Abnormal Occlusion Research Articles

Risk factors for noncarious cervical lesions: A case-control study.

Noncarious cervical lesions (NCCLs) are multifactorial and can be caused by the anatomical structure of the teeth, erosion, abrasion and abnormal occlusion. The aim of this case-control study was to explore the risk factors for NCCLs. Cone-beam computed tomography was used to determine whether a wedge-shaped defect existed at the cementoenamel junction. We compared 63 participants with NCCLs with 63 controls without NCCLs, matched for sex, age (±1 year) and toothbrushing-related factors (e.g., type of bristle and brushing patterns, frequency and strength). All participants were asked to complete a questionnaire about self-administered daily diet habits and health condition. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for NCCLs. Significant variables in the univariate analysis (i.e., p < .2) included frequency of carbonated beverage consumption, sella-nasion-point B angle (SNB) and Frankfort-mandibular plane angle (FMA). Multivariate logistic regression demonstrated that the consumption frequency of carbonated beverages (odds ratio [OR] = 3.147; 95% confidence interval [CI], 1.039-9.532), FMA (OR = 1.100; 95% CI, 1.004-1.204) and SNB (OR = 0.896; 95% CI, 0.813-0.988) was independent influencing factors. The area under the receiver operating characteristic curve (AUC) value of regression Model 1 (established with the frequency of carbonated beverage consumption, FMA, SNB and sleep bruxism) was 0.700 (95% CI, 0.607-0.792; p < .001), and that of regression Model 2 (established using the frequency of carbonated beverage consumption, FMA and SNB) was 0.704 (95% CI, 0.612-0.796; p < .001). The consumption frequency of carbonated beverages and FMA was risk factors for NCCLs; the higher the frequency of carbonated beverage consumption and FMA, the higher was the probability of NCCLs. SNB was a protective factor for NCCL occurrence; the larger the SNB, the lower was the probability of NCCL occurrence. These findings have further clarified the aetiology of NCCLs and provided clinicians with valuable insights into strategies for preventing the loss of dental tissue.

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

GSENet:Global Semantic Enhancement Network for Lane Detection

Lane detection is the cornerstone of autonomous driving. Although existing methods have achieved promising results, there are still limitations in addressing challenging scenarios such as abnormal weather, occlusion, and curves. These scenarios with low visibility usually require to rely on the broad information of the entire scene provided by global semantics and local texture information to predict the precise position and shape of the lane lines. In this paper, we propose a Global Semantic Enhancement Network for lane detection, which involves a complete set of systems for feature extraction and global features transmission. Traditional methods for global feature extraction usually require deep convolution layer stacks. However, this approach of obtaining global features solely through a larger receptive field not only fails to capture precise global features but also leads to an overly deep model, which results in slow inference speed. To address these challenges, we propose a novel operation called the Global feature Extraction Module (GEM). Additionally, we introduce the Top Layer Auxiliary Module (TLAM) as a channel for feature distillation, which facilitates a bottom-up transmission of global features. Furthermore, we introduce two novel loss functions: the Angle Loss, which account for the angle between predicted and ground truth lanes, and the Generalized Line IoU Loss function that considers the scenarios where significant deviations occur between the prediction of lanes and ground truth in some harsh conditions. The experimental results reveal that the proposed method exhibits remarkable superiority over the current state-of-the-art techniques for lane detection.Our codes are available at:https://github.com/crystal250/GSENet.

Abnormal tooth maturation associated with port wine stains.

This study aims to evaluate the potential impact of port wine stains on the development of permanent teeth in mixed dentition and provide insights for managing tooth abnormalities in patients with port wine stains. A retrospective analysis was conducted on 21 patients with mixed dentition and unilateral maxillary port wine stains. Two researchers concurrently utilized Nolla Analysis to assess the developmental stage of bilateral maxillary and permanent mandibular teeth based on panoramic radiographs. The cumulative developmental values of upper and lower permanent teeth on both sides were calculated, and a comparison was made between the developmental stages of the upper and lower jaws. Port wine stains can influence the maturity of permanent upper teeth, within the unilateral maxillary port wine stains range, with an early developmental completion observed on the affected side compared to the unaffected side. While the developmental stages of the lower teeth on both sides showed similarities. Port wine stains can accelerate the maturity of teeth on the affected side, leading to alterations in the order of tooth eruption and subsequent abnormal occlusion in children with mixed dentition. These findings provide a basis for developing appropriate management strategies for addressing tooth abnormalities in patients with port wine stains.

Copyright Research Protocol for Comprehensive Assessment of the Dento-Alveolar Complex in Patients with Temporomandibular Joint Disorders: Clinical Cases

Background. Currently, the issues of diagnosis and treatment of patients with dentoalveolar injuries combined with temporomandibular joint disorders are highly relevant due to a progressive increase in the number of cases of this pathology among the population. Despite the availability of the comprehensive methodology in diagnostics of dentoalveolar injuries, dentists lack standardized algorithms for effective examination and systematization of the data obtained in the diagnostics of such groups of patients, which is necessary for personalized planning and pathogenetic therapy. The authors present the algorithm they developed for comprehensive assessment of dentoalveolar injuries in patients with temporomandibular joint disorders.Case descriptions. The paper presents clinical cases of two patients with abnormal occlusion associated with temporomandibular joint disorder. The patients underwent a comprehensive morphofunctional examination of the dentoalveolar complex in accordance with the diagnostic algorithm patented by the authors, including following methods: clinical (interview, examination), anthropometric (anthropometry of dentition), radiological (cone-beam computed tomography, magnetic resonance imaging of the temporomandibular joint), functional (surface electromyography of the masticatory muscles, computer kinesiography, electro-vibrography, ultrasound examination of the temporomandibular joint), to make the final diagnosis and to determine the order and scope of treatment.Conclusion. The authors presented and proved clinically the algorithm of morphofunctional diagnostics for the dento-alveolar complex of patients with temporomandibular joint disorders, combining clinical, anthropometric, radiological and functional methods of examination, which allow the most dento-alveolar characteristics to be considered in order to make the main diagnosis and a personalized treatment protocol for such groups of patients

DENTAL SPACE DISCREPANCIES AMONG ADULT ORTHODONTIC PATIENTS IN AN EDUCATIONAL INSTITUTION IN MALAYSIA

Malocclusion is an abnormal occlusion with regard to the position of the teeth and shows varied prevalence in different parts of the world. Crowding and spacing of teeth are two common features of malocclusion and are described as a lack or excess of space between the teeth. This study was conducted to evaluate the prevalence of crowding and spacing of teeth and their severity among Malaysian adults aged 18–25 visiting our institution, as well as their association with gender. A total of 150 adult patients were evaluated for crowding and spacing using the Boley caliper intra-orally. The severity of crowding and spacing was also noted. The study included Malay (70%), Chinese (25%), and Indian (5%) participants. Descriptive statistics were done and it was observed that crowding was more common in the mandibular arch (80%), whereas spacing was a common malocclusion found in the maxilla (14%). Based on the severity of crowding, it was observed that mild crowding (1-3 mm) was most frequent in both the maxilla (45%) and mandible (53%). However, in terms of spacing, moderate spacing (4-6 mm) (5.3%) was common in the maxilla; whereas in the mandible, mild spacing (1-3 mm) (9.3%). The Chi square analysis did not reveal any significant association between crowding and spacing with gender. Based on these results, it can be concluded that crowding is a common malocclusion affecting the mandibular arch, whereas spacing is common in the maxilla in the young Malaysian population visiting our institution. Both of these malocclusions were of the milder type and did not show any association with gender in our study population Studies conducted on a larger population are required to determine the association of these traits between genders and races in our population.

A pilot investigation of condylar position and asymmetry in patients with unilateral posterior scissors-bite malocclusion based on three-dimensional reconstructive imaging technique

ObjectiveUnilateral posterior scissors-bite (uPSB) malocclusion is common clinically. This study aimed to investigate the condylar morphological alterations and condyle-fossa relationship in patients with uPSB, through cone beam computed tomography (CBCT) and three-dimensional reconstructive imaging technique.MethodsA retrospective study was designed to comparatively analyze 95 patients with uPSB between July 2016 and December 2021. They were divided into three subgroups: 12 to 20, 21 to 30, and ≥ 31 years, according the age distribution. The morphological parameters regarding condyle, fossa, and joint space after three-dimensional reconstruction were measured and analyzed by a series of digital software. SPSS 26.0 software package was performed for statistical analysis on data sets, using paired t–test, one–way analysis of variance, Wilcoxon signed–rank sun test, Kruskal–Wallis H test, and Bonferroni correction.ResultsThe condylar volume (CV) of scissors-bite side was greater than that of the non-scissors-bite side (CVA = 1740.68 ± 559.80 mm3 > CVN = 1662.25 ± 524.88 mm3, P = 0.027). So was the condylar superficial area (CSA) (CSAA = 818.71 ± 186.82 mm2 > CSAN = 792.63 ± 173.44 mm2, P = 0.030), and the superior joint space (SJS) [SJSA = 2.46 (1.61, 3.68) mm) > SJSN = 2.01 (1.55, 2.87) mm), P = 0.018], and the anterior joint space (AJS) (AJSA = 3.94 ± 1.46 mm > AJSN = 3.57 ± 1.30 mm, P = 0.017). The constituent ratios of the different parts of the bilateral condyles were 23% on the posterior slope, 21% on the top, 20% on the anterior slope, 19% on the lateral slope and 17% on the medial slope, respectively.ConclusionDue to long-term abnormal occlusion of uPSB, the pathological bite force in temporomandibular joint would cause changes in the shape of the condyle. Among them, CV, CSA, SJS and AJS had significant changes in the scissors-bite status, which has the greatest damage to the posterior slope of the condyloid process.

Considerations of the classification and treatment for fused teeth

Fused teeth were a phenomena of teeth anomalies in shape, which can affect the dental teeth both in primary and permanent dentition. Fused teeth do not only cause problems on crowding of dentition, abnormal occlusion and aesthetic, but also increase risks of dental caries, endodontics diseases, periapical diseases and periodontal diseases. Fusion of deciduous teeth may lead to abnormality of subsequent permanent teeth. Treatment of fused teeth may require multidisciplinary approach in endodontics, periodontics, oral and maxillofacial surgery, prosthodontics and orthodontics. The aim of the present article is to review the etiology, classification, clinical manifestations and treatment of fused teeth in order to provide dental clinicians with a reference of clinical management for fused teeth.

MOTFR: Multiple Object Tracking Based on Feature Recoding

The stable continuation of trajectories among different targets has always been the key to the tracking performance of multi-object tracking (MOT) tasks. If features of the target are aggregated and classified simply, the discriminant features of the target will be ignored. This will affect the robustness of the trajectory generated by the model. Meanwhile, many popular models are keen to execute detection and feature extraction tasks in parallel. But these two tasks will conflict with each other when optimized respectively. Therefore, we propose our tracker MOTFR to solve the above problems. In this paper, we propose a Locally Shared Information Decoupling Module (LSIDM) to reduce task optimization conflicts while ensuring the necessary information sharing. Meanwhile, a feature recoding module for deep extraction of identity discriminative features is proposed, which is called the Feature Purification Module (FPM). By combining LSIDM and FPM modules, the model utilizes the discriminative appearance features to guide the optimization of detection and further improves the performance of our model. To solve the problem of targets disappearing due to various abnormal occlusion, a Short-term Trajectory Online Complement Strategy (STOCS) is proposed to realize the trajectories continuation of these targets in the tracking stage. Through sufficient experiments, we demonstrate the superior performance of our MOTFR, which guarantees high-quality detection while achieving the stability of the target trajectory.

PERIODONTAL TISSUE MORPHOLOGY IN CHILDREN WITH ABNORMAL OCCLUSION AND CONNECTIVE TISSUE DYSPLASIA SYNDROME

The study involved an analysis of the data gum biopsies obtained through light microscopy and polarization microscopy in order to identify pathomorphological features and the collagen Type I &amp; Type III ratio in 56 children with occlusion issues, periodontal diseases and various undifferentiated connective tissue dysplasia (UCTD). 32 healthy children with intact periodontium served as a control group. For the histological examination of gum biopsies, the respective sections were stained with hematoxylin and eosin, while Picro-Sirius Red Stain Kit reagents were used to assess the Type I and Type III collagen distribution in the gum connective tissue. The image processing was performed in the ImageJ 1.47 software, while when analyzing the color histograms, the ratio of the red pixels (Type I collagen) and the green pixels (Type III collagen) was identified. The Type I/III collagen ratio (1.41±0.09) in children with chronic catarrhal gingivitis, occlusion issues and a “prominent” degree of UCTD was found to be significantly lower (p≤0.05) the similar ratio observed in patients with clinically healthy periodontium (2.01±0.09), as well as in patients with “mild” and “moderate” UCTD (1.63 ± 0.17) with homogeneous clinical and morphological dental manifestations. The effectiveness of the developed comprehensive dental treatment program for periodontal issues in children with abnormal occlusion associated with UCTD, including conservative anti-inflammatory treatment, pharmacological correction and orthodontic treatment, is justified by an increase in the amount of mature Type I collagen, a decrease in the developing immature Type III collagen, and inflammation in the periodontal tissues. A sufficient degree of maturity and differentiation of connective tissue was also achieved.

MicroRNA-26b regulates BMSC osteogenic differentiation of TMJ subchondral bone through β-catenin in osteoarthritis.

Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease of the joint. The early manifestations of TMJ-OA are abnormal remodeling of condylar subchondral bone. In bone tissue, bone marrow mesenchymal stem cells (BMSCs) and osteoblasts play important roles in the differentiation and maturation of most hematopoietic cells. MicroRNA-26b (miR-26b) is upregulated during the osteogenesis of BMSCs, and miR-26b overexpression leads to the activation of β-catenin and the enhancement of osteogenesis and cartilage formation. However, the pathologic mechanism remains unclear. In the present study, we used a rat model with OA-like changes in the TMJ induced by experimental unilateral anterior crossbite (UAC) and found that the level of miR-26b was markedly lower in BMSCs from the subchondral bones of UAC rats than in those from sham control rats. MiR-26b overexpression by agomiR-26b increased condylar subchondral bone osteogenesis in UAC rats. Notably, although agomiR-26b primarily affected miR-26b levels in the subchondral bone (but not in cartilage or the synovium), the overexpression of miR-26b in BMSCs in UAC rats largely rescued OA-like cartilage degradation, while the inhibition of miR-26b in BMSCs exacerbated cartilage degradation in UAC rats. We measured the expression levels of β-catenin and related osteogenic and osteoclastic factors after using miR-26b mimics and inhibitors in vivo. Moreover, BMSCs were treated with the β-catenin blocker Wnt-C59 and then transfected with miR-26b mimics or inhibitors. Then, we examined the expression of β-catenin as the direct target of miR-26b. The results of the present study indicate that miR-26b may modulate subchondral bone loss induced by abnormal occlusion and influence the osteogenic differentiation of subchondral BMSCs through β-catenin in the context of TMJ-OA progression.

EARLY TREATMENT OF CLASS II DIVISION 1 MALOCCLUSION USING TWIN BLOCK APPLIANCES: A CASE REPORT

Background: Malocclusion is dentofacial growth deviation from its normal size and shape, thus causing abnormal occlusion. One of its etiology is heredity. Removable twin block, a functional appliance that can be used in interceptive orthodontic treatment, can be used to treat Class II malocclusion with large overjet in children during skeletal growth and development. Case: An 11-year-old boy came to pediatric dental specialist clinic with Class II division 1 Angle malocclusion (SNA 82°; SNB 74°; ANB 8°, CVM CS 4, overjet 14 mm, overbite 7 mm, and convex profile). Removable twin block for Class II malocclusion was chosen as the therapy. Case management: Removable twin block appliance with acrylic occlusal bite block was used on maxilla and mandible separately. An angle of 70° was made in the occlusal bite block, which was made based on the bite registration wax during centric occlusion. This device is used 24-hours a day. Monthly dental visit was done to reduce the maxillary and mandibular occlusal bite blocks. After 9 months, an overjet of 5 mm was obtained. Cephalometry calculations became SNA 82°; SNB 7 9 °; ANB 3 °. The patient was given further phase 2 treatment with fixed orthodontic appliance. Conclusion: With proper case selection and good patient cooperation, removable twin block appliance can correct skeletal malocclusion, improve facial profile, reduce overjet and overbite, and correct molar relations.

Effect of Occlusal Splint Therapy on Condylar Movements Recorded Using an Electronic Pantograph: A Prospective Clinical Study.

The effect of occlusal splint therapy on the muscle activity has been addressed in the literature. However, its effect on condylar movements in subjects with normal and abnormal occlusions has not yet been investigated. This prospective clinical study addressed the effect of occlusal splint therapy on condylar movements in subjects with normal and abnormal occlusions using an electronic pantograph. Two groups of subjects were included in this study. The first group included subjects with normal occlusion, whereas the subjects in the other group were diagnosed with abnormal occlusion. The occlusal splint was fabricated, adjusted clinically, and delivered for each subject. Condylar movements were recorded using a Cadiax Compact II electronic pantograph at baseline, 2-, 4-, and 6-month follow-up periods to assess sagittal condylar inclination (SCI), immediate mandibular lateral translation (IMLT), and progressive mandibular lateral translation (PMLT). The t-test, one-way analysis of variance (ANOVA), and two-way ANOVA were used to compare the parameters between the groups and to assess the time effect on these parameters (α = 0.05). Twenty subjects were recruited for this study (n = 10). Among them, 12 were women and eight were men, with a mean age of 34 years. In each group, insignificant differences were reported for each tested parameter at baseline and during the follow-up periods (P > 0.05). However, when comparing the two groups, the only significant difference was found in the SCI during the 6-month follow-up period (P = 0.014). Occlusal splints had an insignificant effect on the parameters SCI, IMLT, and PMLT up to 6 months of follow-up for subjects with normal or abnormal occlusion. SCI increased substantially in normal occlusion subjects compared with abnormal occlusion subjects during the 6-month follow-up period.

Advances in the Study of Upper Airway Characteristics in Children with Malocclusion

Malocclusion is the malformation of teeth, jaw and skull caused by congenital genetic factors or acquired environmental factors in the process of children's growth and development, such as diseases, bad oral habits, abnormal substitute teeth, such as irregular arrangement of teeth, abnormal relationship between upper and lower dental arch, abnormal jaw size and shape, etc. Malocclusion is also accompanied by respiratory diseases and dysfunction, such as obstructive sleep apnea (OSA). Conversely, abnormal occlusion also leads to respiratory tract developmental disorders and dysfunction. The cranio-maxillofacial morphology is closely related to the upper airway morphology. They are cause and effect each other. In recent years, it has been found that orthodontic treatment can not only improve the malocclusion, but also has a significant effect on the upper airway volume. The abnormal upper airway in childhood will affect children's breathing, cause children's sleep apnea, and affect children's growth and development. At the same time, with the development of society, we pay more attention to children's face. Therefore, at present, the upper airway morphological characteristics, influencing factors and correction methods of malocclusion have become the focus of research.

Application of machine learning to predict the occurrence of arrhythmia after acute myocardial infarction

BackgroundEarly identification of the occurrence of arrhythmia in patients with acute myocardial infarction plays an essential role in clinical decision-making. The present study attempted to use machine learning (ML) methods to build predictive models of arrhythmia after acute myocardial infarction (AMI).MethodsA total of 2084 patients with acute myocardial infarction were enrolled in this study. (All data is available on Github: https://github.com/wangsuhuai/AMI-database1.git). The primary outcome is whether tachyarrhythmia occurred during admission containing atrial arrhythmia, ventricular arrhythmia, and supraventricular tachycardia. All data is randomly divided into a training set (80%) and an internal testing set (20%). Apply three machine learning algorithms: decision tree, random forest (RF), and artificial neural network (ANN) to learn the training set to build a model, then use the testing set to evaluate the prediction performance, and compare it with the model built by the Global Registry of Acute Coronary Events (GRACE) risk variable set.ResultsThree ML models predict the occurrence of tachyarrhythmias after AMI. After variable selection, the artificial neural network (ANN) model has reached the highest accuracy rate, which is better than the model constructed using the Grace variable set. After applying SHapley Additive exPlanations (SHAP) to make the model interpretable, the most important features are abnormal wall motion, lesion location, bundle branch block, age, and heart rate. Among them, RBBB (odds ratio [OR]: 4.21; 95% confidence interval [CI]: 2.42–7.02), ≥ 2 ventricular walls motion abnormal (OR: 3.26; 95% CI: 2.01–4.36) and right coronary artery occlusion (OR: 3.00; 95% CI: 1.98–4.56) are significant factors related to arrhythmia after AMI.ConclusionsWe used advanced machine learning methods to build prediction models for tachyarrhythmia after AMI for the first time (especially the ANN model that has the best performance). The current study can supplement the current AMI risk score, provide a reliable evaluation method for the clinic, and broaden the new horizons of ML and clinical research.Trial registration Clinical Trial Registry No.: ChiCTR2100041960.

A Bioresorbable Dynamic Pressure Sensor for Cardiovascular Postoperative Care.

Bioresorbable electronics that can be absorbed and become part of the organism after their service life are a new trend to avoid secondary invasive surgery. However, the material limitation is a significant challenge. There are fewer biodegradable materials with pressure-sensitive properties. Here, a pressure sensor based on the triboelectric effect between bioabsorbable materials is reported. This effect is available in almost all materials. The bioresorbable triboelectric sensor (BTS) can directly convert ambient pressure changes into electrical signals. This device successfully identifies abnormal vascular occlusion events in large animals (dogs). The service life of the BTS reaches 5 days with a high service efficiency (5.95%). The BTS offers excellent sensitivity (11 mVmmHg-1 ), linearity (R2 = 0.993), and good durability (450000 cycles). The antibacterial bioresorbable materials (poly(lactic acid)-(chitosan 4%)) for the BTS can achieve 99% sterilization. Triboelectric devices are expected to be applied in postoperative care as bioresorbable electronics.

Assessment of carotid arteries and brain matter in patients with isolated abnormal tortuosities and those combined with occlusion by computed tomography angiography

Rationale: The prevalence of malformation of internal carotid arteries (ICA) in the population amounts to 46%. In 4 to 16% of the cases, it is associated with clinical manifestations of cerebrovascular insufficiency. Hemodynamic changes in the abnormal arterial vasculature and neurological symptoms are the main indications for surgical intervention. Computed tomography (CT) angiography has shown its high information value in the assessment of ICA occlusions; however, its informativity in the diagnosis of ICA malformations has not been established.Aim: To assess ICA and brain matter in the patients with abnormal tortuosities, both isolated and combined with occlusion, by CT angiography.Materials and methods: We performed a retrospective analysis of medical files of 58 inpatients, who underwent ultrasound examination and CT angiography of extra and intracranial parts of brachycephalic arteries with 256 slice multidetector computer scanner (Philips iCT). CT angiography included native imaging, and contrast-enhanced arterial and venous phases. We assessed the impact of ICA abnormalities on the degree of brain matter lesions in patients with isolated ICA malformations (n=27) and with combination of ICA malformations with its occlusion (n=31).Results: In the group of the patients with isolated ICA malformations, there were no brain focal lesions in 14, small vessel focal lesions and single liquor cysts in 9, and areas and zones of cystic and glial abnormalities in 4. The most frequent in this group were S-like and C-like malformations, together with 2 saccular aneurysms (one of them true and one false). In the group of patients with combination of abnormal ICA tortuosities and occlusions, there were areas and zones of cystic and glial abnormalities in 7, various degrees of small vessel disease and few liquor cysts in 18, and no abnormal brain matter foci in 6. No ICA malformations in combination with true or false aneurysms were found. The patients with combination of ICA malformations and stenosis, the signs of chronic brain ischemia were more advanced, compared to those in the patients with isolated ICA malformations (p=0.012).Conclusion: CT angiography is a highly informative method for the assessment of carotid arteries and brain matter in patients with ICA malformations. The combination with ICA malformations and occlusion is associated with more advanced lesions of brain matter.

EVALUATION OF PARAMETERS FOR THE HEART RATE VARIABILITY AND POSTURAL DISORDERS IN PATIENTS WITH DISTAL AND PHYSIOLOGICAL OCCLUSION

Our study revealed the correlations between parameters that reflect changes in the systemic regulation of physiological functions during abnormal occlusion accompanied by disturbances in postural control. Estimating the heart rate variability, studying the posture (by means of computer optical topography), and performing the tests for activity of the autonomic nervous system showed that a normal functional state is characterized by coordinated activity of the postural control apparatus, occlusion of dentition, and other physiological systems. By contrast, the predominance of sympathetic autonomic regulation and anomaly of occlusion in the form of distal occlusion are is accompanied by the certain postural disorders (scoliosis of the 1st - 2nd degree in the frontal plane). Orthodontic treatment was followed by a decrease in activity of the sympathetic nervous system for heart rate regulation, which illustrates an increase in the adaptability of cardiovascular functions. These data are promising for an improvement of instrumental procedures for functional diagnostics in physiology and dentistry.

Superficial Siderosis and Microbleed Restricted in Cortex Might Be Correlated to Atrophy and Cognitive Decline in Sneddon's Syndrome.

Objective: Sneddon's syndrome is a rare non-inflammatory arteriopathy affecting small and medium-sized arteries, characterized by a generalized livedo reticularis and recurrent transient ischemic attack or ischemic stroke. Hemorrhagic stroke was reported in limited cases, but microbleeds and superficial siderosis were rarely issued. We aimed to investigate the hemorrhagic imaging features of Sneddon's syndrome and explore the possible mechanism and clinical relevance.Methods: Clinical data and cerebral MR imaging including T2* sequence of seven consecutive patients with Sneddon's syndrome were reviewed.Results: The most common neurological manifestations were cognitive impairment and stroke attack (71.4%), followed by seizures and movement disorder (28.6%). Cerebral microbleeds were detected in six patients on T2* sequence, all of them presented with cortical microbleeds, only one of them with microbleeds in basal ganglion. More than five microbleeds were observed in four of these six patients. The majority of the microbleeds were predominantly cortical restricted and especially located in the cortical watersheds. Multiple superficial siderosis were identified mainly involving cortical watersheds in five cases. Significant cerebral atrophy with prominent secondary white matter hyperintensities in bilateral cortical watersheds were also observed. Abnormal tortuous and multiple focal occlusion of bilateral distal MCA were shown in one patient by DSA. No stenosis of proximal segment of cerebral arteries was detected in all the patients.Conclusions: This is the first report illustrating abundant cortical microbleeds and superficial siderosis mainly involved the anterior and posterior cortical watersheds in Sneddon's syndrome. The surprisingly identical topographic distribution of hemorrhagic lesions and the obvious atrophy suggest cerebral atrophy might be secondary to the microangiopathy related hemorrhagic lesions and further contribute to the neurological deficit, especially the early cognitive decline in Sneddon syndrome.

Abstract WP476: Remarkable Hemorrhagic Imaging Manifestations Might Be Responsible for the Prominent Atrophy and Cognitive Decline in Sneddon Syndrome

Objective: Sneddon syndrome is a rare non-inflammatory arteriopathy affecting small and medium-sized arteries, characterized by a generalized livedo reticularis and recurrent ischemic stroke. Hemorrhagic stroke was reported in limited cases, but microbleeds and superficial siderosis were rarely issued, which might be underdiagnosed due to the limitation of technique. We aimed to investigate the hemorrhagic imaging features of Sneddon syndrome and explore the possible mechanism and clinical relevance. Methods: Clinical data and cerebral MR imaging including T2* sequence of 6 consecutive patients with Sneddon syndrome were reviewed. Results: The most common neurological manifestations were cognitive impairment and stroke attack(66.7%), followed by seizures(33.3%) and movement disorder(16.7%). Cerebral microbleeds were detected in all the patients on T2* sequence,four of whom presented more than 5 microbleeds.The majority of the microbleeds were predominantly cortical restricted and especially located in the cortical watersheds. Multiple superficial siderosis were identified and mainly involved cortical watersheds in 5 cases. Significant cerebral atrophy with prominent secondary white matter hyperintensities in bilateral cortical watersheds were also observed. Abnormal tortuous and multiple focal occlusion of bilateral distal MCA were shown in 1 patient by DSA. No stenosis of proximal segment of cerebral arteries was detected in all the patients. Conclusions: This is the first report illustrating abundant cortical microbleeds and superficial siderosis mainly involved the anterior and posterior cortical watersheds in Sneddon syndrome. The surprisingly identical topographic distribution of hemorrhagic lesions and the corresponding obvious atrophy suggest cerebral atrophy might be secondary to the microangiopathy related hemorrhagic lesions and further contribute to the neurological deficit, especially the early cognitive decline in Sneddon syndrome,although further investigation is needed to elucidate the precise underlying pathogenesis. These highlight cortical microbleeds and superficial siderosis located in cortical watershed and the secondary atrophy in youth might be highly indicative of Sneddon syndrome.