Factors influencing CAD/CAM accuracy in fibula free flap mandibular reconstruction

La tecnologia CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) ha migliorato sia i risultati funzionali che morfologici nella chirurgia ricostruttiva mandibolare. L\u2019obiettivo del nostro studio \ue8 stato quello di valutare questo tipo di tecnologia ed i fattori che possono influenzare la sua precisione. Un totale di 26 casi di ricostruzione mandibolare con lembo libero di fibula, utilizzando tecnologia CAD/CAM sono stati operati presso l\u2019Unit\ue0 Maxillofacciale della Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico di Milano, da giugno 2014 a febbraio 2018. Abbiamo valutato l\u2019accuratezza confrontando i files STL di pianificazione chirurgica virtuale (obiettivo pianificato) con il file STL di una scansione TC postoperatoria precoce (risultato postoperatorio ottenuto). Entrambi i file STL sono stati importati su Geomagic Studio 2016 (Geomagic Gmbh). In base alla posizione della placca di ricostruzione (punto di riferimento fisso), abbiamo confrontato la deviazione sul condilo sinistro, gonion sinistro, gnathion, gonion destro e condilo destro, per calcolare l\u2019errore medio di deviazione. L\u2019errore medio di deviazione varia da 0,6 mm a 2,2 mm. Solo 2 dei 26 casi analizzati avevano un errore medio uguale o superiore a 2 mm (7,7%). L\u2019area mediana (symphysis-gnathion) ha mostrato una variazione pi\uf9 bassa (1,05 \ub1 0,92 mm) mentre l\u2019area di gonion ha mostrato maggiore variazione (la variazione media del gonion destro e sinistro era rispettivamente di 1,6 mm e 1,46 mm). Nessuno dei possibili fattori (tempi di ricostruzione, malignit\ue0 o benignit\ue0, sito o dimensione del difetto) che potrebbero influenzare la precisione del CAD/CAM, ha mostrato un\u2019influenza significativa. La tecnologia CAD/CAM nella ricostruzione microvascolare dei difetti mandibolari mediante lembo libero di fibula minimizza gli errori umani ed \ue8 considerato come un intervento chirurgico indipendente dall\u2019operatore con alto grado di accuratezza e riproducibilit\ue0.Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has im-proved the functional and morphological results of mandibular reconstructive surgery. The purpose of this study was to objectively assess this technology and factors affecting its accuracy.Fibula free flap mandibular reconstruction was performed in 26 cases us-ing CAD/CAM technology at the Maxillofacial Unit of Fondazione IRCCS Ca\u2019 Gran-da Ospedale Maggiore Policlinico, Milan, between June 2014 and February 2018. We evaluated the technology\u2019s accuracy by comparing the virtual surgical planning STL file (planned-target mesh) with the STL file from an early postoperative CT scan (postopera-tive-achievement mesh) in each case. The STL files were imported into Geomagic Studio 2016 (Geomagic GmbH). According to the position of the reconstruction plate (fixed reference point), we assessed deviations at the right condyle, right gonion, gnathion, left gonion and left condyle, calculating mean, minimum and maximum error values.Mean error values ranged from 0.6 to 2.2 mm; they were 65 2 mm in only 2 (7.7%) cases. The midline area (symphysis-gnathion) showed the least variation (1.05 \ub1 0.92 mm), and the gonion area showed the greatest variation (right and left means of 1.6 and 1.46 mm, respectively). Among all possible factors that could affect CADCAM accuracy, nothing showed significant influence, including the timing of reconstruction, site and size of the defect and malignancy status. CAD/CAM technology has a high degree of accuracy and reproducibility for microvascular reconstruction of mandibular defects using fibula free flaps, regardless of the defect site and length, use of a single- or double-barrel graft or timing of reconstructio

Anti-Müllerian hormone and response to ovulation induction with clomiphene citrate in women with polycystic ovary syndrome

Background: Anti-Müllerian hormone (AMH) is suggested as an important marker for women with polycystic ovary disease (PCOS). Several studies have found serum level of AMH correlate well to ovarian response to ovulation induction in women with PCOS. This study was conducted to assess the relationship between AMH in women with PCOS and response to ovulation induction with clomiphene citrate.Methods: Prospective observational cohort study conducted at Ain-Shams university maternity hospital from February 2013 to February 2014. 100 women with PCOS were recruited from the infertility outpatient clinic. Serum AMH levels were measured by enzyme linked immunosorbent assay in the early follicular phase (days 3-5). Ovulation induction by clomiphene citrate was started on day 5 as 50 mg daily tablet for 5 days. Ovulation was documented by transvaginal ultrasonography and women who failed to ovulate till day 35 were considered anovulatory.Results: 72 women ovulated within 12 to 33 days of the menstrual cycle, while 28 had undetectable ovulation till day 35. The median serum AMH level was significantly higher in women with failed ovulation [4.05 ng/mL (3.7 - 4.4)] than in ovulating women [2.7 ng/mL (1.9 - 3.1)] (p<0.001). Receiver-operating characteristic (ROC) curve analysis found the best cutoff value of AMH for prediction of successful ovulation ≤3.6 ng/mL (sensitivity = 97.2%, specificity = 82.1%).Conclusions: Anti-Müllerian hormone is a very useful predictor of poor responders to clomiphene citrate among women with polycystic ovary disease

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group compared to the conventional SSF group (3 stage improvement from baseline in SS/ST-F group versus 2 stage improvement only in conventional SSF group).Conclusions: This pilot study provides a modified sacrospinous sacrotuberous ligament colpopexy technique which is easier to be performed and mastered, does not need the use of special devices, provides better improvement of grade of prolapse and less complications compared to the conventional technique.

A Double-Blind, RCT Testing Beneficial Modulation of BDNF in Middle-Aged, Life Style-Stressed Subjects: A Clue to Brain Protection?

Introduction: The aim of this prospective study was to see whether LD-1227, a quality-controlled marine nutraceuticals shown to protect experimental stress-induced hyppocampal degeneration, could beneficially modulate BDNF, as measured in the serum, in otherwise healthy but work-stressed individuals. Materials and Methods: Forty-eight men and women between the ages of 38 and 62 reporting high-demanding work activity but with an overall positive attitude towards their personal life were recruited. Subjects were divided in two group (24 patients each) and blindly supplemented for 2 month with: a) LD-1227 400mg or b) placebo. A third group of healthy non-stressed subjects was used as well. Blood samples were taken before and after the supplementation period. Unstimulated saliva was collected and tested for amylase while serum levels were used to measure BDNF. State Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and psychological wellbeing assessment (PSWB) were measured too. Patients with Val66Met functional polymorphism of BDNF excluded those given their reported association with an impaired release of BDNF. Results: Results showed that, as compared to healthy, nonstressed individuals, stressed ones has a trend decrease of BDNF and this was significantly increased by LD 12-1227 supplementation and the same inverse phenomenon occurred to salivary amylase (p<0.05). No change was noted in the PSQI score but, either STAI or PSWB tests scored better in LD-1227 supplemented subjects. Conclusion: The present data suggest that LD-1227 is beneficially affecting neuromodulation and related symptoms during common stressful life conditions and may have the potential as tools in a neuroprotective clinical strategy

Congenital diaphragmatic hernia in the preterm infant.

BACKGROUND: Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR). METHODS: Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as \u3c37 weeks estimated gestational age at birth. Univariate and multivariate logistic regression analysis were\u3eperformed. RESULTS: During the study period, 5,069 infants with CDH were entered in the registry. Of the 5,022 infants with gestational age data, there were 3,895 term infants (77.6%) and 1,127 preterm infants (22.4%). Overall survival was 68.7%. A higher percentage of term infants were treated with extracorporeal membrane oxygenation (ECMO) (33% term vs 25.6% preterm). Preterm infants had a greater percentage of chromosomal abnormalities (4% term vs 8.1% preterm) and major cardiac anomalies (6.1% term vs 11.8% preterm). Also, a significantly higher percentage of term infants had repair of the hernia (86.3% term vs 69.4% preterm). Survival for infants that underwent repair was high in both groups (84.6% term vs 77.2% preterm). Survival decreased with decreasing gestational age (73.1% term vs 53.5% preterm). The odds ratio (OR) for death among preterm infants adjusted for patch repair, ECMO, chromosomal abnormalities, and major cardiac anomalies was OR 1.68 (95% confidence interval [CI], 1.34-2.11). CONCLUSION: Although outcomes for preterm infants are clearly worse than in the term infant, more than 50% of preterm infants still survived. Preterm infants with CDH remain a high-risk group. Although ECMO may be of limited value in the extremely premature infant with CDH, most preterm infants that live to undergo repair will survive. Prematurity should not be an independent factor in the treatment strategies of infants with CDH

Beneficial modification of functional renal parameters in 5/6 nephrectomized rats by nutraceutical : in view of a kidney-protective intervention

The objective of this study is to ascertain the potential beneficial effects of a novel phytoterapeutic formula (DTS, Kyotsu Jigyo, Japan) on renal function and morphological structure in 5/6 nephrectomized rats. Male Spraque-Dawley rats, 240-280 g, were divided into sham control (Group A) and nephrectomized (Group B and Group C) groups. The 5/6 nephrectomy was performed by removal of the right kidney and 2/3 ligation of left renal artery. After surgery, the animals were kept in individual cage for 6 weeks. Rats in Group A and Group B were fed with a normal protein diet only while those in Group C were fed normal protein diet added with DTS (10 mg/rat/day). The DTS supplementation was started a day after surgery. After 5 weeks, all rats were subjected to renal function study and then their left kidneys were isolated for morphological study. There were no significant differences in body weight, blood pressure, and heart rate among groups. DTS supplementation significantly increased (p < 0.05) plasma creatinine concentration, glomerular filtration rate, effective renal plasma flow, and urine flow rate in nephrectomized rats when compared to sham control (Group A) and untreated nephrectomized (Group B) controls. In contrast, plasma urea concentration and morphological structure were not significantly modified by DTS supplementation in nephrectomized animals. These data suggest that feeding with a normal protein diet and DTS supplementation improves renal function without any morphological effect in 5/6 nephrectomized rats if not a slight preservation

Assessment of Sleep Pattern in Egyptian Elderly Subjects with Vascular Dementia: An Egyptian Study on Elderly Population

Background: Sleep is considered to be very important for cognitive function and also cognitive deficits and sleep disorders are influenced by one another. Currently, growing evidence suggests that sleep disturbances is common in vascular dementia (VaD). Study Objectives: The goal of the current study was to assess the disturbance in sleep pattern in patients with vascular dementia(VaD) and compare it to healthy normally cognitive elderly individuals. The study further investigated whether meaningful differences in the Subjective sleep assessment (ESS and PSQI) and sleep measurements (PSG) in VaD patients. Study Design/Method: Overnight PSG recordings and self-reported sleep measures were obtained from 20 healthy elderly subjects and 20 VaD patients at the sleep laboratory. Results: This study showed abnormal subjective sleep quality in all patients and revealed that the most common sleep complaintsamong VaD patients were excessive daytime sleepiness (EDS), sleep disordered breathing (SDB), insomnia and RLS and PLMS and REM behavioral disordered, respectively. Moreover, patients spent more time in stage I sleep, but less time in SWS and REM sleep compared to control populations, with delayed REML and less 1st REML. In addition, increased sleep fragmentation (WASO and SFI) and increased AI and PLMS index were detected in VaD patients. Finally, VaD patients had significantly (p < 0.05) high apnea, hypopnea and RDI score with high average SpO2 desaturation. Conclusions: It is conclude that sleep is significantly (p < 0.05) impaired in patients with VaD at both the objective and subjective levels which may be used as a diagnostic marker of VaD. SBD is a common feature of VaD leading to fragmented sleep, increased nocturnal confusion and excessive daytime sleepiness. Subjective sleep assessment questionnaire by (ESS and PSQI) can be used in VaD patients when objective sleep assessment by PSG recordings is difficult to be done. The PSG study of sleep continuity, sleep architecture and REM sleep may help in the prevention of progression of VaD

Congenital diaphragmatic hernia and retinoids: searching for an etiology

Congenital diaphragmatic hernia (CDH) is a major life-threatening cause of respiratory failure in the newborn. Recent data reveal the role of a retinoid-signaling pathway disruption in the pathogenesis of CDH. We describe the epidemiology and pathophysiology of human CDH, the metabolism of retinoids and the implications of retinoids in the development of the diaphragm and lung. Finally, we describe the existing evidence of a disruption of the retinoid-signaling pathway in CDH

COVID-19: Rapid antigen detection for SARS-CoV-2 by lateral flow assay: A national systematic evaluation of sensitivity and specificity for mass-testing

Background Lateral flow device (LFD) viral antigen immunoassays have been developed around the world as diagnostic tests for SARS-CoV-2 infection. They have been proposed to deliver an infrastructure-light, cost-economical solution giving results within half an hour. Methods LFDs were initially reviewed by a Department of Health and Social Care team, part of the UK government, from which 64 were selected for further evaluation from 1st August to 15th December 2020. Standardised laboratory evaluations, and for those that met the published criteria, field testing in the Falcon-C19 research study and UK pilots were performed (UK COVID-19 testing centres, hospital, schools, armed forces). Findings 4/64 LFDs so far have desirable performance characteristics (orient Gene, Deepblue, Abbott and Innova SARS-CoV-2 Antigen Rapid Qualitative Test). All these LFDs have a viral antigen detection of >90% at 100,000 RNA copies/ml. 8951 Innova LFD tests were performed with a kit failure rate of 5.6% (502/8951, 95% CI: 5.1–6.1), false positive rate of 0.32% (22/6954, 95% CI: 0.20–0.48). Viral antigen detection/sensitivity across the sampling cohort when performed by laboratory scientists was 78.8% (156/198, 95% CI 72.4–84.3). Interpretation Our results suggest LFDs have promising performance characteristics for mass population testing and can be used to identify infectious positive individuals. The Innova LFD shows good viral antigen detection/sensitivity with excellent specificity, although kit failure rates and the impact of training are potential issues. These results support the expanded evaluation of LFDs, and assessment of greater access to testing on COVID-19 transmission. Funding Department of Health and Social Care. University of Oxford. Public Health England Porton Down, Manchester University NHS Foundation Trust, National Institute of Health Research