Osteoporosis and Bisphosphonate-Related Osteonecrosis of the Jaw Bone

The aim of this longitudinal study is to present data from 76 female patients treated with bisphosphonates (BPs) for postmenopausal osteoporosis and referred to the Unit of Oral Diagnosis and Day Surgery of the University of Milano for diagnosis and treatment. All patients received a thorough oral examination. The diagnosis of osteonecrosis of the jaw bone (ONJ) was made from radiographic and clinical findings. 9% of individuals had BRONJ at first visit. Patients with dental or periodontal abscess were significantly more likely to develop BRONJ (OR: 2.9, 95% CI 0.5–15.9). Patients with osteoporosis receiving BPs may develop BRONJ, especially in the presence of an active infectious process in the mouth. Clinicians should carefully follow up on individuals receiving bisphosphonates therapy to avoid the occurrence of osteonecrotic lesions

Message passing on InfiniBand RDMA for parallel run-time supports

InfiniBand networks are commonly used in the high performance computing area. They offer RDMA-based operations that help to improve the performance of communication subsystems. In this paper, we propose a minimal message-passing communication layer providing the programmer with a point-to-point communication channel implemented by way of InfiniBand RDMA features. Differently from other libraries exploiting the InfiniBand features, such as the well-known Message Passing Interface (MPI), the proposed library is a communication layer only rather than a programming model, and can be easily used as building block for high-level parallel programming frameworks. Evaluated on micro-benchmarks, the proposed RDMA-based communication channel implementation achieves a comparable performance with highly optimised MPI/InfiniBand implementations. Eventually, the flexibility of the communication layer is evaluated by integrating it within the FastFlow parallel framework, currently supporting TCP/IP networks (via the ZeroMQ communication library). © 2014 IEEE

Development of software for handling ship’s pharmacy

Background: Ships are required to carry a given amount of medicinal products and medications depending on the flag and the type of vessel. These medicines are stored in the so called ship’s “medicine chest” or more properly — a ship pharmacy. Owing to the progress of medical sciences and to the increase in the mean age of seafarers employed on board ships, the number of pharmaceutical products and medical devices required by regulations to be carried on board ships is increasing. This may make handling of the ship’s medicine chest a problem primarily on large ships sailing on intercontinental routes due to the difficulty in identifying the correspondence between medicines obtained abroad with those available at the national market. To minimise these problems a tool named Pharmacy Ship (acronym: PARSI) has been developed. Materials and methods: The application PARSI is based on a database containing the information about medicines and medical devices required by different countries regulations. In the first application the system was standardised to comply with the Italian regulations issued on the 1st October, 2015 which entered into force on the 18 January 2016. Results: Thanks to PARSI it was possible to standardize the inventory procedures, facilitate the work of maritime health authorities and make it easier for the crew, not professional in the field, to handle the ‘medicine chest’ correctly by automating the procedures for medicines management. As far as we know there are no other similar tools available at the moment. The application of the software, as well as the automation of different activities, currently carried out manually, will help manage (qualitatively and quantitatively) the ship’s pharmacy. Conclusions: The system developed in this study has proved to be an effective tool which serves to guarantee the compliance of the ship pharmacy with regulations of the flag state in terms of medicinal products and medications. Sharing the system with the Telemedical Maritime Assistance Service may result in avoiding mistakes in drug administration. Last but not least the availability of PARSI could help reduce/ avoid problems with maritime health authorities in case any of the required medicinal products are missing.

An ontology-based consultation system to support medical care on board seagoing vessels

Background: A realistic possibility to obtain medical care for patients located in remote sites such as seagoing vessels, in which health professionals are not available, is to contact a doctor via telecommunication systems. In general, the medical knowledge of who on board ships is in charge of medical care is quite limited and therefore, in a first level telemedical consultation, the flow of information should be correct and its efficiency should be maximised. This paper describes an application conceived to improve requests of medical assistance from sailing ships. The ultimate objective of this system is a) to standardise as much as possible the requests of medical advice at a distance, b) to overcome language barriers and jammed-related troubles that could make difficult or not understandable a telephone conversation. Materials and methods: The application is based on a software engine extracting data from an ontological knowledgebase built ad hoc using Protégé. Results: Compared to the conventional consultation systems based on telephone and e-mail, the proposed device is more accurate and complete in terms of information contained in the request of assistance. Moreover, data received by the medical centre can be more easily managed, as they can be standardised. Conclusions: The system described here allows people responsible of medical care on board ships to forward detailed requests of assistance containing symptom-guided information on patient clinical conditions. This may represent an innovative tool for medical consultations at distance allowing the remote centre to provide more precise and quicker medical advice.

Real-Time Laryngeal Cancer Boundaries Delineation on White Light and Narrow-Band Imaging Laryngoscopy with Deep Learning

Objective: To investigate the potential of deep learning for automatically delineating (segmenting) laryngeal cancer superficial extent on endoscopic images and videos. Methods: A retrospective study was conducted extracting and annotating white light (WL) and Narrow-Band Imaging (NBI) frames to train a segmentation model (SegMENT-Plus). Two external datasets were used for validation. The model's performances were compared with those of two otolaryngology residents. In addition, the model was tested on real intraoperative laryngoscopy videos. Results: A total of 3933 images of laryngeal cancer from 557 patients were used. The model achieved the following median values (interquartile range): Dice Similarity Coefficient (DSC) = 0.83 (0.70-0.90), Intersection over Union (IoU) = 0.83 (0.73-0.90), Accuracy = 0.97 (0.95-0.99), Inference Speed = 25.6 (25.1-26.1) frames per second. The external testing cohorts comprised 156 and 200 images. SegMENT-Plus performed similarly on all three datasets for DSC (p = 0.05) and IoU (p = 0.07). No significant differences were noticed when separately analyzing WL and NBI test images on DSC (p = 0.06) and IoU (p = 0.78) and when analyzing the model versus the two residents on DSC (p = 0.06) and IoU (Senior vs. SegMENT-Plus, p = 0.13; Junior vs. SegMENT-Plus, p = 1.00). The model was then tested on real intraoperative laryngoscopy videos. Conclusion: SegMENT-Plus can accurately delineate laryngeal cancer boundaries in endoscopic images, with performances equal to those of two otolaryngology residents. The results on the two external datasets demonstrate excellent generalization capabilities. The computation speed of the model allowed its application on videolaryngoscopies simulating real-time use. Clinical trials are needed to evaluate the role of this technology in surgical practice and resection margin improvement. Level of evidence: III Laryngoscope, 2024

Towards a Modular Architecture for eXtended Reality Systems

For full-fledged social acceptance of eXtended Reality (XR) systems, emphasis should be on design prototypes to allow frictionless, context-aware, and secure interaction with non-specialized users. This necessitates a modular architecture to ensure that the system is versatile and applicable across applications, and is open to the integration of interaction modalities. We discuss our proposal for (and prototypical implementation of) a modular architecture for XR systems that relies on cloud infrastructure resources and edge computing frameworks with shared communication protocols for scalability. The modules are abstracted from both functional and non-functional requirements, including security

Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study

Objectives The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort.Methods We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications.Results A total of 267 patients were included in the study (130 females; mean age, 51.46 +/- 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 +/- 10.9 vs. 11.3 +/- 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications.Conclusion PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications

Fast high‐resolution electric properties tomography using three‐dimensional quantitative transient‐state imaging‐based water fraction estimation

In this study, we aimed to develop a fast and robust high-resolution technique for clinically feasible electrical properties tomography based on water content maps (wEPT) using Quantitative Transient-state Imaging (QTI), a multiparametric transient state-based method that is similar to MR fingerprinting. Compared with the original wEPT implementation based on standard spin-echo acquisition, QTI provides robust electrical properties quantification towards B1+ inhomogeneities and full quantitative relaxometry data. To validate the proposed approach, 3D QTI data of 12 healthy volunteers were acquired on a 1.5 T scanner. QTI-provided T1 maps were used to compute water content maps of the tissues using an empirical relationship based on literature ex-vivo measurements. Assuming that electrical properties are modulated mainly by tissue water content, the water content maps were used to derive electrical conductivity and relative permittivity maps. The proposed technique was compared with a conventional phase-only Helmholtz EPT (HH-EPT) acquisition both within whole white matter, gray matter, and cerebrospinal fluid masks, and within different white and gray matter subregions. In addition, QTI-based wEPT was retrospectively applied to four multiple sclerosis adolescent and adult patients, compared with conventional contrast-weighted imaging in terms of lesion delineation, and quantitatively assessed by measuring the variation of electrical properties in lesions. Results obtained with the proposed approach agreed well with theoretical predictions and previous in vivo findings in both white and gray matter. The reconstructed maps showed greater anatomical detail and lower variability compared with standard phase-only HH-EPT. The technique can potentially improve delineation of pathology when compared with conventional contrast-weighted imaging and was able to detect significant variations in lesions with respect to normal-appearing tissues. In conclusion, QTI can reliably measure conductivity and relative permittivity of brain tissues within a short scan time, opening the way to the study of electric properties in clinical settings.Quantitative transient-state imaging is used to perform EPT based on water content on healthy volunteers and MS patients at 1.5 T. Conductivity and permittivity maps agreed with theoretical predictions and previous in vivo findings, showing higher anatomical detail and lower variability compared with standard HH-EPT and detecting alterations in lesions.imag

Enhancing quality of life in head and neck cancer patients: a comparative analysis of 3D exoscope-assisted surgery vs. traditional approaches

IntroductionThe increasing population of survivors of head and neck carcinomas is becoming more conspicuous. Consequently, the pivotal role of quality of life, particularly elucidated through the assessment of dysphagia and dysphonia, is progressively influencing the decision-making process. The current study aims to assess whether VITOM 3D could offer a comparable post-treatment quality of life to traditional approaches for patients with laryngeal cancer and oro-hypopharyngeal cancer.MethodsA case series of laryngeal cancer and oro-hypopharyngeal cancer patients treated either with an exoscopic-assisted surgical setup and with conventional treatments (transoral microsurgery and radio-chemotherapy) at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. The post-treatment quality of life of the two cohorts were compared through the administration of the University of Washington Quality of Life Questionnaire, Voiceik Handicap Index-10, M.D. Anderson Dysphagia Inventory were administrated to both cohorts of patients.ResultsIn the laryngeal cancer group, a total of 79 patients were included. Of these, 50.1% underwent transoral exoscope-assisted surgery, while 49.9% underwent primary transoral microscopic-assisted surgical approach. No significant differences were observed in terms of the University of Washington Quality of Life Questionnaire and Voice Handicap Index-10 between the two subgroups. Conversely, in the oro-hypopharyngeal cancer group, 43 patients were included. Of these, 37.2% underwent primary transoral exoscope-assisted surgery, while 62.8% received (chemo)radiotherapy. No notable differences were reported in terms of the University of Washington Quality of Life Questionnaire and M.D. Anderson Dysphagia Inventory between the transoral exoscope-assisted surgery and (chemo)radiotherapy subgroups.ConclusionsAssessments of quality of life, conducted through the University of Washington Quality of Life Questionnaire questionnaire, dysphonia evaluations using the Voice Handicap Index-10, and dysphagia assessments employing the M.D. Anderson Dysphagia Inventory questionnaire, demonstrate analogous outcomes between conventional treatment modalities and transoral interventions utilizing the 3D exoscope