Impact of COVID-19 on maxillofacial surgery practice: a worldwide survey

The outbreak of coronavirus disease 2019 (COVID-19) is rapidly changing our habits. To date, April 12, 2020, the virus has reached 209 nations, affecting 1.8 million people and causing more than 110,000 deaths. Maxillofacial surgery represents an example of a specialty that has had to adapt to this outbreak, because of the subspecialties of oncology and traumatology. The aim of this study was to examine the effect of this outbreak on the specialty of maxillofacial surgery and how the current situation is being managed on a worldwide scale. To achieve this goal, the authors developed an anonymous questionnaire which was posted on the internet and also sent to maxillofacial surgeons around the globe using membership lists from various subspecialty associations. The questionnaire asked for information about the COVID-19 situation in the respondent's country and in their workplace, and what changes they were facing in their practices in light of the outbreak. The objective was not only to collect and analyse data, but also to highlight what the specialty is facing and how it is handling the situation, in the hope that this information will be useful as a reference in the future, not only for this specialty, but also for others, should COVID-19 or a similar global threat arise again

Explicit finite element implementation of a shape memory alloy constitutive model and associated analyses

Shape memory alloys (SMA) represent an important class of smart metallic materials employed in various innovative applications thanks to their unique thermomechanical behavior. Since the 1980s, several SMA constitutive models have been proposed and implemented into both commercial and academic finite element analysis software tools. Such models have demonstrated their reliability and robustness in the design and optimization of a wide variety of SMA-based components. However, most models are implemented using implicit integration schemes, thus limiting their applicability in highly nonlinear analyses. The objective of this work is to present a novel explicit integration scheme for the numerical implementation of the three-dimensional Souza-Auricchio model, a phenomenological model able to reproduce the primary SMA responses (i.e., pseudoelasticity and shape memory effect). The model constitutive equations are formulated by adopting the continuum thermodynamic theory with internal variables, following a plasticity-like approach. An elastic predictor-inelastic corrector scheme is here used to solve the time-discrete non-linear constitutive equations in the explicit framework. The proposed algorithm is investigated through several benchmark boundary-value problems of increasing complexity, considering both pseudoelastic and shape memory response in quasi-static conditions; a comparison with an implicit integration scheme is also performed. Such numerical tests demonstrate the ability of the algorithm to reproduce key material behaviors with effectiveness and robustness. Particularly, the analysis of SMA cables demonstrates the effectiveness of the explicit algorithm to solve complex problems involving widespread nonlinear contact, which prevent the convergence of the implicit scheme. Details such as mass-scaling options are also discussed

Dystonia: sparse synapses for D2 receptors in striatum of a DYT1 knock-out mouse model

Dystonia pathophysiology has been partly linked to downregulation and dysfunction of dopamine D2 receptors in striatum. We aimed to investigate the possible morpho-structural correlates of D2 receptor downregulation in the striatum of a DYT1 Tor1a mouse model. Adult control Tor1a+/+ and mutant Tor1a+/− mice were used. The brains were perfused and free-floating sections of basal ganglia were incubated with polyclonal anti-D2 antibody, followed by secondary immune-fluorescent antibody. Confocal microscopy was used to detect immune-fluorescent signals. The same primary antibody was used to evaluate D2 receptor expression by western blot. The D2 receptor immune-fluorescence appeared circumscribed in small disks (~0.3–0.5 μm diameter), likely representing D2 synapse aggregates, densely distributed in the striatum of Tor1a+/+ mice. In the Tor1a+/− mice the D2 aggregates were significantly smaller (μm2 2.4 ± SE 0.16, compared to μm2 6.73 ± SE 3.41 in Tor1a+/+) and sparse, with ~30% less number per microscopic field, value correspondent to the amount of reduced D2 expression in western blotting analysis. In DYT1 mutant mice the sparse and small D2 synapses in the striatum may be insufficient to “gate” the amount of presynaptic dopamine release diffusing in peri-synaptic space, and this consequently may result in a timing and spatially larger nonselective sphere of influence of dopamine action

The NorthStar Ambulatory Assessment in Duchenne muscular dystrophy: considerations for the design of clinical trials.

With the emergence of experimental therapies for Duchenne muscular dystrophy (DMD), it is fundamental to understand the natural history of this disorder to properly design clinical trials. The aims of this study were to assess the effects produced on motor function by different DMD genotypes and early initiation of glucocorticoids

Giant Prolactinoma Embedded by Pseudoaneurysm of the Cavernous Carotid Artery Treated with a Tailored Therapeutic Scheme

The coexistence of intracranial aneurysm (IA) is generally thought to be highest in patients with pituitary adenomas (PAs). Different mechanisms may play a role in aneurysm formation, but whether the PA contributes to aneurysm formation is still unclear. In the literature, there are numerous reported cases of this association; however, the analyses of the characteristics of PAs, aneurysms, and treatment management are rare and limited to a restricted number of case reports. We report a rare case of an embedded aneurysm in a macroprolactinoma treated with therapeutic management tailored to the clinical, neurological, and radiological characteristics of the patient. To select the best treatment, we reviewed the literature and reported the only cases in which the radiological characteristics of aneurysms, PAs, therapeutic management, and patient outcome are described. We aimed to understand what are the variables that determine the best therapeutic management with the best possible outcome. The presence of a large pseudoaneurysm of the internal carotid artery completely embedded in a giant macroprolactinoma is rare and needs a tailored treatment strategy. The importance of the preoperative knowledge of asymptomatic IA coexisting with PA can avoid accidental rupture of the aneurysm during surgical resection and may lead to planning the best treatment. A high degree of suspicion for an associated aneurysm is needed, and if magnetic resonance imaging shows some atypical features, digital subtraction angiography must be performed prior to contemplating any intervention to avoid iatrogenic aneurysmal rupture. Our multimodal approach with the first-line therapy of low-dose cabergoline to obtain prolactin normalization with minimum risks of aneurysms rupture and subsequent endovascular treatment with flow diverter has not been described elsewhere to our knowledge. In the cases, we suggest adopting a tailored low-dose cabergoline therapy scheme to avoid rupture during cytoreduction and initiate a close neuroradiological follow-up program

Generalized Chern-Simons Modified Gravity in First-Order Formalism

We propose a generalization of Chern-Simons (CS) modified gravity in first-order formalism. CS modified gravity action has a term that comes from the chiral anomaly which is Pontryagin invariant. First-order CS modified gravity is a torsional theory and in a space-time with torsion the chiral anomaly includes a torsional topological term called Nieh-Yan invariant. We generalize the CS modified gravity by adding the Nieh-Yan term to the action and find the effective theory. We compare the generalized theory with the first-order CS modified gravity and comment on the similarities and differences.Comment: 8 pages, an author added, new paragraphs, comments and references added, published in Gen. Relativ. Gravi

Identification of a response amplitude operator for ships

At the European Study Group Mathematics with Industry 2012 in Eindhoven, the Maritime Research Institute Netherlands (MARIN) presented the problem of identifying the response amplitude operator (RAO) for a ship, given input information on the amplitudes of the sea waves and output information on the movement of the ship. We approach the problem from a threefold perspective: a direct least-squares approach, an approach based on truncated Fourier series, and an approach using low-dimensional measures of the RAO. We give a few recommendations for possible further investigations