Repositioning template for mandibular reconstruction with fibular free flap: an alternative technique to pre-plating and virtual surgical planning

Oral malignancies involving the mandibular bone require a complex reconstructive plan. Mandibular reconstruction with a fibular free flap is currently considered the best choice for functional and aesthetic rehabilitation after oncological surgery. This flap can be modelled with multiple osteotomies and can provide bone, muscle and skin for composite reconstruction. One of the most delicate aspects of mandibular reconstruction is the technique of bone modelling; the risk of prolonging the period of ischaemia and not restoring the correct maxillomandibular and occlusal relationships can ultimately lead to a higher rate of complications as well as poor aesthetic and functional results. Recently, there has been rising interest in virtual surgical planning and computer-assisted mandibular reconstruction in pre-operative planning; however, this is not always possible because of the costs involved and the set-up time for the entire procedure. In this paper, we present a simple and inexpensive technique for fibular free flap modelling and repositioning after segmental resection of the mandible; the technique entails the pre-operative preparation of a resin repositioning template on a stereolithographic model. This technique has been successfully applied in four cases: two cases underwent resection involving only the mandibular body, one case involving the mandibular body and symphysis and one case in which a ramus to ramus resection was performed. In this preliminary report, we show that the resin repositioning template is an easy, safe and useful tool for mandibular reconstruction with a fibular free flap

Complicanze sinusali monolaterali da patologia o trattamenti dentali: quando la chirurgia endoscopica endonasale necessita un approccio intraorale?

L'utilizzo diffuso degli impianti dentali e delle procedure ricostruttive per il loro posizionamento ha portato un aumento delle complicanze sinusali da patologia o trattamenti dentali (SCDDT). La diagnosi richiede una valutazione dentale e rinologica accurata, compresa la tomografia computerizzata (TC). Lo scopo di questo studio è stato quello di considerare un approccio multidisciplinare per il trattamento delle SCDDT, combinando la chirurgia endoscopica endonasale (EES) e l'approccio intraorale sulla base di un sistema di classificazione preliminare già proposto da altri autori. Inoltre, gli autori hanno analizzato la percentuale di sinusite mascellare a eziologica odontogena che si estende a interessare i seni etmoidali anteriori come anche i batteri coinvolti nella patogenesi delle SCDDT. Tra il gennaio 2012 e agosto 2015, nella nostra casistica di 31 pazienti, 16/31 pazienti (51,6%) sono stati trattati con approccio EES, 3/31 pazienti (9,7%) con approccio intraorale, e 12/31 pazienti (38,7%) con approccio combinato. Tutti i pazienti hanno riferito un miglioramento dei sintomi della rinosinusite, confermato attraverso i risultati degli esami clinici e della TC di controllo. Non è stata osservata nessuna complicanza significativa, né si è ricorsi a una revisione chirurgica. Infine, i risultati di questo studio preliminare suggeriscono che un approccio multidisciplinare delle SCDDT dalla diagnosi alla terapia permette una diagnosi più precisa e una terapia più esauriente, così da ottenere un rapido recupero, riducendo al minimo il rischio di recidiva

Fibular osteofasciocutaneous flap in computer-assisted mandibular reconstruction: technical aspects in oral malignancies

Lutilizzo della pianificazione virtuale in chirurgia testa e collo è in forte crescita. In letteratura, la validità del metodo dal punto di vista dellacuratezza e lutilità clinica sono stati ampiamente documentati, in modo particolare per il rimodellamento osseo del lembo. Al giorno doggi, laumentato utilizzo della programmazione virtuale in chirurgia oncologica testa-collo e, conseguentemente, la maggiore necessità di ricostruzioni sia ossee che dei tessuti molli, rendono importante realizzare il programma virtuale considerando non solo la ricostruzione ossea, ma anche tutti gli aspetti relativi alla ricostruzione dei tessuti molli con lembi compositi. Descriviamo nel seguente articolo il nostro approccio alla pianificazione virtuale nel caso di lembi compositi. Lo studio riporta sei pazienti consecutivi con malattia maligna programmati mediante ricostruzione mandibolare computer assistita e lembi osteo-fascio-cutanei di perone. In tutti i sei pazienti, la resezione e la ricostruzione sono state progettate concentrandosi sulla posizione dei vasi perforanti cutanei, al fine di programmare la posizione più corretta delle guide di taglio a livello del perone in funzione della posizione dei vasi perforanti stessi. La tecnica descritta ci ha permesso di programmare lembi osteo-fascio-cutanei di perone nella ricostruzione mandibolare computer assistita, con buona precisione della posizione del segmento osseo rispetto alla padella cutanea, importante per la ricostruzione dei tessuti molli. Nonostante il numero limitato di casi, i risultati preliminari dello studio suggeriscono che questo protocollo è utile nella programmazione virtuale. Sono necessarie ulteriori indagini

The Impact of Symbolic and Substantive Actions on Environmental Legitimacy

Drawing on institutional theory and insights from stakeholder theory and impression management, we empirically analyze the impact of both environmental symbolic polices (participation in voluntary environmental programs, green trademarks, environmental-dedicated board committees, environmental pay policies and community communication) and substantive actions (environmental patents and pollution prevention practices) on environmental legitimacy. We show that (1) symbolic actions have a weaker positive effect on legitimacy than substantive actions, (2) that the impact of symbolic actions is greater when they are combined with substantive actions, (3) that this impact is only short-term while substantive actions have both short- and long-term effects

Pharmacokinetics of high-dose oral thiamine hydrochloride in healthy subjects

Background: High dose oral thiamine may have a role in treating diabetes, heart failure, and hypermetabolic states. The purpose of this study was to determine the pharmacokinetic profile of oral thiamine hydrochloride at 100 mg, 500 mg and 1500 mg doses in healthy subjects. Methods: This was a randomized, double-blind, single-dose, 4-way crossover study. Pharmacokinetic measures were calculated. Results: The $AUC_{0-10 hr}$ and $C_{max}$ values increased nonlinearly between 100 mg and 1500 mg. The slope of the $AUC_{0-10 hr}$ vs dose, as well as the $C_{max}$ vs dose, plots are steepest at the lowest thiamine doses. Conclusion: Our study demonstrates that high blood levels of thiamine can be achieved rapidly with oral thiamine hydrochloride. Thiamine is absorbed by both an active and nonsaturable passive process

Examining the mediating role of innovative capabilities in the interplay between lean processes and sustainable performance

Literature, heretofore, has assumed the relationship between ‘lean’ systems and their sustainable performance as direct and static. Researchers have explored this relationship from various perspectives and have taken clear sides, as to whether lean practices are favourable or inimical to the sustainable performance of a firm. We argue that the ‘for (or) against’ debate has been overstretched and has assumed some contingencies that are uncalled for. This study offers a novel perspective of gauging the relationship between lean practices and a firm’s sustainable performance from a dynamic stance. It recognizes that this relationship has both, synergistic and discordant phases. Synergistic phase revs up the sustainable performance and discordant phase is inimical to the sustainable performance of the firm. We propose that lean processes can positively (or) negatively affect a firm’s sustainable performance depending upon the state of innovative capability of the firm. In this regard, we present an iterative and recursive two-phase framework which draws upon the principles of a metaheuristics and is undergirded in dynamic capability theory. This framework discusses the ‘switching behaviour’ of the firm controlled by decoupling point. Switching behaviour determines how a firm should manoeuvre its innovation strategy. The framework was tested by using primary and secondary data (content analysis) in order to triangulate the results. This framework puts forth a set of generic guidelines, which the firms can decipher in their own idiosyncratic environments to bring about the required synergy between their lean processes and innovative capabilities. This synergy shall ensure that the ‘the engines of their sustainable growth’ are always fired up

Managing Carbon Aspirations: The Influence of Corporate Climate Change Targets on Environmental Performance

Addressing climate change is among the most challenging ethical issues facing contemporary business and society. Unsustainable business activities are causing significant distributional and procedural injustices in areas such as public health and vulnerability to extreme weather events, primarily because of a distinction between primary emitters and those already experiencing the impacts of climate change. Business, as a significant contributor to climate change and beneficiary of externalizing environmental costs, has an obligation to address its environmental impacts. In this paper, we explore the role of firms’ climate change targets in shaping their emissions trends in the context of a large multi-country sample of companies. We contrast two intentions for setting emissions reductions targets: symbolic attempts to manage external stakeholder perceptions via “greenwashing” and substantive commitments to reducing environmental impacts. We argue that the attributes of firms’ climate change targets (their extent, form, and time horizon) are diagnostic of firms’ underlying intentions. Consistent with our hypotheses, while we find no overall effect of setting climate change targets on emissions, we show that targets characterized by a commitment to more ambitious emissions reductions, a longer target time frame, and absolute reductions in emissions are associated with significant reductions in firms’ emissions. Our evidence suggests the need for vigilance among policy-makers and environmental campaigners regarding the underlying intentions that accompany environmental management practices and shows that these can to some extent be diagnosed analytically