Craniofacial morphology in Turner syndrome patients treated with growth hormone

ABSTRACT Introduction: In addition to well-established physical characteristics, Turner syndrome patients have distinct craniofacial morphology. Since short stature is the most typical characteristic, Turner syndrome patients are commonly treated with growth hormone in order to increase final height. At the same time, growth hormone treatment was found to influence craniofacial growth and morphology in various groups of treated patients. Whereas craniofacial characteristics of Turner syndrome patients are well documented, comparatively little is known of craniofacial morphology of those who are treated with growth hormone. Aim: The aim of this study was to investigate craniofacial morphology in Turner syndrome patients treated with growth hormone in comparison to healthy females. Materials and methods: The cephalometric evaluation was conducted on twenty lateral cephalograms of Turner syndrome patients (13.53 ± 4.04 years) treated with growth hormone for at least one year (4.94 ± 1.92 years in average). As a control group, forty lateral cephalograms of healthy female controls, who matched Turner syndrome patients by chronological (11.80 ± 2.37 years) and skeletal age, were used. Eleven angular, seven linear measurements and six dimensional ratios were measured to describe craniofacial morphology. Results: The results obtained for angular measurements, in cephalometric analyses for Turner syndrome patients treated with growth hormone, revealed bimaxillary retrognathism. The linear measurements indicated longer mandibular ramus, anterior cranial base and both anterior and posterior facial heights. However, posterior cranial base and maxilla were in proportion to the anterior cranial base, when comparing dimensional ratios. Anterior cranial base, maxilla and mandibular ramus were larger in proportion to mandibular body; as well as posterior facial height was when compared to anterior facial height. Turner syndrome patients treated with growth hormone expressed distinct craniofacial morphology compared to controls. Apart from retrognathic maxilla and mandible, they exhibited overdeveloped mandibular ramus height and elongated facial heights. Conclusions: The results from this study have shown that Turner syndrome patients treated with growth hormone expressed distinct craniofacial morphology compared to controls. These differences include retrognathic maxilla and mandible, overdeveloped mandibular ramus height and elongated facial heights. This specific craniofacial morphology was formed under combined influence of X chromosome deficiency and growth hormone therapy

Primena prebiotika MOS-a u ishrani pastrmki

Ispitivan je uticaj manan oligosaharida (MOS) kao aditiva hrane, primenjenog u koncentraciji od 0,2% (O-I grupa riba) i 0,3% (O-II grupa riba) na morfometrijske karakteristike i osnovne proizvodne pokazatelje gajenja kalifornijske pastrmke. Ogled je sproveden na 450 riba podeljenih u tri grupe sa po 150 jedinki u svakoj grupi i trajao je 40 dana. Analizom dobijenih rezultata, ustanovljen je povoljan efekat primenjenog aditiva na morfometrijske pokazatelje tempa rasta riba, kako njihove završne komadne mase i završnih dužinskih mera, tako i njihovog prirasta, ali bez utvrđenih statistički značajnih razlika (p>0,05). Najveću prosečnu telesnu masu i dužinu tela kod ispitavanih grupa, ostvarile su pastrmke O-II grupe (118,49 g i 19,59 cm), zatim pastrmke O-I grupe (118,04 g i 19,58 cm), a najmanju K-grupa riba (115,94 g i 19,56 cm). Dodavanje MOS-a u smeše za ishranu pastrmki je imalo povoljan uticaj (p>0,05) na ostvarivanje niže konverzije hrane (HK) i boljih vrednosti osnovnih proizvodnih pokazatelja: faktora kondicije (FK), koeficijenta proteinske efikasnosti (PER), specifične stope rasta (SGR) i proizvodnog indeksa (PI) u odnosu na ribe K grupe, koje su hranjene smešama bez dodatka mananoligosaharida. Najbolje rezultate su ostvarile ribe O-II grupe, a iskazano u relativnim pokazateljima u odnosu na K grupu riba: bolju konverziju hrane za 5,61%; bolju vrednost iskorišćenja proteina hrane za 5,94%; veću vrednost faktora kondicije za 1,73%; specifične stopa rasta za 2,26% i bolju vrednost proizvodnog indeksa za 8,27%

Model zaštite prirodnih resursa integracijom upravljačkih funkcija ribarskog i lovnog područja

Ribarska i lovna područja u zakonodavnom, organizacionom i funkcionalnom smislu ispoljavaju veliku sličnost, koja proistiće iz zakonskih definicija. Kvalitet upravljanje obnovljivim resursima u oblasti ribarstva i lovstva uslovljen je političko-zakonodavnim, ekonomskim, socijalnim i tehnološko-ekološkim parametrima (kategorijama) određenim širokim spektrom različitih interesa i potreba. Zato je veoma važno odabrati model upravljanja pomenutim prirodnim resursima koji može zadovoljiti više ciljnih grupa, a da pri tome bude efikasan i ekonomičan. Cilj ovog rada je da se na realan i praktičan način prikažu kriterijumi i alternative za poboljšanje upravljačkih funkcija kroz model zaštite prirodnih resursa integracijom upravljačkih funkcija ribarskog i lovnog područja. Kao polazni materijal u ovom radu korišćeni su zakonska i planska dokumenta iz oblasti održivog korišćenja ribljeg fonda i lovstva. Izvršena je višekriterijumska analiza na osnovu kriterijuma PEST analize u odnosu na moguće alternative (posebno ribarsko, posebno lovno, integralno upravljanje ribarsko-lovnim područjem). PEST analiza se zasniva na analizi eksternih uticaja (Političko-zakonodavna, Ekonomska, Sociološka i Tehnološko-ekološka analiza) koji utiču na izbor organizacionog oblika upravljanja ribarskim i lovnim područijima. Kao kontrolni metod korišćen je analitičko hijerarhijski proces (AHP), sa namerom da se utvrdi u kojoj meri eksterni kriterijumi okruženja deluju na izbor ponuđenih alternativa (Saaty, 1980). Prema većini autora u Srbijii postoji potreba integralnog upravljanja vodnim resursima i vodoprivrednim objektima, koja bi kroz adekvatnu pravnu regulativu ostvarila svoj puni tehnološko-tehnički kapacitet, ekonomičnost, efikasnost i efektivnost. Srbija raspolaže velikim brojem reka, prirodnih i veštačkih akumulacija. Integralno upravljanje rečnim slivom pretpostavlja plansko upravljanje i izradu monitoringa baziranih na ekološkim karakteristikama i kontinuiranom praćenju biotičkih i abiotičkih faktora (Simonović i sar., 2005). U Srbiji je ustanovljeno oko 300 lovišta, u kojima su uočeni kao najčešći nedostaci: nedosledna primena i nepoštovanje zakonskih propisa, monopolizam određenih organizacija i interesnih grupa, nizak nivo tehničko-tehnološkog i institucionalnog razvoja, nepostojanje dokumenta strateškog planiranja u lovstvu, nerazvijeni monitoring divljači i njihovih staništa Sa aspekta održivog upravljanja lovnim područjima osnovni ciljevi su: povećanje brojnosti populacije sitne i krupne divljači, poboljšanje polne i starosne strukture populacija, očuvanje retkih i ugroženih vrsta lovne divljači (Medarević i sar., 2008). Radovi i dokumenta, kao i iskustva drugih zemalja upućuju na potrebu objedinjenog upravljanja pomenutim obnovljivim resursima. Može se zaključiti da bi integralno gazdovanje ribarskim i lovnim područjima poboljšalo upravljačke funkcije, smanjilo troškove i povećalo efikasnost poslovanja. Sigurno bi pozitivno uticalo i na socijalni aspekt i promenu svesti u javnosti da ribolov i lov nisu samo socijalna već i značajna privredna kategorija. Integralnim upravljanjem ribarskim i lovnim područjima bio bi olakšan monitoring sa jasnijim i uporedivim rezultatima, a kontrola i korišćenje finansijskih sredstava bila bi neuporedivo bolja i racionalnija. U pogledu funkcionisanja stručnih i čuvarskih službi potrebno je izvršiti detaljnu analizu geografskog rasporeda, veličine i broja lovnih tj. ribolovnih područja, sa ciljem optimizacije upravljanja istim na ekonomskim i ekološkim principima. Potencijalna korist za državu se vidi u smanjenju troškova uprave, pri čemu bi se mogli formirati regionalni centri na nivou jednog ili više područja, a koji bi služili za obuku kadrova, organizaciju monitoringa, reagovanja u akcidentnim situacijama i slično. Pre toga potrebno je zakonsku regulativu, a potom ribarska i lovna područja učiniti međusobno kompatibilnim

Sex and age differences and outcomes in acute coronary syndromes

Background: There is conflicting information about sex differences in presentation, treatment, and outcome after acute coronary syndromes (ACS) in the era of reperfusion therapy and percutaneous coronary intervention. The aim of this study was to examine presentation, acute therapy, and outcomes of men and women with ACS with special emphasis on their relationship with younger age ( lt = 65 years). Methods: From January 2010 to June 2015, we enrolled 5140 patients from 3 primary PCI capable hospitals. Patients were registered according to the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) registry protocol (ClinicalTrials.gov: NCT01218776). The primary outcome was the incidence of in-hospital mortality. Results: The study population was constituted by 2876 patients younger than 65 years and 2294 patients older. Women were older than men in both the young (56.2 +/- 6.6 vs. 54.1 +/- 7.4) and old (74.9 +/- 6.4 vs. 73.6 +/- 6.0) age groups. There were 3421 (66.2%) patients with ST elevation ACS (STE-ACS) and 1719 (33.8%) patients without ST elevation ACS (NSTE-ACS). In STE-ACS, the percentage of patients who failed to receive reperfusion was higher in women than in men either in the young (21.7% vs. 15.8%) than in the elderly (35.2% vs. 29.6%). There was a significant higher mortality in women in the younger age group (age-adjusted OR 1.52, 95% CI: 1.01-2.29), but there was no sex difference in the older group (age-adjusted OR 1.10, 95% CI: 0.87-1.41). Significantly sex differences in mortality were not seen in NSTE-ACS patients. Conclusions: In-hospital mortality from ACS is not different between older men and women. A higher short-term mortality can be seen only in women with STEMI and age of 65 or less

Revisiting Institutional Economics: Basic Concepts and Research Directions

In the last four decades there is a renewed interest within the economic theory for the institutional structures. Numerous, multiple and often unpredictable effects of institutions on economic process are differently reflected among the leading schools of economic analysis. Certainly, in this sense, the greatest attention should be given to the stream of economic thought known as institutional economics. This heterogeneous research orientation today is already clearly differentiated on Veblenian and the new institutional economics. The paper will make, in the light of its recorded achievements and the subjects of interest of its main protagonists, a general insight into the new institutional economics

Pharyngeal airway changes after bimaxillary orthognathic surgery - preliminary results

Introduction Dentofacial deformity, a deviation from normal facial proportions and dental relationships, is corrected by jaw repositioning in all three spatial planes, which changes the position and tension of the surrounding tissues, bones and muscles. These changes may also affect the dimensions of the pharyngeal airways (PA). Objective The aim of this study was to evaluate and compare three-dimensional PA changes in patients treated by a combination mandibular set-back/maxillary advancement versus patients that had bimaxillary advancement with genioplasty. Methods The sample consisted of 7 patients treated by combined mandibular set-back/maxillary advancement and 7 patients treated with bimaxillary advancement surgery. Nasopharyngeal (NP) volume, oropharyngeal (OP) volume and the area of maximum constriction (AMC) in the OP were measured on CbCt scans (2 mA/120 kV/12'' FOV) taken before (T1 ) and 3 months after surgery (T2). Paired samples t-test was used for analyzing statistical significance of changes (p≤0.05). Results OP volume and AMC increase after bimaxillary advancement was statistically significant, while for the mandibular set-back group the increase was non-significant. NP volume was not reduced in any of the two groups. No significant differences in PA dimensions were found between groups at neither T1 nor T2 time points. Conclusion Results suggest that the combination of mandibular set-back/maxillary advancement did not reduce airway dimensions, while bimaxillary advancement surgery led to a statistically significant increase in the OP dimensions.Uvod Dentofacijalni deformiteti predstavljaju odstupanje u odnosu na normalne proporcije lica i dentalne odnose. Leče se repozicioniranjem vilica u sve tri ravni prostora, što menja položaj i napetost okolnih mekih tkiva, kostiju i mišića. Ove promene mogu da utiču na veličinu faringealnih vazdušnih puteva. Cilj rada Cilj studije je bio da se procene i uporede trodimenzionalne promene faringealnih vazdušnih puteva kod osoba lečenih retropozicioniranjem mandibule uz pomeranje maksile unapred u odnosu na one lečene pomeranjem obe vilice unapred uz genioplastiku. Metode rada Ispitanike je činilo sedam pacijenata lečenih kombinacijom retropozicioniranja mandibule i anteriornog pozicioniranja maksile i sedam pacijenata lečenih bimaksilarnim anteriornim pozicioniranjem. Zapremine nazofarinksa, orofarinksa i površina najužeg dela orofarinksa mereni su na CBCT snimcima (2 tL/120 kV/12' FOV) napravljanim pre operacije (T1) i tri meseca nakon hirurške korekcije (T2). Studentov t-test za uparene uzorke korišćen je za analizu statističke značajnosti promena (p≤0,05). Rezultati Zapremina orofarinksa i površina najužeg dela orofarinksa povećale su se u obe grupe, i to statistički značajno kod ispitanika lečenih bimaksilarnim anteriornim pozicioniranjem, a statistički beznačajno kod ispitanika lečenih kombinacijam retropozicioniranja mandibule i anteriornog pozicioniranja maksile. Ni u jednoj grupi nije došlo do smanjenja zapremine nazofarinksa. Ni pre ni posle terapije nisu uočene značajne razlike u veličini vazdušnih puteva između grupa. Zaključak Rezultati ukazuju na to da retropozicioniranje mandibule uz anteriorno pozicioniranje maksile nije smanjilo dimenzije vazdušnih puteva, dok je bimaksilarno anteriorno pozicioniranje dovelo do statistički značajnog povećanja veličine orofarinksa

PROCESS MINING IN THE MANUFACTURING CONTEXT: REVIEW AND RECOMMENDATIONS

Modern manufacturing systems generate large amounts of data regarding the automation of business processes, which can be analyzed with process mining techniques. However, there is not enough consolidation on process mining methodologies or guidelines on properly applying numerous techniques in particular manufacturing scenarios. This paper aims to synthesize data on process mining projects' goals, utilize information systems, analyze business processes, and apply process mining types, software tools, and algorithms applied in the manufacturing industry. The data on the key research elements are gathered through a systematic literature review and analyzed with descriptive statistics and crosstabs analysis in SPSS. The research results enable process mining practitioners, business analysts, and business managers to gain insight into the trends and benefits of process mining application in the manufacturing context, as well as a guideline on how process mining techniques can be applied depending on the analyzed business process and process mining projects' goal

Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

Introduction The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.Uvod Autologna radiocefalična arteriovenska fistula je najbolji vaskularni pristup za bolesnike na hemodijalizi. Kod nekih bolesnika sa neadekvatnim krvnim sudovima potrebno je kreirati proksimalnu arteriovensku fistulu ili implantirati arteriovenski graft. Visoki procenat ranog zatajivanja grafta najčešće nastaje usled malog prečnika bazilične vene ili brahijalne arterije. Cilj ovoga rada je bio da prikaže novu hiruršku tehniku za kreiranje arteriovenskog grafta kod bolesnika sa neodgovarajućim dijametrom krvnih sudova. Prikaz bolesnika Urađena je implantacija PTFE grafta u vidu petlje na podlaktici u dva akta. U prvom aktu je u distalnom delu nadlaktice kreirana brahio-bazilična latero-terminalna arteriovenska fistula pod uglom od 90 stepeni. Posle četiri nedelje, kontrolnom doplersonografijom je konstatovano znatno povećanje prečnika bazilične vene i brahijalne arterije. U drugom aktu je bazilična vena poprečno presečena i sa dve temino-terminalne anastomoze u vidu petlje umetnut PTFE graft. Zaključak Ovako kreiran arteriovenski graft u dva akta davao je zadovoljavajući protok krvi bez komplikacija. Primarna funkcionalnost je iznosila 30 meseci, a sekundarna 50 meseci. U dostupnoj literaturi ovakav postupak nije objavljen, a preporučujemo ga kod bolesnika bez drugih mogućnosti za kreiranje vaskularnog pristupa

Effects of three types of functional appliances in class II malocclusions treatment - sagittal and vertical changes

Introduction/Objective Class II malocclusions are sagittal malocclusions characterized by a distal relationship of posterior teeth. Depending on the underlying problem, Class II malocclusions can be skeletal or dentoalveolar. Class II malocclusion treatment modality will depend on the cause, severity, and age. Growth modification is the best treatment option in growing patients with skeletal Class II malocclusions. The aim of this study was to establish and compare sagittal and vertical skeletal and dental changes in patients treated with the 'M block' appliance, the Frankel functional regulator, and the Balters' bionator. Methods The sample consisted of 70 patients diagnosed with skeletal Class II malocclusions (ANB > 4°) and mandibular retrognathism (SNB lt 80°). The patients were divided into three groups according to the type of appliance. All the patients went through the standard diagnostic procedure (anamnesis, clinical and functional analysis, study model, panoramic radiograph, and cephalometric analysis), and dental and skeletal age was determined. Treatment effects were analyzed on study models and cephalograms at the end of treatment. Results All the appliances led to significant mandibular anterior movement and sagittal growth, which reduced the ANB values. All three groups of patients presented with neutral growth pattern, upper incisor retrusion, and lower incisor protrusion at the end of treatment. Conclusion The results of this study indicate efficacy of all three appliances in skeletal Class II malocclusion treatment.Uvod/Cilj rada Malokluzije II klase su sagitalne nepravilnosti zagrižaja koje karakteriše distalni odnos bočnih zuba. U zavisnosti od toga koje strukture su u nepravilnom odnosu, dele se na skeletne i dentoalveolarne. Terapija II klase zavisi od uzroka, izraženosti i uzrasta. Najbolji vid terapije ukoliko pacijenti i dalje rastu je modifikacija rasta. Cilj ove studije bio je da se utvrde i uporede sagitalne i vertikalne promene na skeletnim i dentalnim strukturama u toku lečenja M blok-aparatom, Frenklovim regulatorom funkcije tip I i bionatorom po Baltersu tip I. Metode Sedamdeset ispitanika sa dijagnozom skeletnog distalnog zagrižaja (ANB > 4°) i mandibularnog retrognatizma (SNB lt 80°), prema vrsti aparata, podeljeni su u tri grupe. Svi su prošli kroz standardnu dijagnostiku (anamneza, klinička i funkcionalna analiza, analiza studijskih modela, ortopantomografskog i profilnog telerendgenskog snimka). Terapijski efekti i promene analizirani su na studijskim modelima i profilnom snimcima po završetku terapije. Rezultati Sva tri aparata dovela su do značajnog mezijalnog usmeravanja i sagitalnog rasta mandibule, što je smanjilo ANB ugao. U sve tri grupe je utvrđen neutralni rast, kao i retruzija gornjih i protruzija donjih sekutića. Zaključak Rezultati studije ukazuju na efikasnost sva tri ispitivana aparata u lečenju skeletnih malokluzija II klase

Immediate placement of extra-short implants in refined scapula tip microvascular free flaps: In house virtual planning and surgical technique – Proof of concept

Scapula tip flaps have been introduced in the literature as an ideal surgical treatment option for large defects in the horizontal plane of the maxilla. This article aims to present a unique step by step protocol for a near total maxillectomy with a pterygoid bone resection and consecutive microvascular reconstruction with a harvested scapula tip flap. The protocol includes immediate placement of extra-short implants in donor bone with the aid of Virtual Surgical Planning (VSP), and an in-house 3D printing of medical 3D models and surgical guides. So far, there has been no presented surgical technique combining immediate implant placement in the scapula region with simultaneous microvascular repair. This technique allows: tumour resection; flap harvesting; extra-short implant placements and reconstruction to be performed in one simultaneous procedure. The technique is presented with illustrations, VSP (presented on videos), radiographs, and surgical findings. We discovered that this refinement of the scapula tip surgery has enabled reconstructive procedures to be performed at the same time as implant placements, providing expedited functional and aesthetic outcomes in selected cases. Moreover, modification of the surgical technique could enhance the competence of the oropharyngeal edge. In conclusion, this new surgical protocol utilizing VSP, 3D models and simultaneous extra-short implant placement provides indispensable advantages for such a complicated surgical procedures, while significantly shortening the duration of surgery