Blood metabolite levels in normal and handicapped pied flycatchers rearing broods of different sizes

We measured levels of select metabolites (glucose, triglycerides, free fatty acids, glycerol, uric acid) and corticosterone in the blood plasma of adult pied flycatchers Ficedula hypoleuca while they were rearing broods whose sizes were modified experimentally. We also made it more difficult than normal for some pairs of birds to forage by removing certain wing and tail feathers (handicapping them). Both procedures have been shown previously to change parental workload. We did this in order to determine if the birds alter their use of nutrients in response to differences in their workload. Metabolite levels were not influenced by handicapping or brood size. However, the concentration of free fatty acids in the plasma of females and of triglycerides in the plasma of males was directly related to the frequency with which the adults fed their nestlings. These findings suggest that the two sexes have different ways of coping with the work associated with rearing the brood: females apparently undergo brief daily fasts while feeding their chicks, whereas males take more time to feed themselves while providing food for their young, and spend more time doing so as their workload increases. The flycatchers exhibited high concentrations of uric acid and corticosterone in the blood plasma; corticosterone and glycerol were positively correlated in females; and corticosterone and triglyceride levels were negatively correlated in males; all of which suggest that gluconeogenesis provides some of the energy required for their parental activities.

[Orthodontics founded on "proof" or therapeutic decision making based on the literature]

Faced to an abundant literature and to various clinical situations, practitioners are nowadays invited to implement an evidence based approach. This methodology, initially developed in Canada in the 80's, is getting widely used and is perfectly suited for Orthodontics and particularly for the evaluation of interceptive treatments. It is defined as the conscentious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This approach, which requires four different steps, will initially be presented. A methodological guide that allows to grade the evidence among different research protocols, will then be introduced. At the top of the hierarchy, randomized clinical trials have shown to be the best tools available to evaluate treatment efficiency. Different research designs are finally put forward to evaluate interceptive treatments.

[Influence of feeding method on maxillofacial development]

The functional differences between breast-feeding and bottle-feeding may have a significant effect on dento-facial development and on the genesis of some severe malocclusions. Orthodontists should be aware of this sometimes under-estimated aspect of development. They should, in conformity with their role as professional health care providers, advise long-term breast feeding as a way of preventing certain disorders or, at least, reducing their severity.

Possible roles for corticosterone and critical size in the fledging of nestling pied flycatchers

Our study was designed to see whether corticosterone (B) rises abruptly in the blood of nestling pied flycatchers (Ficedula hypoleuca) at the time they fledge, as reported recently for kestrels, and if so, why. We measured the growth and blood levels of B and selected nutrients of nestlings in broods of five, seven, and nine chicks during 1998 and 1999. In half of the broods, we clipped selected wing and tail feathers of both parents with the intention of making it more difficult for them to provide their chicks with food. We collected blood samples when the chicks were six to 10 d old (period of rapid growth) and 15 d of age or older (0-5 d before fledging). B increased substantially several days before the chicks left the nest and then declined somewhat. We found no differences in rates of growth or blood levels of B, nutrients, and hematocrit as a function of either brood size or parental handicapping. Nestlings within a day of fledging appear to have been food deprived in 1998; their glucose was significantly reduced, and B, free fatty acids, and glycerol were significantly elevated compared to levels in chicks 1-4 d younger. Such changes did not occur in 1999. Blood levels of B were significantly correlated with brood size near the day of fledging, but not earlier, in both years of the study. It was possible to predict the day on which chicks would leave the nest, using their wing length when 12 d old. These results suggest that high blood levels of B associated with food restriction and sibling competition induce chicks to fledge, provided they have reached a critical size, and that the importance of fasting, sibling competition, and B may vary from year to year.

[A device for mandibular advancement in respiratory disorders of sleep. Clinical study]

This study describes the technical steps for the making of a mandibular advancement device for sleep disordered patients (apnea index < 10). In a second part of the study, a group of 21 patients with sleep disordered breathing treated successfully with a mandibular advancement device is compared to a homologous control group. The experimental group showed cephalometric characteristics approaching those seen in patients with sleep apnea syndrome. The mandibular advancement device moved the mandibule forward (SNB angle increases by 1.7 degrees) and downward (mandibular plane angle increases by 3 degrees, which can be related to the 7.4 mm anterior vertical height increase). The hyoid bone adopted a more distant position from the cervical vertebrae. Important individual variations were seen among the patients for the optimal repositioning of the mandible.

[Can bite force be predicted from the shape of the face?]

The relationships between maximum bite force (MBF) and facial architecture have been tested in a sample of 118 dental students. The strongest correlations were seen with the variables representative of posterior face height and facial divergence. No correlation could be seen between MBF and incisor's position. MBF allowed only partial discrimination of the individuals in different subgroups constituted by cluster analysis. MBF is to consider as a representation of the individual aptitude to develop more or less powerful forces. It summarises only part of the functional information influencing facial form.

Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea

Increased pharyngeal collapsibility and abnormal anatomic structures have been postulated to contribute to the pathophysiology of obstructive sleep apnea (OSA) syndrome. It is unclear whether the abnormal craniofacial and soft tissue features may affect the pharyngeal collapsibility and contribute to the apnea density. In the present study we examine the relationship between pharyngeal collapsibility and cephalometric variables in a group of 57 male OSA patients. Pharyngeal collapsibility was measured during the night of nasal continuous positive airway pressure (nCPAP) titration by analyzing the pressure-flow relationship. Pharyngeal critical pressure (Pcrit) was calculated as the extrapolated pressure at zero flow. The patients, age 52.0 +/- 9.0 yr, had an average apnea-hypopnea index (AHI) of 72.6 +/- 31.8 and a mean Pcrit of 2.4 +/- 1.0 cm H(2)O. A significant correlation was found between Pcrit and the soft palate length (SPl) (r = 0.27, p = 0.04), the distance from the hyoid bone to the posterior pharyngeal wall (H-Ph) (r = 0. 29, p = 0.03), and the distance from the hyoid bone to posterior nasal space (H-Pns) (r = 0.32, p = 0.02). While in obese patients Pcrit was related to SPl and neck circumference, the distance of the hyoid bone to the mandibular plane (H-MP) affected Pcrit in nonobese patients. Our results show that both pharyngeal soft tissue abnormalities and the lower position of the hyoid bone affect Pcrit in OSA patients, suggesting that an anatomic narrowing contributes to the upper airway collapsibility.

GAPO syndrome: a new case of this rare syndrome and a review of the relative importance of different phenotypic features in diagnosis

The case of GAPO syndrome reported here is the 24th recorded case, 23 cases having been published previously. The 29-year-old male under discussion presents all the typical features of the syndrome, having short stature, dysmorphic craniofacial features, total alopecia and pseudoanodontia. Orally, the erupted primary dentition was extremely worn and on radiographic examination, the second mandibular molars were found to be unerupted, together with the entire permanent dentition. Cephalometry revealed the absence of facial pneumatisation, a deficient cranial base with diminished upper face height and maxillary and mandibular hypoplasia with a prognathic skeletal pattern. Histological examination of an extracted primary incisor and its surrounding root bone revealed extensive ankylosis. This paper describes in detail the clinical findings and reviews, and discusses previously published cases in relation to the present one. As with prior cases, parental consanguinity was present in the pedigree.

Changes in distribution of glycosaminoglycans during the progression of cholesterol induced atherosclerosis in Japanese quail

The temporal and spatial distribution and relative concentration of the proteoglycan glycosaminoglycan component were studied during the progression of atherosclerosis in the systemic arteries of Japanese quail selected for cholesterol induced atherosclerosis (CIA). The CIA quail were placed on either control or 0.5% added cholesterol diets at 3 months of age. The major systemic arteries (dorsal aorta, right and left brachiocephalic) were collected at 1- or 2-week intervals over the 10-week period of cholesterol feeding. In the cholesterol fed quail, alcian blue staining of the dorsal aorta showed elevations of glycosaminoglycans in regions of the artery with atherosclerotic plaque, beginning at the 6-week time point. By biochemical analysis, increases in glycosaminoglycan relative concentration was detected at the 10-week time point. In addition to the change in glycosaminoglycan relative concentration and distribution, the cholesterol fed animals also formed foam cells characteristic of atherosclerotic plaques. Therefore, the conclusion reached was that the CIA line of Japanese quail is a valid animal model for the study of alterations in proteoglycan metabolism in atherosclerotic plaques induced by hypercholesterolemia.

Malocclusion in the deciduous dentition of Caucasian children

In this study the occlusal characteristics of the deciduous dentition in a sample of young children were investigated to determine whether consensual trends exists, and if the occlusal characteristics in the primary dentition may be considered as acceptable predictors for occlusal relationships in the permanent dentition. Four hundred and seven boys and three hundred and eighty-two girls aged 4-6 years participated in the epidemiological study. Recording of the occlusal traits was made according to the method described by the Fédération Dentaire Internationale in 1973, adapted to the primary dentition. Lack of space was frequent (24 per cent in the upper anterior segments), as well as lateral crossbites (16 per cent), excessive overjet of 6 mm or more (6 per cent), Class II relationships (26 per cent) and anterior open bites (37.4 per cent). Obvious similarities could be seen with other investigations on occlusal traits of the primary dentition of Caucasian children. Cross-comparison with available data suggest that the development of the occlusion is a continuum for many aspects, with most of the major occlusal trends characterizing the permanent dentition in Europoid populations detectable at early stages. The striking difference in the primary dentition was the much higher prevalence of anterior open bites: this is the only figure expected to decrease dramatically in the permanent dentition. With due reservation inherent to the nature of epidemiological data on malocclusion and their interpretation, it is concluded that, provided the patient's cooperation is satisfactory, early attention may be given to malocclusion, but should mainly be focused on lateral crossbites and sagittal malrelationships.

Determinants of effective continuous positive airway pressure in obstructive sleep apnea. Role of respiratory effort

We investigated whether cephalometric measurements, nocturnal indices of negative intrathoracic pressure, or the frequency of sleep-related breathing disorders were related to the level of effective continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). We examined 22 OSA patients who underwent two consecutive polysomnographic recordings, the first for diagnosis and the second for CPAP titration. Cephalometric measurements, spirometric data, and blood-gas analysis results were available for all subjects. In the diagnostic polysomnography, at least 30 apneas were analyzed during non-rapid-eye-movement (NREM) sleep and 10 apneas during rapid eye movement (REM) sleep for each patient. Swings in esophageal pressure (Pes) during the preapneic period and during the beginning and the end of obstructive apneas were calculated as the average of three consecutive breaths (or ineffective efforts). The difference in Pes from the minimal initial to the maximal final apneic respiratory effort (DPes) and the rate of increase in Pes (RPes = DPes/apnea duration) during apnea were computed. Within an apnea, the lowest Pes always occurred during the first three occluded breaths and the highest during the last three, with a more marked difference in NREM sleep. The level of effective CPAP was correlated with the length of the soft palate (r = 0.69, p = 0.000), RPes (r = 0.55, p = 0.008), and DPes (r = 0.49, p = 0.02). The correlations of effective CPAP level with body mass index and apnea + hypopnea index were not significant. A model including length of the uvula, DPes, and RPes accounted for 56 to 59% of the variability in effective CPAP.(ABSTRACT TRUNCATED AT 250 WORDS)

[A cephalometric study of the pterygoid process during growth]

This study consists in a three dimensional cephalometric approach of the pterygoid process and its relationships with the neighbouring cranio-facial structures, using biostatistical analysis. The authors present the results of this method comparing the variations of the pterygoid process in relation to the variations of the basi-cranium and the face.

Specialist postgraduate orthodontic training: a comparison of two European universities

The background to current specialist training programmes in orthodontics in the United Kingdom and France is discussed, and the examination structure in the two countries compared with reference to those pertaining in Glasgow and Strasbourg. A sample of 40 of the most recently treated cases submitted by students in each of these two Universities for their final examinations is compared revealing marked differences in case type and treatment philosophy. The differences are explained, to some extent, by the circumstances pertaining to the delivery of orthodontic care in the two countries.

The cranial base in subjects with dental and skeletal Class II

The aim of this study was to test to what extent the cranial base variations may be involved in Class II facial organization. Using Bonferonni probabilities, cranial base size and shape, and facial divergence were compared in two groups: an experimental group of 45 subjects with dental and skeletal Class II and an homologous control group of 41 subjects with a natural Class I ideal occlusion. In all individuals of the experimental group the Class II molar relationship was at least equal to the width of one premolar and the ANB angle was greater than the value of the mean +2 standard deviations of the ANB in the control group. Spacing and crowding was less than 2 mm at each arch in both groups; all subjects were between 10 and 12 years old. The anterior part of the cranial base (SN length and SNBa angle) was identical in the two groups, but in Class II, cranial base flexure (BaSN angle) was more obtuse (P less than 0.05) and posterior cranial base angle (SBaN) was more acute (P less than 0.01). These variations co-existed in the same group with a more retruded position of the condylar neck in the face (P less than 0.01) favouring per se a post-normal relationship of the mandible to the maxilla. The increased extension of the saddle angle in Class II could not be considered here as related to an hyperdivergent facial pattern since facial divergence was unchanged in Class II. Saddle angle and divergence correlated in Class I (r = 0.40; P less than 0.01), but not in Class II.(ABSTRACT TRUNCATED AT 250 WORDS)

[Methods for the anthropologic and teleradiographic study of the pterygoid process]

The relationships of the external pterygoid plate with the other components of the craniofacial building has hardly been explored because of recording difficulties. A method to accurately identify in a reproducible way the main axis of the pterygoid process with the help of two small iron balls was contrasted with other methods seen in the literature. The iron balls technique was shown to be the method of choice with regard to biostatistical consistency.

Fat embolism syndrome complicating intraarterial chemotherapy with cis-platinum

A 19-year-old man with telangiectatic osteosarcoma of the left proximal femur was started on a course of neoadjuvant chemotherapy consisting of intraarterial administration of cis-platinum. Within 72 hours of receiving the first intraarterial dose, the patient developed signs and symptoms of fat embolism syndrome (FES). A physical examination revealed cyanosis, tachycardia, and seizure activity. Laboratory studies demonstrated a pO2 of less than 65 mmHg, lipuria, and a drop in hematocrit of three percentage points. There was no clinical or roentgenographic evidence of pathologic fracture. Tumor necrosis secondary to intraarterial cis-platinum therapy in this patient with osteosarcoma may have caused a sudden release of free fatty acids and embolization of fat macroglobules that precipitated this episode of FES. FES in association with the intraarterial administration of cis-platinum seems not to have been previously reported.

The treatment of bulimia nervosa

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.

Developmental expression of a synaptic vesicle-specific protein in the rat retina

In order to examine the appearance of synaptic vesicles and to correlate it with the formation of the synaptic layers, we have determined the staining pattern of a murine monoclonal antibody (SV 48) to a synaptic vesicle-associated protein in developing rat retina. The antigen was detected by the indirect immunofluorescence technique using cryostat sections of paraformaldehyde-fixed retinas. In the adult retina, the antibody stained both the outer plexiform (OPL) and the inner plexiform layers (IPL). The nuclear layers and the nerve fiber layer (NFL) were devoid of any staining. In prenatal and early postnatal (P) retinas, the antibody stained two bands which corresponded to the respective locations of the NFL and IPL. Staining in the NFL increased until P-4 and began to decline subsequently, and by P-8 little staining was left in this layer. In contrast, in the IPL, the intensity of staining increased gradually and leveled off by P-10. In the outer retina, a band of fluorescence corresponding to the OPL was first observed at P-5 and increased in intensity up to P-10. Immunoblotting studies showed that the major immunoreactive material from adult and embryonic retinas had a Mr approximately 65,000-67,000. As expected from its developmental pattern, all bands appeared initially in the central retina and subsequently in the peripheral retina. Our results show that the synaptic vesicle-protein is present in the nerve fiber layer before synaptogenesis in the central nervous system. Subsequently, the protein is lost from the NFL, possibly as a consequence of synapse formation.

Craniofacial characteristics of cyclopia in man and swine. Implications on role of medial structures in normal growth and development

A rare and bizarre congenital deformity sheds light on the essential function of the nasal septum and other medial structures of cartilaginous origin in the vertical growth of the mid-face.

Cyclophosphamide-induced temporomandibular synostosis

The study of malformations helps toward a better understanding of normal development, which is of significance to the orthodontist. Experiments in teratology have induced an extensive variety of facial abnormalities, but temporomandibular joint (TMJ) synostosis has never been previously reported. Ten pregnant female rabbits were treated with a daily injection of 50 mg. cyclophosphamide (DNA synthesis inhibitor), from day 11 to day 14, which is the period that precedes formation of the face. The control sample comprised five female rabbits. The fetuses were obtained by cesarean section on day 28 and stained with alizarin. Six of the ten treated female animals produced offspring that had TMJ synostosis. The skull with TMJ synostosis showed a retrognathic mandibular pattern in relation to the maxilla, and the bony trabeculae in the mandibular angle showed a downward orientation instead of the horizontal orientation seen in animals without synostosis. The length of the heads was significantly smaller in the treatment group than in the control group; within the treatment group, the heads with synostosis were significantly smaller than those without synostosis. It could be hypothesized that the cyclophosphamide might have affected intrinsic factors in the temporomandibular mesenchyma; an impairment in the development and function of the mandibular musculature, which is a vital factor in joint development and maintenance, might also have contributed to the genesis of the malformation. The association of immobilization and mandibular hypodevelopment seems to be in agreement with today's theories on maxillofacial growth.