Estudio de la evaluación de la planificación 3D en la distracción facial para el tratamiento de malformaciones craneomaxilofaciales

Las deformidades dentofaciales severas y algunos síndromes craneofaciales se asocian a alteraciones de la oclusión que suelen precisar tratamiento quirúrgico para su corrección. En casos leves o moderados se pueden tratar mediante cirugía ortognática pero cuando la deformidad es muy severa precisan la realización de distracción osteogénica. Dicho procedimiento consiste en la realización de una osteotomía, estabilización de los fragmentos para la creación del callo de fractura y elongación progresiva del mismo para generar tejido óseo. Este tratamiento es utilizado rutinariamente para alargar las extremidades y a nivel facial en los maxilares. La planificación 3D consiste en la realización de una TAC y mediante un software específico realizar la cirugía en un entorno virtual para la posterior impresión de modelos físicos 3D y guías de corte y posicionamiento que trasladen la cirugía virtual al quirófano. El estudio consiste en evaluar la eficacia de la planificación 3D en los pacientes sometidos a distracción facial para corregir su oclusión y anatomía facial en tres niveles: 1. Distracción facial en síndromes craneofaciales (Crouzon, Apert, Pfeiffer) que precisen osteotomía de Le Fort III. 2. Distracción maxilar en pacientes con fisura labiopalatina que presenten clase III esquelética por hipoplasia maxilar severa. 3. Distracción mandibular en pacientes con clase II esquelética de causa mandibular que puedan condicionar la vía aérea o con asimetrías mandibulares severas por microsomía hemifacial.Odontologí

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. Objectives: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study Design: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d’Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). Results: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. Conclusions: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance

Patient-specific 3D printed soft models for liver surgical planning and hands-on training

Background: Pre-surgical simulation-based training with three-dimensional (3D) models has been intensively developed in complex surgeries in recent years. This is also the case in liver surgery, although with fewer reported examples. The simulation-based training with 3D models represents an alternative to current surgical simulation methods based on animal or ex vivo models or virtual reality (VR), showing reported advantages, which makes the development of realistic 3D-printed models an option. This work presents an innovative, low-cost approach for producing patient-specific 3D anatomical models for hands-on simulation and training. Methods: The article reports three paediatric cases presenting complex liver tumours that were transferred to a major paediatric referral centre for treatment: hepatoblastoma, hepatic hamartoma and biliary tract rhabdomyosarcoma. The complete process of the additively manufactured liver tumour simulators is described, and the different steps for the correct development of each case are explained: (1) medical image acquisition; (2) segmentation; (3) 3D printing; (4) quality control/validation; and (5) cost. A digital workflow for liver cancer surgical planning is proposed. Results: Three hepatic surgeries were planned, with 3D simulators built using 3D printing and silicone moulding techniques. The 3D physical models showed highly accurate replications of the actual condition. Additionally, they proved to be more cost-effective in comparison with other models. Conclusions: It is demonstrated that it is possible to manufacture accurate and cost-effective 3D-printed soft surgical planning simulators for treating liver cancer. The 3D models allowed for proper pre-surgical planning and simulation training in the three cases reported, making it a valuable aid for surgeons.The research undertaken in this paper has been partially funded by the QuirofAM project (Exp. COMRDI16-1-0011) co-financed by the European Union through the European Regional Development Fund FEDER with the support of ACCIÓ-Generalitat de Catalunya 2014–2020.Peer ReviewedPostprint (published version

Patient comprehension of oncologic surgical procedures using 3D printed surgical planning prototypes

Patient understanding of complex surgical procedures and post-intervention consequences is often poor. Little is known about the effectiveness of 3D printed models to improve the comprehension of the medical information provided to patients. The purpose of this study was to determine if 3D printed patient-specific anatomical models could help improve patients’ satisfaction and understanding of complex oncological surgical procedures, their risks, benefits, and alternatives. Basic procedure A randomized, controlled crossover experiment was performed, where subjects were randomly assigned to different treatments of the study. This experiment involved teenage patients experts from Kids Barcelona, a Young Person's Advisory Group. The team (n = 14, age range 14–20, 9 females and 5 males) was divided into two groups involved in two simulated pre-surgical outpatient visits for complex oncologic surgical procedures: a high-risk stage 4 abdominal neuroblastoma, and a biliary tract rhabdomyosarcoma. Two senior oncologic surgeons participated in the study by performing the structured outpatient pre-surgical visit. Each participant received information before the study explaining the study methodology and was given a questionnaire. Main findings Data analysis of the group using the 3D printed model for the neuroblastoma case showed better results than without the 3D model. On the other hand, conversely, on the data analysis of the rhabdomyosarcoma case with the 3D printed model no better results were observed as compared to the case of not using a 3D model. However, the results of the participants’ knowledge were still better than before the intervention. Satisfaction was significantly better with a 3D model in both cases.Peer ReviewedObjectius de Desenvolupament Sostenible::3 - Salut i BenestarPostprint (published version

A state-of-the-art guide about the effects of sterilization processes on 3D-printed materials for surgical planning and medical applications: a comparative study

Surgeons use different medical devices in the surgery, such as patient-specific anatomical models, cutting and positioning guides, or implants. These devices must be sterilized before being used in the operation room. There are many sterilization processes available, with autoclave, hydrogen peroxide, and ethylene oxide being the most common in hospital settings. Each method has both advantages and disadvantages in terms of mechanics, chemical interaction, and post-treatment accuracy. The aim of the present study is to evaluate the dimensional and mechanical effect of the most commonly used sterilization techniques available in clinical settings, i.e., Autoclave 121, Autoclave 134, and hydrogen peroxide (HPO), on 11 of the most used 3D-printed materials fabricated using additive manufacturing technologies. The results showed that the temperature (depending on the sterilization method) and the exposure time to that temperature influence not only the mechanical behavior but also the original dimensioning planned on the 3D model. Therefore, HPO is a better overall option for most of the materials evaluated. Finally, based on the results of the study, a recommendation guide on sterilization methods per material, technology, and clinical application is presented.The research described in this paper was partially funded by the project named QuirofAM (Exp. COMRDI16-1-0011) and funded by ACCIÓ from the Catalan government and ERDF from European Union.Postprint (published version

Effect of p95HER2/611CTF on the Response to Trastuzumab and Chemotherapy

Human epidermal growth factor receptor 2 (HER2)–positive breast cancers are currently treated with trastuzumab, an anti-HER2 antibody. About 30% of these tumors express a group of HER2 fragments collectively known as p95HER2. Our previous work indicated that p95HER2-positive tumors are resistant to trastuzumab monotherapy. However, recent results showed that tumors expressing the most active of these fragments, p95HER2/611CTF, respond to trastuzumab plus chemotherapy. To clarify this discrepancy, we analyzed the response to chemotherapy of cell lines transfected with p95HER2/611CTF and patient-derived xenografts (n = 7 mice per group) with different levels of the fragment. All statistical tests were two-sided. p95HER2/611CTF-negative and positive tumors showed different responses to various chemotherapeutic agents, which are particularly effective on p95HER2/611CTF-positive cells. Furthermore, chemotherapy sensitizes p95HER2/611CTF-positive patient-derived xenograft tumors to trastuzumab (mean tumor volume, trastuzumab alone: 906mm3, 95% confidence interval = 1274 to 538 mm3; trastuzumab+doxorubicin: 259mm3, 95% confidence interval = 387 to 131 mm3; P < .001). This sensitization may be related to HER2 stabilization induced by chemotherapy in p95HER2/611CTF-positive cells

A deletion at Adamts9-magi1 Locus is associated with psoriatic arthritis risk

Objective: Copy number variants (CNVs) have been associated with the risk to develop multiple autoimmune diseases. Our objective was to identify CNVs associated with the risk to develop psoriatic arthritis (PsA) using a genome-wide analysis approach. Methods: A total of 835 patients with PsA and 1498 healthy controls were genotyped for CNVs using the Illumina HumanHap610 BeadChip genotyping platform. Genomic CNVs were characterised using CNstream analysis software and analysed for association using the χ2 test. The most significant genomic CNV associations with PsA risk were independently tested in a validation sample of 1133 patients with PsA and 1831 healthy controls. In order to test for the specificity of the variants with PsA aetiology, we also analysed the association to a cohort of 822 patients with purely cutaneous psoriasis (PsC). Results: A total of 165 common CNVs were identified in the genome-wide analysis. We found a highly significant association of an intergenic deletion between ADAMTS9 and MAGI1 genes on chromosome 3p14.1 (p=0.00014). Using the independent patient and control cohort, we validated the association between ADAMTS9-MAGI1 deletion and PsA risk (p=0.032). Using next-generation sequencing, we characterised the 26 kb associated deletion. Finally, analysing the PsC cohort we found a lower frequency of the deletion compared with the PsA cohort (p=0.0088) and a similar frequency to that of healthy controls (p>0.3). Conclusions: The present genome-wide scan for CNVs associated with PsA risk has identified a new deletion associated with disease risk and which is also differential from PsC risk

Pasados y presente. Estudios para el profesor Ricardo García Cárcel

Ricardo García Cárcel (Requena, 1948) estudió Historia en Valencia bajo el magisterio de Joan Reglà, con quien formó parte del primer profesorado de historia moderna en la Universidad Autónoma de Barcelona. En esta universidad, desde hace prácticamente cincuenta años, ha desarrollado una extraordinaria labor docente y de investigación marcada por un sagaz instinto histórico, que le ha convertido en pionero de casi todo lo que ha estudiado: las Germanías, la historia de la Cataluña moderna, la Inquisición, las culturas del Siglo de Oro, la Leyenda Negra, Felipe II, Felipe V, Austrias y Borbones, la guerra de la Independencia, la historia cultural, los mitos de la historia de España... Muy pocos tienen su capacidad para reflexionar, ordenar, analizar, conceptualizar y proponer una visión amplia y llena de matices sobre el pasado y las interpretaciones historiográficas. A su laboriosidad inimitable se añade una dedicación sin límites en el asesoramiento de alumnos e investigadores e impulsando revistas, dosieres, seminarios o publicaciones colectivas. Una mínima correspondencia a su generosidad lo constituye este volumen a manera de ineludible agradecimiento

Ensayo clínico randomizado a doble ciego de evaluación de la efectividad del gel bioadhesivo de clorhexidina al 0.2% en la prevención de alveolitis seca tras la exodoncia de terceros molares inferiores

La alveolitis seca es una complicación frecuente tras la exodoncia de los terceros molares. Uno de los agentes más estudiados en su prevención es la clorhexidina. El objetivo de este estudio fue evaluar la eficacia del gel bioadhesivo de clorhexidina al 0,2% colocado intra-alveolar en la prevención de la alveolitis seca después de la extracción de los terceros molares mandibulares y analizar el impacto de los factores de riesgo como el tabaquismo y los anticonceptivos orales. El estudio es un ensayo clínico aleatorizado, a doble ciego, realizado en la Unidad de Cirugía Sin Ingreso del Hospital Universitari Vall d' Hebron desde abril de 2008 hasta noviembre de 2010. El estudio fue aprobado por el Comité de Ética del Hospital en diciembre de 2007. Un total de 160 pacientes recibieron de manera aleatoria gel bioadhesivo de clorhexidina al 0,2 % (80 pacientes) o gel placebo (80 pacientes). El gel bioadhesivo de clorhexidina al 0.2% aplicado intraalveolar tras la exodoncia de los terceros molares reduce la incidencia de alveolitis seca en un 22% respecto al placebo con diferencias que no son estadísticamente significativas. El tabaquismo y la toma de anticonceptivos orales no se han encontrado relacionados con la incidencia de alveolitis seca. El sexo femenino y la dificultad de la intervención quirúrgica (5 o superior en la escala de Koerner) se asocian a una mayor incidencia de alveolitis seca con diferencias estadísticamente significativas. La falta de reacciones adversas y complicaciones relacionadas con el gel de clorhexidina apoya su uso clínico y añade algunas ventajas en comparación con los enjuagues en cuanto a la duración del tratamiento y la reducción de sus efectos secundarios.Alveolar osteitis is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine. The aim of this study was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of alveolar osteitis after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of alveolar osteitis. The study was a randomized, double-blind, placebo-controlled, clinical trial conducted at the Minor Outpatient Surgery Unit of Hospital Universitari Vall dʼHebron from april 2008 until november 2010. The study was approved by the Ethics Committee of the Hospital in December 2007. A total of 160 patients randomly received 0.2% bioadhesive chlorhexidine gel (80 patients) or bioadhesive placebo gel (80 patients). 0.2% bioadhesive chlorhexidine gel applied inside the alveolus after the extraction of mandibular third molars reduces the incidence of dry socket by 22% compared to placebo with differences that are not statistically significant. Smoking and the use of oral contraceptives did not increase the incidence of alveolar osteitis. Female patients and the surgical difficulty (5 or higher in the Koernerʼs index) were associated with a higher incidence of alveolar osteitis with statistically significant differences. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of the side effects

Ensayo clínico randomizado a doble ciego de evaluación de la efectividad del gel bioadhesivo de clorhexidina al 0.2% en la prevención de alveolitis seca tras la exodoncia de terceros molares inferiores

La alveolitis seca es una complicación frecuente tras la exodoncia de los terceros molares. Uno de los agentes más estudiados en su prevención es la clorhexidina. El objetivo de este estudio fue evaluar la eficacia del gel bioadhesivo de clorhexidina al 0,2% colocado intra-alveolar en la prevención de la alveolitis seca después de la extracción de los terceros molares mandibulares y analizar el impacto de los factores de riesgo como el tabaquismo y los anticonceptivos orales. El estudio es un ensayo clínico aleatorizado, a doble ciego, realizado en la Unidad de Cirugía Sin Ingreso del Hospital Universitari Vall d' Hebron desde abril de 2008 hasta noviembre de 2010. El estudio fue aprobado por el Comité de Ética del Hospital en diciembre de 2007. Un total de 160 pacientes recibieron de manera aleatoria gel bioadhesivo de clorhexidina al 0,2 % (80 pacientes) o gel placebo (80 pacientes). El gel bioadhesivo de clorhexidina al 0.2% aplicado intraalveolar tras la exodoncia de los terceros molares reduce la incidencia de alveolitis seca en un 22% respecto al placebo con diferencias que no son estadísticamente significativas. El tabaquismo y la toma de anticonceptivos orales no se han encontrado relacionados con la incidencia de alveolitis seca. El sexo femenino y la dificultad de la intervención quirúrgica (5 o superior en la escala de Koerner) se asocian a una mayor incidencia de alveolitis seca con diferencias estadísticamente significativas. La falta de reacciones adversas y complicaciones relacionadas con el gel de clorhexidina apoya su uso clínico y añade algunas ventajas en comparación con los enjuagues en cuanto a la duración del tratamiento y la reducción de sus efectos secundarios.Alveolar osteitis is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine. The aim of this study was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of alveolar osteitis after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of alveolar osteitis. The study was a randomized, double-blind, placebo-controlled, clinical trial conducted at the Minor Outpatient Surgery Unit of Hospital Universitari Vall dʼHebron from april 2008 until november 2010. The study was approved by the Ethics Committee of the Hospital in December 2007. A total of 160 patients randomly received 0.2% bioadhesive chlorhexidine gel (80 patients) or bioadhesive placebo gel (80 patients). 0.2% bioadhesive chlorhexidine gel applied inside the alveolus after the extraction of mandibular third molars reduces the incidence of dry socket by 22% compared to placebo with differences that are not statistically significant. Smoking and the use of oral contraceptives did not increase the incidence of alveolar osteitis. Female patients and the surgical difficulty (5 or higher in the Koernerʼs index) were associated with a higher incidence of alveolar osteitis with statistically significant differences. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of the side effects