New navigation system for oral surgery

La chirurgia guidata dalle immagini(IGS) è usata in numerosi settori della chirurgia. Un innovativo sistema di navigazione chiamato Implanav è stato sviluppato dall'Università di Bologna insieme alla ditta BresMedical per consentire al chirurgo di monitorare in tempo reale le strutture anatomiche, durante il posizionamento degli impianti in campo maxillo-facciale. L'obbiettivo dello studio è di valutare in vitro ed in vivo le potenzialità e la precisione di questo sistema.Image-Guided Surgery (IGS) is used in a variety of medical procedures. An innovative system called ImplaNav has been developed by University of Bologna and BresMedical for oral and maxillofacial surgical navigation, in order to generate three-dimensional volumetric representations of the maxillofacial area, which allow surgeons to evaluate a patient's anatomy before surgery and assist in planning for the placement of implants in appropriate , ideal or preferred positions. The objective of this study is to evaluate the accuracy of the ImplaNavTM software and registration tools by presenting results obtained deploying the system in-vitro and in-vivo cases. The investigation focuses on how the surgical guidance, by way of visualization of a surgeon's instrument via optical tracking offered by the ImplaNavTM system, generates an immediate feedback on the possible misplacement or positioning of a dental implant

Psychiatric disorders in epilepsy: a proposal for classification by the ILAE commission on neuropsychiatry

INTRODUCTION: The relationship between psychiatric disorders (PD) and epilepsy is among the most frequent and important aspects of epileptology. PD are present in all epileptic syndromes and contribute to increase the difficulties in treating these patients. OBJECTIVE: We reviewed the classifications for the PD in epilepsy and highlighted the proposal by the ILAE Commission on Neuropsychiatry. CONCLUSION: The classification proposal by the ILAE attempted to separate disorders comorbid with epilepsy and those that reflect ongoing epileptiform activity from epilepsy-specific disorders and are based on clinical and descriptive symptoms rather than in etiological classification. It also presents clear and operational criteria that could be of greater utility for future studies of PD in epilepsy.INTRODUÇÃO: Um dos aspectos mais importantes da epileptologia é o da sua relação com as comorbidades psiquiátricas. Transtornos psiquiátricos (TP) são associados a praticamente todas as síndromes epilépticas e contribuem para uma maior dificuldade no manejo desses pacientes. OBJETIVO: O presente trabalho tem como objetivo fazer uma revisão das classificações dos TP na epilepsia e destacar a proposta elaborada pela Comissão de Neuropsiquiatria da ILAE. CONCLUSÃO: A proposta de classificação elaborada pela ILAE procurou diferenciar os TP que ocorrem em comorbidade daqueles que refletem atividade epileptiforme ou que ocorrem especificamente na epilepsia, sendo baseada em aspectos clínicos e descritivos mais do que em etiologias. Apresenta ainda critérios bastante claros e operacionais, constituindo-se de grande utilidade para futuros estudos dos quadros psiquiátricos na epilepsia.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) UNIPETEUNIFESP, EPM, UNIPETESciEL

Three-Dimensional Radiographic Evaluation of the Malar Bone Engagement Available for Ideal Zygomatic Implant Placement

Zygomatic implant rehabilitation is a challenging procedure that requires an accurate prosthetic and implant plan. The aim of this study was to evaluate the malar bone available for three-dimensional zygomatic implant placement on the possible trajectories exhibiting optimal occlusal emergence. After a preliminary analysis on 30 computed tomography (CT) scans of dentate patients to identify the ideal implant emergencies, we used 80 CT scans of edentulous patients to create two sagittal planes representing the possible trajectories of the anterior and posterior zygomatic implants. These planes were rotated clockwise on the ideal emergence points and three different hypothetical implant trajectories per zygoma were drawn for each slice. Then, the engageable malar bone and intra- and extra-sinus paths were measured. It was possible to identify the ideal implant emergences via anatomical landmarks with a high predictability. Significant differences were evident between males and females, between implants featuring anterior and those featuring posterior emergences, and between the different trajectories. The use of internal trajectories provided better bone engagement but required a higher intra-sinus path. A significant association was found between higher intra-sinus paths and lower crestal bone heights

Computer-Aided Rehabilitation Supported by Zygomatic Implants: A Cohort Study Comparing Atrophic with Oncologic Patients after Five Years of Follow-Up

The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All complications were managed without affecting the treatment. The quality of life increased by 71.3% in the atrophic group and by 82.9% in the oncologic group. Zygomatic implant rehabilitation seems to be a reliable technique for patients with maxillary atrophy and for oncologic patients. The three-dimensional computer-aided approach allows the surgeon to plan the surgery and increase its predictability. Early prosthesis loading certainly allows for better functional outcomes

Dynamic Navigation in Dental Implantology: The Influence of Surgical Experience on Implant Placement Accuracy and Operating Time. An in Vitro Study

Aim: the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator's experience. Materials and methods: sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was digitally planned on this. The models were randomly assigned to four operators with different levels of surgical experience. One hundred and twelve implant sites were drilled using a dynamic navigation system and operating times were measured. Based on postoperative CBCTs, dental implants were virtually inserted and superimposed over the planned ones. Two-dimensional and 3D deviations between planned and virtually inserted implants were measured at the entry point and at the apical point. Angular and vertical errors were also calculated. Results: considering coronal and apical 3D deviations, no statistically significant differences were found between the four operators (p = 0.27; p = 0.06). Some vectorial components of the deviation at the apical point and the angular errors of some operators differed from each other. Conclusions: within the limitations of this study, dynamic navigation can be considered a reliable technique both for experienced and novice clinicians

Prevalência de transtornos psiquiátricos em pacientes com esclerose mesial temporal

OBJECTIVE: Behavioral changes in patients with epilepsy can range from depression, anxiety to psychosis and personality traits. We evaluated the frequency of psychiatric disorders (PD) in a homogenous series of patients with refractory temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS) aiming at determining the frequency of PD and possible correlations to clinical variables and to laterality of MTS. METHODS: Data from 106 refractory TLE patients were reviewed. Psychiatric evaluation was based on DSM-IV criteria. Statistical analysis was performed through the chi-square (chi&sup2;), Student's t test and Fisher's exact test. P value considered significant was < 0.05. RESULTS: PD were found in 65 patients (61.3%). Among them, mood disorders were the most frequent (32 patients; 30%), followed by interictal (15 patients; 14%) and postictal (10 patients; 9.4%) psychosis. Postictal and interictal psychosis were significantly associated with left side MTS (p < 0.05), while PD in general and mood disorders were not associated to any side. CONCLUSION: There was a high prevalence of PD in patients with refractory TLE associated to MTS. The most common were mood and psychotic disorders. Psychosis was significantly associated to left side. These findings are concordant with data in literature, confirming the existence of anatomic alterations, and also a possible left laterality effect in the mesial temporal lobe structures in patients with epileptic psychosis.OBJETIVOS: Foi avaliada a freqüência de transtornos psiquiátricos (TP) em uma série homogênea de pacientes com epilepsia do lobo temporal (ELT) associada à esclerose mesial temporal (EMT), com o objetivo de verificar a prevalência e os tipos de TP nessa população e de correlacionar tais transtornos a aspectos clínicos e à lateralidade da EMT. METODOLOGIA: Dados de 106 pacientes com ELT refratária associada a EMT foram revisados. A avaliação psiquiátrica foi baseada nos critérios diagnósticos do DSM-IV. A análise estatística foi realizada através do teste do qui-quadrado (chi&sup2;), do teste t de Student e do teste exato de Fisher. O valor de P considerado significante foi < 0,05. RESULTADOS: TP foram diagnosticados em 65 pacientes (61,3%). Transtornos do humor foram os mais freqüentemente encontrados (32 pacientes; 30%), seguidos por psicose interictal (15 pacientes; 14%) e por psicose pós-ictal (10 pacientes; 9.4%). Tanto a psicose interictal como a psicose pós-ictal foram associadas a EMT à esquerda (p < 0,05), enquanto TP em geral e transtornos do humor não foram correlacionados a nenhum lado. CONCLUSÃO: HOUVE uma elevada prevalência de TP em pacientes com ELT refratária associada a EMT. Os mais freqüentemente encontrados foram transtornos do humor e psicóticos. Quadros psicóticos foram associados a EMT à esquerda. Tais achados são concordantes com dados da literatura atual em relação à prevalência de TP na ELT, confirmando a existência de alterações anatômicas e uma possível associação da EMT à esquerda com quadros psicóticos na ELT.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Unidade de Pesquisa e Tratamento das EpilepsiasUNIFESP, Unidade de Pesquisa e Tratamento das EpilepsiasSciEL

Universal and Specific Services for University Students with Specific Learning Disabilities: The Relation to Study Approach, Academic Achievement, and Satisfaction

In recent years, an increasing number of students with specific learning disabilities (SLDs) have enrolled in universities. The present exploratory study examined the frequency of use and appreciation of universal (open to every student) and specific services (offered to students with SLDs) and their relation to age, academic achievement, satisfaction, self-efficacy, and use of self-regulated learning (SRL) strategies. Participants were 147 Italian university students with SLD diagnoses (42 males; mean age: 22.49, SD = 3.29). Results showed that, overall, the frequency of use and appreciation of specific services were positively related to academic satisfaction, self-efficacy, and SRL strategies. Furthermore, frequency of use of compensatory tools and dispensatory measures was positively associated with academic achievement. These findings suggest that universities play an important role in supporting students with SLDs during their academic years by providing them with useful services and accommodations

Efficient Data-Intensive Event-Driven Interaction in SOA

International audienceThis paper presents a middleware that enables the efficient delivery of events carrying large attachments. We transpar- ently decouple event-description from event-data, in order to avoid useless data-transfers and modifications to endpoints business logic. Our solution relieves the event-delivery sys- tem of large data transfers, by enabling direct, but trans- parent, publisher to subscriber data-exchange. The experi- ments show that we can reduce the average event delivery time by half, compared to a standard approach requiring the full mediation of the event-delivery system