Post expansion evaluation of the midpalatal suture in children submitted to rapid palatal expansion: A CT study

The aim of this prospective study was to evalute the midpalatal suture in children submitted to rapid palatal expansion, at the end of the retention stage, with CT scans. The sample was comprised of 17 children aged between 5 years 2 months and 10 years 5 months. The tomographic images showed that the midpalatal suture was completely ossified from the anterior nasal spine area to the posterior nasal spine area at the end of the retention phase, that is, 8 to 9 months post-expansion.

A new design methodology for multipulse rectifiers with Delta auto-connected transformers and a retrofit application in Adjustable Speed Drives (ASDs)

Multipulse rectifiers can replace a conventional six pulse three-phase rectifier (diode bridge) providing a DC voltage with low ripple, low Total Harmonic Distortion of current (THDi) and a high Power Factor (PF). In this context is presented a multipulse rectifier with generalized Delta-differential autotransformer topology, which can provide any level of DC output voltage for any level of three-phase AC input voltage. This paper presents all the possible configurations for Delta topology in order to choose, through graphics, one configuration that presents reduced weight and volume. The average voltage on the DC bus must be compatible with the DC voltage in the six pulse rectifier used in commercial ASDs. Therefore, it is possible to apply the retrofit technique to replace the conventional bridge rectifier by the proposed multipulse rectifier. Based on mathematic models and simulation results, an 18-pulse rectifier with Delta topology, 220 V of line voltage, 315 V of DC output, and rating 2.5 kW of power was designed, implemented and applied for three different commercial ASDs. Experimental results as voltage and current waveforms and results about PF and THDi will be presented. © 2012 IEEE.

Acquisition of suture skills during medical graduation by instructor-directed training: A randomized controlled study comparing senior medical students and faculty surgeons

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning. © 2013 Springer-Verlag Italia.

Midpalatal suture maturation: Classification method for individual assessment before rapid maxillary expansion

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of soft laser in bone repair after expansion of the midpalatal suture in dogs

Introduction: The purpose of this research was to study the influence of soft laser treatment on the process of bone repair after expansion of the midpalatal suture. Methods: The sample for this case-control experimental study was 11 dogs. They were randomly divided into 2 groups, both of which underwent rapid maxillary expansion with a hyrax appliance. The animals in group 1 were also treated with laser therapy. They were killed, and histologic specimens of the palatal suture were prepared. The Student t test was applied for independent data, and the Mann-Whitney test was used for nonparametric data. Results: A significant difference was observed in the quality of the palatal sutures between the animals in groups 1 and 2. The connective tissues of the sutures in the group 1 animals were similar to the original configurations, with more advanced osteogenesis and fibrogenesis, compared with those of group 2. Conclusions: Soft laser appears to influence the behavior of the repair process, contributing to suture reorganization and palatal bone osteogenesis during and after expansion. (Am J Orthod Dentofacial Orthop 2012; 142: 615-24)

Bidirectional Barbed Suture for Bladder Neck Reconstruction, Posterior Reconstruction and Vesicourethral Anastomosis During Robot Assisted Radical Prostatectomy

Background: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. Objective: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. Material and methods: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture Results: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. Conclusion: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.

Orthodontic movement of a maxillary incisor through the midpalatal suture A case report

Orthodontic space closure is a treatment alternative when a maxillary central incisor is missing. The objective of this report was to present an unusual treatment in which a right maxillary central incisor was moved through the midpalatal suture to replace the absent contralateral tooth. The biologic aspects and clinical appearance of the recontoured lateral and central incisors were analyzed. The position of the examined teeth and the appearance of the surrounding soft tissues were satisfactory; however, the upper midline frenulum deviated to the left. The incisor was successfully moved with no obvious detrimental effects as observed on the final radiographs. In the radiographic and tomographic examinations, the midline suture seemed to have followed the tooth movement. The patient expressed satisfaction with the results. It was concluded that orthodontic movement of the central incisor to replace a missing contralateral tooth is a valid treatment option, and the achievement of an esthetic result requires an interdisciplinary approach, including restorative dentistry and periodontics. (Angle Orthod. 2012;82:370-379.)

Characterization of igneous terranes by zircon dating: implications for the UHP relicts occurrences and suture identification in the Central Rhodope, Northern Greece

One of the key for the understanding of an orogenic belt is the characterization of the terranes involved and the identification of the suture(s) separating crustal blocks: these are essential information for large-scale paleo-reconstructions. In addition, the structural relationships between the terranes involved in the collisional processes and the eventual UHP relicts may provide first order inputs to exhumation models of subducted rocks. The structure of the Rhodope Massif (northern Greece and southern Bulgaria) results from the stacking of high-grade nappes during a continental collision, which age is comprised between Latest-Jurassic and Early-Cenozoic. UHP and HP relicts, associated with oceanic and ultramafic material, suggest the presence of a dismembered suture zone within the massif. The location of this suture remains unclear; furthermore, up to now, the UHP and eclogitic localities represent isolated spots and no synthesis on their structural position within the massif has been proposed. The first aim of this work is to define the relationships between HP-UHP relicts, crustal blocks, shear zones and amphibolitic material. To achieve this objective, we characterized the accreted blocks in terms of protoliths ages of the orthogneisses mainly along two cross sections on the Greek part of the belt. Geochemical affinities of meta-igneous rocks served as a complementary tool for terrane characterization and geodynamic interpretation. Single-zircon Pb-Pb evaporation and zircon U-Pb SHRIMP dating of orthogneiss protoliths define two groups of intrusion-ages: Permo-Carboniferous and Late Jurassic-Early Cretaceous. Structurally, these two groups correspond to distinct units: the Late Jurassic gneissic complex overthrusts the one bearing the Permo-Carboniferous orthogneisses. Mylonites, eclogites, amphibolites of oceanic affinities, and UHP micaschists, mark a “melange” zone, intensively sheared towards the SW, which separates the two units. Thus, we interpret them as two distinct terranes, the Rhodope and Thracia terranes, separated by the Nestos suture. The correlation of our findings in northern Greece to the Bulgarian part of the Massif suggests a northern rooting of the Nestos Suture. This configuration results of the closure of a marginal oceanic basin of the Tethys system by a north-directed subduction. This interpretation is supported by the geochemical affinities of the orthogneisses: the Late-Jurassic igneous rocks formed by subduction-related magmatism, pprobably the same north-directed subduction that gave rise to the UHP metamorphism of the metasediments of the “melange” zone. It is noteworthy that the UHP-HP relicts seem to be restricted to the contact between the two terranes suggesting that the UHP relicts are exhumed only within the suture zone. Furthermore, the singularity of the suture suggests that the Late-Jurassic subduction explains the occurrence of UHP and eclogite relicts in the Central Rhodope despite the large age range previously attributed the UHP and/or HP stage.

An adjustable sling in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape

The aim of this prospective study was to evaluate the feasibility and outcome of an adjustable sling system AMI in patients with recurrent urinary stress incontinence after failed suburethral sling insertion.

Material properties of common suture materials in orthopaedic surgery

Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic surgeon in selection and application of appropriate suture materials and calibers to specific tasks.

Loop ileostomy closure: comparison of cost effectiveness between suture and stapler

Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques.

Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation

Mesh fixation during laparoscopic ventral hernia repair can be performed using transfascial sutures or metal tacks. The aim of the present study is to compare mesh shrinkage and pain between two different techniques of mesh fixation in a prospective randomized trial.