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<b>Introduction</b>: Today one of the primary goals of any kind of dental treatment is the achievement of balanced smile aesthetics, as patients increasingly attend dental clinics to improve their appearance. The main aim of the present study was to assess and compare the smile aesthetics created by the use of two orthodontic bracket systems (self-ligating vs. conventional ligating) as a part of analysing secondary outcomes of two randomised clinical trials comparing between these two systems. <b>Methodology</b>: The assessment of smile aesthetics was done by analysing and scoring post-orthodontic treatment 125 frontal smile photographs subjectively and objectively. The subjective evaluation was performed by 20 dental professionals and 20 laypeople, while the objective assessment was done by one principal examiner using a group of smile aesthetics parameters. <b>Statistical analysis</b>: Multiple regression statistical analyses were performed to test the association between subjective and objective assessment of smile aesthetics in order to find the significant smile aesthetics predictors and assess the effect of the bracket type (self-ligating vs conventional) on the resulting smile aesthetics. <b>Results</b>: The finding from this research shows that the bracket type was not an important smile aesthetics factor in all the statistical models, although there are other important smile aesthetics factors as there was a significant correlation between the subjective and objective assessment of smile aesthetics parameters (Pearson’s correlation coefficients “r” > 0.50). <b>Conclusion</b>: There is insufficient evidence to reject the null hypotheses of no significant difference in the smile aesthetics created by the two orthodontic bracket systems. An Orthodontic Smile Aesthetics Rating (OSAR) tool has been developed.

Der Median- und der Oberbauchquerschnitt werden als operative Zugänge bei Pankreas- und Magenoperationen verwendet. Bislang ist jedoch ungeklärt, welche Schnittführung hinsichtlich der Lungenfunktion, des Wundschmerzempfindens und der Morbidität vorteilhafter ist. Zwischen 4/96 und 4/98 wurden alle Patienten, die wegen einer Pankreas- oder Magenerkrankung elektiv primär operiert wurden, in eine prospektiv-randomisierte Studie aufgenommen. Ziel der Studie war es, unter Einschluß der Parameter Wundheilung, Lungenfunktion (FVC und FEV 1) und Wundschmerzempfinden als Hauptzielkriterien den günstigsten Zugangsweg für eine Pankreas- bzw. Magenoperation zu bestimmen. Als Nebenzielkriterien wurden die Operationsdauer, der Temperaturverlauf, die Inzidenz pulmonaler Komplikationen, die Bewertung des kosmetischen Ergebnisses sowie die Dauer des Klinikaufenthaltes und die Kliniksletalität untersucht. Insgesamt wurden 94 Patienten in die Studie aufgenommen, von denen 52 am Pankreas (quer : median = 27:25) und 42 am Magen (quer : median=20:22) operiert wurden. Für die FVC und das FEV 1 konnten postoperativ bei allen Patienten signifikant erhöhte Werte nach einem Oberbauchquerschnitt gegenüber einem Medianschnitt gezeigt werden. Es bestand allerdings keine Korrelation zur Inzidenz postoperativer pulmonaler Komplikationen oder Wundkomplikationen. Die Patienten mit einem Oberbauchquerschnitt gaben im postoperativen Verlauf ein signifikant geringeres Wundschmerzempfinden an. Die Eröffnungszeit des Oberbauches war bei einer medianen Laparotomie signifikant vermindert. Für die Verschlußzeit und die gesamte Operationsdauer bestanden wie auch für die Inzidenz allgemeiner Komplikationen sowie die Kliniksletalität und die Dauer des Kliniksaufenthaltes keine signifikanten Unterschiede zwischen den beiden operativen Zugängen. Die Bewertung des kosmetischen Ergebnisses zeigte bei einer signifikant kürzeren Wundlänge nach einer medianen Laparotomie ebenfalls keinen signifikanten Unterschied. Nach einem Oberbauchquerschnitt kommt es postoperativ zu einer besseren Lungenfunktion und zu einem niedrigeren Wundschmerzempfinden ohne Einfluß auf die Komplikationsrate. / The median and the transverse laparotomy are both common incisions in operations of the pancreas and the stomach. The aim of this study was to determine which of the two incisions is best with respect to the pulmonary function, the incisional pain and the morbidity. In a series between 4/96 and 4/98 all patients undergoing major laparotomy for a disease of the pancreas or the stomach were enrolled in this study. The healing of the wound, the pulmonary function (FVC and FEV1), and the incisional pain were taken into account. Further parameters were the duration of the operation, the body temperature, the incidence of postoperative pulmonary complications, the cosmetic result of the wound healing, the duration of the hospitalisation, and the lethality. In total, 94 patients met the study criteria. 52 were operated for a disease of the pancreas (transverse:midline = 27:25) and 42 for a disease of the stomach (transverse:midline = 20:22). After a transverse incision compared to a midline incision the patients had a significantly higher FVC and FEV1. But there was no correlation to the incidence of postoperative pulmonary complications or complications of the wound healing. The patients with a transverse incision suffered significantly lower incisional pain. In contrast, midline incisions took less time to perform. No differences were noticed with regard to the incidence of further postoperative complications, the letality and the duration of hospital stay. Neither were there any evident differences between the cosmetic results of the two ways of aproach. The respiratory function is better, and the sensation of pain lower after a transverse incision but there is no influence on the number of postoperative complications.

Embryonen von Höheren Krebsen (Malacostraca) zeigen ein stereotypes Zellteilungsmuster im Ektoderm des Rumpfes, im Verlaufe dessen paarige seitliche Reihen von Zellen und eine unpaare mittlere Reihe von Zellen gebildet werden. Das Muster der seitlichen Zellen ist von Dohle (1970, 1976) und Mitarbeitern geklärt worden. Die vorliegende Arbeit untersucht die cell lineage und Zelldifferenzierung der Mittellinienzellen im Thorax. Diese Zellen sind von besonderem Interesse, weil sie bei Insekten bereits intensiv erforscht wurden. (i) Die DiI Markierungen von Mittellinienzellen von Orchestia cavimana zeigen: Die Bildung der Mittellinie beginnt mit einer Zelle, die sich zweimal in Längsrichtung teilt. Die resultierenden vier Zellen werden mit a0, b0, c0 und d0 bezeichtet. Aus den Zellen a0, b0 und c0 gehen Paare von Gliazellen hervor. Die Tochterzellen von a0 und c0 umhüllen die Kommissuren. Die Zelle d0 ist ein medianer Neuroblast, aus dem mehrere Neurone hervorgehen, unter anderem ein unpaares Neuron im medianen Fasertrakt, interneurone und ein Motoneuron. (ii)BrdU Markierungen von Porcellio scaber zeigen: In den Ganglienanlagen liegt in der Mittellinie je eine Zelle, die größer ist als die benachbarten, schneller proliferiert und deshalb vermutlich ein medianer Neuroblast ist. (iii) Die Expression von engrailed setzt bei Orchestia und Porcellio ein in der Zelle a0 und wird in den zwei Tochterzellen fortgesetzt. Für Orchestia wird gezeigt, daß diese Expression zurückgeht und die Tochterzellen der Zelle d0 de novo mit einer Expression von engrailed beginnen.Aus den Ergebnissen kann abgeleitet werden, daß der gemeinsame Vorfahr von Insekten und Höheren Krebsen eine Mittellinie differenziert, die Vorläufer für Glia der Kommissuren und einen medianen Neuroblasten umfaßt und eine Expression von engrailed in den Tochterzellen des Neuroblasten zeigt. / Embryos of higher crustaceans (Malacostraca) show a highly stereotypic cell division pattern in the ectoderm of the trunk region while forming paired rows of lateral cells and an unpaired median row of midline cells. By using nuclear dyes, the pattern of the lateral cells has been determined by Dohle (1970, 1976) an co-workers. This study addresses the cell lineage and cell differentiation of the midline cells in the thorax. These kind of cells are of particular interest as they have been investigated extensively in insects. (i) The DiI labelling of midline cells in Orchestia cavimana reveals: Formation of the midline starts with a single midline cell that divides twice in longitudinal direction. The resulting four cells are termed a0, b0, c0, and d0. The cells a0, b0, and c0 give rise to pairs of glial cells. The progeny of a0 and c0 enwrap the commissures. The cell d0 is a median neuroblast that gives rise to several neurons, among them an unpaired neuron in the median fibre tract, interneurons and probably a single motoneuron. (ii) BrdU labelling in Porcellio scaber shows: there is a single larger and faster dividing cell in the midline in each segmental ganglion anlage that is a putative median neuroblast. (iii)The expression of engrailed starts in Orchestia and Porcellio the cell a0 and continues in the two daughter cells during segmentation. In Orchestia it can be shown that this expression ceases and progenies of the cell d0 start de novo with the expression of engrailed. From the results can be concluded that the common ancestor of insects and higher crustaceans differentiated an unpaired midline comprising precursors for glial cells enwrapping the commissures and a single median neuroblast whose derivatives express engrailed.

Objective: To collect data regarding Canadian laypersons perceptions of smile esthetics and compare these data to US data in order to evaluate cultural differences. Methods: Using Adobe® Photoshop® 7, a digital image of a posed smile of a sexually ambiguous lower face was prepared so that hard and soft tissue could be manipulated to alter Buccal Corridor (BC), Gingival display (GD), Occlusal Cant (OC), Maxillary Midline to Face Discrepancy (MMFD) and Lateral Central Gingival Discrepancy (LCGD). Adult Canadian laypersons (n=103) completed an interactive computer-based survey of 29 randomized images to compare smile preferences for these variable. The custom survey was developed to display fluid, continuously appearing modifiable smile variables using MATLAB® R2008 for presentation. These data were compared to previously published data for US laypersons. Statistical inference was determined using Wilcoxon Rank Sum tests. Results: Canadian laypersons were more sensitive in detecting deviations from ideal and had a narrower range of acceptability thresholds for BC, GD, OC, MMFD and LCGD. Ideal esthetic values were significantly different only for BC. Conclusions: It appears cultural differences do exist related to smile characteristics. Clinically significant differences in the preference of the smile characteristics were found between Canadian and US laypersons. Canadian laypersons, on average, were more discriminating to deviations from ideal and had a narrower range of acceptability.

Objective: To collect data regarding Canadian laypersons perceptions of smile esthetics and compare these data to US data in order to evaluate cultural differences. Methods: Using Adobe® Photoshop® 7, a digital image of a posed smile of a sexually ambiguous lower face was prepared so that hard and soft tissue could be manipulated to alter Buccal Corridor (BC), Gingival display (GD), Occlusal Cant (OC), Maxillary Midline to Face Discrepancy (MMFD) and Lateral Central Gingival Discrepancy (LCGD). Adult Canadian laypersons (n=103) completed an interactive computer-based survey of 29 randomized images to compare smile preferences for these variable. The custom survey was developed to display fluid, continuously appearing modifiable smile variables using MATLAB® R2008 for presentation. These data were compared to previously published data for US laypersons. Statistical inference was determined using Wilcoxon Rank Sum tests. Results: Canadian laypersons were more sensitive in detecting deviations from ideal and had a narrower range of acceptability thresholds for BC, GD, OC, MMFD and LCGD. Ideal esthetic values were significantly different only for BC. Conclusions: It appears cultural differences do exist related to smile characteristics. Clinically significant differences in the preference of the smile characteristics were found between Canadian and US laypersons. Canadian laypersons, on average, were more discriminating to deviations from ideal and had a narrower range of acceptability.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23128号 / 人健博第90号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 稲富 宏之, 教授 精山 明敏, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs. The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.