Management of severe Class II malocclusion with sequential removable functional and orthodontic appliances: a case for MorthRCSEd examination

INTRODUCTION: Functional appliances are an effective way of treating skeletal Class II malocclusion in children and adolescents. A 12 month step-wise mandibular advancement protocol has been proved to enhance the condylar growth and improve the mandibular prognathism using Herbst appliance. OBJECTIVES: The following case report documented a 11 year-old Chinese girl with 11 mm overjet treated by a Phase I 12-month growth modification therapy using Twin Block appliance with Hyrax palatal expander and high pull headgear in a step-wise mandibular advancement protocol followed by a Phase II preadjusted Edgewise appliance therapy. This is one of the cases submitted for the Membership of Orthodontics Examination of the Royal College of Surgeons of Edinburgh.published_or_final_versio

Clinical effect of a topical herbal ointment on pain in temporomandibular disorders: A randomized placebo-controlled trial

Objectives: The aim of this study was to compare the effectiveness of using Ping On ointment and using petroleum jelly in the treatment of temporomandibular joint (TMJ) and masticatory muscle pain, in order to establish the true efficacy of Ping On ointment. Methods: In this randomized, double-blinded, placebo-controlled trial, 55 subjects with TMJ and/or masticatory pain (Group I patients according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) received Ping On ointment for 4 weeks, or placebo for 4 weeks. Subjects were evaluated with standard measures of efficacy: pain intensity measured by visual analogue scale and maximal comfortable mandibular opening, at baseline and again after 4 weeks of treatment. Results: Ping On ointment significantly reduced the symptoms of painful TMJs and/or masticatory muscles. Maximal comfortable mandibular opening also improved in the Ping On ointment group compared with the placebo, but was not clinically significant. Conclusions: This preliminary study suggests that topical application of Ping On ointment may be considered for further investigation as a potential first-line treatment modality, before prescribing analgesics, for the management of TMDs. It is topically applied, safe, reversible, and effective in managing TMDs and masticatory muscle pain. © 2009, Mary Ann Liebert, Inc.published_or_final_versio

Noninvasive Prenatal Diagnosis of Fetal Trisomy 18 and Trisomy 13 by Maternal Plasma DNA Sequencing

Massively parallel sequencing of DNA molecules in the plasma of pregnant women has been shown to allow accurate and noninvasive prenatal detection of fetal trisomy 21. However, whether the sequencing approach is as accurate for the noninvasive prenatal diagnosis of trisomy 13 and 18 is unclear due to the lack of data from a large sample set. We studied 392 pregnancies, among which 25 involved a trisomy 13 fetus and 37 involved a trisomy 18 fetus, by massively parallel sequencing. By using our previously reported standard z-score approach, we demonstrated that this approach could identify 36.0% and 73.0% of trisomy 13 and 18 at specificities of 92.4% and 97.2%, respectively. We aimed to improve the detection of trisomy 13 and 18 by using a non-repeat-masked reference human genome instead of a repeat-masked one to increase the number of aligned sequence reads for each sample. We then applied a bioinformatics approach to correct GC content bias in the sequencing data. With these measures, we detected all (25 out of 25) trisomy 13 fetuses at a specificity of 98.9% (261 out of 264 non-trisomy 13 cases), and 91.9% (34 out of 37) of the trisomy 18 fetuses at 98.0% specificity (247 out of 252 non-trisomy 18 cases). These data indicate that with appropriate bioinformatics analysis, noninvasive prenatal diagnosis of trisomy 13 and trisomy 18 by maternal plasma DNA sequencing is achievable

Systematic Identification of Spontaneous Preterm Birth-Associated RNA Transcripts in Maternal Plasma

<div><h3>Background</h3><p>Spontaneous preterm birth (SPB, before 37 gestational weeks) is a major cause of perinatal mortality and morbidity, but its pathogenesis remains unclear. Studies on SPB have been hampered by the limited availability of markers for SPB in predelivery clinical samples that can be easily compared with gestational age-matched normal controls. We hypothesize that SPB involves aberrant placental RNA expression, and that such RNA transcripts can be detected in predelivery maternal plasma samples, which can be compared with gestational age-matched controls.</p> <h3>Principal Findings</h3><p>Using gene expression microarray to profile essentially all human genes, we observed that 426 probe signals were changed by >2.9-fold in the SPB placentas, compared with the spontaneous term birth (STB) placentas. Among the genes represented by those probes, we observed an over-representation of functions in RNA stabilization, extracellular matrix binding, and acute inflammatory response. Using RT-quantitative PCR, we observed differences in the RNA concentrations of certain genes only between the SPB and STB placentas, but not between the STB and term elective cesarean delivery placentas. Notably, 36 RNA transcripts were observed at placental microarray signals higher than a threshold, which indicated the possibility of their detection in maternal plasma. Among them, the <em>IL1RL1</em> mRNA was tested in plasma samples taken from 37 women. It was detected in 6 of 10 (60%) plasma samples collected during the presentation of preterm labor (≤32.9 weeks) in women eventually giving SPB, but was detected in only 1 of 27 (4%) samples collected during matched gestational weeks from women with no preterm labor (Fisher exact test, p = 0.00056).</p> <h3>Conclusion</h3><p>We have identified 36 SPB-associated RNA transcripts, which are possibly detectable in maternal plasma. We have illustrated that the <em>IL1RL1</em> mRNA was more frequently detected in predelivery maternal plasma samples collected from women resulting in SPB than the gestational-age matched controls.</p> </div

An anti-inflammatory and analgesic ointment for the relief of temporomandibular joint and masticatory muscle pain

AIM: To compare the effectiveness of using a topical cream, Ping On ointment, or Vaseline in the treatment of temporomandibular joint (TMJ) and masticatory muscle pain, in order to establish the true effi cacy of Ping On ointment. SUBJECTS AND METHOD: In this randomized, double-blinded, placebo-controlled trial, 55 subjects with TMJ and/or masticatory pain (Group 1 patients according to the Research Diagnostic Criteria for Temporomandibular Disorder) received Ping On Ointment for 4 weeks or a placebo for 4 weeks. The subjects were evaluated with standard measures of effi cacy: pain intensity measured by visual analogue scale and maximal comfortable mandibular opening, at baseline and after 4 weeks of treatment. RESULTS: Ping On ointment signifi cantly reduced the symptoms of painful TMJs and/or masticatory muscles. Maximal comfortable mandibular opening also improved signifi cantly with Ping On ointment compared with the placebo, but this was not clinically signifi cant. CONCLUSIONS: Topical application of Ping On ointment may be considered to be one of the fi rst line treatment modalities before prescribing analgesics, for the management of temporomandibular dysfunction (TMD). It is topically applied, with minimal systemic effect, reversible, economical and effective in managing TMD and masticatory muscle pain.link_to_subscribed_fulltex

Traditional chinese medicine and temporomandibular disorders management: a review

Background: Temporomandibular Disorders is a prevalent disease affecting a large population worldwide. Traditional Chinese medicine, as a part of complementary alternative medicine, has been used in treating TMDs for thousands of years in the Chinese society and being postulated beneficial. The aim of this article is to review the possible mechanisms and effectiveness of various TCM approaches in treating TMDs. Methods: Literatures in English and Chinese including clinical trials with sample randomization and control groups and basic scientific studies were analysed. Conclusions: The most common TCM treatment modalities in treating TMDs include acupuncture, moxibustion with or without acupuncture and medicated compress. A review of these TCM treatment modalities showed that possible beneficial effects existed in TMDs management. Acupuncture seems to be the most evidenced based treatment modality among the three and being investigated the most. However, due to a lack of evidence based studies, more scientific and rigorous randomised controlled clinical trials are needed to further evaluate TCM's safety, efficacy and effectiveness.link_to_subscribed_fulltex

Gene therapy: an alternative strategy for correction of severe craniofacial deformities

Objective. Gene therapy is a novel strategy for correction of severe deformities. To test whether such therapy could be used to control condylar growth, an experimental model entailing Sprague-Dawley rats was developed. Methods. Either recombinant adenoassociated virus (rAAV)–mediated angiogenesis inhibitor (experimental group) or rAAVmediated reporter expressing green fluorescent protein (control group) was transduced into the temporomandibular joint of Sprague-Dawley rats for 3 weeks. Rats in both groups were sacrificed and samples were collected for image analysis, immunostaining, periodic acid-Schiff staining, and tartrate-resistant acid phosphatase staining. Vascular formations, bone formation, and osteoclast activities of the two groups were compared. Results. Virus vector–mediated angiogenesis inhibitor expression in condylar cartilage inhibited vascular formation, bone formation, osteoclast activity, and condylar growth. Conclusion. Gene therapy can be considered an alternative strategy for the correction of severe craniofacial growth deformities

Management of severe class II malocclusion with sequential fixed functional and orthodontic appliances: a case for MOrhRCSEd examination

Fixed functional appliance is an effective way of treating skeletal Class II malocclusion in children and adolescents. The following case report documented a 13-year-old boy with 15 mm overjet treated by a phase I 12-month growth modification therapy using Herbst appliance with Hyrax palatal expander and high pull headgear in a stepwise mandibular advancement protocol followed by a phase II pre-adjusted edgewise appliance therapy. It is one of the cases submitted for the Membership of Orthodontics Examination of the Royal College of Surgeons of Edinburgh

Outbreak of Fusarium keratitis - Hong Kong experience

Aim: To describe a regional outbreak of Fusarium keratitis among contact lens wearers in Hong Kong. Methods: In this retrospective hospital-based study, all cases of fungal keratitis among contact lens wearers receiving treatment in 1 of the 7 hospital clusters in Hong Kong (United Christian Hospital and Tseung Kwan O Hospital)from May 2005 to September 2006 were reviewed. Additional clinical information was obtained through telephone interviews conducted by the same trained interviewer. Results: Fourteen patients (16 affected eyes) were identified as contact lens wearers with culture positive Fusarium keratitis during the study period. The mean age was 31.3 years (SD, 9.4 years; range, 18 to 49 years) with female predominance (male to female ratio, 3:11). Eleven of 12 patients (92%) reported using ReNu MoistureLoc multipurpose contact lens solution prior to the onset of infection. The onset of symptoms ranged from 1 to 7 days (average, 2.5 days). Five patients (36%) were treated with topical antibiotics without the need for specific antifungal therapy. Nine patients (64%) were treated with topical antifungal therapy. No patients required therapeutic penetrating keratoplasty. Fourteen eyes (87.5%) resolved with vision 20/40 or better and no eyes had vision 20/60 or worse. No recurrence of fungal lesions was noted. Conclusions: These findings showed that the majority of the affected patients were using ReNu solution prior to infection. Early commencement of either intensive topical broad-spectrum antibiotics or antifungal treatment was associated with improved visual outcome. © 2007 Scientific Communications International Limited.link_to_subscribed_fulltex