Development of a Prediction Model for Short-Term Success of Functional Treatment of Class II Malocclusion

(1) Background: The nature of the changes that contribute to Class II correction with functional appliances is still controversial. A broad variation in treatment responses has been reported. The purpose of this study was to find cephalometric predictors for individual patient responsiveness to twin-block treatment in patients with Class II Division 1 malocclusion; (2) Methods: The study was performed on a sample of 39 pubertal patients (21 females, 18 males) treated with the twin block appliance. Lateral cephalograms were available at the start of the treatment (T1) and at the end of functional therapy (T2). The outcome variable was the T2-T1 change in the sagittal position of the soft tissue pogonion with respect to the vertical line perpendicular to the Frankfort plane and passing through point subnasale. The predictive variables were age, gender at T1, and all the cephalometric parameters measured T1. Forward stepwise linear regression withpvalue to enter 0.05 andpvalue to leave 0.10 was applied; (3) Results: The only significant predictive variable that was selected was the Co-Go-Me angle (p= 0.000); (4) Conclusions: A greater advancement of the soft tissue chin on the profile is expected with smaller pretreatment values of Co-Go-Me angle

Força da musculatura respiratória de pacientes tetraplégicos sentados e em supino

Most patients with high spinal cord lesion (CÍ-CÓ) present decreased respiratory function, which is the principal cause of mortality among these individuals, especially during the early period pos lesion. These patients usually show reduced pulmonary volumes and capacities, impaired pulmonary function, and decreased respiratory muscle strength. Ten patients with Spinal Cord Injury (C4 to C7) were studied in order to evaluate the maximal inspiratory pressure (PImáx), maximal expiratory pressure (PEmáx), and forced vital capacity (F VC), which were measuredin supine and sitting positions. The measurements were taken according to international standards, and determined in a random order. The researcher was blinded to the measurement values. The obtained data were compared with the predict values in both positions (supine and sitting) according to Wicoxon's Test. The significance was set at 0.05 level. The obtained values of PImax, PEmáx, and FVC, in the sitting position, were smaller than the expected values (PImáx = 60 ± 17,15 cm H20 , 50% predicted; PEmáx = 22 ± 5,69 cm H2O,10% predicted and CVF = 1,60 ± 0,55 L, 41% predicted) (p < 0,05). When the positions were compared, the results in the sitting position were lower than in the supineposition (PImáx = 71 + 25,42 cmH20, 60% predicted; PEmáx = 31 + 15,92 cm H20,14% predicted and CVF =2,22 ± 0,64L, 53% predicted) (p < 0,05). In conclusion, tetraplegic patients presented decreased respiratory muscles strength. In addition, the FVC values were higher in the supine position than in the sitting position.A maioria dos indivíduos com lesão medular alta (C4 a C6) apresentam diminuição na sua função respiratória a partir do momento da lesão, sendo esta a principal causa de mortalidade nesses indivíduos, nosprimeiros meses após a lesão. Assim, estes pacientes apresentam diminuição de volumes e capacidades pulmonares, da função pulmonar e da força dos músculos respiratórios, porém o percentual de perda de alguns destes parâmetros, avaliados na posição sentada, varia entre os autores. Dez pacientes com lesão medular (C4 a C7) foram avaliados para mensurar a pressão inspiratória máxima (PImáx), pressão expiratória máxima (PEmáx) e capacidade vital forçada (CVF), nas posições supina e sentada. O método de medidas seguiu padronização internacional, em seqüência aleatória, com o examinador "cego" sobre o valor das medidas. Os dados obtidos foram comparados com os valoresprevistos e entre as duas posições, de acordo com a prova de Wilcoxon, com nível de significância de 0,05 ou 5%. Os valores obtidos de PImáx, PEmáx e CVF, na posição sentada, foram menores que os valores previstos (PImáx = 60 ± 17,15 cm H20, 50% do previsto; PEmáx = 22 ± 5,69 cm H20, 10% do previsto; CVF = 1,60 ± 0,55 L, 4 1% do previsto) (p < 0,05); quando comparadas as posições, os valores na posição sentadaforam menores que na posição supina (PImáx = 71 ± 25,42 cm H20, 60% do previsto; PEmáx = 31 ± 15,92 cmH20,14% do previsto; CVF = 2,22 ± 0,64L, 53% do previsto)(p < 0,05). Concluímos, portanto, que, pacientes tetraplégicos apresentam diminuição da força da musculatura respiratóriae da CVF e que as perdas de CVF são menores na posição supina do que na posição sentada

A Combined Robotic and Cognitive Training for Locomotor Rehabilitation: Evidences of Cerebral Functional Reorganization in Two Chronic Traumatic Brain Injured Patients

It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found

Kappa Index Versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders

Cerebrospinal fluid (CSF) kappa free light chains (KFLC) are gaining increasing interest as markers of intrathecal immunoglobulin synthesis. The main aim of this study was to assess the diagnostic accuracy (AUC) of the kappa index (CSF/serum KFLC divided by the CSF/serum albumin ratio) compared to CSF oligoclonal IgG bands (OCB) in predicting Multiple Sclerosis (MS) or a central nervous system infectious/inflammatory disorder (CNSID)

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Observation of the B0 → ρ0ρ0 decay from an amplitude analysis of B0 → (π+π−)(π+π−) decays

Proton–proton collision data recorded in 2011 and 2012 by the LHCb experiment, corresponding to an integrated luminosity of 3.0 fb−1 , are analysed to search for the charmless B0→ρ0ρ0 decay. More than 600 B0→(π+π−)(π+π−) signal decays are selected and used to perform an amplitude analysis, under the assumption of no CP violation in the decay, from which the B0→ρ0ρ0 decay is observed for the first time with 7.1 standard deviations significance. The fraction of B0→ρ0ρ0 decays yielding a longitudinally polarised final state is measured to be fL=0.745−0.058+0.048(stat)±0.034(syst) . The B0→ρ0ρ0 branching fraction, using the B0→ϕK⁎(892)0 decay as reference, is also reported as B(B0→ρ0ρ0)=(0.94±0.17(stat)±0.09(syst)±0.06(BF))×10−6

Study of the rare B-s(0) and B-0 decays into the pi(+) pi(-) mu(+) mu(-) final state

A search for the rare decays $B_s^0 \to \pi^+\pi^-\mu^+\mu^-$ and $B^0 \to \pi^+\pi^-\mu^+\mu^-$ is performed in a data set corresponding to an integrated luminosity of 3.0 fb$^{-1}$ collected by the LHCb detector in proton-proton collisions at centre-of-mass energies of 7 and 8 TeV. Decay candidates with pion pairs that have invariant mass in the range 0.5-1.3 GeV/$c^2$ and with muon pairs that do not originate from a resonance are considered. The first observation of the decay $B_s^0 \to \pi^+\pi^-\mu^+\mu^-$ and the first evidence of the decay $B^0 \to \pi^+\pi^-\mu^+\mu^-$ are obtained and the branching fractions are measured to be $\mathcal{B}(B_s^0 \to \pi^+\pi^-\mu^+\mu^-)=(8.6\pm 1.5\,({\rm stat}) \pm 0.7\,({\rm syst})\pm 0.7\,({\rm norm}))\times 10^{-8}$ and $\mathcal{B}(B^0 \to \pi^+\pi^-\mu^+\mu^-)=(2.11\pm 0.51\,({\rm stat}) \pm 0.15\,({\rm syst})\pm 0.16\,({\rm norm}) )\times 10^{-8}$, where the third uncertainty is due to the branching fraction of the decay $B^0\to J/\psi(\to \mu^+\mu^-)K^*(890)^0(\to K^+\pi^-)$, used as a normalisation.A search for the rare decays Bs0→π+π−μ+μ− and B0→π+π−μ+μ− is performed in a data set corresponding to an integrated luminosity of 3.0 fb−1 collected by the LHCb detector in proton–proton collisions at centre-of-mass energies of 7 and 8 TeV . Decay candidates with pion pairs that have invariant mass in the range 0.5–1.3 GeV/c2 and with muon pairs that do not originate from a resonance are considered. The first observation of the decay Bs0→π+π−μ+μ− and the first evidence of the decay B0→π+π−μ+μ− are obtained and the branching fractions, restricted to the dipion-mass range considered, are measured to be B(Bs0→π+π−μ+μ−)=(8.6±1.5 (stat)±0.7 (syst)±0.7(norm))×10−8 and B(B0→π+π−μ+μ−)=(2.11±0.51(stat)±0.15(syst)±0.16(norm))×10−8 , where the third uncertainty is due to the branching fraction of the decay B0→J/ψ(→μ+μ−)K⁎(892)0(→K+π−) , used as a normalisation.A search for the rare decays Bs0→π+π−μ+μ− and B0→π+π−μ+μ− is performed in a data set corresponding to an integrated luminosity of 3.0 fb−1 collected by the LHCb detector in proton–proton collisions at centre-of-mass energies of 7 and 8 TeV . Decay candidates with pion pairs that have invariant mass in the range 0.5–1.3 GeV/c2 and with muon pairs that do not originate from a resonance are considered. The first observation of the decay Bs0→π+π−μ+μ− and the first evidence of the decay B0→π+π−μ+μ− are obtained and the branching fractions, restricted to the dipion-mass range considered, are measured to be B(Bs0→π+π−μ+μ−)=(8.6±1.5 (stat)±0.7 (syst)±0.7(norm))×10−8 and B(B0→π+π−μ+μ−)=(2.11±0.51(stat)±0.15(syst)±0.16(norm))×10−8 , where the third uncertainty is due to the branching fraction of the decay B0→J/ψ(→μ+μ−)K⁎(892)0(→K+π−) , used as a normalisation.A search for the rare decays $B_s^0 \to \pi^+\pi^-\mu^+\mu^-$ and $B^0 \to \pi^+\pi^-\mu^+\mu^-$ is performed in a data set corresponding to an integrated luminosity of 3.0 fb$^{-1}$ collected by the LHCb detector in proton-proton collisions at centre-of-mass energies of 7 and 8 TeV. Decay candidates with pion pairs that have invariant mass in the range 0.5-1.3 GeV/$c^2$ and with muon pairs that do not originate from a resonance are considered. The first observation of the decay $B_s^0 \to \pi^+\pi^-\mu^+\mu^-$ and the first evidence of the decay $B^0 \to \pi^+\pi^-\mu^+\mu^-$ are obtained and the branching fractions, restricted to the dipion-mass range considered, are measured to be $\mathcal{B}(B_s^0 \to \pi^+\pi^-\mu^+\mu^-)=(8.6\pm 1.5\,({\rm stat}) \pm 0.7\,({\rm syst})\pm 0.7\,({\rm norm}))\times 10^{-8}$ and $\mathcal{B}(B^0 \to \pi^+\pi^-\mu^+\mu^-)=(2.11\pm 0.51\,({\rm stat}) \pm 0.15\,({\rm syst})\pm 0.16\,({\rm norm}) )\times 10^{-8}$, where the third uncertainty is due to the branching fraction of the decay $B^0\to J/\psi(\to \mu^+\mu^-)K^*(890)^0(\to K^+\pi^-)$, used as a normalisation

Precise measurements of the properties of the B-1(5721)(0,+) and B-2*(5747)(0,+) states and observation of B-+,B-0 pi(-,+) mass structures

Invariant mass distributions of $B^+\pi^-$ and $B^0\pi^+$ combinations are investigated in order to study excited B mesons. The analysis is based on a data sample corresponding to $3.0 fb^{-1}$ of $pp$ collision data, recorded by the LHCb detector at centre-of-mass energies of 7 and 8 TeV. Precise measurements of the masses and widths of the $B_1(5721)^{0,+}$ and $B_2^*(5747)^{0,+}$ states are reported. Clear enhancements, particularly prominent at high pion transverse momentum, are seen over background in the mass range $5850$-$6000$ MeV in both $B^+\pi^-$ and $B^0\pi^+$ combinations. The structures are consistent with the presence of four excited B mesons, labelled $B_J(5840)^{0,+}$ and $B_J(5960)^{0,+}$, whose masses and widths are obtained under different hypotheses for their quantum numbers.Invariant mass distributions of B$^{+}$ π$^{−}$ and B$^{0}$ π$^{+}$ combinations are investigated in order to study excited B mesons. The analysis is based on a data sample corresponding to 3.0 fb$^{−1}$ of pp collision data, recorded by the LHCb detector at centre-of-mass energies of 7 and 8 TeV. Precise measurements of the masses and widths of the B$_{1}$(5721)$^{0,+}$ and B$^{2}$(5747)$^{0,+}$ states are reported. Clear enhancements, particularly prominent at high pion transverse momentum, are seen over background in the mass range 5850-6000 MeV in both B$^{+}$ π$^{−}$ and B$^{0}$ π$^{+}$ combinations. The structures are consistent with the presence of four excited B mesons, labelled B$_{J}$ (5840)$^{0,+}$ and B$_{J}$ (5960)$^{0,+}$, whose masses and widths are obtained under different hypotheses for their quantum numbers.Invariant mass distributions of B+pi- and B0pi+ combinations are investigated in order to study excited B mesons. The analysis is based on a data sample corresponding to 3.0 fb-1 of pp collision data, recorded by the LHCb detector at centre-of-mass energies of 7 and 8 TeV. Precise measurements of the masses and widths of the B_1(5721)^(0,+) and B_2*(5747)^(0,+) states are reported. Clear enhancements, particularly prominent at high pion transverse momentum, are seen over background in the mass range 5850--6000 MeV in both B+pi- and B0pi+ combinations. The structures are consistent with the presence of four excited B mesons, labelled B_J(5840)^(0,+) and B_J(5960)^(0,+), whose masses and widths are obtained under different hypotheses for their quantum numbers

Measurement of the lifetime of the Bc+B_c^+ meson using the Bc+→J/ψπ+B_c^+\rightarrow J/\psi\pi^+ decay mode

The difference in total widths between the $B_c^+$ and $B^+$ mesons is measured using 3.0fb$^{-1}$ of data collected by the LHCb experiment in 7 and 8 TeV centre-of-mass energy proton-proton collisions at the LHC. Through the study of the time evolution of $B_c^+ \rightarrow J/\psi \pi^+$ and $B^+\rightarrow J/\psi K^+$ decays, the width difference is measured to be $\Delta\Gamma \equiv \Gamma_{B_c^+} - \Gamma_{B^+} = 4.46 \pm 0.14 \pm 0.07mm^{-1}c,$ where the first uncertainty is statistical and the second systematic. The known lifetime of the $B^+$ meson is used to convert this to a precise measurement of the $B_c^+$ lifetime, $\tau_{B_c^+} = 513.4 \pm 11.0 \pm 5.7fs,$ where the first uncertainty is statistical and the second systematic.The difference in total widths between the B+ c and B+ mesons is measured using 3.0 fb−1 of data collected by the LHCb experiment in 7 and 8 TeV centre-of-mass energy proton-proton collisions at the LHC. Through the study of the time evolution of B+ c → J/ψπ+ and B+ → J/ψK+ decays, the width difference is measured to be ∆Γ ≡ ΓB + c − ΓB+ = 4.46 ± 0.14 ± 0.07 mm−1 c, where the first uncertainty is statistical and the second systematic. The known lifetime of the B+ meson is used to convert this to a precise measurement of the B+ c lifetime, τB + c = 513.4 ± 11.0 ± 5.7 fs, where the first uncertainty is statistical and the second systematic.The difference in total widths between the Bc+ and B+ mesons is measured using a data sample corresponding to an integrated luminosity of 3.0 fb−1 collected by the LHCb experiment in 7 and 8 TeV centre-of-mass energy proton–proton collisions at the LHC. Through the study of the time evolution of Bc+→J/ψπ+ and B+→J/ψK+ decays, the width difference is measured to be ΔΓ≡ΓBc+−ΓB+=4.46±0.14±0.07 mm−1c, where the first uncertainty is statistical and the second systematic. The known lifetime of the B+ meson is used to convert this to a precise measurement of the Bc+ lifetime, τBc+=513.4±11.0±5.7 fs, where the first uncertainty is statistical and the second is systematic.The difference in total widths between the Bc+ and B+ mesons is measured using a data sample corresponding to an integrated luminosity of 3.0 fb−1 collected by the LHCb experiment in 7 and 8 TeV centre-of-mass energy proton–proton collisions at the LHC. Through the study of the time evolution of Bc+→J/ψπ+ and B+→J/ψK+ decays, the width difference is measured to be ΔΓ≡ΓBc+−ΓB+=4.46±0.14±0.07 mm−1c, where the first uncertainty is statistical and the second systematic. The known lifetime of the B+ meson is used to convert this to a precise measurement of the Bc+ lifetime, τBc+=513.4±11.0±5.7 fs, where the first uncertainty is statistical and the second is systematic