Paediatric and adult bronchiectasis: Specific management with coexisting asthma, COPD, rheumatological disease and inflammatory bowel disease

Bronchiectasis, conventionally defined as irreversible dilatation of the bronchial tree, is generally suspected on a clinical basis and confirmed by means of chest high-resolution computed tomography. Clinical manifestations, including chronic productive cough and endobronchial suppuration with persistent chest infection and inflammation, may deeply affect quality of life, both in children/adolescents and adults. Despite many cases being idiopathic or post-infectious, a number of specific aetiologies have been traditionally associated with bronchiectasis, such as cystic fibrosis (CF), primary ciliary dyskinesia or immunodeficiencies. Nevertheless, bronchiectasis may also develop in patients with bronchial asthma; chronic obstructive pulmonary disease; and, less commonly, rheumatological disorders and inflammatory bowel diseases. Available literature on the development of bronchiectasis in these conditions and on its management is limited, particularly in children. However, bronchiectasis may complicate the clinical course of the underlying condition at any age, and appropriate management requires an integration of multiple skills in a team of complementary experts to provide the most appropriate care to affected children and adolescents. The present review aims at summarizing the current knowledge and available evidence on the management of bronchiectasis in the other conditions mentioned and focuses on the new therapeutic strategies that are emerging as promising tools for improving patients' quality of life

Non-cystic fibrosis bronchiectasis in children and adolescents: Neglected and emerging issues.

Pediatric non-cystic fibrosis (CF) bronchiectasis is characterized by endobronchial suppuration, airway neutrophilic inflammation and poor mucus clearance and is associated with persistent productive cough due to recurrent airway infections. Most recommendations are based on expert opinion or extrapolated from CF practice. The present narrative review aims to address some issues on the management of children or adolescents with non CF-bronchiectasis that still require attention, and analyze what available literature offers to reply to open questions. We focused on the potential offered by technological advances on lung disease assessment through novel chest imaging techniques and new or old pulmonary function tests. We also summarized the main novelties in the disease prevention and treatment. Finally, a novel diagnostic algorithm is proposed, that might help physicians in the daily clinical decision-making process. Future directions for research on pediatric non-CF bronchiectasis should include larger study populations and longer prospective clinical trials, as well as new clinical and laboratory endpoints to determine the underlying mechanisms of lung disease progression and support the role of new and existing treatments

Pathological Fractures Of The Jaws Due To Cystic Lesions: A Three Case Series With A Brief Review Of The Literature

This study aims to describe pathologic fractures of the jaws due to cystic bone lesions. Their daily clinical practice findings are not very common, so their treatment can be challenging. In addition, endosseous benign lesions like a radicular, residual, solitary, aneurysmal cyst, and odontogenic keratocyst, might weaken the bone so that trauma, or usual chewing, could break it. We follow from the first clinical examination to the X-ray or CBCT examination and surgical management of our patients, reporting all procedures and results to explain our approach to these cases. We also reviewed the literature briefly to determine if our operative management is in line with the scientific community. Mandibular angle and body are common locations, while symphysis and condyle are less so. Young men are the most affected, and trauma is the most triggering event. Cyst enucleation, followed by fracture reduction and fixation, is the treatment of choice for our clinical team and the scientific community. We observe how impactful it is to approach the cavity of the cystic lesion from the fracture line as the surgical gold standar

Postoperative pain and surgical time comparison using piezoelectric or conventional implant site preparation systems

Since its introduction, piezoelectric bone surgery has established an important role in oral surgery and dental implantology. Piezoelectric surgery is efficient at preparing implant site osteotomies due to its selective cut, micro-streaming and cavitational effects, which preserve and maintain the soft tissue. Several advantages have been outlined in patient\u2019s symptoms, both in terms of improved intraoperative comfort and postoperative course. The aim of this study was to compare implant insertion procedures using piezoelectric surgery or conventional drilling. Intra- and postoperative pain, implant site preparation time and learning curve were evaluated. Methods: A total of 13 (7 women/6 men, aged between 45 and 75 years) partially edentulous patients were rehabilitated with 40 titanium implants (n=20). Implant therapy consisted in the inclusion of at least two conical implants between 3.8 and 4.5 mm diameter with a maximum torque of 35 Ncm in randomised bilateral edentulous areas. First sites were prepared with piezodevice (test sites) and the contralateral ones with conventional drilling (control sites). Surgery was always performed by the same operator. Implant site preparation timing was measured from flap elevation until implant inclusion. Patients recorded their subjective intraoperative and postoperative pain daily for 7 days and at 15th day after surgery using a Visual Analog Scale (VAS). Results: Patients treated with piezoelectric technique presented a lower VAS, minor swelling and less recovery time compared to the conventional technique. No operative complications were reported and the implant survival rate at 1 year was 100% for both the techniques. VAS significant differences were found for the test sites as intraoperative symptoms (p = 0.009), after 1 day (p = 0.010), 2 days (p = 0.016), 3 days (p = 0.017), 5 days (p = 0.015), 6 days (p = 0.018) and 7 days (p = 0.039). The average surgical times of implant sites preparation were: 10 (\ub1 1.4) minutes for the test sites, and 7.00 (\ub1 1.7) minutes for the control sites. In 69.2% of cases (9 of 13 patients) the operator has found advantages in terms of better access to the posterior sites, enhanced intraoperative visibility and insertion axis maintenance using the piezoelectric technique. The learning curve with piezodevice has seen a decrease in timing (rho = -0827, p = 0.001) from the first to the last intervention; whereas no significant difference was evaluated with the traditional method. Conclusion: Compared to traditional methods, piezoelectric technique enables optimal healing because it reduces the postsurgery swelling and discomfort. The average time necessary for the piezoelectric implant site osteotomy was approximately 3 minutes more than conventional technique

Observational Study on the Preparation of the Implant Site with Piezosurgery vs. Drill: Comparison between the Two Methods in terms of Postoperative Pain, Surgical Times, and Operational Advantages

Purpose. Recent advances show that ultrasonic implant site osteotomy is related to a decreased trauma and a better postoperative healing of the surgical site when compared to traditional drilling techniques. The micrometric bone cutting control and the operative advantages related to the piezoelectric approach are also characterized by a learning curve for the clinician in surgical practice and an increased operative duration of the procedure. The aim of this investigation is to compare the operative time, the postoperative pain, and the amount of painkillers taken by the patient during the healing period. Methods. A total of 65 patients were treated at the Unit of Oral Surgery (Department of Medical Sciences, Surgery and Health, University of Trieste, Italy) using a split mouth model: 75 drill-inserted implants (G1) and 75 piezoelectric device-inserted implants (G2) were placed. The Visual Analogue Scale (VAS) was performed to evaluate the postoperative pain at 15 days from surgery. The operative time and frequency of intake of painkillers were measured. Results. The G1 and G2 groups showed a significant difference with a higher use of painkillers observed for G1. The G2 patients showed a lower level of pain (VAS) at all experimental times between 8 hours to 7 days (p<0.01) postsurgery. At 15 days, the pain levels were similar for both groups. No differences were found in site preparation duration between the study groups. Conclusions. The evidence supports the application of the piezoelectric approach compared to the drill's osteotomy as a useful technique for implant site preparation. This trial is registered with NCT03978923

The use of compound options for credit risk modelling

When a company experiences credit-rating downgrades, its equity inevitably drops by a sizable amount as well as the prices of the derivative contracts written on the company’s equity and debt react accordingly. Stemming from the works of Merton (1974), Geske (1977) and Geske (1979), a new structural model of default is introduced. As the reference firm is assumed to have issued n bonds maturating at different future dates, the firm’s equity is modelled as an n fold compound option written on the firm’s assets and struck at the face values of the bonds outstanding. This framework is used across the chapters of the thesis, each constituting a different and original piece of research. The first paper, ‘The Impact of Credit Risk on Equity Options’ analyses the effect of credit risk on equity options. In order to conduct the analysis, a measure of impact of credit risk option contracts is introduced. Consistently with the theory and economic intuition, the option contracts which are mostly affected by changes in the underlying default risk are put options. I further document that their pricing is consistent with the probability of default embedded in the credit default swaps written on the same reference entity. It is also shown that the implied volatilities estimated á la Black-Scholes tend to average out the effect of credit risk over the moneyness space, leading to potential biases when applied for risk management purposes. The second paper, ‘Credit Spreads, Leverage and Volatility: A Cointegration Approach’ documents the existence of a cointegration relationship between credit spreads, leverage and equity volatility for a large set of US companies. It is shown that accounting for the long-run equilibrium dynamic is essential to correctly explain credit spread changes. Once credit these variables are correctly modelled, the fit of the regressions sensibly increases if compared to the results of previous research. The third paper, ‘The Option-implied Asset Volatility Surface’ provides a simple way to estimate the option-implied asset volatility surface. To describe the properties of the surfaces, principal component analysis is conducted both across the moneyness and the time-to-maturity dimension, as well as on the overall surface. Finally, the joint evolution of the smirk and the slope of the surface is modelled as a Vector Autoregressive model with exogenous variables. Both slope and smirk appear to be jointly autocorrelated

Genetic and Phenotypic Analysis of Meat Quality Traits in Buffalo Beef and Correlations to Carcass Composition

Abstract: Meat quality traits in buffalo beef were examined and their genetic parameters and genetic correlations to carcass composition were estimated. Dissection was performed on 40 buffalo beef carcasses and all traits recorded for each animal, as well as the weight on muscle lungissimus dorsi (LD). The temperature and pH were recorded at 1 and 48h post-slaughter. Intramuscular fat, protein, dry matter, meat colour (redness, a*, yellowness b* and lightness L*) were recorded. Hereditability estimates ranged from 0.12 and 0.99 for dissection traits and 0.61 and 0.68 for meat quality traits, which was significant for all traits except for ultimate pH and b*. Genetic correlation with L* were negative for a* and high and positive for b*. Intramuscular fat was moderate to highly genetically correlated to the a*, b* and half hot carcass weight. The not significant genetic correlation found between several of the meat quality traits, and between meat quality traits and carcasses composition traits, suggests that the meat quality traits analyzed should be implemented into breeding programme with care since their full effect on the other traits under selection cannot be accurately estimated. For more accurate estimates, further studies that especially include a large number of records for colour meat measures are needed

Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users

How is music perceived by cochlear implant (CI) users? This question arises as "the next step" given the impressive performance obtained by these patients in language perception. Furthermore, how can music perception be evaluated beyond self-report rating, in order to obtain measurable data? To address this question, estimation of the frontal electroencephalographic (EEG) alpha activity imbalance, acquired through a 19-channel EEG cap, appears to be a suitable instrument to measure the approach/withdrawal (AW index) reaction to external stimuli. Specifically, a greater value of AW indicates an increased propensity to stimulus approach, and vice versa a lower one a tendency to withdraw from the stimulus. Additionally, due to prelingually and postlingually deafened pathology acquisition, children and adults, respectively, would probably differ in music perception. The aim of the present study was to investigate children and adult CI users, in unilateral (UCI) and bilateral (BCI) implantation conditions, during three experimental situations of music exposure (normal, distorted and mute). Additionally, a study of functional connectivity patterns within cerebral networks was performed to investigate functioning patterns in different experimental populations. As a general result, congruency among patterns between BCI patients and control (CTRL) subjects was seen, characterised by lowest values for the distorted condition (vs. normal and mute conditions) in the AW index and in the connectivity analysis. Additionally, the normal and distorted conditions were significantly different in CI and CTRL adults, and in CTRL children, but not in CI children. These results suggest a higher capacity of discrimination and approach motivation towards normal music in CTRL and BCI subjects, but not for UCI patients. Therefore, for perception of music CTRL and BCI participants appear more similar than UCI subjects, as estimated by measurable and not self-reported parameters

A wire-loop technique for implantation of an iliac branched device in a patient with previous surgery for a ruptured abdominal aortic aneurysm

We described a modified technique for implanting a bridging stent-graft into an iliac branched device. A 79-year-old male who had received aortobiiliac synthetic graft surgery for a ruptured abdominal aortic aneurysm six months earlier was admitted to our unit for treatment of a left common iliac aneurysm involving the origin of the hypogastric artery. A standard technique was unsuccessful at implanting the bridging stent-graft, and therefore a wire-loop guidewire over the graft bifurcation was used to stabilize the contralateral sheaths and to complete the implantation. © Turkish Society of Radiology 2012