Right adolescent idiopathic thoracic curve (Lenke 1 A and B): does cost of instrumentation and implant density improve radiographic and cosmetic parameters?

In adolescent idiopathic scoliosis (AIS) there has been a shift towards increasing the number of implants and pedicle screws, which has not been proven to improve cosmetic correction. To evaluate if increasing cost of instrumentation correlates with cosmetic correction using clinical photographs. 58 Lenke 1A and B cases from a multicenter AIS database with at least 3 months follow-up of clinical photographs were used for analysis. Cosmetic parameters on PA and forward bending photographs included angular measurements of trunk shift, shoulder balance, rib hump, and ratio measurements of waist line asymmetry. Pre-op and follow-up X-rays were measured for coronal and sagittal deformity parameters. Cost density was calculated by dividing the total cost of instrumentation by the number of vertebrae being fused. Linear regression and spearman`s correlation were used to correlate cost density to X-ray and photo outcomes. Three independent observers verified radiographic and cosmetic parameters for inter/interobserver variability analysis. Average pre-op Cobb angle and instrumented correction were 54A degrees (SD 12.5) and 59% (SD 25) respectively. The average number of vertebrae fused was 10 (SD 1.9). The total cost of spinal instrumentation ranged from $6,769 to $21,274 (Mean $12,662, SD $3,858). There was a weak positive and statistically significant correlation between Cobb angle correction and cost density (r = 0.33, p = 0.01), and no correlation between Cobb angle correction of the uninstrumented lumbar spine and cost density (r = 0.15, p = 0.26). There was no significant correlation between all sagittal X-ray measurements or any of the photo parameters and cost density. There was good to excellent inter/intraobserver variability of all photographic parameters based on the intraclass correlation coefficient (ICC 0.74-0.98). Our method used to measure cosmesis had good to excellent inter/intraobserver variability, and may be an effective tool to objectively assess cosmesis from photographs. Since increasing cost density only improves mildly the Cobb angle correction of the main thoracic curve and not the correction of the uninstrumented spine or any of the cosmetic parameters, one should consider the cost of increasing implant density in Lenke 1A and B curves. In the area of rationalization of health care expenses, this study demonstrates that increasing the number of implants does not improve any relevant cosmetic or radiographic outcomes.

Oral lesions in HIV infected individuals from Ribeirao Preto, Brazil

Objectives: The aim of this study was to diagnosis oral lesions related to HIV infection in individuals followed in the General Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil. The presence of oral lesions was correlated with gender, age, smoking habit, levels of CD4 lymphocytes, HIV load, time of HIV seropositivity, AIDS condition, use of removable dental prosthesis, and use of HAART. Materials and Methods: 340 HIV infected individuals were selected for this study, all participants of the study were examined by only one practiced dentist which performed anamnesis, peribuccal and oral examination. Results: Oral lesions were observed in 113 of 340 (33.2%) HIV infected individuals. These oral lesions included: oral candidiasis (17.7%) of pseudomembranous (10.8%) and of erythematous types (6.9%), angular cheilitis (13.9%), hairy leukoplakia (11.8%), and oral ulcers (2.1%). Oral candidiasis lesions were more frequently observed in women (p. 033). Smoking addict participants presented a high frequency of tongue hairy leukoplakia (p. 038) and a reduced frequency of oral ulcers (p. 018). Hairy leukoplakia and pseudomembranous candidiasis were inversely correlated to CD4+ L levels and directly correlated with HIV load, behaving as immune depression markers. Hairy leukoplakia and pseudomembranous candidiasis also showed an inverse correlation with HAART use (p < .0001). Patients using mobile dental prosthesis presented a high frequency of erythematous candidiasis (p. 003). Conclusion: The inverse correlation with CD4+ L level and the direct correlation with HIV load suggest that oral lesions could be used as alternative clinical markers for poor immune condition in HIV infected individuals.

Oral status and Candida colonization in patients with Sjogren`s Syndrome

Objective: To determine the oral status, salivary flow rate, Candida carriage in saliva, and prevalence of Candida albicans colonization in several areas of the mouth in patients with primary and secondary Sjogren`s syndrome as opposed to those of healthy subjects. Study design: Thirty-seven patients with Sjogren`s syndrome (SS), [14 patients with primary SS (SS-1) and 23 patients with secondary SS (SS-2)], along with 37 healthy controls were examined in regard to number of teeth, pro-bing pocket depth (PPD), approximal plaque index (API), bleeding on probing (BOP), presence of prosthetic appliances and smoking habits. Salivary flow rate (SFR), Candida carriage in saliva, presence of Candida albicans colonization on buccal, angular, palatal and sulcular areas, on dentures and on the tongue`s dorsal surface were determined. Statistical analyses were performed using the 2-tailed Fisher exact and Kruskal-Wallis test. Results: No statistically significant difference was found between SS-1 and SS-2 groups based on the parameters analysed. Statistically significant differences were observed between patients with SS and healthy subjects in terms of SFR, oral signs and symptoms, API, BOP, C. albicans colonization on tongue and buccal area, and Candida carriage in saliva. In the gingival crevicular fluid positive C. albicans colonization was found in only one subject of SS subgroup. Conclusions: SS patients carry a higher risk of having periodontitis and are more predisposed to develop candidiasis. C. albicans is scarcely detected in gingival crevicular fluid despite high scores on C. albicans colonization in different areas of the oral cavity in SS patients.

Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate

The aim of this study was to determine the applicability of multislice and cone-beam computerized tomography (CT) in the assessment of bone defects in patients with oral clefts. Bone defects were produced in 9 dry skulls to mimic oral clefts. All defects were modeled with wax. The skulls were submitted to multislice and cone-beam CT. Subsequently, physical measurements were obtained by the Archimedes principle of water displacement of wax models. The results demonstrated that multislice and cone-beam CT showed a high efficiency rate and were considered to be effective for volumetric assessment of bone defects. It was also observed that both CT modalities showed excellent results with high reliability in the study of the volume of bone defects, with no difference in performance between them. The clinical applicability of our research has shown these CT modalities to be immediate and direct, and they is important for the diagnosis and therapeutic process of patients with oral cleft. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: 249-257)

Precise Insertion of Orthodontic Miniscrews with a Stereolithographic Surgical Guide Based on Cone Beam Computed Tomography Data: A Pilot Study

Purpose: Orthodontic miniscrews are commonly used to achieve absolute anchorage during tooth movement. One of the most frequent complications is screw loss as a result of root contact. Increased precision during the process of miniscrew insertion would help prevent screw loss and potential root damage, improving treatment outcomes. Stereo lithographic surgical guides have been commonly used for prosthetic implants to increase the precision of insertion. The objective of this paper was to describe the use of a stereolithographic surgical guide suitable for one-component orthodontic miniscrews based on cone beam computed tomography (CBCT) data and to evaluate implant placement accuracy. Materials and Methods: Acrylic splints were adapted to the dental arches of four patients, and six radiopaque reference points were filled with gutta-percha. The patients were submitted to CBCT while they wore the occlusal splint. Another series of images was captured with the splint alone. After superimposition and segmentation, miniscrew insertion was simulated using planning software that allowed the user to check the implant position in all planes and in three dimensions. In a rapid-prototyping machine, a stereolithographic guide was fabricated with metallic sleeves located at the insertion points to allow for three-dimensional control of the pilot bur. The surgical guide was worn during surgery. After implant insertion, each patient was submitted to CBCT a second time to verify the implant position and the accuracy of the placement of the miniscrews. Results: The average differences between the planned and inserted positions for the ten miniscrews were 0.86 mm at the coronal end, 0.71 mm at the center, and 0.87 mm at the apical tip. The average angular discrepancy was 1.76 degrees. Conclusions: The use of stereolithographic surgical guides based on CBCT data allows for accurate orthodontic mini screw insertion without damaging neighboring anatomic structures. INT J ORAL MAXILLOFAC IMPLANTS 2011;26:860-865

Comparative distalization effects of Jones jig and pendulum appliances

Introduction: In this study, we compared the dentoalveolar changes of Class II patients treated with Jones jig and pendulum appliances. Methods: The experimental group comprised 40 Class II malocclusion subjects, divided into 2 groups: group 1 consisted of 20 patients (11 boys, 9 girls) at a mean pretreatment age of 13.17 years, treated with the Jones jig appliance for 0.91 years; group 2 comprised 20 patients (8 boys, 12 grls) at a mean pretreatment age of 13.98 years, treated with the pendulum appliance for 1.18 years. Only active treatment time of molar distalization was evaluated in the predistalization and postdistalization lateral cephalograms. Molar, second premolar, and incisor angular and linear variables were obtained. The intergroup treatment changes in these variables were compared with independent t tests. Results: The maxillary second premolars showed greater mesial tipping and extrusion in the Jones jig group, indicating more anchorage loss during molar distalization with this appliance. The amounts and the monthly rates of molar distalization were similar in both groups. Conclusions: The Jones jig group showed greater mesial tipping and extrusion of the maxillary second premolars. The mean amounts and the monthly rates of first molar distalization were similar in both groups. (Am J Orthod Dentofacial Orthop 2009;135:336-42)

Influence of root parallelism on the stability of extraction-site closures

Introduction: In premolar extraction cases, root parallelism is recommended to preserve the stability of space closures. The influence of the degree of root parallelism on relapse of tooth extraction spaces has been a controversial topic in the literature. The aim of this study was to compare the angle between the long axes of the canine and the second premolarin patients with and without stability of extraction-space closures. Methods: A sample of 56 patients, treated with 4 premolar extractions, was divided into 2 groups: group 1, consisting of 25 patients with reopening of extraction spaces; and group 2, consisting of 31 patients without reopening of extraction spaces. Panoramic radiographs of each patient were analyzed at the posttreatment and 1-year posttreatment stages. The data were statistically analyzed by using chi-square tests, t tests, analysis of variance (ANOVA), and Pearson correlation coefficients. Results: The results showed that the groups did not differ regarding the angle between the canine and the second premolar, and there was no correlation between angular changes and reopening of extraction spaces, showing that dental angular changes are not determining factors for relapse, and other factors should be investigated. Conclusions: The final angle and the posttreatment changes observed in the angle between the long axes of the canine and the second premolar showed no influence on the relapse of extraction spaces. (Am J Orthod Dentofacial Orthop 2011; 139: e505-e510)

Morphodigital study of bone quality in the mandibular angle in patients with third molar impacted

The aim of this study was to analyze if the presence of impacted third molars, and their positions in the mandibular angle, can change the bone quality in this area, considering the measure of the cortical thickness in this region as representative or not for mandible fracture risk. Software was used to analyze 50 digital images from panoramic radiographs of patients who had one or two impacted third molars in the mandible, and 30 digital images of patients with agenesis of the mandibular third molar. The thickness of the cortical region of the mandible was measured; it was possible to draw a parallel line to the posterior portion of the mandible and a parallel line to the body of this bone on each side of the image. At the intersection of these lines near the distal portion of the second molar, another line was set up to serve as reference in the cortical thickness measurement. It could be concluded that the cortical thickness of the mandibular angle in male patients without impacted third molars was greater than the thickness in patients with these teeth, and no difference in thickness was found for the female group.

Dynamic portrait of the planetary 2/1 mean-motion resonance - I. Systems with a more massive outer planet

We analyse the global structure of the phase space of the planar planetary 2/1 mean-motion resonance in cases where the outer planet is more massive than its inner companion. Inside the resonant domain, we show the existence of two families of periodic orbits, one associated to the librational motion of resonant angle (sigma-family) and the other related to the circulatory motion of the difference in longitudes of pericentre (Delta pi-family). The well-known apsidal corotation resonances (ACR) appear as intersections between both families. A complex web of secondary resonances is also detected for low eccentricities, whose strengths and positions are dependent on the individual masses and spatial scale of the system. The construction of dynamical maps for various values of the total angular momentum shows the evolution of the families of stable motion with the eccentricities, identifying possible configurations suitable for exoplanetary systems. For low-moderate eccentricities, several different stable modes exist outside the ACR. For larger eccentricities, however, all stable solutions are associated to oscillations around the stationary solutions. Finally, we present a possible link between these stable families and the process of resonance capture, identifying the most probable routes from the secular region to the resonant domain, and discussing how the final resonant configuration may be affected by the extension of the chaotic layer around the resonance region.

A multispectral view of the periodic events in eta Carinae

A full description of the 5.5-yr low excitation events in. Carinae is presented. We show that they are not as simple and brief as previously thought, but a combination of two components. The first, the slow variation component, is revealed by slow changes in the ionization level of circumstellar matter across the whole cycle and is caused by gradual changes in the wind wind collision shock-cone orientation, angular opening and gaseous content. The second, the collapse component, is restricted to around the minimum, and is due to a temporary global collapse of the wind-wind collision shock. High-energy photons (E > 16 eV) from the companion star are strongly shielded, leaving the Weigelt objects at low-ionization state for more than six months. High-energy phenomena are sensitive only to the collapse, low energy only to the slow variation and intermediate energies to both components. Simple eclipses and mechanisms effective only near periastron (e. g. shell ejection or accretion on to the secondary star) cannot account for the whole 5.5-yr cycle. We find anti-correlated changes in the intensity and the radial velocity of P Cygni absorption profiles in Fe II lambda 6455 and He I lambda 7065 lines, indicating that the former is associated to the primary and the latter to the secondary star. We present a set of light curves representative of the whole spectrum, useful for monitoring the next event (2009 January 11).

On the use of rotational splitting asymmetries to probe the internal rotation profile of stars: Application to beta Cephei stars

Rotationally-split modes can provide valuable information about the internal rotation profile of stars. This has been used for years to infer the internal rotation behavior of the Sun. The present work discusses the potential additional information that rotationally splitting asymmetries may provide when studying the internal rotation profile of stars. We present here some preliminary results of a method, currently under development, which intends: 1) to understand the variation of the rotational splitting asymmetries in terms of physical processes acting on the angular momentum distribution in the stellar interior, and 2) how this information can be used to better constrain the internal rotation profile of the stars. The accomplishment of these two objectives should allow us to better use asteroseismology as a test-bench of the different theories describing the angular momentum distribution and evolution in the stellar interiors. (C) 2010 WILEY-VCH Verlag GmbH&Co. KGaA, Weinheim

Galactic outflows and the pollution of the galactic environment by supernovae

We here explore the effects of the SN explosions into the halo of star-forming galaxies like the Milky Way. Successive randomly distributed and clustered SNe explosions cause the formation of hot superbubbles that drive either fountains or galactic winds above the galactic disk, depending on the amount and concentration of energy that is injected by the SNe. In a galactic fountain, the ejected gas is re-captured by the gravitational potential and falls back onto the disk. From 3D non-equilibrium radiative cooling hydrodynamical simulations of these fountains, we find that they may reach altitudes up to about 5 kpc in the halo and thus allow for the formation of the so called intermediate-velocity-clouds (IVCs) which are often observed in the halos of disk galaxies. The high-velocity-clouds that are also observed but at higher altitudes (of up to 12 kpc) require another mechanism to explain their production. We argue that they could be formed either by the capture of gas from the intergalactic medium and/or by the action of magnetic fields that are carried to the halo with the gas in the fountains. Due to angular momentum losses to the halo, we find that the fountain material falls back to smaller radii and is not largely spread over the galactic disk. Instead, the SNe ejecta fall nearby the region where the fountain was produced, a result which is consistent with recent chemical models of the galaxy. The fall back material leads to the formation of new generations of molecular clouds and to supersonic turbulence feedback in the disk. (C) 2009 COSPAR. Published by Elsevier Ltd. All rights reserved.

Modelling the secular evolution of migrating planet pairs

The subject of this paper is the secular behaviour of a pair of planets evolving under dissipative forces. In particular, we investigate the case when dissipative forces affect the planetary semimajor axes and the planets move inwards/outwards the central star, in a process known as planet migration. To perform this investigation, we introduce fundamental concepts of conservative and dissipative dynamics of the three-body problem. Based on these concepts, we develop a qualitative model of the secular evolution of the migrating planetary pair. Our approach is based on the analysis of the energy and the orbital angular momentum exchange between the two-planet system and an external medium; thus no specific kind of dissipative forces is invoked. We show that, under the assumption that dissipation is weak and slow, the evolutionary routes of the migrating planets are traced by the Mode I and Mode II stationary solutions of the conservative secular problem. The ultimate convergence and the evolution of the system along one of these secular modes of motion are determined uniquely by the condition that the dissipation rate is sufficiently smaller than the proper secular frequency of the system. We show that it is possible to reassemble the starting configurations and the migration history of the systems on the basis of their final states and consequently to constrain the parameters of the physical processes involved.

Hydrodynamical simulations of Galactic fountains - II. Evolution of multiple fountains

The ejection of gas out of the disc in late-type galaxies is related to star formation and is mainly due to the explosion of Type II supernovae (SN II). In a previous paper, we considered the evolution of a single Galactic fountain, that is, a fountain powered by a single SN cluster. Using three-dimensional hydrodynamical simulations, we studied in detail the fountain flow and its dependence with several factors, such as the Galactic rotation, the distance to the Galactic centre and the presence of a hot gaseous halo. As a natural followup, this paper investigates the dynamical evolution of multiple generations of fountains generated by similar to 100 OB associations. We have considered the observed size-frequency distribution of young stellar clusters within the Galaxy in order to appropriately fuel the multiple fountains in our simulations. Most of the results of the previous paper have been confirmed, like for example the formation of intermediate velocity clouds above the disc by the multiple fountains. Also, this work confirms the localized nature of the fountain flows: the freshly ejected metals tend to fall back close to the same Galactocentric region where they are delivered. Therefore, the fountains do not change significantly the radial profile of the disc chemical abundance. The multiple fountain simulations also allowed us to consistently calculate the feedback of the star formation on the halo gas. We found that the hot gas gains about 10 per cent of all the SN II energy produced in the disc. Thus, the SN feedback more than compensate for the halo radiative losses and allow for a quasi steady-state disc-halo circulation to exist. Finally, we have also considered the possibility of mass infall from the intergalactic medium and its interaction with the clouds that are formed by the fountains. Though our simulations are not suitable to reproduce the slow rotational pattern that is typically observed in the haloes around the disc galaxies, they indicate that the presence of an external gas infall may help to slow down the rotation of the gas in the clouds and thus the amount of angular momentum that they transfer to the coronal gas, as previously suggested in the literature.

Constraining the orbital orientation of eta Carinae from H Paschen lines

During the past decade, several observational and theoretical works have provided evidence of the binary nature of eta Carinae. Nevertheless, there is still no direct determination of the orbital parameters, and the different current models give contradictory results. The orbit is, in general, assumed to coincide with the Homunculus equator although the observations are not conclusive. Among all systems, eta Car has the advantage that it is possible to observe both the direct emission of line transitions in the central source and its reflection by the Homunculus, which is dependent on the orbital inclination. In this work, we studied the orbital phase-dependent hydrogen Paschen spectra reflected by the south-east lobe of the Homunculus to constrain the orbital parameters of eta Car and determine its inclination with respect to the Homunculus axis. Assuming that the emission excess originates in the wind-wind shock region, we were able to model the latitude dependence of the spectral line profiles. For the first time, we were able to estimate the orbital inclination of eta Car with respect to the observer and to the Homunculus axis. The best fit occurs for an orbital inclination to the line of sight of i similar to 60 degrees +/- 10 degrees, and i* similar to 35 degrees +/- 10 degrees with respect to the Homunculus axis, indicating that the angular momenta of the central object and the orbit are not aligned. We were also able to fix the phase angle of conjunction as similar to -40 degrees, showing that periastron passage occurs shortly after conjunction.