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A finite element analysis of stress distribution with various directions of intermaxillary fixation using orthodontic mini-implants and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy
No full textObjective: This finite element analysis (FEA) aimed to assess the stress distribution in the mandible and fixation system with various directions of the intermaxillary fixation (IMF) using mini-implants (MIs) and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy (BSSRO). Materials and Methods: A total of nine mandibular advancement models were set according to the position of the MIs (1.6 mm in diameter, 8 mm in length) and direction of the IMF elastics (1/4 inch, 5 oz). Major and minor principal stresses in the cortical and cancellous bones, von Mises stresses in the fixation system (miniplate and monocortical screws), and bending angles of the miniplate were analysed. Results: Compressive and tensile stress distributions in the mandible and von Mises stress distributions in the fixation system were greater in models with a Class III IMF elastic direction and a higher IMF elastic force than in models with a Class II IMF elastic direction and a lower IMF elastic force. The bending angle of the miniplate was negligible. Conclusions: Stress distributions in the bone and fixation system varied depending on the direction, amount of force, and position of IMF elastics and MIs. Conclusively, IMF elastics in the Class II direction with minimal load in the area close to the osteotomy site should be recommended
Clinical application of a lingual retractor with temporary anchorage devices (TADs) for patients with lip protrusion and anterior open bite
No full textAnterior open bite (AOB) is considered one of the most difficult malocclusions to correct and achieve successful and stable results. Various treatment approaches have been proposed for the treatment of AOB in adults. Intrusion of the entire maxillary dentition is necessary for AOB patients with severe incisor exposure. In previous reports, a labial appliance with temporary anchorage devices (TADs) implanted in various positions has been used to achieve total intrusion of the maxillary dentition. This article describes the design and biomechanics of an anteroposterior lingual retractor (APLR) to attempt retraction of anterior teeth and total intrusion of maxillary dentition after premolar extraction in patients with both lip protrusion and AOB and the functions of each component of APLR is considered. When force is applied between the anterior lever arm of the APLR and a TAD in the midpalatal area, the anterior teeth are intruded and retracted with torque control. Because the direction of the APLR force and the guide bar are not parallel, intrusive force is generated in the posterior teeth. Due to this total intrusion of the maxillary dentition, the mandible is rotated counterclockwise, improving AOB with severe incisor exposure. Various cases are presented in which APLR was applied to AOB patients, and the clinical considerations behind the treatment are explained in detail
Purely bone-borne rapid palatal expansion with bracket plates and replaceable expansion screw assembly
No full textTooth-bone-borne rapid palatal expansion (RPE) often results in unwanted buccal tipping of anchor teeth, particularly in cases where midpalatal suture expansion is not successful. This report presents a novel approach to treating transverse maxillary deficiency through purely bone-borne RPE using bracket plates. The method involves strategically placing four mini-implants in the palate before inserting the RPE screw. Subsequently, right and left bracket plates are fixed over the mini-implant heads to connect two anteroposterior mini-implants. The RPE screw is then attached to the bracket plates, securing the RPE connecting arms into 0.032 × 0.040-inch slot brackets on the bracket plates. The primary advantage of this method is that the RPE screw is replaceable and adjustable. This enhances the freedom in selecting mini-implant placement sites, ensuring better skeletal anchorage on the palatal bone compared to tooth-bone-borne RPE, where mini-implant placement sites are limited to the periphery of the RPE screw. This report presents two cases in which midpalatal suture expansion was successfully achieved using purely bone-borne RPE without incurring any dental side effects
The Crocodylian proatlas functions to redistribute venous blood and cerebrospinal fluid
No full textThe proatlas, a bone located between the skull and the neural spines of the cervical vertebrae, is best known from reptiles. Most previous studies of the proatlas have centered on its developmental, debating the relationship between the proatlas and the cervical neural arches. The present study was intended as a description of the proatlas in the American alligator (Alligator mississippiensis) and an experimental test of its hypothesized role in venous blood and cerebrospinal fluid (CSF) distribution. In Alligator, the proatlas is chevron-shaped; ventrally it has a loose connection to the dorsal surface of the first cervical vertebrae, dorsally it has a robust elastic tissue tether on the otoccipital and supraoccipital bones. The ventral surface of the proatlas parallels the dorsal margin of the foramen magnum and rests on the dorsal surface of the spinal venous sinus. Experimental manipulation of the proatlas demonstrated that displacement of the proatlas causes pressure changes in both the spinal venous sinus and the enclosed spinal CSF. The results of this study represent the first demonstration of an explicit functional role for the proatlas, the circulation of fluids between the cranial and spinal compartments of the central nervous system
The presence of a foramen of Luschka in the American alligator (Alligator mississippiensis) and the continuity of the intraventricular and subdural spaces
No full textIn humans and most mammals, there is a notch-like portal, the foramen of Luschka (or lateral foramen), which connects the lumen of the fourth ventricle with the subdural space. Gross dissection, light and scanning electron microscopy, and μCT analysis revealed the presence of a foramen of Luschka in the American alligator (Alligator mississippiensis). In this species, the foramen of Luschka is a notch in the dorsolateral wall of the pons immediately caudal to the peduncular base of the cerebellum, near the rostral end of the telovelar membrane over the fourth ventricle. At the foramen of Luschka there was a transition from a superficial pia mater lining to a deep ependymal lining. There was continuity between the lumen of the fourth ventricle and the subdural space, via the foramen of Luschka. This anatomical continuity was further demonstrated by injecting Evans blue into the lateral ventricle which led to extravasation through the foramen of Luschka and pooling of the dye on the lateral surface of the brain. Simultaneous subdural and intraventricular recordings of cerebrospinal fluid (CSF) pressures revealed a stable agreement between the two pressures at rest. Perturbation of the system allowed for static and dynamic differences to develop, which could indicate varying flow patterns of CSF through the foramen of Luschka
A combination of generated hydrogen sulfide and nitric oxide activity has a potentiated protectant effect against cisplatin induced nephrotoxicity
Get PDFAim: Hydrogen sulfide and nitricoxide possess cytoprotective activity and in vivo, they are generated from exogenous sodium hydrosulfide and L-arginine respectively. Cisplatin is a major chemotherapeutic agent used to treat cancer and has a high incidence of nephrotoxicity as a side effect. The study aim was to explore the effects of NaHS and L-arginine or their combination on cisplatin induced nephrotoxicity in rats. Methods: Wistar Kyoto rats were given a single intraperitoneal dose of cisplatin (5 mg/kg) followed either by NaHS (56 μmol/kg, i. p.), L-arginine (1.25 g/L in drinking water) or their combination daily for 28-days. Post-mortem plasma, urine and kidney samples were collected for biochemical assays and histopathological analysis. Results: Cisplatin decreased body weights and increased urinary output, while plasma creatinine and urea levels were elevated, but sodium and potassium concentrations were diminished. The renal function parameters, blood urea nitrogen and creatinine clearance, were raised and decreased respectively. Regarding markers of reactive oxygen species, plasma total superoxide dismutase was reduced, whereas malondiadehyde was augmented. Cisplatin also diminished plasma and urinary H2S as well as plasma NO, while NaHS and L-arginine counteracted this activity on both redox-active molecules. Cisplatin cotreatment with NaHS, and/or L-arginine exhibited a reversal of all other measured parameters. Conclusion: In current study, NaHS and L-arginine as monotherapy protected the rats from cisplatin-induced nephrotoxicity but the combination of both worked more effectively suggesting the augmented anti-inflammatory and antioxidative potential of test treatments when administered together
Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians
No full textThe early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth
Understanding the Role of OT in Infertility
Get PDFInfertility is prevalent in the United States, affecting approximately 16% of couples. Those affected by infertility often seek Assistive Reproductive Technology (ART) treatments to help them conceive. Past literature has found that ARTs have negative effects on those undergoing treatments in their occupations, routines, habits, and mental health. Although it is commonly known in the medical literature, there is a dearth of research and clinical support for individuals who are experiencing disturbances in the above-described areas, leaving a gap in care for individuals who are undergoing ARTs. The present research study consists of 13 in-depth qualitative interviews, which gather data regarding the lived experience of women undergoing ART treatments. The primary researcher collected data through recorded interviews via online video with 13 women who have completed ARTs. This research was approved by the institutional review board at A.T. Still University. The results of the interviews demonstrate that women experienced negative effects in ADLs, IADLs, health management, rest and sleep, work, leisure, social participation, quality of life, and mental health. The analysis of the interviews utilizes the Occupational Therapy Practice Framework to identify areas of occupational disruptions, and discusses the way in which the profession of occupational therapy can improve disturbances in occupations, habits, and routines
Maximizing Prehabilitative Care for Breast Cancer: Program Evaluation and Quality Improvement in Outpatient Therapy
Get PDFBackground. Individuals with breast cancer experience side effects and impairments from the disease and treatments that impact their physical, cognitive, neurological, emotional, and social health. Breast cancer-related psychosocial issues are most prevalent right after diagnosis. Services prior to receiving breast cancer treatment or surgery are termed prehabilitation (prehab) and have been shown to improve patient outcomes. Occupational therapy (OT) practitioners play an important role in the rehabilitation of patient with cancer and can contribute to prehab services.
Methods. This was a program evaluation and quality improvement project that used data collected during prehab evaluations for breast cancer to create supplemental resources. The 14-week project was broken into four phases including recruitment and survey design, observations and data collection, needs assessment and resource creation, and dissemination and project evaluation. After dissemination, a final participant survey determined the effectiveness and outcomes of the project.
Results and Discussion. Identified gaps include limited screening and interventions for psychosocial needs of patients with breast cancer and limited OT participation in prehab. Two screening tools and two patient handouts were provided to HonorHealth to supplement the prehab evaluations. Following dissemination, HonorHealth therapists indicated that the project and its deliverables will help improve the quality and effectiveness of the prehab evaluations. Multiple limitations were identified in the methods and results of the project, but the overall project outcomes indicate a need for further to services address the psychosocial needs of patients newly diagnosed with breast cancer and further OT involvement in prehab services for this population
Healthy Living After Cancer: A community-based program to improve exercise and nutrition in cancer survivors
Get PDFPersevering through cancer treatment is an uphill battle, but continuing survivorship for the rest of their lives becomes the biggest challenge for cancer survivors. Concerns in survivorship include side effects from cancer treatment, fear of recurrence, and returning to previous roles and routines. Additionally, survivors must maintain their health and well-being through exercise and nutrition. Occupational therapists possess the necessary skill set to create programming for cancer survivors that is relevant and realistic. They can take side effects from treatment into consideration and offer personalization of goals and maintenance strategies. Furthermore, occupational therapists can offer simple alternatives to maintaining a healthy lifestyle and use relevant theoretical frameworks that ensure success in the engagement of healthy habits. Healthy Living After Cancer was a community-based program created for participants at Cancer Support Community of Arizona to learn about exercise and nutrition and engage in physical activity through group walking. Participants completed quantitative surveys to measure exercise and nutrition self-efficacy and habits. Qualitative data was also collected through follow-up phone calls. Consolidating both types of data showed that the program was successful in facilitating and maintaining exercise and nutrition behaviors over a short term. Future research should persist to enhance community programming, improve implementation of programs in the community setting, and increase programming options for a diverse participant population