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This case report presents oropharyngeal dysphagia due to oromandibular and cervical dystonia, a rare consequence of aseptic meningitis. A 19-year-old male who was diagnosed with aseptic meningitis visited the rehabilitation outpatient clinic for a sense of foreign body in his throat and odynophagia. Repetitive involuntary movements of his facial, tongue, and laryngeal muscles accompanied by lateroanterior torticollis were observed. Videofluoroscopic swallowing study showed inefficient bolus formation due to repetitive rolling of his tongue and vallecular stasis without penetration or aspiration. Dysphagia and odynophagia had brought the patient significant weight loss and frustration. We provided swallowing training to improve the efficiency and safety of swallowing. The patient’s symptoms improved gradually along with body weight gain and emotional stability. Acute-onset oropharyngeal dysphagia is devastating for young adults. A multidisciplinary approach is mandatory for optimal outcome. We share our experience as a team work and emphasize the rehabilitation aspect.

Patient‐dentist discourse is a core nonoperational competency in dental education. The skills of querying patients and responding to questions are noncognitive attributes, and their evaluation by the standardized patient objective structured clinical examination (OSCE) is particularly necessary. However, it is not clear whether students' test anxiety affects these attributes. This study aims to examine the relationship between dental students' state‐trait anxiety, noncognitive performance, and examination results during their first OSCE. A single dental school cohort (n = 226) of 5 year students attending their first clinical examination from 2014 to 2017 was studied. Participants completed the Chinese Mandarin Version State‐Trait Anxiety Inventory Y form before taking the OSCE. The difference between state and trait anxiety levels was compared by paired t test. Gender differences and the effect of age group in these anxiety levels were analyzed using multivariate analysis of variance. Moreover, gender, age group, state anxiety, and trait anxiety scores were compared with the OSCE items of noncognitive performance using a chi‐square test. Students showed significantly higher state anxiety than trait anxiety levels; moreover, women showed significantly higher state anxiety than men. Furthermore, gender, age group, state anxiety, and trait anxiety had no association with the noncognitive performance examination results. Most participants showed moderate state and trait anxiety levels during their first OSCE. Further, the state‐trait anxiety had no significant effect on their noncognitive performance. However, 26.5% of participants did not pass the examination; therefore, dental educators should increase communication skill training courses during clerkship training to improve students' noncognitive attributes.

Background This study evaluated the operating performance of an implant navigation system used by dental students and dentists of prosthodontic background with varying levels of experience. A surgical navigation system and optical tracking system were used, and dentists’ accuracies were evaluated in terms of differences between the positions of actually drilled holes and those of the holes planned using software before surgeries. Methods The study participants were 5 dental students or dentists who had studied in the same university and hospital but had different experience levels regarding implants. All participants were trained in operating the AqNavi system in the beginning of the study. Subsequently, using 5 pairs of dental models, each participant drilled 5 implant holes at 6 partially edentulous positions (11, 17, 26, 31, 36, and 47). In total, each participant conducted 30 drilling tests. Results In total, 150 tests among 5 dentists at 6 tooth positions (11, 17, 26, 31, 36, and 47) were conducted. Although a comparison of the tests revealed significant differences in the longitudinal error (P P = .0011), no significant difference was observed in the total error among the dentists. Conclusions A relatively long operating time was associated with relatively little implant experience. Through the dental navigation system, dental students can be introduced to dental implant surgery earlier than what was possible in the past. The results demonstrated that the operational accuracy of the dental implant navigation system is not restricted by participants’ implant experience levels. The implant navigation system assists the dentist in the ability to accurately insert the dental implant into the correct position without being affected by his/her own experience of implant surgery.

OBJECTIVE. Nosocomial transmission of coronavirus disease (COVID-19) to frontline health care workers is well known, and health care workers may inadvertently become vectors for onward transmission. Ultrasound (US) service providers are at significant risk because scanning usually requires prolonged close patient contact. The bulky US equipment may also facilitate fomite transmission of disease. With increasing use of point-of-care and portable diagnostic US services, the risk is substantial. CONCLUSION. Our experience and protocols may help service providers with their own effective response against COVID-19.

Rupture of a postirradiated internal carotid artery (ICA) pseudoaneurysm in patients with nasopharyngeal carcinoma (NPC) is a rare yet life-threatening emergency. In contrast to pseudoaneurysms found in patients with other head and neck malignancies, those identified in NPC patients have a propensity to occur in the petrous segment of the ICA, which pose a serious challenge to clinical physicians. Over the past few decades, endovascular treatment with covered stents has widely been adopted as the treatment of choice for patients at risk of brain ischemia after occluding the parent vessel of the pseudoaneurysm. Although recent series have demonstrated that immediate hemostasis can be achieved in most of the patients undergoing covered stent placement, a high incidence of delayed complications has been reported, including delayed cerebral ischemia, in-stent thrombosis, and septic thromboembolism.We present two NPC patients with a postirradiated pseudoaneurysm involving the petrous segment of the internal carotid artery. As direct parent vessel occlusion was infeasible, we established an emergency high-flow extracranial-intracranial (EC-IC) bypass followed by endovascular parent vessel occlusion. Both of the patients were followed-up for more than 24 months without neurological deficit or rebleeding. We suggest that EC-IC bypass with parent vessel occlusion should be considered as a practical and durable treatment option for patients with postirradiated ICA pseudoaneurysms who cannot tolerate direct carotid occlusion. Keywords: Pseudoaneurysm, Nasopharyngeal carcinoma, High-flow bypass

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

No study has investigated the effect of learning curves on the accuracy of dental implant navigation systems. This study evaluated the accuracy of the dental implant navigation system and established the learning curve according to operation site and operating time. Each dental model was used for drilling 3 missing tooth positions, and a patient tracking module was created. The same dentist performed the drilling test for 5 sets of dental models. CT back scanning was performed on the dental models. Customized implants based on the drilled holes were inserted. The relative error between the preoperative planning and actual implant was calculated. Using the dental navigation system could help dentists position implants more accurately. Increasing the frequency with which a dentist used the navigation system resulted in shorter operations. Longitudinal and angular deviation were significantly (P

Periodontal disease is a chronic inflammatory disease that is commonly treated with surgical and nonsurgical techniques. However, both approaches have limitations. Low-level laser therapy (LLLT) has been widely applied in reducing inflammatory reactions, and research indicates that LLLT induces an anti-inflammatory effect that may enhance periodontal disease therapy. The purpose of this study was to investigate the anti-inflammatory effect of LLLT on human periodontal ligament cells (hPDLCs) in an inflammatory environment and aimed to determine the possible mechanism of action. Cells were cultured and treated with or without lipopolysaccharide (LPS) from Porphryromonas gingivalis or Escherichia coli, followed by irradiation with a gallium-aluminum-arsenide (GaAlAs) laser (660 nm) at an energy density of 8 J/cm2. Quantitative real-time polymerase chain reactions were used to assess the expression of pro-inflammatory genes, including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8. The dual-luciferase reporter assay was used to examine nuclear factor-κB (NF-κB) transcriptional activity. An enzyme-linked immunosorbent assay was used to monitor the concentration of intracellular cyclic adenosine monophosphate (cAMP). Both LPS treatments significantly induced the mRNA expression of pro-inflammatory cytokines. However, LLLT inhibited the LPS-induced pro-inflammatory cytokine expression and elevated intracellular levels of cAMP. The LLLT inhibitory effect may function by downregulating NF-κB transcriptional activity and by increasing the intracellular levels of cAMP. LLLT might inhibit LPS-induced inflammation in hPDLCs through cAMP/NF-κB regulation. These results should be further studied to improve periodontal therapy.

Patients with type 2 diabetes mellitus (T2DM) experience many cardiovascular complications. Several studies have demonstrated the cardioprotective effects of incretin-based therapies; however, there are few studies on the effects of long-term incretin-based therapies on cardiovascular events. Therefore, the present study conducted a systematic review and network meta-analysis to evaluate the effects of long-term incretin-based therapies on ischaemic diseases. We searched PubMed, CENTRAL, and Clinicaltrial.gov to retrieve randomised control trials reported until December 2016 and enrolled only RCTs with more than a 1-year follow-up. The network meta-analysis was performed using R Software with a GeMTC package. A total of 40 trials were included. Dipeptidyl peptidase 4 inhibitors and glucagon-like peptide-1 agonists were associated with a lower risk of myocardial infarction (MI) than were sulfonylureas (odds ratio [95% credible interval] 0.41 [0.24–0.71] and 0.48 [0.27–0.91], respectively). These results suggested that patients with T2DM receiving long-term incretin-based therapies have a lower risk of MI than do those receiving sulfonylurea-based therapy. These findings highlight the risks of cardiovascular events in patients who receive long-term incretin-based therapies, and may provide evidence for the selection of antidiabetic therapy in the future.

Color Doppler imaging (CDI) can be used to noninvasively create images of human blood vessels and quantitatively evaluate blood flow in real-time. The purpose of this study was to assess the effects of acupuncture on the blood flow of the peripheral, mesenteric, and retrobulbar arteries by CDI. Statistical significance was defined as P values less than 0.05. Blood flow in the radial and brachial arteries was significantly lower during needle stimulation on LR3 than before in healthy volunteers, but was significantly higher after needle stimulation than before. LR3 stimulation also resulted in a significant decrease in the vascular resistance of the short posterior ciliary artery and no significant change of blood flow through the superior mesenteric artery (SMA) during acupuncture. In contrast, ST36 stimulation resulted in a significant increase in blood flow through the SMA and no significant change in the vascular resistance of the retrobulbar arteries. Additionally, acupuncture at previously determined acupoints in patients with open-angle glaucoma led to a significant reduction in the vascular resistance of the central retinal artery and short posterior ciliary artery. Our results suggest that acupuncture can affect blood flow of the peripheral, mesenteric, and retrobulbar arteries, and CDI can be useful to evaluate hemodynamic changes by acupuncture.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

Aims/Introduction To elucidate whether axonal changes arise in the prediabetic state and to find a biomarker for early detection of neurophysiological changes. Materials and Methods We enrolled asymptomatic diabetes patients, as well as prediabetic and normoglycemic individuals to test sensory nerve excitability, and we analyzed those findings and their correlation with clinical profiles. Results In nerve excitability tests, superexcitability in the recovery cycle showed increasing changes in the normoglycemic, prediabetes and diabetes cohorts (−19.09 ± 4.56% in normoglycemia, −22.39 ± 3.16% in prediabetes and −23.71 ± 5.15% in diabetes, P = 0.002). Relatively prolonged distal sensory latency was observed in the median nerve (3.12 ± 0.29 ms in normoglycemia, 3.23 ± 0.38 ms in prediabetes and 3.45 ± 0.43 ms in diabetes, P = 0.019). Superexcitability was positively correlated with fasting plasma glucose (r = 0.291, P = 0.009) and glycated hemoglobin (r = 0.331, P = 0.003) in all participants. Conclusions Sensory superexcitability and latencies are the most sensitive parameters for detecting preclinical physiological dysfunction in prediabetes. In addition, changes in favor of superexcitability were positively correlated with glycated hemoglobin for all participants. These results suggest that early axonal changes start in the prediabetic stage, and that the monitoring strategy for polyneuropathy should start as early as prediabetes., We explored early changes of axonal function in prediabetes using axonal excitability test. The changes progressed from normoglycemia, prediabetes and early diabetes. Superexcitability is the most sensitive parameter for sensory axonal dysfunction. Fasting sugar and glycated hemoglobin were correlated with superexcitability in all participants.

Increasing prevalence of mobile technology and declining mobility often lead to poor posture and increased healthcare costs, all of which require better ergonomic interventions. Musculoskeletal disorders are often caused by progressive compromised posture and diminished physical recovery. They are commonly seen in the workplace which not only negatively impact productivity and increase absentees but incur significant health costs. The purpose of this review is to evaluate the existing research regarding the effectiveness of ergonomic interventions designed to improve musculoskeletal wellness in the workplace, and present newly wellness technology for potential ergonomic improvement. Twenty-one studies sourced from Google Scholar and PubMed were reviewed. The programs evaluated in these studies include sit-stand desks; intermittent standing bouts; ergonomic interventions or education; exercise programs; and posture wear. The results were mostly positive in preventing and alleviating musculoskeletal symptoms but failed to decrease health care costs. More research and innovations should be focus on more cost-effective interventions to improve posture in the workplace, especially on workplace posture correcting cost effective solutions.

The aim of this study was to compare the accuracy of implant placement by using the conventional freehand method, the surgical guide alone, the dental navigation system alone, and the dental navigation system with a surgical guide. The participants were aged 20 years or older and were requiring dental implant surgery according to an assessment made by a dentist between July 2014 and December 2017. A total of 128 dental implants were inserted, 32 dental implants in each group, and participants with similar or identical age (i.e., 20&ndash, 50 years or 50 years or above) and missing tooth locations were paired for comparison. Accuracy was measured by overlaying the real position in the postoperative Cone Beam Computerized Tomography (CBCT) on the virtual presurgical placement of the implant in a CBCT image. Using the dental navigation system with a surgical guide could help dentists to position implants more accurately. Total, longitudinal, and angular error deviation were significantly different (p &lt, 0.0001). The same level of accuracy could be obtained for the different jaws and tooth positions. The one-way analysis of variance (ANOVA) showed that the total, longitudinal, and angular errors differed significantly (p &lt, 0.0001). A comparison of the four dental implant surgical methods indicated that the combination of a dental implant navigation system and a surgical guide kit achieved the highest accuracy in terms of the different tooth positions and jaws.

Pulmonary embolism (PE) is associated with mortality. There are many clinical prediction tools to predict early mortality in acute PE but little consensus on which is best. Our study aims to validate existing prediction tools and derive a predictive model that can be applied to all patients with acute PE in both inpatient and outpatient settings. This is a retrospective cohort study of patients with acute PE. For each patient, the Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), European Society of Cardiology (ESC), and Angriman scores were calculated. Scores were assessed by the area under the receive-operating curve (AUC) for 30-day, all-cause mortality. To develop a new prognostic model, elastic logistic regression was used on the derivation cohort to estimate β-coefficients of 8 different variables; these were normalized to weigh them. A total of 321 patients (mean age 60±17 years) were included. Overall 30-day mortality was 10.3%. None of the scores performed well; the AUCs for the PESI, sPESI, ESC, and Angriman scores were 0.67 (95% confidence interval [CI], 0.57-0.77), 0.58 (0.48-0.69), 0.65 (0.55-0.75), and 0.67 (0.57-0.76), respectively. Our new prediction model outperformed PESI, with an AUC of 0.82 (95% CI, 0.76-0.88). At a cutoff score of 100, 195 (60.1%) patients were classified as low risk. Thirty-day mortality was 2.1% (95% CI, 0.8%-5.2%) and 23.0% (16.5%-31.1%) for low- and high-risk groups, respectively ( P < .001). In conclusion, we have developed a new model that outperforms existing prediction tools in all comers with PE. However, further validation on external cohorts is required before application.

Headaches are common in primary care. For safe assessment and management of the patient with headache, a focused history and physical examination are important to identify secondary headache, and find out whether an immediate referral to the emergency department or a non-emergent referral to the neurologist is warranted. The majority of patients with primary headache may be safely managed in the outpatient setting. Key steps include proper categorisation of the primary headache, attention to lifestyle and psychosocial factors, prescription of analgesics for acute pain relief, and the use of preventive medication when indicated. The patient with a cluster headache, a headache of uncertain diagnosis and/or poor response to preventive strategies or a migraine with persistent aura, or a headache with associated motor weakness, should be referred to a neurologist. Secondary headache and the diagnosis of medication overuse headache should be considered in a patient on long-term analgesics with unremitting headache.

Opioid addiction is a major public health issue worldwide. Methadone maintenance treatment (MMT) is used to detoxify users of illicit opiates, but drug relapse is common and associated with poor quality of life (QoL). This study investigated the associations between the GRIN3A, GRM6, and TPH2 genetic variants and QoL in the MMT population. A total of 319 participants were included in the study, and genotyping of GRIN3A, GRM6, and TPH2 genes was performed using the Sequenom iPLEX. Associations between genotypes and the domains of QoL were examined through posthoc analysis with LSMEANS syntax using SAS 9.1.3. The single nucleotide polymorphisms rs9325202 and rs1487275 in the TPH2 gene were significantly associated with the QoL domain of physical functioning. The least absolute shrinkage and selection operator regression model revealed that the risk allele rs1487275-G was significantly correlated with the domain of physical functioning when clinical characteristics were considered as covariates. The results of the present study illuminate the importance of the genetic basis of QoL in the MMT population, and suggest that genotypes should be considered as a potential QoL indicator.

The influence of aneurysmal subarachnoid hemorrhage (SAH) on brain microcirculation has not yet been systematically investigated. We established an animal model to examine (1) the brain surface microcirculation (2) the influences of cerebrospinal fluid (CSF) from aneurysmal SAH on the brain surface microcirculation. A rat SAH model was induced by injection of autologous arterial blood into the cisterna magnum, and the brain surface microcirculation was evaluated by a capillary videoscope with craniotomy at the fronto-parietal region. CSF from SAH rats and SAH patients was applied on the brain surface of naïve rats to assess the resulting microcirculatory changes. In the SAH rats, diffuse constriction of cortical arterioles within 24 hours of SAH was observed. Similar patterns of microcirculation impairment were induced on normal rat brain surfaces via application of CSF from SAH rats and SAH patients. Furthermore, the proportion of subjects with arteriolar vasoconstriction was significantly higher in the group of SAH patients with delayed ischemic neurological deficits (DIND) than in those without DIND (p

Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH.Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed.There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015).By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.

Ultrasound has been commonly used to guide clinical procedures in Western medicine, such as peripheral nerve blocks, biopsies, and fluid aspiration. Ultrasound is a useful tool because it is non-invasive, allows real-time visualisation of body images, and poses no risk to the human body, as it uses sound waves that are generally safe. In addition to guiding clinical procedures, ultrasound has been used to train medical students to perform clinical examinations.1 From a review of the literature, only one study has explored the use of ultrasound for acupuncture, and this focused on detecting soft-tissue displacement from movement of the needle.2 No study has explored the use of ultrasound in demonstrating the relationship between an acupuncture needle and the surrounding anatomical structures real-time in vivo. The aim of our study was to evaluate its feasibility and to discuss the implications for education and research. This study was conducted on a human cadaveric hand. Ultrasound scans were conducted using a Siemens Acuson P300 ultrasound system with a …

OBJECTIVEDirect brain compression and secondary injury due to increased intracranial pressure are believed to be the pathognomic causes of a grave outcome in acute subdural hemorrhage (aSDH). However, ischemic damage from aSDH has received limited attention. The authors hypothesized that cerebral microcirculation is altered after aSDH. Direct visualization of microcirculation was conducted in a novel rat model.METHODSA craniectomy was performed on each of the 18 experimental adult Wistar rats, followed by superfusion of autologous arterial blood onto the cortical surface. Changes in microcirculation were recorded by capillary videoscopy. Blood flow and the partial pressure of oxygen in the brain tissue (PbtO2) were measured at various depths from the cortex. The brain was then sectioned for pathological examination. The effects of aspirin pretreatment were also examined.RESULTSInstantaneous vasospasm of small cortical arteries after aSDH was observed; thrombosis also developed 120 minutes after aSDH. Reductions in blood flow and PbtO2 were found at depths of 2–4 mm. Blood-brain barrier disruption and thrombi formation were confirmed using immunohistochemical staining, while aspirin pretreatment reduced thrombosis and the impairment of microcirculation.CONCLUSIONSMicrocirculation impairment was demonstrated in this aSDH model. Aspirin pretreatment prevented the diffuse thrombosis of cortical and subcortical vessels after aSDH.

For some years, bi-directional porous aero-thrust bearing systems have been receiving much attention. They are now applied extensively where there is a need for rigidity in high-precision instruments and mechanisms that run at high speed. Although the carrying capacity of gas bearings is not as good as that of oil film bearings, the heat generated at high speed is lower and does not cause spindle deformation. Under certain conditions, the shaft will display unstable non-periodic movement, and this can even become chaotic. This irregular behavior, when serious, can even damage the mechanical parts, cause a breakdown, and stop production. The aim of this study was to gain an understanding of this phenomenon and the conditions under which it might arise and to find a means for avoiding irregular vibrations and eliminating the air hammer effect that accompanies them. A detailed examination of the related characteristics of a gas bearing shaft system was carried out using numerical value analysis such as the finite difference and differential transformation methods. An analysis of the nonlinear dynamic behavior of the main axis was then carried out using bifurcation diagrams, Poincaré sections, and spectral response.

Object Experimental studies have demonstrated the crucial role of posthemorrhagic erythrocyte catabolism in the pathogenesis of subarachnoid hemorrhage (SAH). The authors of this study aimed to investigate the prognostic value of a series of CSF biomarkers linked to heme metabolism in SAH patients. Methods Patients with Fisher Grade III aneurysmal SAH undergoing early aneurysm obliteration were enrolled. The levels of heme oxygenase–1 (HO-1), oxyhemoglobin, ferritin, and bilirubin in intrathecal CSF were measured on the 7th day posthemorrhage. The associations of functional outcome with clinical and CSF parameters were analyzed. Results The study included 41 patients (mean age 59 ± 14 years; 16 male, 25 female), 17 (41.5%) of whom had an unfavorable outcome (Glasgow Outcome Scale score ≤ 3) 3 months after SAH. In terms of the clinical data, age > 60 years, admission World Federation of Neurosurgical Societies Grade ≥ III, and the presence of acute hydrocephalus were independent factors associated with an unfavorable outcome. After adjusting for clinical parameters, a higher level of HO-1 appeared to be the most significant CSF parameter related to an unfavorable outcome among all tested CSF molecules (OR 0.934, 95% CI 0.883–0.989, p = 0.018). Further analysis using a generalized additive model identified a cutoff HO-1 value of 81.2 μM, with higher values predicting unfavorable outcome (82.4% accuracy). Conclusions The authors propose that the level of intrathecal CSF HO-1 at Day 7 post-SAH can be an effective outcome indicator in patients with Fisher Grade III aneurysmal SAH.

Background/purpose We studied the correlation between clinical covariates and blood loss under hypotensive anesthesia, in patients undergoing a bilateral vertical ramus osteotomy (BVRO). Materials and methods BVROs were performed on 37 patients with mandibular prognathism. The preoperative and postoperative values of blood constituents were examined and analyzed. Correlations among blood loss, sex, age, operative time, and reduced values of blood constituents were statistically assessed. Results The average operative time was 255.5 ± 42.56 minutes, and blood loss was 105.9 ± 66.83 mL. No patient required a blood transfusion in this study. There were no significant correlations between blood loss and related factors (sex, operative time, and reductions in blood constituents). Comparing sexes, blood loss and reductions in blood constituents exhibited non-significant differences. However, male patients had significantly larger values for presurgical and postsurgical blood constituents than female patients. Conclusion In our study, blood loss was acceptable in patients who underwent a BVRO, and thus, no preoperative autologous blood donation was necessary.

Background/purpose: Improper assessment of the maxillary buccal vestibular space can contribute to the fabrication of maxillary dentures with inadequate buccal flange extensions. The purpose of this study was to determine whether a significant difference existed between the anatomic dimensions of the buccal vestibules and the corresponding buccal flanges of maxillary complete dentures in an edentulous population. Materials and methods: The anterior, middle, and posterior depth and width of the maxillary buccal vestibules in 100 randomly selected subjects were measured with a periodontal probe. Corresponding measurements of the buccal flanges of the subjects' existing dentures were recorded. The differences between buccal vestibule widths and depths and denture flange widths and lengths were statistically compared according to site. Results: The difference in the mean depth between the vestibules and the flanges in the posterior area (6.4 mm and 10.3 mm, respectively) was approximately 38% (P

Background/purpose Although proper training of medical and dental interns is particularly important, there are no studies to date in Taiwan examining the quality of dental services provided to the public by interns. The purpose of study is to investigate the significant factors that influence the patient's satisfaction with the quality of dental treatment provided by Interns. Materials and methods This study randomly selected patients from a dental department in a medical center located in southern Taiwan and used a structured questionnaire and response scales (Likert) to investigate the level of emphasis and satisfaction of patients with the dental treatment provided by interns in February to April 2004 (52 total valid questionnaires). Results With regard to technical competence compared to that of dentists, we found statistically significant differences according to the type of treatment received, gender, marital status, educational level attained, and household income (P Conclusion Medical centers should guide interns in clinical cases and provide structured training. These measures could enhance the public's confidence in interns and improve patient satisfaction with interns through improved clinical skills, and provide an excellent work force for the dental field.

Objective: to understand the effectiveness of the health and fitness evaluation among the staff members in Asia University. Method: Evaluating and analyzing 95 staff members by using descriptive statistic (17 male, 58 female). The average age of male was 37.73, and 31.59 years old for the female. The evaluation included physical health norm and physical fitness level. The result showed that the average male BMI was over the standard, with blood pressure a little higher than normal. The female BMI and blood pressure were showed as normal. The waistline of both male and female were normal. In the physical fitness area, the male aerobic fitness level was normal, muscular strength was very good and flexibility was normal. The aerobic fitness level of female was normal, muscular strength was good and flexibility was poor. In conclusion, both male and female staff members were doing well in terms of their physical fitness. The male staff members especially need to control their weight in the BMI area. The female staff members should use stretching exercises to improve their flexibility. By doing the health and fitness evaluation helped us to understand the participation in physical activities of the staff members. Their physical fitness level indicated as a reference for their personal physical and health status. Practicing health and physical evaluation has a positive meaning and qualitative reasons. In promoting physical fitness activities and gets the staff members to involve in physical activities in daily basis also develop it as a lifetime habit. Not only to improve the staff members’ health and fitness level effectively, but also the quality of their life.

We aim to determine the cerebrospinal fluid levels of high mobility group box 1 in subarachnoid hemorrhage patients and to investigate the involvement of the receptor for advanced glycation end products and high mobility group box 1 in the pathogenesis of post-subarachnoid hemorrhage neuronal death. The study included 40 patients (mean age, 59 ± 19 years) with Fisher's grade ≥ III aneurysmal subarachnoid hemorrhage. Cerebrospinal fluid was collected on the seventh day post-hemorrhage. Receptor for advanced glycation end products expression was examined in rat brain tissue following subarachnoid hemorrhage and in cultured neurons exposed to post-subarachnoid hemorrhage cerebrospinal fluid. Therapeutic effects of the recombinant soluble form of RAGE on subarachnoid hemorrhage models were also investigated. The results indicated that a higher level of cerebrospinal fluid high mobility group box 1 was independently associated with unfavorable outcome at three months post-subarachnoid hemorrhage (OR = 1.061, 95% CI: 1.005–1.121). Expression of RAGE increased in post-subarachnoid hemorrhage rat brain cells and in cultured neuron with stimulation of post-subarachnoid hemorrhage cerebrospinal fluid. Administration of recombinant soluble form of RAGE significantly reduced the number of positive TUNEL staining cells in subarachnoid hemorrhage rat and improved cell viability in post-subarachnoid hemorrhage cerebrospinal fluid-treated cultured neurons. Thus, the level of cerebrospinal fluid high mobility group box 1 can be a prognostic indicator for patients with Fisher's grade ≥ III aneurysmal subarachnoid hemorrhage and that treatment with soluble form of RAGE is a novel approach for subarachnoid hemorrhage.

This study aims to discuss the effects of the 12-week exercise intervention on the functional fitness of community elderly. Total 25 community elderly aged above 65 are proceeded functional fitness tests. The data are analyzed with Descriptive Statistics. The results show that the male elderly significantly enhance the upper limb strength (musculus biceps brachii left arm curling, musculus biceps brachii right arm curling), static balance (open-eye single leg standing), and agility and dynamic balance (chair stand detour) and the female elderly make remarkable progress on the upper limb strength (musculus biceps brachii left arm curling, musculus biceps brachii right arm curling), cardiorespiratory endurance (high knees in place), static balance (open-eye single leg standing), and agility and dynamic balance (chair stand detour) after the 12-week regular exercise intervention. With functional fitness tests, the research findings reveal that regular exercise presents the effectiveness on distinct physical fitness of community elderly, while the aerobic endurance and upper/lower body flexibility still require improvement. Apparently, it is suggested to practice courses with stages and match fitness test results to adjust types of exercise and exercise intensity in order to achieve the effect.

Aim: Research is a key component of evidence-based medical imaging. Good knowledge and attitude towards research is important in implementing the paradigm shift from the traditional model of practice to evidence-based practice. The aim of this study was to ascertain the attitude, level of awareness and knowledge of radiographers about research. Potential barriers might also be identified so that programmes and schemes could be developed to raise the profile of research in clinical practice. Methods: A 20-item scale self-completion questionnaire was designed and distributed to radiographers in the Department of Diagnostic Radiology, SGH. The questionnaire consisted of questions pertaining to years of working experience, specialization of practice, role/involvement in any research, training needs and identification of potential barriers to research. Results: The final response rate was 67% (N ¼ 114). Although the involvement in research is 39% (N ¼ 44), the radiographers strongly believed that it is essential for them to participate in research to develop themselves and the profession, as well as to improve the quality of care delivered to patients. The main identified perceived barriers to research included lack of time, resources and heavy clinical workload. Sixty-four percent (N ¼ 73) of participants indicated that provision of courses would improve their research skills, such as research methodology, biostatistics, literature critique, and a lack of these could be some of the reasons for low research involvement among radiographers. Conclusions: The data suggest that positive attitudes, institutional support and provision of research related courses are needed to increase radiographers’ involvement in research.

Objective To determine whether perfusion computed tomography (CT) is useful for identifying patients with poor-grade subarachnoid hemorrhage (SAH) with reversible etiologies and whether early obliteration in patients with poor-grade aneurysmal SAH leads to favorable outcomes. Methods Patients with new-onset aneurysmal SAH in World Federation of Neurological Surgeons (WFNS) grade IV or V neurologic condition who had perfusion CT performed at admission were eligible for the study. The study retrospectively enrolled 38 patients seen between January 2007 and July 2009. The decision to perform an early obliteration was made by the family after a discussion with the neurosurgeons, neurointensivists, and interventional radiologists. The functional outcomes were correlated with the Glasgow Outcome Scale (GOS) at 6 months, and quantitative perfusion CT data were collected. Results This study included 10 (26%) grade IV and 28 (74%) grade V patients. Favorable outcomes occurred in 19 (50%) patients, and 11 (29%) patients died. After a multivariate logistic regression analysis of the parameters, older age (odds ratio 1.104, P = 0.0317), bilateral prolonged mean transient time (MTT) at the thalami (odds ratio 4.155, P = 0.0362), and early obliteration (odds ratio 0.098, P = 0.003) were predictive of poor outcome. Conclusions Early bilateral prolonged MTT at the thalami and old age are associated with a poor outcome. Early obliteration benefits a significant portion of SAH patients.

Ischemia is an important etiology of painful neuropathies. We generated a mouse system of ischemic neuropathy by ligation-reperfusion of the femoral artery to mimic neuropathic pain and nerve injury patterns observed clinically. Mice exhibited spontaneous neuropathic pain behaviors, which were most obvious after ischemia for 5 h. Mechanical and cold allodynia developed by post-operative day (POD) 7 and persisted through the experimental period up to POD 56. Neuropathic pain behaviors were alleviated with intraperitoneal gabapentin (50 and 100 mg/kg) in a dose-dependent manner. Large-fiber deficit assessed with nerve conduction studies was demonstrated by reduced amplitudes of the compound muscle action potential (CMAP) on POD 7 (48.4% of the control side, p < 0.001). Small-fiber impairment was demonstrated by decreased epidermal nerve density (END) on POD 7 (29.1% of the control side, p < 0.001). Reductions in CMAP amplitudes and ENDs persisted through POD 56. Our system replicated the clinical manifestations of ischemic neuropathy: (1) neuropathic pain with cold and mechanical allodynia and (2) nerve injury to both large and small fibers with pathologic and physiologic evidence. This system produced by a simple procedure provides an opportunity to investigate mechanisms and further treatments of ischemic neuropathy on genetically engineered mice.

Background/purpose The objective of this study was to assess the relationship between the essential functional qualities of complete dentures and participants' oral health-related well-being among an elderly edentulous population. Materials and methods Four hundred elderly participants from Taiwan, aged ≥ 65 years, with diverse levels of formal education, received intraoral examinations in accordance with the 10 criteria embedded in the Functional Assessment of Dentures (FAD) and personal interviews in accordance with the Oral Health Impact Profile (OHIP)-14. The mean OHIP-14 scores were compared among categories using a t test or ANOVA. A multiple-regression analysis was used to identify significant FAD criteria related to specific OHIP-14 domains, while adjusting for gender, age, and educational level. Results Maxillary stability and retention, denture articulation, and occlusion demonstrated significant relationships with the mean OHIP-14 scores and individual mean OHIP-14 domain scores. Maxillary denture stability and denture articulation were the two most significant denture-related variables. Conclusion A stable and retentive maxillary denture with adequate articulation provided the optimal environment for oral function with the highest level of patient oral health-related well-being in this elderly population.

Background/purpose In this study, we investigated outcomes for conventional deltopectoral (DP) flaps and L-extension deltopectoral (L-DP) flaps in head-and-neck reconstructions. Materials and methods Twenty-three conventional DP flaps and 10 L-DP flaps were created in 33 patients. The latter flaps were applied with no delay. The flaps were folded only in the L-DP-flap group. Seven of 10 L-DP flaps were folded to become bilayered flaps in order to repair full-thickness defects. Flap success rates and complication rates were compared between the conventional DP-flap and L-DP-flap groups. Results Success rates were 91.3% in the DP-flap group and 90% in the L-DP-flap group. Overall complication rates of the transferred flaps were 30.4% and 40% for DP and L-DP flaps, respectively. Complications in the two groups were analyzed by a Chi-square test, and no significant differences were found. Conclusions Although the DP flap is considered to be the "aged workhorse" in contemporary head-and-neck reconstructions, it was shown to be a beneficial regional flap with a dependable pedicle and easy technique. The L-DP flap is of value particularly when used to treat full-thickness defects of the head-and-neck.

Object The object of this study was to identify the clinical features and outcomes of a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH) who had active contrast extravasation from a ruptured aneurysm during initial cerebral CT angiography (CTA). Methods The authors performed a retrospective study of spontaneous SAH cases involving patients treated at their institute. They identified 9 cases in which active contrast extravasation was evident on the initial CT angiogram. Another 12 similar cases were also identified in a literature review and data was gathered from these cases to evaluate the outcomes. Results Analysis of all 21 cases revealed that the overall outcomes in cases characterized by active aneurysmal bleeding during CTA were poor. Seventy-six percent of patients had unfavorable results. Patients who showed poor neurological status at presentation died no matter what kind of treatment they received. In contrast, patients who presented with good neurological status initially had a chance of favorable outcome. Among the patients with good initial neurological status, most demonstrated rapid deterioration of their condition during the CTA examination; only those who received immediate and effective decompressive surgery and aneurysm obliteration had good results. Conclusions Active aneurysmal rebleeding during CTA is an uncommon but devastating event. Though the mortality of this distinct group of patients remains high, a clinical subgroup may benefit from immediate surgery. Patients with good initial neurological status who show rapid neurological deterioration may still have a favorable outcome if they undergo timely and successful decompressive surgery and proper aneurysm obliteration. Patients who present with poor neurological status do badly, and there is no effective treatment for such patients.

This study aimed to evaluate the tongue’s role in supporting maxillary denture retention (MDR), in providing additional stabilization for the mandibular denture, and the tongue’s relationship with the oral health-related well being in elderly complete denture patients. Four hundred elderly individuals, 263 males and 137 females, were enrolled in this study. All were older than 65 years, and wore complete dentures. Intraoral examinations were performed in accordance with the 10 criteria embedded in the Functional Assessment of Dentures (FAD). Participants also received personal interviews and completed the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The associations between MDR (tongue support) with the mean OHIP-14 sum scores and FAD categories were analyzed using the t test or analysis of variance (ANOVA). Combinations of MDR (tongue support), MDR (resistance to vertical pull), and mandibular denture stability (anterior–posterior movement) were also assessed with the remaining FAD criteria and OHIP-14 domain scores. Individuals with adequate MDR (tongue support) were significantly associated with denture articulation, denture occlusion, MDR (resistance to vertical pull), maxillary denture stability (pronounced rocking), and mandibular denture stability (anterior–posterior movement). When individuals with adequate MDR (tongue support) were analyzed in conjunction with adequate MDR (resistance to vertical pull) and adequate mandibular denture stability (anterior–posterior movement), significant associations were observed with the mean OHIP-14 sum score and three individual OHIP-14 domains: functional limitation, physical pain, and physical disability (p ＜ 0.05). The mean OHIP-14 sum score was lower among individuals with both adequate MDR (tongue support) and inadequate MDR (resistance to vertical pull) than among participants with both inadequate MDR (tongue support) and inadequate MDR (resistance to vertical pull). MDR (tongue support) demonstrated significant differences from denture occlusion, denture articulation, MDR (resistance to vertical pull), maxillary denture stability (pronounced rocking), and mandibular denture stability (anterior–posterior movement). MDR (tongue support), in conjunction with both adequate MDR (resistance to vertical pull) and adequate mandibular stability (anterior–posterior movement), were significantly associated with the individuals’ oral health-related well being.

During surgical correction of facial deformities, accurate prediction of the resulting facial profile is important for the patient and the surgeon. The purpose of the present study was to investigate profile changes after surgical treatment of mandibular prognathism. Thirty patients (20 females and 10 males; ages 17–28 years) with mandibular prognathism underwent vertical ramus osteotomy. Preoperative and postoperative cephalograms were analyzed; landmarks were identified and compared. The mean horizontal setback of the pogonion (Pog) was 11.7mm. The setback ratios of labrale inferius (Li)/incision inferius (Ii), labiomental sulcus (Si)/point B, and soft tissue pogonion (PogS)/pogonion (Pog) were 0.98, 0.99, and 0.95, respectively. There were no sex-related changes in soft tissue. These findings indicate that changes in soft tissue closely correlate with the amount of mandibular setback in the horizontal direction. Such information might facilitate more accurate prediction of the outcome of orthognathic surgery.

Object Traumatic subdural effusion (TSE) is a common sequela of traumatic brain injury. Surgical intervention is suggested only when TSE exerts mass effect. The authors have found that many patients with TSE exerting mass effect have concomitant hydrocephalus. Patient experiencing this occurrence were studied, and the pathogenesis of this phenomenon was discussed in the context of recent advances in the understanding of CSF circulation. Methods During a 2-year period, the authors' institution treated 14 patients with TSE who developed hydrocephalus, after 1 of the patients suffered subdural drainage and other 13 received subdural peritoneal shunt (SPSs). Thirteen of those who had SPSs received programmable ventriculoperitoneal shunts (VPSs) for the hydrocephalus. The clinical characteristics as well as the imaging and operative findings of these patients were reviewed. Results All patients with symptomatic TSE exerting mass effect received SPSs. All of these patients had a modified Frontal Horn Index of more than 0.33 at presentation, and high opening pressure on durotomy. Following a brief period (4–7 days) of clinical improvement, the condition of all patients deteriorated due to hydrocephalus. Programmable VPSs were inserted with the initial pressure set at approximately 8–10 cm H2O according to opening pressure at ventriculostomy. Shunt valve pressure was gradually decreased to 5–7 cm H2O, according to clinical and radiological follow-up. Conclusions Elevated modified Frontal Horn Index in patients with TSE is suggestive of concomitant hydrocephalus. The authors propose that tearing of the dura-arachnoid plane following trauma contributes to TSE and may also impede CSF circulation, causing hydrocephalus. Shunt pressure was adjusted to relative low pressure, indicating the old age of the patients and poor reexpansion of brain parenchyma after the mass effect. Subdural peritoneal shunts and VPSs are indicated in those patients with TSE exerting mass effect with concomitant hydrocephalus.

doi: 10.1111/j.1741-2358.2012.00632.x Evaluation of a self-assessed screening test for masticatory ability of Taiwanese older adults Objectives: The aim of this study was to evaluate a screening test based on a food intake questionnaire to discriminate the masticatory ability of Taiwanese older adults with 20 and more natural teeth and at least 8 functional tooth units (FTUs) from the masticatory ability of those with fewer than 20 natural teeth and 8 FTUs. Materials and Methods: The subjects were 2244 patients (mean age, 60.4±10.0 years) recruited from 23 counties and cities in Taiwan. Information about their demographic data, dentition, and masticatory ability was collected. Masticatory ability was measured for 23 food groups comprising 35 common Taiwanese foods, and receiver operation characteristic curve analysis was performed. Results: The results showed that the final questionnaire included 14 food groups and a subject choosing ’difficult to eat‘ responses for 4 and more of these food groups had the same masticatory ability as individuals with fewer than 20 natural teeth and 8 FTUs. Conclusion: In conclusion, foods that are the most difficult to eat are not necessarily good discriminatory indicators. Hence, the 14-food group questionnaire can be considered the best screening test for masticatory ability of Taiwanese older adults in terms of the presence of 20 and more natural teeth and at least 8 FTUs.

doi: 10.1111/j.1741-2358.2011.00500.x Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study Objective: The aim of this study was to evaluate the correlation between patient satisfaction with removable partial dentures and denture maintenance by patients, including regular application of denture adhesives and cleansers. Background: The success of removable partial dentures depends on patient satisfaction with dentures and their regular denture maintenance. Materials and methods: Demographic information, the Oral Impacts on Daily Performance (OIDP) indicator and details of denture maintenance (including the use of denture cleansers and adhesives) were collected from 193 (41.5% men and 58.5% women) participants by using questionnaires. A dentist performed oral examinations to evaluate denture function according to the OIDP items photographically and recorded the number of remaining teeth and Kennedy’s classification. Results: Most participants were satisfied with their removable partial dentures and tended to have higher satisfaction levels than the dentist’s estimation. Further, those using denture adhesives and cleansers had higher satisfaction levels than those not using such denture maintenance. Conclusions: Appropriate education regarding denture use is important because regular denture maintenance by patients affects their degree of satisfaction with dentures, as well as the dentist’s skill and the patient’s oral condition. Dentists could use this information to predict the potential success of dentures.

Statement of the Problem: Fabrication of normal crown contour to maintain gingival health is difficult in the absence of emergence angle data. Purpose: The aim of this study was to measure the geometric values of the emergence angles on the cementoenamel junction (CEJ) for natural maxillary anterior teeth. Material and Methods: This study collected 148 natural permanent maxillary anterior teeth (74 central incisors, 59 lateral incisors, and 15 canines) with intact cervixes for this study. The teeth were scanned with a three-dimensional (3D) scanner to construct 3D models. This study measured the emergence angles of the cervical CEJ on the zenith of labial, palatal, mesial, and distal, for each tooth. Results: Measurements made on 148 maxillary anterior teeth showed the emergence angle to be within a narrow range from 11.30° to 15.26°, irrespective of the tooth location. There were no statistically significant differences between any two groups (p > 0.05). Conclusions: On the basis of measurements taken from natural teeth, we conclude that the emergence angles of the CEJ in natural maxillary anterior teeth should be 15° from the root surface. CLINICAL SIGNIFICANCE The information presented in this article may be useful in helping to create dental restorations with optional emergence angles over the CEJ in natural maxillary anterior teeth. Prior to the treatment the dentist should consider not only the fit of the crown, but also the emergence angles and contours of the soft tissues surrounding the involved teeth. (J Esthet Restor Dent 23:362–370, 2011)

The gonial region is coincided with harmonious face and masticatory function. The aims of the present study were to assess changes in the gonial region in patients who had mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) and to investigate the contributing factors in relation to skeletal relapse.Twenty-one patients with mandibular prognathism were corrected by IVRO. Three cephalometric radiographs were collected from preoperative orthodontic treatment (T1), immediately after surgery (T2), and at 2-year postoperative follow-up (T3). Relapse was defined as forward movement of menton (Me) after the 2-year follow-up. Three angular (SN-Go angle, mandibular plane angle, and gonial angle) and 2 linear (horizontal-Me and vertical-Me) measurements were compared after immediate operation and at the 2-year follow-up. Spearman rank correlation and Student t tests were used for statistical analysis.The mean setback of the Me was 12.7 mm, and the mean relapse was 1.5 mm. The magnitude of setback was not significant for relapse. There were weak correlations between relapse and factors concerned with the gonial region (SN-Go angle, mandibular plane angle, and gonial angle).Surgical correction of mandibular prognathism using IVRO can lead to an increase in the angle changes of gonial region but not correlate to skeletal relapse in long-term follow-up.

Several reports have pointed out that endodontically treated teeth can lack strength, and that the teeth can be reinforced using posts. However, it has not been clear how to select posts that meet the needs of most clinical situations, particularly in terms of the post diameter, which has a major influence on the occurrence of root fracture. The purpose of this study was to analyze the stress distributions of posts of various diameters during masticatory loads using a finite element method. A 3-dimensional (3D) finite element model of a lower first premolar was developed. We used the image software Geomagic Studio (3D Digital 2002; Geomagic, Research Triangle Park, NC, USA) to reduce the post diameter by 6 ratios to a root diameter of 20, 30, 40, 50, 60, and 80% and then individually implemented them into the root of a tooth. A chewing static force of 100 N was applied as a 45° diagonal load on the buccal cusp tip, and the σ(von Mises) and σ(max) stresses were calculated. Analysis of the σ(von Mises) values revealed that the stresses were concentrated in the middle 1/3 of both the post and the root surface for all models, as were the σ(max) values. The results also indicated that when the diameter of the post was 50% of that of the root, the stress distributions of the post and the root surface were most favorable. In conclusion, the clinical implications of the results will need to be further studied and discussed.

The purpose of this study is to analyze biomechanical interactions in the alveolar bone surrounding implants with smaller-diameter abutments by changing position of the fixture-abutment interface, loading direction, and thickness of cortical bone using the finite element method.Twenty different finite element models including four types of cortical bone thickness (0.5, 1, 1.5, and 2 mm) and five implant positions relative to bone crest (subcrestal 1, implant shoulder 1 mm below bone crest; subcrestal 0.5, implant shoulder 0.5 mm below bone crest; at crestal implant shoulder even with bone crest; supracrestal 0.5, implant shoulder 0.5 mm above bone crest; and supracrestal 1, implant shoulder 1 mm above bone crest) were analyzed. All models were simulated under two different loading angles (0 and 45 degrees) relative to the long axis of the implant, respectively. The three factors of implant position, loading type, and thickness of cortical bone were computed for all models.The results revealed that loading type and implant position were the main factors affecting the stress distribution in bone. The stress values of implants in the supracrestal 1 position were higher than all other implant positions. Additionally, compared with models under axial load, the stress values of models under off-axis load increased significantly.Both loading type and implant position were crucial for stress distribution in bone. The supracrestal 1 implant position may not be ideal to avoid overloading the alveolar bone surrounding implants.

Oral appliances are a range of devices that are designed to alter upper airway patency. The efficiency of these appliances for treatment of obstructive sleep apnea (OSA) has been rarely discussed. This case report describes two designs of mandibular repositioning appliances used to treat OSA. A 36-year-old man was diagnosed with mild OSA by his physician. A single-piece, soft oral appliance and a two-piece, acrylic appliance were used in this patient. Polysomnography was performed three times (baseline, and with the single-piece, and two-piece appliances). The apnea/hypopnea index was improved significantly with both appliances, but to a greater degree with the single-piece soft appliance. Our study concluded that oral appliances may assist in the management of OSA.

Background Patients who wear mandibular dentures and hold their tongues in retracted positions alter the dimensions of the sublingual space and disrupt the peripheral seal that is needed for optimal denture retention. The authors studied whether retention could be improved if patients moved their tongues from a retracted resting position to an ideal resting position. Methods The authors observed and classified the mandibular residual ridge morphologies of 85 participants who wore complete dentures. The authors recorded and compared the retention of the mandibular denture before and after repositioning the tongue to the ideal resting position. Results When the participants’ tongues were in a retracted resting position, the average retention of the mandibular denture was 75.38 gram weight (± 81.83 standard deviation [SD]). After participants repositioned their tongues to the ideal resting position, the average retention of the mandibular denture was 118.89 gw (± 93.00 SD), an increase of 57.73 percent. Conclusions In all morphological classes, when participants held their tongues in the ideal resting position, the average mandibular denture retention increased by 57.73 percent, a statistically significant improvement compared with when participants held their tongues in a retracted resting position. Clinical Implications Clinicians are encouraged to evaluate carefully the tongue resting position in all patients who wear dentures, help create reasonable therapeutic expectations by informing patients about the significant effect that tongue position will have on future denture retention and provide helpful neuromuscular training for patients with retracted-tongue habits.

Various techniques and modifications have been introduced in the treatment of mandibular prognathism. However, there are still few reports concerning long-term stability, especially using the intraoral vertical ramus osteotomy (IVRO) method. The purpose of this study was to investigate the long-term stability for correction of mandibular prognathism using IVRO. Twenty-five mandibular prognathism patients were treated by bilateral IVRO, and were evaluated cephalometrically by reference to the menton. A set of 3 standardized lateral cephalograms were obtained from each subject preoperatively (T1), immediately postoperatively (T2), and after 2 years postoperatively (T3). Relapse was defined as forward movement of menton after the 2-year follow-up. The mean setback of the menton was 12.8 mm in horizontal direction and 0.9 mm downward in vertical direction. The average follow-up was 33.9 months. The mean relapse was 1.3 mm (10.2% = 1.3 of 12.8) in forward direction and 0.6 mm in upward direction. There was no significant movement in the vertical direction. However, significant relapse was shown in the horizontal direction, even though the amount was small. The long-term stability of our present study suggested that IVRO is useful for correction of mandibular prognathism.

Clinically, many implant cases with different angulation over the lower posterior area have been found. The purpose of this study was to analyze the bony stress with different implant tilting during normal masticatory load using the finite element method (FEM), with the hope of discovering a desirable installation of implant. A three-dimensional finite element method was employed to analyze the bony stress generated by different angulation designs (15 degrees) of implant bodies. Eight solid models of the mandibular first and second molars were built up and then transferred to a mesh model in FEM (ANSYS) to perform a stress analysis. A simulated load (400 N) was applied to the splinted crowns with vertical and horizontal forces. The loading sites were on the central fossa of the splinted crowns. For stress distribution, some designs will be better than a parallel installation. The results suggested that not all implant bodies tilting with the splinted crowns lead to stress concentration.