The measurement of craniofacial morphology head posture and nasal airflow in patients with congenital clefts of the lip and palate

The present study was both methodological and investigative in nature. This included the development of computerised rhinomanometry and establishment of cephalometric measurement apparatus together with a standardised lateral cephalometric radiography technique to record natural head posture.The method errors of both the measurement systems and the operator were tested by duplicate determinations and subsequent statistical analysis. Recordings for all the variables in the study were reproducible without systematic error and with a very small method error.Apparatus was used to record nasal respiratory resistance (NRR), craniofacial form and head posture in a control group for comparison with subjects with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP).The results of the rhinomanometric recording indicated that the bilateral nasal resistance did not differ significantly between the cleft samples and the controls. Unilateral measurements of nasal resistance showed higher values for the cleft side than for the non-cleft side, both in cleft lip (CL) and the unilateral cleft lip and palate (UCLP) samples. In the cleft palate (CP) sample as well as in the controls, unilateral nasal resistance did not differ between the two sides.Comparisons were made between cephalometric measurements for craniofacial form and head posture for each category of the clefting deformity and the controls and the statistically significant differences tabulated.Previous studies have demonstrated associations between cranio-cervical angulation and craniofacial morphology, and between airway adequacy and cranio-cervical angulation.In the present study, differences and correlations were calculated between face height, head posture and airway resistance which were in agreement with the predicted pattern of associations between cranio-cervical angulation and craniofacial morphology (face height) and between airway adequacy and cranio-cervical angulation

A comparison of the reproducibility of manual tracing and on-screen digitization for cephalometric profile variables

The aim of this investigation was to analyse and compare the reproducibility of manual cephalometric tracings with on-screen digitization using a soft tissue analysis. A random sample of 20 lateral cephalometric radiographs, in the natural head posture, was selected. On-screen digitization using Viewbox (R) 3.1.1.9 cephalometric software and manual tracing on a 1:1 printout of the image was carried out twice in different sessions 1 week apart. Differences were analysed using a repeated measurement analysis of variance with method, session, and method-session interaction as explaining variables. The differences were expressed as an absolute percentage of the overall mean. The findings of the present study indicate that the two measurement methods differ significantly for 11 variables (P = 0.001 to P = 0.042). The area around stomion was the least reproducible. Except for s-n(s)-unt, nasal protrusion, with the manual technique, all mean differences between sessions and between methods were less than 1 degree or 1 mm and were, on-screen, smaller for 13 variables compared with those traced manually. Absolute percentage differences of the overall mean were smaller for seven variables with the digital technique and three variables in the manual technique, while four manual variables and one on-screen variable exceeded 2 per cent of the overall mean. Although small significant differences were found, the clinical relevance remains questionable

A randomised controlled trial of the Neuro Emotional Technique (NET) for childhood Attention Deficit Hyperactivity Disorder (ADHD): a protocol

<p>Abstract</p> <p>Background</p> <p>An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM).</p> <p>The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60–65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET.</p> <p>Design/methods</p> <p>A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD.</p> <p>Children aged 5–12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months.</p> <p>The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity.</p> <p>Calculations for the sample size were set with a significance level of 0.05 and the power of 80%, yielding a sample size of 93.</p> <p>Discussion</p> <p>The present study should provide information as to whether the addition of NET to an existing medical regimen can improve outcomes for children with ADHD.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trial Registration Number: ANZCTRN 012606000332527</p

Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study

OBJECTIVES: To determine the degree of interinstitutional transfusion practice variation and reasons why red cells are administered in critically ill patients. STUDY DESIGN: Multicentre cohort study combined with a cross-sectional survey of physicians requesting red cell transfusions for patients in the cohort. STUDY POPULATION: The cohort included 5298 consecutive patients admitted to six tertiary level intensive care units in addition to administering a survey to 223 physicians requesting red cell transfusions in these units. MEASUREMENTS: Haemoglobin concentrations were collected, along with the number and reasons for red cell transfusions plus demographic, diagnostic, disease severity (APACHE II score), intensive care unit (ICU) mortality and lengths of stay in the ICU. RESULTS: Twenty five per cent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95 ± 1.39 and ranged from 0.82 ± 1.69 to 1.08 ± 1.27 between institutions (P < 0.001). Independent predictors of transfusion thresholds (pre-transfusion haemoglobin concentrations) included patient age, admission APACHE II score and the institution (P < 0.0001). A very significant institution effect (P < 0.0001) persisted even after multivariate adjustments for age, APACHE II score and within four diagnostic categories (cardiovascular disease, respiratory failure, major surgery and trauma) (P < 0.0001). The evaluation of transfusion practice using the bedside survey documented that 35% (202 of 576) of pre-transfusion haemoglobin concentrations were in the range of 95-105 g/l and 80% of the orders were for two packed cell units. The most frequent reasons for administering red cells were acute bleeding (35%) and the augmentation of O(2) delivery (25%). CONCLUSIONS: There is significant institutional variation in critical care transfusion practice, many intensivists adhering to a 100g/l threshold, and opting to administer multiple units despite published guidelines to the contrary. There is a need for prospective studies to define optimal practice in the critically ill

Fevipiprant (QAW039), a slowly dissociating CRTh2 antagonist with the potential for improved clinical efficacy

Here we describe the pharmacologic properties of a series of clinically relevant chemoattractant receptor-homologous molecules expressed on T-helper type 2 (CRTh2) receptor antagonists, including fevipiprant (NVP-QAW039 or QAW039), which is currently in development for the treatment of allergic diseases. [3H]-QAW039 displayed high affinity for the human CRTh2 receptor (1.14 ± 0.44 nM) expressed in Chinese hamster ovary cells, the binding being reversible and competitive with the native agonist prostaglandin D2 (PGD2). The binding kinetics of QAW039 determined directly using [3H]-QAW039 revealed mean kinetic on (kon) and off (koff) values for QAW039 of 4.5 × 107 M-1min-1 and 0.048 minute-1, respectively. Importantly, the koff of QAW039 (half-life = 14.4 minutes) was >7-fold slower than the slowest reference compound tested, AZD-1981. In functional studies, QAW039 behaved as an insurmountable antagonist of PGD2-stimulated [35S]-GTPγS activation, and its effects were not fully reversed by increasing concentrations of PGD2 after an initial 15-minute incubation period. This behavior is consistent with its relatively slow dissociation from the human CRTh2 receptor. In contrast for the other ligands tested this time-dependent effect on maximal stimulation was fully reversed by the 15-minute time point, whereas QAW039's effects persisted for >180 minutes. All CRTh2 antagonists tested inhibited PGD2-stimulated human eosinophil shape change, but importantly QAW039 retained its potency in the whole-blood shape-change assay relative to the isolated shape change assay, potentially reflective of its relatively slower off rate from the CRTh2 receptor. QAW039 was also a potent inhibitor of PGD2-induced cytokine release in human Th2 cells. Slow CRTh2 antagonist dissociation could provide increased receptor coverage in the face of pathologic PGD2 concentrations, which may be clinically relevant