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Clinical Rheumatology Mar 2022
Topics: Arthritis, Gouty; Gout; Humans; Nasal Bone
PubMed: 34599715
DOI: 10.1007/s10067-021-05897-z -
The Cochrane Database of Systematic... Mar 2017Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life.Non-invasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing.Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive and false negative screening tests (i.e. invasive diagnostic testing, and the possibility that a miscarried fetus may be chromosomally normal). The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down's syndrome will have.
OBJECTIVES
To estimate and compare the accuracy of first trimester ultrasound markers alone, and in combination with first trimester serum tests for the detection of Down's syndrome.
SEARCH METHODS
We carried out extensive literature searches including MEDLINE (1980 to 25 August 2011), Embase (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), and The Database of Abstracts of Reviews of Effects (the Cochrane Library 2011, Issue 7). We checked reference lists and published review articles for additional potentially relevant studies.
SELECTION CRITERIA
Studies evaluating tests of first trimester ultrasound screening, alone or in combination with first trimester serum tests (up to 14 weeks' gestation) for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection.
DATA COLLECTION AND ANALYSIS
Data were extracted as test positive/test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS criteria. We used hierarchical summary ROC meta-analytical methods to analyse test performance and compare test accuracy. Analysis of studies allowing direct comparison between tests was undertaken. We investigated the impact of maternal age on test performance in subgroup analyses.
MAIN RESULTS
We included 126 studies (152 publications) involving 1,604,040 fetuses (including 8454 Down's syndrome cases). Studies were generally good quality, although differential verification was common with invasive testing of only high-risk pregnancies. Sixty test combinations were evaluated formed from combinations of 11 different ultrasound markers (nuchal translucency (NT), nasal bone, ductus venosus Doppler, maxillary bone length, fetal heart rate, aberrant right subclavian artery, frontomaxillary facial angle, presence of mitral gap, tricuspid regurgitation, tricuspid blood flow and iliac angle 90 degrees); 12 serum tests (inhibin A, alpha-fetoprotein (AFP), free beta human chorionic gonadotrophin (ßhCG), total hCG, pregnancy-associated plasma protein A (PAPP-A), unconjugated oestriol (uE3), disintegrin and metalloprotease 12 (ADAM 12), placental growth factor (PlGF), placental growth hormone (PGH), invasive trophoblast antigen (ITA) (synonymous with hyperglycosylated hCG), growth hormone binding protein (GHBP) and placental protein 13 (PP13)); and maternal age. The most frequently evaluated serum markers in combination with ultrasound markers were PAPP-A and free ßhCG.Comparisons of the 10 most frequently evaluated test strategies showed that a combined NT, PAPP-A, free ßhCG and maternal age test strategy significantly outperformed ultrasound markers alone (with or without maternal age) except nasal bone, detecting about nine out of every 10 Down's syndrome pregnancies at a 5% false positive rate (FPR). In both direct and indirect comparisons, the combined NT, PAPP-A, free ßhCG and maternal age test strategy showed superior diagnostic accuracy to an NT and maternal age test strategy (P < 0.0001). Based on the indirect comparison of all available studies for the two tests, the sensitivity (95% confidence interval) estimated at a 5% FPR for the combined NT, PAPP-A, free ßhCG and maternal age test strategy (69 studies; 1,173,853 fetuses including 6010 with Down's syndrome) was 87% (86 to 89) and for the NT and maternal age test strategy (50 studies; 530,874 fetuses including 2701 Down's syndrome pregnancies) was 71% (66 to 75). Combinations of NT with other ultrasound markers, PAPP-A and free ßhCG were evaluated in one or two studies and showed sensitivities of more than 90% and specificities of more than 95%.High-risk populations (defined before screening was done, mainly due to advanced maternal age of 35 years or more, or previous pregnancies affected with Down's syndrome) showed lower detection rates compared to routine screening populations at a 5% FPR. Women who miscarried in the over 35 group were more likely to have been offered an invasive test to verify a negative screening results, whereas those under 35 were usually not offered invasive testing for a negative screening result. Pregnancy loss in women under 35 therefore leads to under-ascertainment of screening results, potentially missing a proportion of affected pregnancies and affecting test sensitivity. Conversely, for the NT, PAPP-A, free ßhCG and maternal age test strategy, detection rates and false positive rates increased with maternal age in the five studies that provided data separately for the subset of women aged 35 years or more.
AUTHORS' CONCLUSIONS
Test strategies that combine ultrasound markers with serum markers, especially PAPP-A and free ßhCG, and maternal age were significantly better than those involving only ultrasound markers (with or without maternal age) except nasal bone. They detect about nine out of 10 Down's affected pregnancies for a fixed 5% FPR. Although the absence of nasal bone appeared to have a high diagnostic accuracy, only five out of 10 affected Down's pregnancies were detected at a 1% FPR.
Topics: Biomarkers; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Down Syndrome; False Positive Reactions; Female; Humans; Maternal Age; Nasal Bone; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 28295158
DOI: 10.1002/14651858.CD012600 -
BioMed Research International 2021The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular...
The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular morphology among different skeletal patterns. Cephalograms of 240 participants were divided into 3 groups based on the skeletal pattern (Class I, Class II, and Class III). The dimensions of nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way analysis of variance and Pearson's correlation test were used for statistical analysis. No significant differences were observed among the skeletal patterns in terms of nasal bone length, palatal length, maxillary height, or condylar length. Class II had a significantly shorter ramus, mandibular body, and entire mandibular length compared with those of Class I and Class III. Nasal ridge length exhibited a significant moderate correlated with nasal bone length (correlation coefficient: 0.433) and maxillary height (correlation coefficient: 0.535). The entire mandibular length exhibited a significant moderate correlated with ramus length (correlation coefficient: 0.485) and body length (correlation coefficient: 0.536). In conclusion, nasal and maxillary dimensions exhibited no significant difference among the 3 skeletal patterns. Mandibular body and entire mandibular lengths were significantly positively correlations with Class III skeletal patterns.
Topics: Adolescent; Adult; Cephalometry; Female; Humans; Male; Mandible; Maxilla; Nasal Bone
PubMed: 34124250
DOI: 10.1155/2021/5599949 -
Nasal bone to nasal tip length ratio for describing nasal bone hypoplasia and predicting trisomy 21.Archives of Medical Science : AMS 2022Fetal nasal bone hypoplasia has been proven to be a strong marker for trisomy 21 during second trimester ultrasonography. Rather than evaluating the nasal bone...
INTRODUCTION
Fetal nasal bone hypoplasia has been proven to be a strong marker for trisomy 21 during second trimester ultrasonography. Rather than evaluating the nasal bone hypoplasia according to the nomograms, it may be possible to evaluate it with a more practical and specific method.
MATERIAL AND METHODS
Retrospectively collected data were provided from the saved and stored patient data between 2012 and 2017. Nasal bone length and nasal tip length were measured and the ratio was calculated. The ratio ≤ 1/3 was defined as the threshold ratio for the definition of the marker. Nasal bone nasal tip length (NB/NL) ratio values were compared among groups with trisomy 21 and euploid fetuses.
RESULTS
A total of 59 fetuses had trisomy 21 and 2304 euploid fetuses were included in the study. The ratio of nasal bone to nasal tip length was 1/3 and below in 21/59 (35.5%) of fetuses with trisomy 21 whereas this ratio was 31/2304 (1.3%) in euploid fetuses. The difference was statistically significant ( < 0.001). Sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of nasal bone/nasal tip ratio ≤ 1/3 were 35.5%, 98.6%, 26.4 and 0.6 for Down syndrome, respectively.
CONCLUSIONS
This study suggested that the nasal bone to nasal tip length ratio may be a new promising and practical sonographic marker in the second trimester genetic sonography. Although its sensitivity is not high, it seems to be more practical and specific than the evaluation of fetal nasal bone length.
PubMed: 35316896
DOI: 10.5114/aoms.2019.85655 -
CMAJ : Canadian Medical Association... Apr 2024
Topics: Humans; Fractures, Bone; Nasal Bone
PubMed: 38684280
DOI: 10.1503/cmaj.231013-f -
Archives of Craniofacial Surgery Feb 2022There have been many reports of nasal bone fractures in adults, but there are few clinical reports of them in adolescents, although adolescence is the main growth period...
BACKGROUND
There have been many reports of nasal bone fractures in adults, but there are few clinical reports of them in adolescents, although adolescence is the main growth period of the nasal bone. In addition, previous studies have tended to classify and describe child and adolescent nasal fractures in the same category. The aim of this study was to identify the clinical aspects of nasal fractures in adolescents, and to evaluate the characteristics of nasal fractures in the growth period.
METHODS
Our institution's database was reviewed to extract data on adolescent patients between the age of 13 to 18 who had isolated nasal bone fractures from March 2012 to February 2020. The study excluded patients with other facial fractures, previous facial fractures, or congenital deformities.
RESULTS
This study included 243 boys and 26 girls. Interpersonal violence and sports-related accidents accounted for 85 and 79 cases, respectively. There were 128 frontal impact injuries and 132 lateral impact injuries, and 97 patients had accompanying septal fractures. An accompanying septal fracture was present in 36.06% of all patients, but in 51.20% of those who underwent surgery.
CONCLUSION
The prevalence of adolescent nasal fractures was significantly higher in boys, to a greater extent than observed for pediatric or adult fractures. The main causes of fractures were interpersonal violence and sports-related accidents. An explanation for these results is that adolescent boys are more prone to have violent accidents or companionship with active sports than other age or sex groups, leading to substantially more fractures.
PubMed: 35255593
DOI: 10.7181/acfs.2022.00038 -
The Angle Orthodontist Nov 2008To test the hypothesis that there is no difference between the information produced by superimposition of serial lateral headfilms on anatomical structures and that...
OBJECTIVE
To test the hypothesis that there is no difference between the information produced by superimposition of serial lateral headfilms on anatomical structures and that produced by superimposition on metallic implants according to the protocols of Björk.
MATERIALS AND METHODS
Serial cephalograms of 10 untreated subjects who had tantalum implants placed in the maxilla and mandible during childhood were analyzed. Headfilms taken at six consecutive stages of cervical vertebral maturation (CS1-CS6) for six female and four male subjects were used. Tracings were superimposed according to the methods of superimpositions advocated by the American Board of Orthodontics (ABO). In addition, superimpositions along the inferior border of the mandible were performed. Finally, superimpositions of serial tracings on stable intraosseous implants were made to determine the actual growth and remodeling patterns of the maxilla and mandible.
RESULTS
The ABO maxillary superimposition method underestimates the vertical displacement and overestimates the forward movement of maxillary landmarks. Superimposing on the internal cortical outline of the symphysis and the inferior alveolar nerve canals generally approximates the mandibular superimposition on implants, although the lower anterior border of the symphysis may be a preferable area of superimposition. Superimposition on the lower border of the mandible does not reflect accurately the actual pattern of growth and remodeling of the mandible.
CONCLUSIONS
When analyzing serial headfilms, erroneous information concerning patterns of bone growth and remodeling can be obtained if convenient, but biologically incorrect superimposition protocols are used. In addition, tooth movements measured can be distorted significantly depending on the method of superimposition.
Topics: Age Determination by Skeleton; Bone Development; Bone Remodeling; Cephalometry; Cervical Vertebrae; Child; Chin; Dental Materials; Facial Bones; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Mandible; Mandibular Condyle; Maxilla; Nasal Bone; Palate; Prostheses and Implants; Skull; Tantalum
PubMed: 18947269
DOI: 10.2319/070107-301.1 -
American Journal of Otolaryngology 2019To determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures.
OBJECTIVE
To determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures.
STUDY DESIGN
An 8-question survey on isolated nasal bone fractures was designed.
SETTING
Surveys were sent to all otolaryngology residency program directors for distribution among residents and faculty. Additional surveys were distributed to private practice otolaryngology groups.
RESULTS
140 physicians responded to the survey. 57% of the respondents were practicing otolaryngologists (75% with 10+ years of experience), while 43% of respondents were residents-in-training. 56% of respondents treated 1-5 nasal bone fractures per month. 80% of all respondents reported imaging being performed prior to consultation. If imaging was obtained before consultation, plain films and computed tomography (CT) maxillofacial/sinus scans were the most frequent modalities. 33% of residents and 70% of practicing otolaryngologists report imaging as 'rarely' or 'never' helpful in guiding management. 42% of residents and 20% of practicing otolaryngologists report asking for imaging when it wasn't already obtained. Decreased use of radiography was associated with greater years in practice and higher frequency of fractures treated.
CONCLUSIONS AND RELEVANCE
Otolaryngologists seldom request imaging to evaluate and treat isolated nasal bone fractures. When ordered, imaging is utilized more often among residents-in-training and non-otolaryngology consulting physicians. This study highlights an opportunity to educate primary care and emergency room providers as well as otolaryngology residents on the value of comprehensive physical exam over radiographic imaging in the work-up of isolated nasal fractures. In addition, widespread adoption of a "no x-ray policy" in this setting may result in better resource utilization.
Topics: Humans; Nasal Bone; Otolaryngology; Patient Selection; Practice Patterns, Physicians'; Radiography; Skull Fractures; Surveys and Questionnaires
PubMed: 31526629
DOI: 10.1016/j.amjoto.2019.102295 -
Archives of Craniofacial Surgery Feb 2020Nowadays, the incidence of nasal bone fracture is increasing because of social complexity with frequent social activity, and reduction of fractures is relatively simple...
Nowadays, the incidence of nasal bone fracture is increasing because of social complexity with frequent social activity, and reduction of fractures is relatively simple and can be corrected in short operation time. However, the postoperative results are known to be less satisfied with higher complication rates relatively. These problems could have resulted from inaccurate recognition and interpretation of fracture aspect, inaccurate planning of operation resulting in under or overcorrection, ignoring septal management, complication related nasal packings with removal, postoperative management, and patient satisfaction with complication.
PubMed: 32126613
DOI: 10.7181/acfs.2020.00031