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Objective This study was aimed to evaluate the perception of changes in soft tissue profile by comparing profile silhouettes before and after treatment with the Forsus appliance, assessed by laypersons, orthodontists and patients. Methods The sample included 18 Class II patients (3 girls and 15 boys; mean age: 12.16 years) treated with the Forsus fatigue resistance device combined with fixed orthodontics. A set of images containing the before and after treatment profile silhouettes based on the lateral cephalograms of the patients were randomly prepared and presented to 135 examiners as a single page. Three groups of examiners assessed the images: G1, laypersons (n = 45); G2, orthodontists (n = 45); and G3, Class II orthodontic patients (n = 45). Each examiner rated the aesthetics of each facial profile using a visual analogue scale. Comparisons between before and after treatment silhouettes and among the three groups of examiners were performed using Wilcoxon and Kruskal-Wallis tests, respectively. A significance level of 5% was used. Results The after treatment profile silhouettes were preferred by G2 and G3. The higher scores were given by the patients. The outcomes were not influenced by sex. Conclusions Orthodontic treatment performed with the Forsus fatigue resistance device combined with fixed orthodontics had a positive outcome according to orthodontists and patients. The better attractive profile rates scored by patients may suggest a higher acceptance of the Class II facial characteristics. These data may guide orthodontists to discuss the treatment goals with patients considering their expectations and esthetic perceptions.

Cleidocranial dysostosis (CCD) is a congenital skeletal disorder with significant manifestations in facial and dental development. Patients are affected with CCD present maxillary deficiency, late dental eruption, and supernumerary teeth. Early and multidisciplinary approach is necessary to treat CCD patients, especially to manage dental eruption and Class III malocclusion with maxillary deficiency. Several orthodontic and surgical interventions are performed to enable traction and extraction of teeth. Yet the maxillary deficiency may be protracted followed by orthodontic dental compensation. On the other hand, it is important to note that CCD patients' treatment is closely related to the severity of transversal and sagittal deformities, as well as the discrepancies in the lower third of the face. In this context, patients with facial impairment highly affected by CCD may need ortho-surgical decompensation to reach more aesthetic outcomes. The present study reports a case of a 14-year-old young patient affected by CCD. Clinically, the patient presented Class III malocclusion, maxillary deficiency, short lower facial third, posterior crossbite, and anterior open bite leading to facial disharmony. The patient underwent treatment in 2 stages: the interceptive approach aimed to transversally expand the maxilla and promote its protraction; and the corrective phase combined with the orthognathic surgery treated the patients' main complains; the anterior open bite, unerupted teeth, and chin prominence. The treatment approach applied in the clinical report allowed the correction of the malocclusion and facial profile satisfying completely the patient's expectations.

The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens.A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI)≥3, a total burn surface area (TBSA)≥10%, and an ICU stay of at least 24h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray.A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n=78;46%), gram-positive bacteria (n=69;40%), and fungi (n=24;14%) median after 14days (range, 1-164), 16days (range, 1-170), and 16days (range, 0-89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n=26), followed by Candida sp. and Pseudomonas sp. (n=22 for both) was significantly associated with increased TBSA (p≤0.006) and ABSI (p0.0001) and need for fasciotomy (p0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8-32.8; p0.0001).A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp.