Objective:To assess the effects of Herbst two phase treatment on temporomandibular joint(TMJ) position analyzed by CBCT.Methods:15 patients of permanent dentition with class Ⅱ malocclusion combined with mandibular retrusion were treated by Herbst appliance as the 1st phase,then the 4 1st premolars of each patient were extracted,the fixed appliance of edgewise was applied as the 2nd phase of treatment.CBCT examination was carried out at the following stages:2 weeks before Herbst treatment(T1),at the start of the treatment when Herbst appliance was placed(T2),immediately after Herbst appliance was removed(T3) and immediately after the edgewise appliance was removed(T4).The InvivoDental software was used to calculate the joint space of TMJ from the three -dimensional CBCT images.The acquired data were then statistically analyzed.Results:During T1-T2-T3 stages,the anterior joint space was decreased and then increased,superior joint space and posterior joint space were increased and then decreased.During T3-T4 stages,the superior joint space and posterior joint space decreased further,but anterior joint space did not change.No significant difference was found in the anterior joint space,superior joint space and posterior joint space between T1 and T4 stage.Conclusion:At the start of treatment with Herbst appliance,the condyle is displaced in an anterior and inferior direction.At the end of functional treatment,especially the end of two phase treatment,the condyle is drawed back nearly to the original position.

Objective To explore the psychological experience of ICU nurses who had worked follow different work patterns, and find the most appropriate staffing model. Methods A phenomenological approach of qualitative research was conducted in 5 ICU nurses by intensive interview,then the data collected were read, analyzed, reflected,finally the theme was got. Results In the work pattern of shifted every 12 hours, with low work frequency and strong feeling of fatigue. In the work pattern of shifted every 8 hours, with high work frequency and the disadvantage of nurse- patient relationship. In the short-time continuous APN work pattern, with continuous management of patients' condition, promotion of nurse-patient relationship, improvement of doctor-nurse relationship, comparatively stable biological clock. Conclusions The short-time continuous APN work pattern can concentrate nurses' work and rest time, relieve the press that caused by the shifted work, at the same time, promote the patients',patients' family and doctors' satisfaction degree with nursing work, increase nurses' effect in the ICU team, guarantee the quality of care, eventually ensure the patients' safety.

OBJECTIVEThis study assessed the effects of two-phase treatment with Herbst appliance on the bony structure of the temporomandibular joint via cone beam computed tomography (CBCT) analysis.

METHODSThis study selected 15 patients exhibiting early permanent dentition and classⅡmalocclusion combined with mandibular retrusion treated by a two phase treatment (Herbst and fixed appliance). The CBCT scans of the patients were obtained at the following stages: 2 weeks before Herbst treatment (T1), at the start of treatment when the Herbst appliance was set in place (T2), immediately after removal of the Herbst appliance (T3), and immediately after removal of the edgewise appliance (T4). Three-dimensional reconstruction and related measurements were performed using InvivoDental software, and the acquired data were statistically analyzed.

RESULTS1) CBCT showed a crescent-shaped hyperplasia at the posterior-superior border of the condyles that the outer edge was highly dense and the inner region was lowly dense in T3 in 14 patients (28 condyles). 2) In T3-T2 and T4-T1, the diameters of the anteroposterior condyles increased by 0.62 and 0.66 mm, respectively (P<0.01), and the condylar head height correspondingly increased by 0.54 and 0.53 mm (P<0.01).

CONCLUSIONSCondylar growth remodeling occurs during Herbst treatment.
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Bone and Bones ; Cone-Beam Computed Tomography ; Humans ; Orthodontic Appliances, Functional ; Retrognathia ; Temporomandibular Joint

Objective To assess the effects of two phase treatment(Herbst and fixed appliance) and fixed appliance treatment only(edgewise appliance) on temporomandibular joint in Cass Ⅱ patients with mandibular retrusion using cone-beam CT(CBCT) analysis.Methods Thirty Class lⅡ patients with mandibular retrusion in the permanent dentition were divided into two groups.Group A consisted of 15 patients with two phase treatment.Group B consisted of 15 patients with fixed appliance treatment only.CBCT was taken before(T1) and after(T2) treatment.The Invivo Dental software was used to calculate the relevant parameters of temporomandibular joint.Wilcoxon analysis was carried out.Results In group A,the condylar anterior-posterior diameters(7.41[2.55]) and the condylar head height(3.58[0.86]) increased significantly after treatment(P＜O.05).In group B,all skeletal measurements had no significant changes(P＞0.05) after treatment.The changes of condylar head height in group A(0.60[0.48]) showed greater than in group B(0.02[0.21])(P＜0.05).No significant differences in the temporomandibular joint spaces were found before and after treatment,and between the two groups(P＞0.05).Conclusions Compared with fixed appliance treatment only,except for condylar growth changes,no significant changes of other skeletal morphology of the temporomandibular joint and the condyle position within the glenoid fossa were found between patients with two phase treatment and with fixed appliance treatment only.

Objective:To investigate the pathogenesis, precaution and treatment of neonatal congenital complete heart block (CCHB) in twins.Methods:The clinical data of a case of premature twins with neonatal CCHB from the Department of Neonatology, the First Affiliated Hospital of Xinxiang Medical University were retrospectively analyzed and related literature was reviewed.Results:(1)Case review: the 37-year-old gravida had no symptoms.Fetal ultrasound cardiogram(fUCG)at 23 weeks of gestation indicated bradycardia and CCHB.Then, the mother was diagnosed with undifferentiated connective tissue disease.After treatment with human immunoglobulin, dexamethasone and hydroxychloroquine, fUCG at 31 weeks of gestation still suggested CCHB.An emergency cesarean section was performed on the diagnosis of threatened preterm labor.With weakly positive neonatal antinuclear antibody (ANA), and positive Ro60 and Ro52 autoantibodies, twins were diagnosed with CCHB by 24 hour-Holter monitors.One of the twins was discharged with CCHB (ventricular rate of 80-90 times/min) after systemic therapy, but the weight increased to 2 200 g. The other one of the twins suffered from the sudden decrease of heart rate and blood pressure and finally died of sudden cardiac arrest.(2) Literature search: two cases in Chinese and 9 cases in English were reviewed.Among them, 9 cases were sjogren syndrome type A (SSA)/Ro and sjogren syndrome type B(SSB)/La related CCHB, and 2 cases were idiopathic CCHB.Conclusions:The placental transfer of anti-SSA or anti-SSB is an important mechanism of neonatal CCHB in twins, and other factors may also be involved.Current treatments are unsatisfactory.Most patients need pacemaker implantation.Early diagnosis and prenatal management can improve the prognosis.