Cephalometric measurements performed on CBCT and reconstructed lateral cephalograms: a cross-sectional study providing a quantitative approach of differences and bias

Background: Cephalometric analysis is traditionally performed on skull lateral teleradiographs for orthodontic diagnosis and treatment planning. However, the skull flattened over a 2D film presents projection distortions and superimpositions to various extents depending on landmarks relative position. When a CBCT scan is indicated for mixed reasons, cephalometric assessments can be performed directly on CBCT scans with a distortion free procedure. The aim of the present study is to compare these two methods for orthodontic cephalometry. Methods: 114 CBCTs were selected, reconstructed lateral cephalometries were obtained by lateral radiographic projection of the entire volume from the right and left sides. 2D and 3D cephalometric tracings were performed. Since paired t-tests between left and right-side measurements found no statistically significant differences, mean values between sides were considered for both 2D and 3D values. The following measurements were evaluated: PNS-A; S-N; N-Me; N-ANS; ANS-Me; Go-Me; Go-S; Go-Co; SNA, SNB, ANB; BaŜN; S-N^PNS-ANS; PNS-ANS^Go-Me; S-N^Go-Me. Intraclass correlation coefficients, paired t-test, correlation coefficient and Bland-Altman analysis were performed to compare these techniques. Results: The values of intra- and inter-rater ICC showed excellent repeatability and reliability: the average (± SD) intraobserver ICCs were 0.98 (± 0.01) and 0.97(± 0.01) for CBCT and RLCs, respectively; Inter-rater reliability resulted in an average ICC (± SD) of 0.98 (± 0.01) for CBCT and 0.94 (± 0.03) for RLC. The paired t-tests between CBCT and reconstructed lateral cephalograms revealed that Go-Me, Go-S, PNS-ANS^Go-Me and S-N^Go-Me measurements were statistically different between the two modalities. All the evaluated sets of measurements showed strong positive correlation; the bias and ranges for the 95% Limits of Agreement showed higher levels of agreement between the two modalities for unpaired measurements with respect to bilateral ones. Conclusion: The cephalometric measurements laying on the mid-sagittal plane can be evaluated on CBCT and used for orthodontic diagnosis as they do not show statistically significant differences with those measured on 2D lateral cephalograms. For measurements that are not in the mid-sagittal plane, the future development of specific algorithms for distortion correction could help clinicians deduct all the information needed for orthodontic diagnosis from the CBCT scan

Brain Correlates of Persistent Postural-Perceptual Dizziness: A Review of Neuroimaging Studies.

Persistent postural-perceptual dizziness (PPPD), defined in 2017, is a vestibular disorder characterized by chronic dizziness that is exacerbated by upright posture and exposure to complex visual stimuli. This review focused on recent neuroimaging studies that explored the pathophysiological mechanisms underlying PPPD and three conditions that predated it. The emerging picture is that local activity and functional connectivity in multimodal vestibular cortical areas are decreased in PPPD, which is potentially related to structural abnormalities (e.g., reductions in cortical folding and grey-matter volume). Additionally, connectivity between the prefrontal cortex, which regulates attentional and emotional responses, and primary visual and motor regions appears to be increased in PPPD. These results complement physiological and psychological data identifying hypervigilant postural control and visual dependence in patients with PPPD, supporting the hypothesis that PPPD arises from shifts in interactions among visuo-vestibular, sensorimotor, and emotional networks that overweigh visual over vestibular inputs and increase the effects of anxiety-related mechanisms on locomotor control and spatial orientation

The Role of Quantic Molecular Resonance (QMR) in the Treatment of Inferior Turbinate Hypertrophy (ITH): Our Experience With Long-Term Follow-Up in Allergic and Nonallergic Rhinitis Refractory to Medical Therapy. Preliminary Results.

Objective: The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. Methods: This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. Results: Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. Conclusions: In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes

Applying Mining Techniques to Analyze Vestibular Data

AbstractThe vestibular apparatus allows to perform audiological and equilibrium human functions and to capture movements with respect to gravity. Damages to the vestibular system causes diseases that can be measured by using Vestibular Evoked Myogenic Potentials (VEMPs) test. The test produces a lot of data that has to be collected and analyzed to allow a disease study and classification. We propose a framework that includes algorithms able to perform pathology distribution and classification. It has been tested on electronic patient records loaded from the University Hospital database. The software allows to manage the structure and framework and a blind application of one of the available classification techniques shows a relation among gender and vestibular apparatus disease

Tidal signatures in Neogene to Quaternary mixed deposits of southern Italy straits and bays

Some of the Neogene to Quaternary sedimentary successions cropping out in the southern Italy orogenic belt exhibit distinct stratigraphic intervals of mixed, silici-bioclastic arenites. These deposits represent bay- and strait-fill successions that accumulated during tectonically-driven, rapid transgressions in peripheral marine basins of the central Mediterranean, experiencing microtidal conditions similar to those presently existing in the Mediterranean Sea. The Upper Miocene to Middle Pleistocene successions of Basilicata, Calabria and NE Sicily, show laterallyaccreted, cross-strata of mixed composition, with the siliciclastic fraction derived from either sedimentary or metamorphic rocks and the bioclastic fraction produced by an in situ or near situ heterozoan factory. Tidal cyclicity of semi-diurnal and diurnal to monthly and yearly periodicities has been detected in the studied deposits, where tidal bundling is revealed by the rhythmic alternation of siliciclastic and bioclastic set of laminae, repeated according to different cycles. This rhythmic signature appears to be more evident where randomly-occurring processes, such as waves, storms and currents, were mitigated by engulfed or strait palaeo-settings. Palaeo-bays preserved short-term tidal cycles in shoreface to offshore-transition mixed deposits because hydrodynamically isolated from open marine conditions and therefore subjected to tidal influence only during fair-weather periods. On the contrary, palaeo-straits recorded tidal cyclicities of longer duration in deeper mixed deposits subjected to steady tidal currents

Study of the association between gait variability and physical activity

Background: Gait variability can be considered an indirect measure of gait stability, in particular regarding temporal or spatial variability assessment. Physical activity, such as walking, is advised for the elderly and can be improved by gait stability. The aim of this study was to investigate the associations between gait stability and physical activity in women of different age ranges. Methods: Forty-two healthy women of different age ranges (18-40 yrs. and 65-75 yrs.) were recruited in the study. To assess physical activity, the subjects wore a multi-sensor activity monitor for a whole week, inferring the time spent in moderate to vigorous physical activity (MVPA). MVPA were analysed in bouts of at least 10 subsequent minutes (MVPAbouts) and in overall minutes (MVPAtot). A kinematic analysis was performed with an optoelectronic system to calculate gait variability - expressed as standard deviation (SD) and coefficient of variability (CV) of step width, stride length, stance and swing time (during treadmill walking at different speeds). Results: Elderly women, with high walking speed (5 km/h), and moderate step width variability (CV = 8â\u80\u9327%), met the recommended levels of physical activity (MVPAtotand MVPAbouts). Furthermore, gait variability, adjusted for age and number of falls, was significantly and negatively associated with MVPAtotonly at 3.5 km/h, and with MVPAboutsonly at 4 km/h. Conclusions: In a population of healthy elderly women, gait variability was significantly and negatively associated with the level of physical activity. Healthy elderly women, with moderate gait variability (step width variability), and high preferred walking speed, seem to be able to meet the recommended levels of physical activity

Nasal, pharyngeal and laryngeal endoscopy proceduresduring COVID‐19 pandemic: available recommendations from national and international societies

The Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2), also known as COVID-19, pandemic is engaging clinicians around the world in an unprecedented effort to limit the viral spread and treat affected patients; the rapid diffusion of the disease represents a risk for healthcare providers who have a close contact with the upper aerodiges- tive tract during medical, diagnostic and surgical procedure

Interplay of tidal and fluvial processes in an early Pleistocene, delta-fed, strait margin (Calabria, Southern Italy)

The architecture and morphodynamics of modern and ancient tidal straits and in particular the deposits of strait-margin zones, have been significantly understudied compared to other marginal marine settings, even though many reservoirs in the North Sea and the Norwegian Continental Shelf are developed in narrow grabens or seaways. This paper presents a detailed sedimentological and stratigraphic analysis of an early Pleistocene marginal-marine succession deposited along the northern margin of the Siderno paleostrait (southern Italy). This area represents an excellent case study of sedimentation along a tidal strait margin, interpreted to record the interaction of fluvial and tidal processes. Here, syn-depositional tectonics produced a complex coastal morphology, significantly influencing sedimentation and hydrodynamic processes. Along the strait margin, the emplacement of an isolated tectonic high (Piano Fossati) created a ca. 3.5 km-wide local passageway. This morpho-structural element induced interplays between fluvio-deltaic processes (fed from the northern strait margin) and tidal current reworking (active within the marine strait).The field-based facies analysis reported here documents an initial stage of non-tidal shallow-marine sedimentation across the strait. A subsequent regression caused river-generated hyperpycnal flows and the transfer of large volumes of pebbly and shelly sandstones into deeper water. Tidal currents became amplified in the strait, and, in the delta-front area, they were able to rework river-derived sediments generating large dune fields. Following the local tidal transport pathway, strong tidal currents skewed the delta front (causing it to be asymmetrical) and elongated sand bodies in a direction parallel to the marine strait axis. Differently from the classical tide-influenced deltas in which onshore-offshore tidal flow predominates, coast-parallel deflection and strong asymmetry of delta-front deposits is a typical feature of deltas entering tide-dominated seaways and straits, where strong tidal currents are capable of dispersing large volumes of sand for significant distances along the coast and along the strait axis. This process became progressively enhanced during the following transgression, when tide-modulated currents reworked biocalcarenitic sands over the previous delta deposits, generating southeasterly migrating dunes. At the end of the transgression, strandplain deposits formed in this area. This last stage of sedimentation was followed by a dramatic regional-scale structural uplift, which ended any marine circulation within the strait. This work provides new insights on sedimentation in a tide-dominated strait, and helps to predict sandbody distribution along the strait margin and axis. These findings can be applied to any other setting characterized by a narrow (possibly structurally-confined) basin dominated by tidal currents

Altered Insular and Occipital Responses to Simulated Vertical Self-Motion in Patients with Persistent Postural-Perceptual Dizziness.

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a common functional vestibular disorder characterized by persistent symptoms of non-vertiginous dizziness and unsteadiness that are exacerbated by upright posture, self-motion, and exposure to complex or moving visual stimuli. Recent physiologic and neuroimaging data suggest that greater reliance on visual cues for postural control (as opposed to vestibular cues-a phenomenon termed visual dependence) and dysfunction in central visuo-vestibular networks may be important pathophysiologic mechanisms underlying PPPD. Dysfunctions are thought to involve insular regions that encode recognition of the visual effects of motion in the gravitational field. METHODS: We tested for altered activity in vestibular and visual cortices during self-motion simulation obtained via a visual virtual-reality rollercoaster stimulation using functional magnetic resonance imaging in 15 patients with PPPD and 15 healthy controls (HCs). We compared between groups differences in brain responses to simulated displacements in vertical vs horizontal directions and correlated the difference in directional responses with dizziness handicap in patients with PPPD. RESULTS: HCs showed increased activity in the anterior bank of the central insular sulcus during vertical relative to horizontal motion, which was not seen in patients with PPPD. However, for the same comparison, dizziness handicap correlated positively with activity in the visual cortex (V1, V2, and V3) in patients with PPPD. CONCLUSION: We provide novel insight into the pathophysiologic mechanisms underlying PPPD, including functional alterations in brain processes that affect balance control and reweighting of space-motion inputs to favor visual cues. For patients with PPPD, difficulties using visual data to discern the effects of gravity on self-motion may adversely affect balance control, particularly for individuals who simultaneously rely too heavily on visual stimuli. In addition, increased activity in the visual cortex, which correlated with severity of dizziness handicap, may be a neural correlate of visual dependence

Accuracy of automated 3D cephalometric landmarks by deep learning algorithms: systematic review and meta-analysis

Objectives The aim of the present systematic review and meta-analysis is to assess the accuracy of automated landmarking using deep learning in comparison with manual tracing for cephalometric analysis of 3D medical images. Methods PubMed/Medline, IEEE Xplore, Scopus and ArXiv electronic databases were searched. Selection criteria were: ex vivo and in vivo volumetric data images suitable for 3D landmarking (Problem), a minimum of five automated landmarking performed by deep learning method (Intervention), manual landmarking (Comparison), and mean accuracy, in mm, between manual and automated landmarking (Outcome). QUADAS-2 was adapted for quality analysis. Meta-analysis was performed on studies that reported as outcome mean values and standard deviation of the difference (error) between manual and automated landmarking. Linear regression plots were used to analyze correlations between mean accuracy and year of publication. Results The initial electronic screening yielded 252 papers published between 2020 and 2022. A total of 15 studies were included for the qualitative synthesis, whereas 11 studies were used for the meta-analysis. Overall random effect model revealed a mean value of 2.44 mm, with a high heterogeneity (I-2 = 98.13%, tau(2) = 1.018, p-value < 0.001); risk of bias was high due to the presence of issues for several domains per study. Meta-regression indicated a significant relation between mean error and year of publication (p value = 0.012). Conclusion Deep learning algorithms showed an excellent accuracy for automated 3D cephalometric landmarking. In the last two years promising algorithms have been developed and improvements in landmarks annotation accuracy have been done