respectively (3.63 ± 3.63 vs 1.19 ± 1.19 events/h). Male sex, phenotype, nasal obstruction, oral breathing, and young age at surgery (< 3 years) were significantly related to higher respiratory event index. Using the Sleep Clinical Score > 6.5 cut-off, patients with persistent sleep apnea were significantly distinct from chronic snoring (2.72 ± 2.67 vs 0.58 ± 0.55, P < .01). CONCLUSIONS: Oronasal anatomical and functional abnormalities were quite prevalent and various in persistent sleep-disordered breathing after adenotonsillectomy. Nasal disuse and tongue motor immaturity were associated with a higher obstructive respiratory event index in the long term, whereas craniofacial risk factors might have a more pronounced impact at younger age.

Comparative Genomic Screen in Two Yeasts Reveals Conserved Pathways in the Response Network to Phenol Stress.

Living organisms encounter various perturbations, and response mechanisms to such perturbations are vital for species survival. Defective stress responses are implicated in many human diseases including cancer and neurodegenerative disorders. Phenol derivatives, naturally occurring and synthetic, display beneficial as well as detrimental effects. The phenol derivatives in this study, butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and bisphenol A (BPA), are widely used as food preservatives and industrial chemicals. Conflicting results have been reported regarding their biological activity and correlation with disease development; understanding the molecular basis of phenol action is a key step for addressing issues relevant to human health. This work presents the first comparative genomic analysis of the genetic networks for phenol stress response in an evolutionary context of two divergent yeasts, Schizosaccharomyces pombe and Saccharomyces cerevisiae Genomic screening of deletion strain libraries of the two yeasts identified genes required for cellular response to phenol stress, which are enriched in human orthologs. Functional analysis of these genes uncovered the major signaling pathways involved. The results provide a global view of the biological events constituting the defense process, including cell cycle arrest, DNA repair, phenol detoxification by V-ATPases, reactive oxygen species alleviation, and endoplasmic reticulum stress relief through ergosterol and the unfolded protein response, revealing novel roles for these cellular pathways.

Persistent sleep disordered breathing after adenoidectomy and/or tonsillectomy: a long-term survey in a tertiary pediatric hospital.

PURPOSE: To determine the long-term prevalence of persistent sleep disordered breathing (SDB) in children, after adenoidectomy, tonsillectomy or adenotonsillectomy, and to assess the relationship between baseline characteristics and persistent nocturnal symptoms. METHODS: The clinical charts of children operated for adenoidectomy and/or tonsillectomy in a tertiary hospital, between January 2000 and March 2016, were retrospectively reviewed. All patients who had signs of SDB prior to surgery received a six-question validated pediatric questionnaire, the Hierarchic Severity Clinical Scale (HSCS). RESULTS: A total of 4000 children showing SDB prior to surgery were selected out of 5809 (68.9%); 1176 parents returned the questionnaire (29.4%), with a mean age at surgery of 4.3 ± 2.2 and age at survey of 9.6 ± 3.6. Complete resolution of SDB was subjectively reported in 798 patients (67.9%), and mild SDB was suspected in 301 children (25.6%, HSCS > 0 with chronic snoring), while 77 (6.5%) had a HSCS > 2.72, suggesting persistent obstructive sleep apnea. In non-syndromic children, male sex, history of sole adenoidectomy, or sole tonsillectomy, and early age of surgery (< 2 years-old) were associated with higher HSCS scores (p < 0.05). Moreover, symptoms had a tendency to decrease from 1 to 6 years, re-occur at age 7-8, and also after 13, with boys reporting more severe symptoms, at a younger age. CONCLUSIONS: Surgical excision of lymphoid tissue to treat SDB in childhood seems to be effective in the long term in two-thirds of subjects, while partial surgeries, specific age groups and early surgery are more likely to have persistent or recurrent symptoms.

Ablation of PRDM16 and beige adipose causes metabolic dysfunction and a subcutaneous to visceral fat switch.

A clear relationship exists between visceral obesity and type 2 diabetes, whereas subcutaneous obesity is comparatively benign. Here, we show that adipocyte-specific deletion of the coregulatory protein PRDM16 caused minimal effects on classical brown fat but markedly inhibited beige adipocyte function in subcutaneous fat following cold exposure or ß3-agonist treatment. These animals developed obesity on a high-fat diet, with severe insulin resistance and hepatic steatosis. They also showed altered fat distribution with markedly increased subcutaneous adiposity. Subcutaneous adipose tissue in mutant mice acquired many key properties of visceral fat, including decreased thermogenic and increased inflammatory gene expression and increased macrophage accumulation. Transplantation of subcutaneous fat into mice with diet-induced obesity showed a loss of metabolic benefit when tissues were derived from PRDM16 mutant animals. These findings indicate that PRDM16 and beige adipocytes are required for the "browning" of white fat and the healthful effects of subcutaneous adipose tissue.

Changes in facial profile after maxillomandibular advancement surgery for obstructive sleep apnea syndrome.

UNLABELLED: The aim of this study was to assess changes in the profile of adult male patients treated for obstructive sleep apnea syndrome (OSAS) with maxillomandibular advancement (MMA) surgery and to measure patient perception of changes compared with that of different panels. MATERIALS AND METHODS: Fifteen consecutive apneic patients displaying a wide variety of morphological types, mean age 42 years (20-59), a BMI of 26.60 kg/m(2) (22-29), a mean initial Apnea Hypopnea Index (AHI) of 50.9 (19-85), underwent MMA. Assessment was done by facial photography, lateral cephalographs (Tweed analysis modified by Riley and Delaire architectural analysis), polysomnographic records and a validated self-assessment questionnaire. Patients' pre- and postoperative profiles were taken from photographs using Photoshop 7™ software. Their darkened outlines were shown randomly in positions A or B (pre- and postoperative) to panels composed of orthodontists (n=40), fine arts students (n=50) and lay persons (n=50) who were requested to choose the most attractive profiles. RESULTS: The MMA success rate for OSAS was 80% (12/15) for an AHI less than 15, with no surgical complications. All patients reported a reduction of their symptoms and 14 out of 15 were satisfied with the esthetic outcome. Mean advancement was 8.4mm (3.0-10.0) for the maxilla and 10.8mm (10.0-13.0) for the mandible. Following MMA, 12 out of 15 exhibited maxillary protrusion and six out of 15 mandibular protrusion. The mean change in the nasolabial angle was -5.7° (-27°; 14°). The postoperative profiles were preferred by 85% of the combined panels (P=<0.001), showing no significant difference from one panel to another. No skeletal characteristic could be correlated with the esthetic preference. Upper lip retrusion, open nasolabial angle and dolichofacial type emerged as positive preoperative predictors of esthetic preference. CONCLUSION: The profile changes following MMA were favorably perceived in the majority of cases. However, specific orthodontic preparation could be offered to patients with pronounced preoperative protrusion.

Ankylosis of permanent first molars: genetics or environment? A case report of a discordant twin pair.

The rare condition of secondary retention has been reported in the literature as being of genetic origin, with some authors suggesting an autosomal dominant pattern. We report the unusual case of two monozygotic biamniotic, bichorionic male twins, who were discordant for permanent first molar secondary retention, involving ankylosis. Twin A showed normal occlusion and eruption patterns, whereas Twin B displayed a left open bite, in relation with a totally submerged primary second molar leading to retention of the underlying premolar (35), and severe infraocclusion of the adjacent permanent molar (36). After orthodontic failure to close the open bite, ankylosis of 36 was confirmed, whereas 26 became severely infraoccluded.The mother had a history of bilateral molar ankylosis and presented reduced posterior alveolar height. Discordance in this twin pair demonstrates that environmental influences, in addition to epigenetic and local factors, may play a role in secondary retention, which is difficult to diagnose and challenging to treat.

Treatment of the obstructive sleep apnea syndrome in adults by mandibular advancement device: the state of the art.

The obstructive sleep apnea syndrome (OSAS) constitutes a non-negligible risk which requires management by specialists of the upper airways. When OSAS is diagnosed, it needs to be treated and different resources are listed. Different forms of treatment can be envisaged: positive pressure ventilation (VCPP), mandibular advancement devices (MAD), and surgery (soft and hard tissues). The authors focus especially the treatments for MAD, outlining their positive and negative impact on ventilation, TMJ, the bony base and interarch relationships.

[Twins: a response to the question of genetic/environmental influence on development?]. / Les jumeaux : une réponse à la question de l'influence génétique/environnement sur le developpement ?

This article presents recent data about human twinning and explains how twin studies can bring precious informations about craniofacial growth. These natural experiences of growth phenomenon can give clues about genetic/environment interactions during development.

[Twins and the heritability of dentofacial phenotype]. / Jumeaux et héritabilité des phénotypes dento-faciaux.

In orthodontics and dentofacial orthopaedics, where genetic and environmental factors interpenetrate from the early stages of development, the clinician tries to determine how mechanics could influence patient's growth pattern. Comparing monozygotic and dizygotic twins, in their similarities and their differences, gives some answers... but raises some questions too. In this article, we gather some clinical studies and case reports, on diagnosis and treatment aspects of malocclusions.