SINCONAPP: A Computerized learning tool for CBCT normal anatomy and variants of the nose and paranasal sinuses

1. Purpose To supply an useful learning tool aimed to interactively display on mobile devices normal anatomy and variants of the nose and paranasal sinuses as seen on CBCT images. 2. Methods and Materials Images Images of the nose and paranasal sinuses were derived by a study series acquired by a CBCT device. CBCT studies of the paranasal sinuses were acquired in patients referred for nasal obstruction or sinusitis with the following parameters: 90 kVp, 12.5 mA, 20 s rotation time, FOV 13 x 14.5 cm, 0.25 x 0.25 x 0.25 mm voxel size. Software The application has been developed for iOS based mobile devices through the platform XCode provided by Apple®, and it is developed using the Objective-C programming language. The application has been configured as Master-Detail. This configuration splits the mobile device display in two panels. The left panel displays a list of the interesting items, while the right panel shows the relative details. Touching an item from the menu on the left panel, the textual description is shown on the same side, while the panel on the right will show the relative image. The application allows interactively navigation through normal anatomy and variants of the nose and paranasal sinuses, as represented on CBCT images in axial, sagittal and coronal planes. Cross-reference images to localize the same anatomic structures on different section planes are available. The navigation is intuitive, with multiple shortcuts. Different labels have been proposed in accordance with the specific anatomic lessic of the district and current literature references. High image quality with a zooming tool are available. 4. Conclusion An App for IOs devices was developed, that can represent an useful educational tool for medical students, residents and continuous medical education in radiology and other medical specialties dealing with nose and paranasal sinuses. This interactive atlas based on CBCT images could be also an useful option to be implemented on CBCT software

Targeted delivery of neutralizing anti-C5 antibody to renal endothelium prevents complement- dependent tissue damage

Complement activation is largely implicated in the pathogenesis of several clinical conditions and its therapeutic neutralization has proven effective in preventing tissue and organ damage. A problem that still needs to be solved in the therapeutic control of complement-mediated diseases is how to avoid side effects associated with chronic neutralization of the complement system, in particular, the increased risk of infections. We addressed this issue developing a strategy based on the preferential delivery of a C5 complement inhibitor to the organ involved in the pathologic process. To this end, we generated Ergidina, a neutralizing recombinant anti-C5 human antibody coupled with a cyclic-RGD peptide, with a distinctive homing property for ischemic endothelial cells and effective in controlling tissue damage in a rat model of renal ischemia/reperfusion injury (IRI). As a result of its preferential localization on renal endothelium, the molecule induced complete inhibition of complement activation at tissue level, and local protection from complement-mediated tissue damage without affecting circulating C5. The ex vivo binding of Ergidina to surgically removed kidney exposed to cold ischemia supports its therapeutic use to prevent posttransplant IRI leading to delay of graft function. Moreover, the finding that the ex vivo binding of Ergidina was not restricted to the kidney, but was also seen on ischemic heart, suggests that this RGD-targeted anti-C5 antibody may represent a useful tool to treat organs prior to transplantation. Based on this evidence, we propose preliminary data showing that Ergidina is a novel targeted drug to prevent complement activation on the endothelium of ischemic kidney

CBCT in the diagnosis of osteonecrosis of the jaws

Short Summary: ONJ is associated with bisphosphonates, and recently with antiangiogenic drugs. Another cause is radiotherapy. Few papers have previously investigated the value of CBCT in the diagnosis of ONJ. Purpose/Objectives: To describe the CBCT findings in the diagnosis of osteonecrosis of the jaws (ONJ) according to a new staging system of ONJ. Methods and Materials: 9 patients (5 women, 4 men, 54-76 yrs.) affected by ONJ were studied with a CBCT device (90 kV, 12.5 mA, 0.25 mm voxel size) in 2012-2013. 7/9 patients were treated with bisphosphonates (5 for bone metastasis, 2 for osteoporosis), 1/9 patient was treated with an antiangiogenic drug, 1/9 patient received radiotherapy. Patients were divided in 3 stages, according to a new clinical-radiologic classification of ONJ, made by SICMF (Italian Society of Maxillo-Facial Surgery) and SIPMO (Italian Society of Oral Medicine), that gives more prominence to the radiologic findings and includes 3 stages: stage 1 focal ONJ, a) symptomatic, b) asymptomatic; stage 2 diffuse ONJ, a) symptomatic, b) asymptomatic; stage 3 complicated ONJ. Axial, panoramic, cross sectional, multiplanar and 3D reformations were analysed. Results: Radiologic findings of ONJ were found in maxilla (7/9 patients) and mandible (7/9 patients). Patients were staged as follows: 1/9 stage 1b), 1/9 stage 2a), 4/9 stage 2b), and 3/9 stage 3. CBCT findings varied from simple osteosclerosis in stage 1b), to multifragmentary fracture, extraoral fistula, and fistula between oral cavity and maxillary sinus or nasal cavity in stage 3 patients, passing through osteonecrosis and bone sequestrum in 7 patients in stage 2-3. Conclusion: CBCT is a valuable tool in the radiologic assessment of ONJ and proved useful in this new SICMF-SIPMO staging system. Keywords: Staging, jaws, osteonecrosis, CBC