Quale analisi cefalometrica per la chirurgia maxillo-mandibolare in pazienti con sindrome delle apnee ostruttive notturne?

L’avanzamento maxillo-mandibolare (AMM) è un trattamento efficace per pazienti affetti da sindrome delle apnee ostruttive notturne (OSAS) di grado severo. Sebbene il miglioramento dell’OSAS sia l’obiettivo principale di tale chirurgia, è necessario evitare un avanzamento maxillo-mandibolare eccessivo per garantire un gradevole risultato in termini di estetica facciale. A tale scopo, è necessario programmare preoperatoriamente l’entità dell’AMM mediante un’analisi estetica e cefalometrica. Le analisi cefalometriche di Steiner e Delaire vengono comunemente impiegate nella programmazione della chirurgia ortognatica per deformità dentofaciali, tuttavia resta controverso il ruolo di tali analisi nei pazienti con OSAS candidati a AMM. Quarantotto pazienti con OSAS severa sono stati sottoposti a AMM. Abbiamo effettuato le analisi cefalometriche di Steiner e Delaire in tutti i soggetti. Per il tracciato di Steiner, abbiamo misurato la variazione degli angoli SNA e SNB, mentre per l’analisi di Delaire, abbiamo misurato la variazione degli angoli C3/FM-CPA e C3/ FM-Me. L’AMM medio è stato di 6,9 + 3,8 mm per il mascellare superiore e 13,6 + 5 mm per la mandibola. Dopo l’intervento abbiamo riscontrato un miglioramento dell’Indice di Apnea-Ipopnea (40,47 + 7,64 preoperatoriamente vs. 12,56 + 5,78 postoperatoriamente). In tutti i pazienti, entrambe le tecniche cefalometriche hanno dimostrato una retrusione bimascellare preoperatoria. Dopo l’intervento, l’angolo SNA medio è aumentato da 78,18° a 85,58° (p < 0,001), mentre l’angolo C3/FM-CPA medio è aumentato da 81,19° a 89,71° (p < 0,001). Il valore medio dell’angolo SNB è aumentato da 74,33° a 80,73° (p < 0,001), mentre l’angolo medio C3/FM-CPA è passato da 80,10° a 87,29° (p < 0,001). Postoperatoriamente, sia il mascellare superiore che la mandibola risultavano in una posizione più protrusa (p < 0,001) se analizzati secondo l’analisi di Steiner rispetto al tracciato di Delaire. L’utilizzo dell’analisi cefalometrica di Delaire nella programmazione dell’AMM in pazienti con OSAS comporta un avanzamento maxillo-mandibolare superiore rispetto al tracciato di Steiner. È opportuno considerare le conseguenze di tale risulto sull’estetica facciale durante la programmazione chirurgica e nel consenso informato preoperatorio in pazienti con OSAS candidati a AMM

Randomized trial on the effects of a combined physical/cognitive training in aged MCI subjects: the Train the Brain study

Age-related cognitive impairment and dementia are an increasing societal burden. Epidemiological studies indicate that lifestyle factors, e.g. physical, cognitive and social activities, correlate with reduced dementia risk; moreover, positive effects on cognition of physical/cognitive training have been found in cognitively unimpaired elders. Less is known about effectiveness and action mechanisms of physical/cognitive training in elders already suffering from Mild Cognitive Impairment (MCI), a population at high risk for dementia. We assessed in 113 MCI subjects aged 65-89 years, the efficacy of combined physical-cognitive training on cognitive decline, Gray Matter (GM) volume loss and Cerebral Blood Flow (CBF) in hippocampus and parahippocampal areas, and on brain-blood-oxygenation-level-dependent (BOLD) activity elicited by a cognitive task, measured by ADAS-Cog scale, Magnetic Resonance Imaging (MRI), Arterial Spin Labeling (ASL) and fMRI, respectively, before and after 7 months of training vs. usual life. Cognitive status significantly decreased in MCI-no training and significantly increased in MCI-training subjects; training increased parahippocampal CBF, but no effect on GM volume loss was evident; BOLD activity increase, indicative of neural efficiency decline, was found only in MCI-no training subjects. These results show that a non pharmacological, multicomponent intervention improves cognitive status and indicators of brain health in MCI subjects

A multi-sensor wearable system for the assessment of diseased gait in real-world conditions

Introduction: Accurately assessing people’s gait, especially in real-world conditions and in case of impaired mobility, is still a challenge due to intrinsic and extrinsic factors resulting in gait complexity. To improve the estimation of gait-related digital mobility outcomes (DMOs) in real-world scenarios, this study presents a wearable multi-sensor system (INDIP), integrating complementary sensing approaches (two plantar pressure insoles, three inertial units and two distance sensors). Methods: The INDIP technical validity was assessed against stereophotogrammetry during a laboratory experimental protocol comprising structured tests (including continuous curvilinear and rectilinear walking and steps) and a simulation of daily-life activities (including intermittent gait and short walking bouts). To evaluate its performance on various gait patterns, data were collected on 128 participants from seven cohorts: healthy young and older adults, patients with Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, congestive heart failure, and proximal femur fracture. Moreover, INDIP usability was evaluated by recording 2.5-h of real-world unsupervised activity. Results and discussion: Excellent absolute agreement (ICC >0.95) and very limited mean absolute errors were observed for all cohorts and digital mobility outcomes (cadence ≤0.61 steps/min, stride length ≤0.02 m, walking speed ≤0.02 m/s) in the structured tests. Larger, but limited, errors were observed during the daily-life simulation (cadence 2.72–4.87 steps/min, stride length 0.04–0.06 m, walking speed 0.03–0.05 m/s). Neither major technical nor usability issues were declared during the 2.5-h acquisitions. Therefore, the INDIP system can be considered a valid and feasible solution to collect reference data for analyzing gait in real-world conditions

Assessing real-world gait with digital technology? Validation, insights and recommendations from the Mobilise-D consortium

Background Although digital mobility outcomes (DMOs) can be readily calculated from real-world data collected with wearable devices and ad-hoc algorithms, technical validation is still required. The aim of this paper is to comparatively assess and validate DMOs estimated using real-world gait data from six different cohorts, focusing on gait sequence detection, foot initial contact detection (ICD), cadence (CAD) and stride length (SL) estimates. Methods Twenty healthy older adults, 20 people with Parkinson’s disease, 20 with multiple sclerosis, 19 with proximal femoral fracture, 17 with chronic obstructive pulmonary disease and 12 with congestive heart failure were monitored for 2.5 h in the real-world, using a single wearable device worn on the lower back. A reference system combining inertial modules with distance sensors and pressure insoles was used for comparison of DMOs from the single wearable device. We assessed and validated three algorithms for gait sequence detection, four for ICD, three for CAD and four for SL by concurrently comparing their performances (e.g., accuracy, specificity, sensitivity, absolute and relative errors). Additionally, the effects of walking bout (WB) speed and duration on algorithm performance were investigated. Results We identified two cohort-specific top performing algorithms for gait sequence detection and CAD, and a single best for ICD and SL. Best gait sequence detection algorithms showed good performances (sensitivity > 0.73, positive predictive values > 0.75, specificity > 0.95, accuracy > 0.94). ICD and CAD algorithms presented excellent results, with sensitivity > 0.79, positive predictive values > 0.89 and relative errors < 11% for ICD and < 8.5% for CAD. The best identified SL algorithm showed lower performances than other DMOs (absolute error < 0.21 m). Lower performances across all DMOs were found for the cohort with most severe gait impairments (proximal femoral fracture). Algorithms’ performances were lower for short walking bouts; slower gait speeds (< 0.5 m/s) resulted in reduced performance of the CAD and SL algorithms. Conclusions Overall, the identified algorithms enabled a robust estimation of key DMOs. Our findings showed that the choice of algorithm for estimation of gait sequence detection and CAD should be cohort-specific (e.g., slow walkers and with gait impairments). Short walking bout length and slow walking speed worsened algorithms’ performances

Mobilise-D insights to estimate real-world walking speed in multiple conditions with a wearable device

This study aimed to validate a wearable device’s walking speed estimation pipeline, considering complexity, speed, and walking bout duration. The goal was to provide recommendations on the use of wearable devices for real-world mobility analysis. Participants with Parkinson’s Disease, Multiple Sclerosis, Proximal Femoral Fracture, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and healthy older adults (n = 97) were monitored in the laboratory and the real-world (2.5 h), using a lower back wearable device. Two walking speed estimation pipelines were validated across 4408/1298 (2.5 h/laboratory) detected walking bouts, compared to 4620/1365 bouts detected by a multi-sensor reference system. In the laboratory, the mean absolute error (MAE) and mean relative error (MRE) for walking speed estimation ranged from 0.06 to 0.12 m/s and − 2.1 to 14.4%, with ICCs (Intraclass correlation coefficients) between good (0.79) and excellent (0.91). Real-world MAE ranged from 0.09 to 0.13, MARE from 1.3 to 22.7%, with ICCs indicating moderate (0.57) to good (0.88) agreement. Lower errors were observed for cohorts without major gait impairments, less complex tasks, and longer walking bouts. The analytical pipelines demonstrated moderate to good accuracy in estimating walking speed. Accuracy depended on confounding factors, emphasizing the need for robust technical validation before clinical application. Trial registration: ISRCTN – 12246987

Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?

Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperativelyby both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner’s SNA angle increased from 78.18° to 85.58° (p &lt; 0.001), while mean Delaire’s C3/FM-CPA angle increased from 81.19° to 89.71° (p &lt; 0.001). The mean value of Steiner’s SNB angle increased from 74.33° to 80.73° (p &lt; 0.001), while Delaire’s C3/FM-Me angle increased from 80.10° to 87.29° (p &lt; 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p &lt; 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA

EFFICACIA DI UN TRATTAMENTO COMBINATO PER IL RECUPERO DELLA FUNZIONE DELLA MANO IN PAZIENTI CON EMIPARESI SPASTICA IN FASE CRONICA SOTTOPOSTI AD INIEZIONE DI TOSSINA BOTULINICA

Numerose evidenze supportano l’utilizzo della tossina botulinica di tipo A nei muscoli dell’arto superiore al fine di migliorare l’esecuzione dei movimenti di reaching e di grasping in soggetti affetti da ictus. Inoltre, è stato dimostrato che il trattamento post inoculo è fondamentale per aumentare l’efficacia della tossina botulinica e migliorare la funzione dell’arto superiore, se presente. Obiettivo del presente studio osservazionale è determinare l’efficacia di un trattamento con stimolazione elettrica funzionale (FES) sulla funzione della mano nel periodo successivo all’iniezione di tossina botulinica in pazienti affetti da emiparesi spastica in fase cronica

Right heart function in obstructive sleep apnea syndrome by three-dimensional echocardiography and speckle tracking echocardiography

Purpose. It is known that obstructive sleep apnea syndrome (OSAS) can affect right ventricular (RV) performance even in the absence of systemic hypertension and other known cardiac or obstructive pulmonary disease. We assessed changes in ventricular parameters determined by three-dimensional echocardiography (3DE) and speckle tracking imaging (STI) before and after continuous positive airway pressure (CPAP) treatment. Methods. We recruited 31 patients with OSAS and 31 healthy subjects without signs of cardiopulmonary dysfunction. OSAS was defined as apnea hypopnea index (AHI) ≥5 events per hour. Twelve patients with severe OSAS (AHI≥30) underwent chronic nocturnal nasal CPAP therapy. RV end-diastolic and end-systolic volumes were measured from three-dimensional echocardiographic datasets and right ventricular ejection fraction (3D-RVEF) was calculated. Pulmonary arterial systolic pressure was obtained by standard Doppler methods. Pulmonary hypertension was defined as a pulmonary artery systolic pressure of 40 mmHg or greater. To assess regional and global RV systolic function in the longitudinal direction using STI, we adopted a 6-segment RV model (basal RV lateral wall, mid RV lateral wall, apical RV wall, apical septum, mid septum, and basal septum). RV peak systolic strain and time to peak-systolic strain from the onset of QRS were recorded for the 6 RV myocardial segments and for the entire RV myocardium (EchoPAC BT09, GE Ultrasound). Global longitudinal strain was calculated by averaging local strains along the entire right ventricle using machine software. RV dyssynchrony (RV-SD6) was defined as the standard deviation of the six time to peak systolic strain values. Results. 3D-RVEF was lower in patients with OSAS and pulmonary hypertension compared to the control group (p<0.001) and compared to patients with OSAS and normal pulmonary pressure (p<0.05). A significant correlation was found between RV-SD6 and pulmonary artery systolic pressure (r = 0.74, p <0.005) and between RV-SD6 and AHI (r = 0.77, p <0.001). The group treated with CPAP had a significant decrease in pulmonary artery systolic pressure, total pulmonary vascular resistance and RV-SD6 as well as significant increase in 3D-RVEF. By multivariate analysis, RV-SD6 (p=0.006) and 3D-RVEF (p=0.03) were predictive of AHI