DIAGNOSTIC AND THERAPEUTIC MANAGEMENT OF IATROGENIC LESIONS OF LINGUAL AND INFERIOR ALVEOLAR NERVE

Trigeminal nerve branches injuries are more and more frequent because of the wide spread of oral surgery. When the nerve damage involves the lingual nerve (LN) or the inferior alveolar nerve (IAN), the negative impact of the nervous dysfunction on the daily life of patients is relevant. Patients usually describe their condition as a crippling disease interfering with their common daily activities (talking, eating and drinking) and, consequently, forcing them to give up their social life. This difficult situation is undoubtedly worse when pain is present. It is about a neuropathic pain due to the nerve damage and the wrong regeneration process that make a mixture of nervous fibres and scar tissue. It is a dull pain described by one of our patient as \u201ca monster that never gives up, always present as a new life-mate\u201d. Moreover, all these feelings and patients\u2019 adaptability have always to be correlate to the kind of surgery that caused the symptoms themselves. It\u2019s not easy to understand and accept a complete lingual anaesthesia associated with continuous pain appeared after the removal of an asymptomatic wisdom molar! The same symptoms appeared after the removal of a malign tumour are usually more acceptable. Unfortunately, even today, there is no worldwide consensus about how to early recognize and eventually treat this kind of lesions. Nowadays, these iatrogenic nerve damages culminate more and more frequent in legal matters. A standardization of diagnostic and therapeutic management is necessary, to clarify which the correct approach for each patient is. This project aimed to standardize through the founding of a specific Clinic the management of patients affected by lingual nerve and inferior alveolar nerve lesion, in order to propose a common diagnostic process, followed by both the patient-specific reconstructive surgery and the regular clinic and neurophysiological follow up. The standardized management allows to understand the actual efficacy of this kind of surgery

Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy

The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck\u2013otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues\u2019 burden. Specific issues and management decisions are discussed in detail in the article

Conditional measurements on multimode pairwise entangled states from spontaneous parametric downconversion

We address the intrinsic multimode nature of the quantum state of light obtained by pulsed spontaneous parametric downconversion and develop a theoretical model based only on experimentally accessible quantities. We exploit the pairwise entanglement as a resource for conditional multimode measurements and derive closed formulas for the detection probability and the density matrix of the conditional states. We present a set of experiments performed to validate our model in different conditions that are in excellent agreement with experimental data. Finally, we evaluate nonGaussianity of the conditional states obtained from our source with the aim of discussing the effects of the different experimental parameters on the efficacy of this type of conditional state preparation

Orbital medial wall fractures: Purely endoscopic endonasal repair with polyethylene implants

Our technique couples the stronger support granted by non-resorbable materials and the minimal invasiveness of the endoscopic approach without the need for long-term nasal packing

Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures

Facial palsy is a severe condition that may be ameliorated by facial reanimation, but there is no consensus about how to judge its success. In this study we aimed to test a new method for assessing facial movements based on 3-dimensional analysis of the facial surfaces. Eleven patients aged between 42 and 77 years who had recently been affected by facial palsy (onset between 6 and 18 months) were treated by an operation based on triple innervation: the masseteric to temporofacial nerve branch, 30% of the hypoglossal fibres to the cervicofacial nerve branch, and the contralateral facial nerve through two cross-face sural nerve grafts. Each patient had five stereophotogrammetric scans: at rest, smiling on the healthy side (facial stimulus), biting (masseteric stimulus), moving the tongue (hypoglossal stimulus), and corner-of-the-mouth smile (Mona Lisa). Each scan was superimposed onto the facial model of the "rest" position, and the point-to-point root mean square (RMS) value was automatically calculated on both the paralysed and the healthy side, together with an index of asymmetry. One-way and two-way ANOVA tests, respectively, were applied to verify the significance of possible differences in the RMS and asymmetry index according to the type of stimulus (p = 0.0329) and side (p < 0.0001). RMS differed significantly according to side between the facial stimulus and the masseteric one on the paralysed side (p = 0.0316). Facial stimulus evoked the most asymmetrical movement, whereas the masseteric produced the most symmetrical expression. The method can be used for assessing facial movements after facial reanimation

Experimental joint signal-idler quasi-distributions and photon-number statistics for mesoscopic twin beams

Joint signal-idler photoelectron distributions of twin beams containing several tens of photons per mode have been measured recently. Exploiting a microscopic quantum theory for joint quasi-distributions in parametric down-conversion developed earlier we characterize properties of twin beams in terms of quasi-distributions using experimental data. Negative values as well as oscillating behaviour in quantum region are characteristic for the subsequently determined joint signal-idler quasi-distributions of integrated intensities. Also the conditional and difference photon-number distributions are shown to be sub-Poissonian and sub-shot-noise, respectively.Comment: 7 pages, 6 figure

Technical refinements in mandibular reconstruction with free fibula flaps: Outcome-oriented retrospective review of 99 cases = Accorgimenti tecnici nelle ricostruzioni mandibolari con lembi liberi di fibula: analisi retrospettiva dei risultati su 99 casi

Congenital disease, major trauma, tumour resection and biphosphonate-related osteonecrosis can lead to partial, subtotal, or total loss of the mandibular bone. Minor defects can be easily reconstructed using bone grafts, whereas microvascular free tissue transfer may be unavoidable in the case of major bone loss or poor quality of soft tissue. Simple bone or composite osteocutaneous fibula free flaps have proven invaluable and remain the workhorse for microvascular mandibular reconstruction in daily practice. Our experience with 99 consecutive fibular free flaps confirms the available data in terms of high success rate. In these cases, 90% had total success, while 7 had complete flap failures. Three of our patients showed skin paddle necrosis with bony conservation. This report focuses on the technical refinements used by the authors that can prove valuable in obtaining predictable and precise results: in particular, we discuss surgical techniques that avoid vascular pedicle ossification by removing the fibular periosteum from the vascular pedicle itself and reduce donor site morbidity and aid in management of the position in the new condylar fossa. Finally, new technologies such as intraoperative CT and custom premodelled fixation plates may also increase the predictability of morpho-functional results

Everolimus Nanoformulation in Biological Nanoparticles Increases Drug Responsiveness in Resistant and Low-Responsive Breast Cancer Cell Lines

Everolimus (Eve) is an FDA approved drug that inhibits mammalian target of rapamycin (mTOR). It is employed in breast cancer treatment even if its responsiveness is controversial. In an attempt to increase Eve effectiveness, we have developed a novel Eve nanoformulation exploiting H-ferritin nanocages (HEve) to improve its subcellular delivery. We took advantage of the natural tumor targeting of H-Ferritin, which is mediated by the transferrin receptor-1 (TfR1). Breast cancer cells overexpressing TfR-1 were successfully recognized by H-Ferritin, displaying quick nanocage internalization. HEve has been tested and compared to Eve for in vitro efficacy in sensitive and resistant breast cancer cells. Nanoformulated Eve induced remarkable antiproliferative activity in vitro, making even resistant cell lines sensitive to Eve. Moreover, the antiproliferative activity of HEve is fully in accordance with cytotoxicity observed by cell death assay. Furthermore, the significant increase in anticancer efficacy displayed in HEve-treated samples is due to the improved drug accumulation, as demonstrated by UHPLC-MS/MS quantifications. Our findings suggest that optimizing Eve subcellular delivery, thanks to nanoformulation, determines its improved antitumor activity in a panel of Eve-sensitive or resistant breast cancer cell lines

Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience

Introduction: Evaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome. Materials and methods: From 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire). Results: 72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p &lt; 0.001), height of the foramina (p &lt; 0.001), thickness of the yellow ligament (p = 0.001) and anterior height of the interbody space (p = 0.02) were observed. Older age (p = 0.042), presence of spondylolisthesis (p = 0.042), presence of intra-articular facet effusion (p = 0.003) and posterior height of the implanted cage (p = 0.020) positively affected the increase of the canal area. Change in root canal area (p &lt; 0.001), height of the implanted cage (p = 0.020) and younger age (p = 0.035) were predictive factors of root pain relief, while increased vertebral canal area (p = 0.020) and height of the interbody fusion cage (p = 0.023) positively affected the severity of clinical stenosis. Conclusions: LLIF indirect decompression showed both clinical and radiological improvements. Presence and degree of spondylolisthesis, presence of intra-articular facet effusion, age of the patient and height of the cage were predictive factors of major clinical improvements

Simultaneous identification and quantitative determination in urine of the more significant metabolites of synthetic cannabinoids JWH-018, JWH-073, JWH-122 and JWH-250 using authentic references and deuterated isotopologues as internal standards

Introduction Synthetic cannabinoids (SC) are substances displaying a high affinity for cannabinoid receptor CB1 and represent the psychoactive agents in herbal mixtures called \u201cSpice\u201d or \u201cK2\u201d which are sold as an incense or smoking material mainly through the Internet. Because of its great abusive potential, several SC are banned in many countries, but despite this, the widespread use of herbal smoking mixtures containing SC may be partially explained by the fact that post-ingestion urines are known to produce negative results in standard toxicological screening methods for cannabis. As a consequence, an increasing number of analytical methods have been developed in forensic and doping control laboratories to enable the detection of illegal intake of these psychoactive substances in human fluids originating from psychiatric patients, emergency units or assessment of fitness to drive. Due to rapid metabolic transformation, the native SC are not usually detectable in urine samples and then the analytical methods must be based on the identification and quantization of their metabolites. Aims The aim of our study is to set-up, using synthesized reference standards, a LC-MS/MS method for routine screening procedures to assess the assumption of JWH-018, JWH-073, JWH 122 and JWH-250, the SC included in Table 1 of narcotic and psychotropic substances banned in Italy. The method gives the simultaneous identification of the three more significant metabolites of each cannabinoid and adequate sensitivity, precision and accuracy are assured by the use of deuterated internal standards. Methods For each of the four cannabinoids were synthesized the three more significant metabolites, the \u3c9- and (\u3c9-1)-hydroxyl and the \u3c9-carboxyl derivatives (\u3c9 position represent the terminal carbon of the N-alkyl side chain) while as internal standards were synthesized the (\u3c9-1)-hydroxyl metabolites trideuterated on the terminal methyl of the side chain. Urine samples were subjected to deconjugation using 30% hydrochloric acid at 90-95\ub0C for 60 min, followed by a solvent extraction procedure with n-hexane-ethyl acetate (9/1 v/v). The LC-MS/MS analysis was performed in positive mode on an API 4000 Triple Quadrupole Mass Spectrometer (AB Sciex) equipped with a 1,8\ub5m Acquity C-18 HSS T3 100 x 2 mm HPLC column (Waters) with isocratic elution (55 % of 10 mM HCOONH4 in water containing 0.1% HCOOH and 45 % of acetonitrile) at 45 \ub0C and at flow rate of 0.4 mL/min. Two transitions in \u2018multiple reaction monitoring\u2019 mode and the retention time have permitted the unambiguous identification of each metabolite which, through the presence of a suitable internal standard, was quantified. Result and discussion All the synthesized compounds were fully characterized with regard to the structure and purity, by 1H,13C NMR and GC-MS (after esterification with CH2N2 for the \u3c9-carboxylic metabolites). For sample treatment, the recovery of the metabolites was evaluated at different pH (1, 3, 5, 9 and 10). The validation of the method was performed testing linearity (0.5-100 ng/mL), reproducibility and accuracy (ranged between -15% and + 15%) at three levels. The method developed was applied to the analysis of urine samples from individuals who have taken SC. This LC-MS/MS method can be used for routine screening of urine specimens from subjects suspected of using \u201cherbal incense\u201d or \u201cSpice\u201d products spiked with the synthetic cannabinoids JWH-018, JWH-073, JWH 122 or JWH-250