Rapid maxillary expansion and its consequences on the nasal and oropharyngeal anatomy and breathing function of children and adolescents: An umbrella review.

OBJECTIVE: To identify, qualify, and summarize the evidence from different systematic reviews about the outcomes of Rapid Maxillary Expansion (RME) on upper airway dimensions and breathing function in young patients. METHODS: A literature search (from 2000 to December 2022) was conducted through PubMed (MEDLINE), the Cochrane Library, EMBASE, and Dentistry & Oral Science Source. The authors conducted the following umbrella review phases: research question, study selection criteria (systematic reviews involving randomized clinical trials and longitudinal observational designs), data extraction, and critical appraisal (bias risk assessment) of selected articles through the ROBIS tool. RESULTS: The initial search yielded 65 potential references. After screening titles and summaries, and the elimination of duplicated publications, 15 articles were eligible for the evaluation of the full-text document. Finally, 11 systematic reviews (5 combined with meta-analysis) were selected, reporting 132 single studies; 38 of them were unrepeatable. Risk-of-bias assessment showed an average global moderate/high quality among the included studies. There was high heterogeneity between the systematic reviews' (and meta-analyses') methodologies used. CONCLUSIONS: The present umbrella review concludes that significant and stable increases in the nasal and oropharyngeal space volumes and a decrease in airway resistance of growing children and adolescents, occur immediately after RME and at 3, 6- and 12-months follow-up.

Disyunción maxilar rápida asistida con microtornillos en pacientes en crecimiento con deficiencia maxilar transversal / Miniscrew assisted rapid maxillary expansion in growing patients with transverse maxillary deficiency

RESUMEN: Introducción: La disyunción maxilar rápida tradicional (RME) ha sido el tratamiento de elección para corregir la maloclusión secundaria a la deficiencia maxilar transversal. Debido a las complicaciones que pueden presentar los pacientes, se han desarrollado técnicas de disyunción maxilar asistida por microtornillos (MARPE). Sin embargo, aún no hay consenso respecto a los reales beneficios de la disyunción maxilar rápida asistida por microtornillos por sobre la disyunción tradicional en pacientes jóvenes y en crecimiento. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos siete revisiones sistemáticas que en conjunto incluyeron seis estudios primarios, de los cuales todos corresponden a ensayos aleatorizados. Concluimos que: la disyunción maxilar rápida asistida por microtornillos (MARPE) probablemente disminuye la pérdida de hueso alveolar bucal y la resistencia de la vía aérea nasal en comparación a la disyunción maxilar rápida tradicional (RME) (certeza evidencia moderada). MARPE podría disminuir la inclinación dentaria y resultar en poca o nula diferencia en la percepción de dolor en comparación con RME (certeza de la evidencia baja). No es posible establecer con claridad si MARPE aumenta la expansión maxilar en comparación con RME, debido a que la certeza de la evidencia ha sido evaluada como muy baja.

ABSTRACT: Introduction: Traditional rapid maxillary expansion (RME) has been the gold-standard treatment to correct malocclusion secondary to transverse maxillary deficiency. Due to related complications, mini screw assisted maxillary expansion (MARPE) techniques have been developed. However, there is no consensus regarding the benefits of mini screw assisted maxillary expansion over traditional expansion in young and growing patients. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified seven systematic reviews including six studies overall, all of which were randomized trials. We concluded that mini screw maxillary expansion (MARPE) probably reduces buccal alveolar bone and nasal airway resistance compared to traditional rapid maxillary expansion (RME). MARPE may reduce dental inclination and result in little or no difference in pain perception compared to RME. We are uncertain whether MARPE improves maxillary expansion compared to RME, as the certainty of the evidence has been assessed as very low.

Nonlinear models for estimating cherry tomato yield / Modelos não-lineares para a estimativa da produção de tomate do tipo cereja

The aim of this paper was to test nonlinear regression models for estimating the cherry tomato production and to identify the plot size with better fitting quality and adjustment of the models, using two uniformity trials in greenhouse. The logistic and von Bertalanffy models were used on variables, as the means fruit weight, the means number of fruits and bunches accumulated in the multiple harvests and with different plot sizes. The models presented similar estimates for all parameters in all plot sizes studied. The nonlinear models adequately describe the behavior of the production of cherry tomato fruits cultivated in greenhouse. Plots constituted by two and three plants, respectively in trials with greenhouse of 250 m2 and 200 m2, provide a good fitting quality in the models adjustment.(AU)

Os objetivos do trabalho foram ajustar modelos de regressão não-linear para a estimativa da produção de frutos de tomate tipo cereja e identificar o tamanho da parcela com melhor poder de explicação e ajuste dos modelos, utilizando dois ensaios de uniformidade em estufa plástica. Os modelos ajustados foram o logístico e o de von Bertalanffy, para peso médio de frutos, número médio de frutos e de cachos acumulado nas múltiplas colheitas e com diferentes tamanhos de parcela. Os modelos apresentaram estimativas semelhantes entre si e as mesmas estimativas dos parâmetros em todos os casos de tamanho de parcela. Os modelos de regressão não-linear estudados descrevem satisfatoriamente o comportamento da produção de frutos de tomate tipo cereja cultivado em estufa plástica. Parcela constituída de duas plantas para ensaios em estufa plástica de 250m2 e de três plantas em estufa plástica de 200m2 proporcionam bom poder de explicação nas estimativas dos parâmetros dos modelos.(AU)