Comment on Reply to Comment of Finger et al. (2013) on: 'Evidence for an Early-Middle Miocene age of the Navidad Formation (central Chile): Paleontological, paleoclimatic and tectonic implications' of Gutiérrez et al. (2013, Andean Geology 40 (1): 66-78)

Indexación: Web of Science; ScieloIn their answer to our Comment (Finger et al., 2013), Le Roux et al. (2013) misunderstand several of our remarks and present what we view as f lawed arguments, principally their case for a shallow-marine environment for part of the Navidad Formation. We do not wish to see this exchange evolve into an endless discussion, but we feel obligated to clarify some points. We think this is necessary because of history and importance of the Navidad Formation as the reference for the marine Miocene of Chile. Here we also expound upon some concepts relevant to the distinction between shallow-and deep-marine environments

Gingival crevicular fluid alkaline phosphatase activity in relation to pubertal growth spurt and dental maturation: A multiple regression study

Introduction: The identification of the onset of the pubertal growth spurt has major clinical implications when dealing with orthodontic treatment in growing subjects. Aim: Through multivariate methods, this study evaluated possible relationships between the gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity and pubertal growth spurt and dentition phase. Materials and methods: One hundred healthy growing subjects (62 females, 38 males; mean age, 11.5±2.4 years) were enrolled into this doubleblind, prospective, cross-sectional-design study. Phases of skeletal maturation (pre - pubertal, pubertal, post - pubertal) was assessed using the cervical vertebral maturation method. Samples of GCF for the ALP activity determination were collected at the mesial and distal sites of the mandibular central incisors. The phases of the dentition were recorded as intermediate mixed, late mixed, or permanent. A multinomial multiple logistic regression model was used to assess relationships of the enzymatic activity to growth phases and dentition phases. Results: The GCF ALP activity was greater in the pubertal growth phase as compared to the pre - pubertal and post - pubertal growth phases. Significant adjusted odds ratios for the GCF ALP activity for the pre - pubertal and post - pubertal subjects, in relation to the pubertal group, were 0.76 and 0.84, respectively. No significant correlations were seen for the dentition phase. Conclusions: The GCF ALP activity is a valid candidate as a non - invasive biomarker for the identification of the pubertal growth spurt irrespective of the dentition phase

Radiographic growth indicators: The issue of diagnostic reliability and clinical feasibility

The use of radiographic growth indicators, such as the hand-and-wrist maturation (HWM) and cervical vertebral maturation (CVM)methods, has been recommended in previous clinical trials on the skeletal effects obtained by functional treatment in growing ClassII patients. The concept behind the use of indicators resides in the identification of the pubertal growth spurt in individual patients allowing the delivery of the treatment at this specific stage of skeletal maturation when the mandible response is expected to be maximum growth. Interestingly, while many of the former types of investigations reported a poor correlation between the stages of growth indicators (mainly the CVM) and mandibular growth spurt, most of the latter type of investigations reported clinically relevant favorable effects when the growth indicators are used. It is perhaps that investigations are still missing the relevant piece of evidence.The first critical issue relates to the correlation between two variables (i.e., stages of maturation and mandibular growth) that does not imply diagnostic accuracy, as it has been extensively reported for the case of dental maturation. The other relevant issue relates to the clinical feasibility of the repetition of the recording when dealing with invasive methods based on X-rays, irrespective of whether the methods are accurate. Meanwhile, more opportunity will be given by the use of non-invasive (serum or GCF) biomarkers. According to all these considerations, more reports will be necessary to elucidate the role of the growth indicators in orthodontics fully

Disc Displacement with Intermittent Lock: A Case Series of a Rarely-addressed Disorder

Aim: We describe a series of five cases presented with disc displacement with reduction and intermittent lock (DDwRIL), from presentation to follow-up. Background: Disc displacement with reduction with intermittent lock is a temporomandibular disorder in which the disc is displaced and reduced, along with temporary locking leading to limited opening. Due to the fact that it has only been recognized as a separate disease in 2013, there is no clear guideline on the management of these cases. Cases descriptions: We present five cases of clinically established DDwRIL in different age groups. We walk through clinical presentation and diagnostic workup. Several modalities were used in the management of described cases from noninterventional management with counselling only to physical and splint therapies. Conclusion: Disc displacement with reduction, with intermittent locking is a challenging temporomandibular disorder with risk to progress into disc displacement without reduction and hence necessitates a tailored approach and long-term follow-up. Clinical significance: To our knowledge, this is the first case series reported on DDwRIL which provides detailed clinical presentation, examination, management, and discussion for orofacial pain practitioners as well as for future studies on this disease

Extracciones dentarias en pacientes en tratamiento con anticoagulantes: revisión de la literatura

Objetivo del trabajo. En pacientes en terapia con anticoagulantes orales, una simple extracción puede provocar hemorragias importantes. En la literatura se describen dos enfoques terapéuticos en casos de intervenciones quirúrgicas en esta categoría de pacientes. Uno propone la reducción de la dosis terapéutica del fármaco, mientras que el segundo sugiere la sustitución con heparina. El objetivo de este trabajo es revisar la literatura que trata este tema con el fin de obtener un protocolo ideal. Conclusiones. En caso de extracciones simples es suficiente usar anestesia con vasoconstrictor (en el caso de que no haya otras contraindicaciones), realizar suturas bien tensadas, aplicar coadyuvantes hemostáticos locales y ácido tranexámico tópico. Solo en casos de intervenciones más complejas, o con valores de INR mayores a 3,5, será necesario reducir la dosis del fármaco y consecuente sustitución con heparina de acuerdo a las instrucciones del hematólogo y del cardiólogo. Aim of the work. In patients treated with oral anticoagulants, even simple tooth extractions can produce large hemorrhages. There are two main therapeutic outlines suggested in literature in case of little oral surgery. The first one is based on the reduction of the therapeutic dose of the drug, and the second one on the substitution with heparin. The aim of this paper was to review the.literature on the management of patients treated with anticoagulants in order to obtain univocal guidelines. Conclusion. In case of simple tooth extractions generally a vasoconstrictive anaesthetic (if there are no other contraindications), tight sutures, the application of hemostats and tronexamic acid are enough. Only in case of more complex surgery or of INR values higher than 3,5 it is necessory to reduce the anticoagulant dose or to change the therapy with heparin, if agreed by the hoemotologist and/ or the cardiologist

Outcome stability of orthopaedic treatment of skeletal Class III malocclusion: A study of prognostic agreement between three models

Introduction: Long-term stability of the treatment outcome of skeletal Class III malocclusion is always not achievable, thereforeseveral prediction models of stability of orthopaedic treatment of the Class III malocclusion have been proposed. Aim: This cross-sectional study was aimed at the evaluation of the prognostic agreement and association between three differentprediction models based on skeletal parameters recorded on lateral cephalograms. Materials and methods: A total of 75 subjects (34 females and 41 males, age range 7-11, mean age 9.1±1.2years) having skeletal ClassIII malocclusion were included in the study. Prediction models reported by Baccetti et al. 2004 (prediction model 1), Moon et al.2005 (prediction model 2) and Yoshida et al. 2006 (prediction model 3), were considered. Percentage agreement and unweighted kappa coefficient evaluated the agreement between the prediction models in terms of stable or unstable cases. Multiple regressions were run to evaluate the association between the absolute scores obtained from each of the prediction model (prediction scores). Results: Percentage agreement ranged from 77.3% (models 2 and 3) to 89.3%, (models 1 and 2) and corresponding unweighted kappa coefficients ranged from 0.099 (models 1 and 3) to 0.205 (models 2 and 3). The prediction score from model 3 was significantly associated with those from both the other models; on the contrary, prediction scores from models 1 and 2 were not significantly associated. Conclusions: Agreement in terms of stability or instability outcome derived from these models is only partial and not satisfactory,even though significant association between the prediction scores denotes a common biological meaning of the models

Treatment effects of fixed functional appliances alone or in combination with multibracket appliances: A systematic review and meta-analysis

"Abstract Objective: To assess skeletal and dentoalveolar effects of fixed functional appliances, alone or in combination with multibracket appliances (comprehensive treatment), on Class II malocclusion in pubertal and postpubertal patients. Materials and Methods: Literature survey was conducted using the Medline, SCOPUS, LILACS, and SciELO databases and The Cochrane Library, and through a manual search. The studies retrieved had to have a matched untreated control group. No restrictions were set regarding the type of fixed appliance, treatment length, or to the cephalometric analysis used. Data extraction was mostly predefined at the protocol stage by two authors. Supplementary mandibular elongation was used for the meta-analysis. Results: Twelve articles qualified for the final analysis of which eight articles were on pubertal patients and four were on postpubertal patients. Overall supplementary total mandibular longationsas mean (95 confidence interval) were 1.95 mm (1.47 to 2.44) and 2.22 mm (1.63to 2.82) among pubertal patients and -1.73 mm (-2.60 to -0.86) and 0.44 mm (-0.78 to 1.66) among postpubertal patients, for the functional and comprehensive treatments, respectively. For pubertal subjects, maxillary growth restraint was also reported. Nevertheless, skeletal effects alone would not account for the whole Class II correction even in pubertal subjects with dentoalveolar effects always present. Conclusions: Fixed functional treatment is effective in treating Class II malocclusion with skeletal effects when performed during the pubertal growth phase, very few data are available on postpubertal patients.

Low Arousal Threshold Estimation Predicts Failure of Mandibular Advancement Devices in Obstructive Sleep Apnea Syndrome

Introduction: The treatment of choice for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP). However, CPAP is usually poorly tolerated and mandibular advancement devices (MADs) are an alternative innovative therapeutic approach. Uncertainty still remains as to the most suitable candidates for MAD. Herein, it is hypothesized that the presence of low arousal threshold (low ArTH) could be predictive of MAD treatment failure. Methods: A total of 32 consecutive patients, with OSAS of any severity, who preferred an alternate therapy to CPAP, were treated with a tailored MAD aimed at obtaining 50% of their maximal mandibular advancement. Treatment response after 6 months of therapy was defined as AHI 58.3%. Results: There were 25 (78.1%) responders (p-value < 0.01) at 6 months. Thirteen patients (40.6%) in the non-severe group reached AHI lower than 5 events per hour. MAD treatment significantly reduced the median AHI in all patients from a median value of 22.5 to 6.5 (74.7% of reduction, p-value < 0.001). The mandibular advancement device reduced AHI, whatever the disease severity. A significant higher reduction of Delta AHI, after 6 months of treatment, was found for patients without low ArTH. Conclusions: Low ArTH at baseline was associated with a poorer response to MAD treatment and a lower AHI reduction at 6 months. A non-invasive assessment of Low ArTH can be performed through the Edwards' score, which could help to identify an endotype with a lower predicted response to oral appliances in a clinical setting

Tracheal sleeve pneumonectomy for bronchogenic carcinoma

For a long time, primary tumors arising less than 2 cm distal to the carina have presented a contraindication to surgical excision. Tracheal sleeve pneumonectomy technique allows carinal resection and reconstruction but still carries considerable postoperative complications. From 1983 to 1992 we performed 27 right tracheal sleeve pneumonectomies and one left. Fourteen patients had N0 nodes, nine had N1, and five had N2. No anastomotic complications, either fistula or stenosis, were observed. Successful outcome depends on meticulous attention to surgical details and careful anaesthetic management with a new ventilation tube. One patient died on the twenty- second postoperative day from myocardial infarction. Complications included pneumonia (one), vocal cord paresis (two), and pleural empyema without bronchial fistula (one). Conservative treatment allowed complete recovery from all complications. There are seven patients alive at 4 years after operation and one at 5 years. Six patients have been disease-free for between 1 and 32 months. Two patients died free of disease at 13 and 42 months. Two patients died of mediastinal recurrence and 10 of distant metastases within 6 and 54 months

Abundance stratification in Type Ia Supernovae - II: The rapidly declining, spectroscopically normal SN 2004eo

The variation of properties of Type Ia supernovae, the thermonuclear explosions of Chandrasekhar-mass carbon-oxygen white dwarfs, is caused by different nucleosynthetic outcomes of these explosions, which can be traced from the distribution of abundances in the ejecta. The composition stratification of the spectroscopically normal but rapidly declining SN2004eo is studied performing spectrum synthesis of a time-series of spectra obtained before and after maximum, and of one nebular spectrum obtained about eight months later. Early-time spectra indicate that the outer ejecta are dominated by oxygen and silicon, and contain other intermediate-mass elements (IME), implying that the outer part of the star was subject only to partial burning. In the inner part, nuclear statistical equilibrium (NSE) material dominates, but the production of 56Ni was limited to ~0.43 \pm 0.05 Msun. An innermost zone containing ~0.25 Msun of stable Fe-group material is also present. The relatively small amount of NSE material synthesised by SN2004eo explains both the dimness and the rapidly evolving light curve of this SN.Comment: 12 pages, 7 figures. Accepted for publication in MNRA