Orofacial muscles activity in children with swallowing dysfunction and removable functional appliances

Swallowing dysfunction is a frequent disorder among children and refers to an altered tongue posture and abnormal tongue movement during swallowing. Removable functional appliance is one of the treatments applied by dentistry to correct this disorder. The aim of this study was to evaluate any differences on orofacial muscles activity in children with swallowing dysfunction with and without removable functional appliances. 68 children were eligible for the study and divided into the orthodontic group (OG) and the no-orthodontic group (NO-OG). Both groups performed a dental occlusion-class evaluation, a swallowing function test and a myoscan analysis in order to measure perioral forces (i.e. tongue extension force, lip pressure, masseter contraction force). Our results showed a significant difference (P=0.02) between OG and NO-OG for the tongue extension force, whereas no significant differences (P>0.05) were found for the other parameters. Our findings suggest that children with swallowing dysfunction and removable functional appliance show orofacial muscles activity within the range of reference values (except for the lip pressure). However, we hypothesize that orthodontic treatment can achieve more effective results with integration of myofunctional therapy

Tongue Posture, Tongue Movements, Swallowing, and Cerebral Areas Activation: A Functional Magnetic Resonance Imaging Study

The aim of this study was to pinpoint the cerebral regions implicated during swallowing by comparing the brain activation areas associated with two different volitional movements: tongue protrusion and tongue elevation. Twenty-four healthy subjects (11—males 22 ± 2.9 y; 13—females 23 ± 4.1 y; were examined through functional magnetic resonance imaging (fMRI) while performing two different swallowing tasks: with tongue protrusion and with tongue elevation. The study was carried out with the help of fMRI imaging which assesses brain signals caused by changes in neuronal activity in response to sensory, motor or cognitive tasks. The precentral gyrus and the cerebellum were activated during both swallowing tasks while the postcentral gyrus, thalamus, and superior parietal lobule could be identified as large activation foci only during the protrusion task. During protrusion tasks, increased activations were also seen in the left-middle and medial frontal gyrus, right thalamus, inferior parietal lobule, and the superior temporal gyrus (15,592-voxels; Z-score 5.49 ± 0.90). Tongue elevation activated a large volume of cortex portions within the left sub-gyral cortex and minor activations in both right and left inferior parietal lobules, right postcentral gyrus, lentiform nucleus, subcortical structures, the anterior cingulate, and left insular cortex (3601-voxels; Z-score 5.23 ± 0.52). However, the overall activation during swallowing tasks with tongue elevation, was significantly less than swallowing tasks with tongue protrusion. These results suggest that tongue protrusion (on inferior incisors) during swallowing activates a widely distributed network of cortical and subcortical areas than tongue elevation (on incisor papilla), suggesting a less economic and physiologically more complex movement. These neuromuscular patterns of the tongue confirm the different purpose of elevation and protrusion during swallowing and might help professionals manage malocclusions and orofacial myofunctional disorders

Il Museo anatomico “Luigi Rolando”

L’Istituto anatomico di Sassari, ora sezione di Anatomia e Istologia del Dipartimento di Scienze Biomediche della Facoltà di Medicina, come altre sedi universitarie italiane (Bologna, Cagliari, Ferrara, Firenze, Modena, Napoli, Parma, Pavia, Roma, ecc.) è dotato di un Museo anatomico, nato in primo luogo per provvedere alle esigenze didattiche dell’insegnamento dell’Anatomia umana. In questi ultimi anni l’interesse suscitato dai musei anatomici è andato via via crescendo, tanto è vero che nell’assemblea generale dei soci della Società Italiana di Anatomia, svoltasi a Torino nell’autunno del 1997, veniva affidata ufficialmente al prof. Vincenzo Mezzogiorno, direttore dell’Istituto di Anatomia umana della seconda Università di Napoli, quale massimo esperto in materia, l’incarico ufficiale di provvedere al censimento ed alla realizzazione di una guida ai musei anatomici italiani. A Sassari, nonostante l’insegnamento universitario dell’anatomia risalga a quasi quattro secoli fa, la costituzione ufficiale di un Museo anatomico, intitolato all'illustre Prof. Luigi Rolando, è relativamente recente (fine degli anni Ottanta); questo perché, facendo parte dell’Istituto anatomico, ne ha seguito, rimanendone condizionato, le vicende storiche e i diversi cambiamenti di sede

Educational methods in neuroanatomy: a review

Among the basic sciences providing relevant medical awareness, human anatomy, which includes gross and neuroanatomy, represents a crucial science in medical schools (Verhoeven et al., 2002). Although numerous changes have been performed in medical curricula worldwide, the anatomic background is deemed a cornerstone for approaching clinical medicine (McLachlan and Patten, 2006). In the last decades, several modifications in anatomy and, in particular, in neuroanatomy education have been done and numerous strategies have been identified to improve the skills of the students (Rizzolo et al, 2010). We carried out a non-systematic review focusing our interest on the transformation of traditional teaching methodology of neuroanatomy. Articles on neuroanatomy education were selected if the study described an approach for teaching/learning neuroanatomy and if the neuroanatomy course was aimed to all medical students but dental or healthcare students. PubMed database was used to select manuscripts with a predefined combined list of search terms: “neuroanatomy”, “anatomy”, “teaching”, “learning”, “methods and strategies”. Our search included only English language manuscripts published from December 1990 to January 2012. Abstracts and unpublished studies were excluded. References of all relevant retrieved articles, of relevant recent review articles, and abstracts published in proceedings were also evaluated manually in order to find additional articles. For data extraction an electronic form was prepared. Only eighteen of the fifty (36%) selected articles met the inclusion criteria. Two described the dissection as the primary educational method, whereas the majority used electronic tools providing three-dimensional information. Some authors highlighted that students could be more enthusiastic when they have the chance to study with cadavers deeming this approach near to clinical medicine (Zurada et al, 2011); however the comprehension of topography and spatial relationships of various structures is equally achieved with the use of electronic means. The post-mortem examination represents an opportunity to evaluate the variability of human anatomy; however, logistical, ethical, and safety issues hamper the implementation of this method in medical schools (Winkelmann, 2007). The method used for anatomy and neuroanatomy teaching is essential to augment the interest of the medical students towards medicine but several obstacles can hinder the implementation and scale-up of the best educational method

Is the corpus callosum degeneration a predictor of long-term disability in Multiple Sclerosis patients?

Axonal injury and loss of white matter has been well documented in corpus callosum (CC) of patients with multiple sclerosis (MS), an inflammatory demyelinating disorder of the of Central Nervous System (CNS). The CC is the largest compact white matter fiber bundle of the brain connecting the two cerebral hemispheres. It seems that CC continue to mature structurally from infancy to adulthood (Muetzel RL, 2008). The topographical organization of its fibers allows the association of its abnormalities with those of specific cortical regions. It is one of the few white matter tracts that can be adequately evaluated by conventional Magnetic Resonance Imaging (MRI), having sharply demarcated two-dimensional limits on a mid-saggital T1W imaging (Fiqueira FF, 2007). So, as a consequence of these anatomic characteristics, it is reasonable to assume that CC morphometrics might be used as a possible marker for the analysis of its integrity. Conventional and non-conventional MRI techniques have been used to characterize pathological damages of the CC; for instance, diffusion tensor imaging (DTI) can show white matter changes undetected by conventional MRI (Bester M, 2008). We carried out a review focusing our interest on the diagnostic efficacy of MRI to predict MS disability. PubMed search engine was used to select manuscripts with predefined search terms: “corpus callosum”, “multiple sclerosis”, “disability” and “magnetic resonance imaging”. Only manuscripts in English language, published from January 2003 to January 2013, were selected. Abstracts and unpublished studies were excluded. References of all relevant retrieved articles, of review articles, were also evaluated manually in order to find additional articles. For data extraction an electronic form was prepared. The findings of the review suggest that CC atrophy is a more sensitive marker of disease activity than the global atrophy measures, predicting clinically definite multiple sclerosis (CDMS)conversion as early as 6 months of clinically isolated syndrome (CIS) (Kalincik T, 2012). Furthermore, the occurrence or growth of lesions over the first year in the splenium of corpus callosum, together with the cerebellum and the thalamus, was associated with cognitive worsening at year 5. CC atrophy seems to be a simple and an accurate predictor of disability, mostly for secondary progressive MS (Fiqueira FF, 2007), and it seems helpful for routine clinical activities (Vaneckova M, 2012)

Preliminary results about the archeological and paleopathological study of roman necropolis of Monte Carru - Alghero (Sardinia)

Following the discovery of burials in Monte Carru – Alghero (Sardinia) during the preliminary investigation to the creation of a housing development detected a Imperial Roman necropolis (I-III century A.D.). A total of 350 tombs – 150 burials and 200 cremations. This necropolis is supposed belongs to the undiscovered village of Carbia mantioned by the sources. Up to now have been analyzed 11 burials. The samples are clened by water and glued with PVA glue. Subsequently has been performed the anthropological study following the mains anthropological methods ( Meindel & Lovejoy, 1985; Iscan 1985; Ubelaker 1989; Trotter & Gleser 1952) and some new method (Vance – Steyn- L’Abbé 2011; Chibba e Bidmos, 2007; Bidmos, 2006). Every burial has been sampled for metagenomic and DNA study. Up to now have been analyzed 10 adults and 1 subadult. The adults are in 60% female and just 1 is undeterminate; the age of death is between 25 and 45 years; it was no possible to determinate the height . There were no obvius pathology but this can be for the extreme deterioration of bones. There are dental wear widespread mainly on premolars and first molar ; caries is present mainly on molars and dental calculus mainly on incisors. The analyzed population of Monte Carru in Roman Age shows a good state of health, no obvious pathologies and a enamel wear. More analysies are neccesary to better understand the site

Ultrasound and autoptic diagnosis of asphyxiating thoracic dysplasia

Background. The skeletal system develops from mesoderm. In most bones (e.g., the long bones), ossification is preceded by cartilage (endochondral ossification). In other cases, such as flat bones, ossification develops directly in the mesenchyme without cartilage formation (intramembranous ossification). Skeletal dysplasias are a heterogeneous group of more disorders associated with developmental abnormalities of bone and cartilage. The modes of transmission are similar: autosomal dominant and recessive and X-linked dominant and recessive. Despite the potential advantages of 3-dimensional ultrasound (3D-US), antenatal diagnosis of skeletal dysplasia is difficult, given the large variety and complexity of these disorders: their phenotypes are variables and their features are overlapping. We present a case report of a woman with prenatal diagnosis of skeletal thoracic dysplasia, confirmed by postnatal radiography and fetal autopsy. Case report. A 26-year-old woman, primigravida, was referred for routine ultrasonic examination during her second trimester of pregnancy. Ultrasonography (USG) showed a single live foetus of a gestational age of 20+3 weeks; biparietal diameter and head circumference were adequate for the week of gestation. There was a polyhydramnios. The fetal thorax was extremely narrow. The thoracic circumference (TC) measured 100 mm (< 5th percentile), the abdominal circumference (AC) measured 157 mm (50th percentile), and the TC/AC ratio was 0.64 (normal range: 0.77–1.01). The long-bone lengths measured < 5th percentile, especially the proximal part of the upper limbs. Ultrasound scans of fetal abdomen revealed bilateral slight increase in the size of kidneys. There were no neural tube defects, and the fetal stomach and urinary bladder were normal. Fetal echocardiography revealed mild ventricular septal defect with good hemodynamic effect. Based on these findings, the diagnosis postulated as possible was asphyxiating thorax dysplasia (ATD). After genetic counseling, the patient decided for an elective termination of the pregnancy. A stillborn male fetus was delivered with a weight of 470 g. Infantogram and gross autopsy findings (narrow thorax, short upper limb bones, poor definition of pyramids of kidneys) supported the diagnosis made. Conclusion. Although skeletal anomalies are difficult to diagnose antenatally, a detailed scan of fetal anatomy between 20 and 32 gestational weeks exclude majority of major skeletal dysplasias. Termination of pregnancy is indicated and must be followed by genetic counseling for recurrence risk

Enamel thickness and trace elements: a new approach to the paleonutritional study

The paleonutrition study of ancient people mainly affects the teeth as the outer and the strongest part of the digestive tract, perfused with blood and lymphatic vessels; bring a lot of information that may be useful to understand the nourishment in the past. The aim of this study is to identify possible correlations between the thickness of the enamel and the presence of trace elements as indicators of Palaeolithic diet. The samples came from seven different Sardinian sites dated back to the 3000 bC and 1400 AD. previously subjected to a classical anthropological study, were washed in absolute acetone and rinsed in distilled water. To calculate the amount of enamel on the teeth and its correlation with the dentin, we chose to analyse the samples with micro-CT oriented perpendicular to the occlusal plane with 360° rotation. For the qualitative estimation of trace elements, we used a X-ray fluorescence spectrometer. The study on the thickness of the enamel showed that the total area is approximately uniform and varying the total area, both the area of the enamel and of the dentine proportionally vary. As regards the study of trace elements, the samples showed an almost constant presence of Zinc, Strontium and Manganese due to a diet essentially omnivorous, the enamel appears thicker in the sites where the elements found were Iron, Manganese, Zinc, Copper and Phosphorus reporting to a carnivorous diet. The thickness of the enamel may be affected by the trace elements present in it, so it may be also related to the type of diet. A quantitative study of the elements them- selves could provide, in the near future, more reliable data

Morphological findings in malformed fetuses with normal karyotype

In our Department morphological findings on fetuses from therapeutic interruption of pregnancy or spontaneous abortion are performed since ten years in order to correlate the ultrasound and/or chromosomic diagnosis with a real presence of malformations. The fetopathologic examination generally agrees with the chromosomal diagnosis, while in several cases it is possible to find malformations also in presence of a normal karyotype (Gitz, 2011). In our experience over the past 5 years we have found that 17 fetuses with a normal karyotype showed different heterogeneous ultrasound malformations. Only in 2 cases the fetuses died in uterus (17th and 22nd weeks of gestation), the other cases, aged between 14th and 23rd weeks of gestation, went from voluntary abortions. In 7 cases the karyotype was defined by amniocentesis while in the remaining 10 was determined by fetal fibroblasts culture; in only 30% of the observed cases the couple had carried out a genetic evaluation. External malformations were present in 16 fetuses, often related to the face (such as micrognathia, low-set of ears, flattened nasal bridge, cleft lip) or limb (short, curved, stubby) of spine (spina bifida) or genitalia (hypospadias). Malformations of internal organs were present in 10 cases, often affecting the cardiovascular system (complex heart defects and abnormal origin of the greath vessels), and nervous system (meningocele, agenesia of the corpus callosum, ventricular dilatation and Arnold-Chiari malformation); less frequent were malformations of other systems (digestive, respiratory and urinary). There was a single case of situs viscerum inversus associated with complex cardiac malformations and atresia of the bucco-pharyngeal membrane. These results indicate that the fetal morphological study is useful not only to confirm but often to supplement and complete the ultrasound data. Moreover genetic evaluation, utilizing fetopatholgical study, may have an important role in defining the diagnostic and clinical procedure, especially in relapses with malformed fetus and normal karyotype