Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

Purpose: The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods: We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results: The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2-25.9 mm) or 14.5 mm (range: 8.8-22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7-9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9-10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion: Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury. Keywords: Mandibular condylar process; Maxillary artery; Middle meningeal artery; Topographic relationship

Accuracy of Computer-Guided Template-Based Implant Surgery: A Computed Tomography-Based Clinical Follow-Up Study

OBJECTIVE The aim of this clinical study was to analyze the accuracy of computer-guided implant surgery. MATERIALS AND METHODS Assisted by computed tomography (CT)-based planning software and navigational templates, 16 patients successfully received 26 dental implants. Each implant parameter (a-d) was calculated based on superimposed preoperative and postoperative cone beam CT scans: (a) deviation at entry point; (b) deviation at apex; (c) angular deviation; and (d) depth deviation. RESULTS Mean central deviation at implant entry point and apex was 0.91 mm (standard error [SE] = 0.11 mm; 95% confidence interval [CI]: 0.69-1.13) and 1.22 mm (SE = 0.11 mm; 95% CI: 0.99-1.45), respectively. Mean angulation deviation was 4.11 degrees (SE = 0.52 degrees; 95% CI: 3.04-5.17) and the average depth deviation was 0.65 mm (SE = 0.11 mm; 95% CI: 0.42-0.87). For the total number of implants placed, the maximum error was 2.34 mm at entry point, 2.71 mm at apex, 9.44 degrees in angular deviation, and 2.00 mm in depth deviation. CONCLUSION Great accuracy was reached even in advanced cases with prior bone augmentation and complex traumas. This leads to the conclusion that particularly in advanced cases, computer-guided implantation can be beneficial

Evaluation der kantonalen Aktionsprogramme für die Jahre 2017 bis 2020: Schlussbericht

Die Stiftung Gesundheitsförderung Schweiz (GFCH) verfolgt mit den kantonalen Aktionsprogrammen (KAP) die Absicht, in Zusammenarbeit mit den Kantonen die Gesundheit der Schweizer Bevölkerung zu fördern. Während die KAP zu Programmbeginn 2007 auf die Themen Ernährung und Bewegung bei Kindern und Jugendlichen gerichtet waren, hat sich der Fokus 2017 um das Themenfeld psychische Gesundheit einerseits und um die Zielgruppe ältere Menschen erweitert. Den Kantonen bot sich dadurch die Möglichkeit, diese Themenfelder und Zielgruppen mit vier KAP-Modulen abzudecken. Im Jahre 2020 beteiligten sich lediglich zwei Kantonen nicht an den KAP, während 18 Kantone alle KAP-Module umsetzten. Der Fokus der Evaluation liegt auf der Analyse der Umsetzung und Wirkung der KAP und auf den damit in Zusammenhang stehenden Massnahmen von GFCH. Die Evaluation ist primär formativ aus-gerichtet, indem die Evaluationserkenntnisse eine Verbesserung der Umsetzung der KAP fördern und deren Steuerung unterstützen sollen. In Ergänzung dazu soll die Evaluation aber auch summative Funktionen erfüllen, namentlich indem sie Befunde erarbeitet, inwiefern die KAP das Engagement der Kantone in der Gesundheitsförderung stärken. Die Evaluation befasste sich mit insgesamt zehn Evaluationsfragen zum Engagement und den Tätigkei-ten der Kantone, zu den Finanzen, zu den Leistungen von GFCH sowie zur Zielerreichung. Zur Bear-beitung dieser Fragestellung realisierte die Evaluation zehn Evaluationsbausteinen, in deren Rahmen Analysen aus verschiedenen Perspektiven (Kantone, Umsetzungspartner, Interessengruppen, Fach-kreise sowie GFCH) und mit vielfältigen Methoden und Verfahren (Dokumentenanalyse, Sekundärda-tenanalyse, Befragungen, Interviews, Gruppendiskussionen) umgesetzt wurden. Die Evaluation wurde im Zeitraum 2018 bis 2021 durchgeführt. Die Evaluation hat aufgezeigt, dass die KAP bei den Kantonen in wesentlichem Umfang gesundheits-fördernde Aktivitäten in den Themenfeldern Ernährung & Bewegung und psychische Gesundheit aus-gerichtet auf die Zielgruppen Kinder und Jugendliche sowie ältere Menschen auslösen konnte. Die Aus-weitung hinsichtlich der Themenfelder und Zielgruppen hat sich bewährt. Neben den finanziellen Leis-tungen erbringt GFCH materielle Leistungen zur Steuerung und Unterstützung der KAP in den Kanto-nen, die von den kantonalen Interaktionspartnern geschätzt werden. Bezüglich der inhaltlichen Aus-richtung, der Berichterstattung, der dezentralen Organisationsstrukturen sowie der finanziellen und materiellen Leistungen bestehen aber noch Klärungsbedarf und/oder Verbesserungsmöglichkeiten, weshalb die Evaluation insgesamt zwölf Empfehlungen zu graduellen Anpassungen in den genannten Aspekten formuliert

A Protective Allergy Vaccine Based on CpG- and Protamine-Containing PLGA Microparticles

Purpose: Allergen-specific immunotherapy (SIT) requires dozens of subcutaneous injections over 3 to 5years in order to control IgE-mediated hypersensitivity, which is a T-helper 2 (Th2)-associated pathology. This study investigates the use of poly(lactide-co-glycolide) (PLGA) microparticles combined with immunostimulatory oligodeoxynucleotide (CpG), as well as protamine in SIT. Materials and Methods: We prepared microparticle formulations with the major allergen of bee venom, phospholipase A2 (PLA2), and analyzed the effect of co-encapsulated or admixed CpG in both naïve and bee venom allergic mice. Results: Mice immunized with microparticles containing only PLA2 induced weak antibody responses. In contrast, the combination with CpG resulted in strong PLA2-specific antibody responses. The presence of CpG was required for the induction of the Th1-associated isotype IgG2a, and the titers of IgG2a in sensitized mice correlated with a better protection against an allergen challenge. The effect of CpG was further strengthened when protamine was co-encapsulated for complexation of CpG. Conclusions: This study shows that allergen-specific immunotherapy with a PLGA-based allergen-delivery system in combination with CpG enhanced the induction of protective IgG2a immune responses. This may improve SIT compliance and shorten its duratio

Automatic estimation of gestational age in ultrasound images based on direct least-squares fitting of ellipse

Measurement of the fetal head biparietal diameter (BPD) and head circumference (HC) is crucial for estimation of fetal age. Due to the noisy nature of ultrasound images and variation in image acquisition and measurement techniques, manual measurements of these parameters are subject to inter- and intraobserver variability. In this study, we present an approach for estimation of gestational age in ultrasound images, based on direct least-squares fitting of an ellipse. The process goes through three steps: image preprocessing, object extraction, and fitting an ellipse to the resultant shape and measuring its parameters. The proposed technique was tested and evaluated on 20 ultrasound images of fetal head. The images had a combination of noise and low contrast. Excellent linear correlation between manual and automatic measurement was obtained, which verifies the reliability of the proposed automatic approach

Charles Bonnet syndrome in cranio-maxillofacial surgery: case report

Background: Complex visual hallucinations in the presence of a clear mental state and in the absence of underlying neurological disorders have received increased recognition since Charles Bonnet reported visual hallucinations secondary to mature cataracts in 1760. The prevalence of Charles Bonnet syndrome (CBS) varies widely in the literature and might be underestimated in most settings. The current paper presents a case of acute-onset CBS due to a unilateral Frost suture after revision of an orbit floor fracture. Case report: A 68-year-old male patient underwent an operation to repair a unilateral orbital floor fracture and subsequent eye patching by a Frost suture. The patient complained of complex, colored visual hallucinations ∼3h after waking from general anesthesia. The visual hallucinations stopped during sleep and reappeared in the morning. The symptoms disappeared completely ∼2h after removal of the Frost suture. Discussion: Frost sutures are commonly used in oculoplastic surgery and may result in acute onset of visual hallucinations. CBS is often neglected, and clinicians must be aware of the association between acute visual deprivation and CBS

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention

Control of human cytomegalovirus replication by liver resident natural killer cells

Natural killer cells are considered to be important for control of human cytomegalovirus– a major pathogen in immune suppressed transplant patients. Viral infection promotes the development of an adaptive phenotype in circulating natural killer cells that changes their anti-viral function. In contrast, less is understood how natural killer cells that reside in tissue respond to viral infection. Here we show natural killer cells resident in the liver have an altered phenotype in cytomegalovirus infected individuals and display increased anti-viral activity against multiple viruses in vitro and identify and characterise a subset of natural killer cells responsible for control. Crucially, livers containing natural killer cells with better capacity to control cytomegalovirus replication in vitro are less likely to experience viraemia post-transplant. Taken together, these data suggest that virally induced expansion of tissue resident natural killer cells in the donor organ can reduce the chance of viraemia post-transplant