Relationship between cervical spine and skeletal class II in subjects with and without temporomandibular disorders

AIM. To assess changes of cranio-cervical structure and of hyoid bone position in skeletal Class II subjects with and without Temporomandibular disorders (TMD). MATERIAL AND METHODS. The cephalometric analysis of 59 subjects with skeletal Class II were evaluated and compared. The measurements considerated were: ANB as parameter of Class II and C0-C1 distance, C1-C2 distance, cranio-cervical angle and hyoid bone position for the cervical spine analysis. Patients were divided into two subgroups: patients with TMD (group A) and patients without TMD (group B). TMD were evaluated with the Diagnostic Criteria for TMD (DC/TMD). Descriptive statistics and Pearson and Spearman correlation analysis, with p-value <0,005, were performed. RESULTS. C0-C1 and C1-C2 distance values and hyoid bone position resulted within normal range in the majority of patients examined. Cranio-cervical angle was alterated in 33 patients. The reduction of this angle with the increase of the ANB value resulted statistically significant in the group A, according to Pearson correlation index. No other data was statistically significant. CONCLUSIONS. Significant relationship between skeletal Class II and cervical spine cannot be highlighted. The alteration of cranio-cervical angle seems to be mildly present, with backward counterclockwise rotation of the head upon the neck in the sample (group A and B). The presence of TMDs as key factor in changes of neck posture could explain the different result between the two groups about relationship between ANB and cranio-cervical angle. This result should be further analyzed in order to better understand if cervical spine changes could be related to mandibular postural ones in the cranio-cervical space or to temporomandibular joints retropositioning, more recognizable in Class II with TMD, which could determine functional changes in other structures of this unit; neck posture also could be the result of a compensatory/ antalgic mechanism in response to TM

Managing chronic conditions: lessons learnt from a comparative analysis of seven years’ policies for chronic care patients in Italy

This policy paper aims to compare what policies are developed in Italy for the management of chronic patients in order to improve population health, quality of care and patient experience and reduce per-capita cost. The paper also aims to identify the key trends and evolutionary trajectories across the Country. Methodology: The analysis focuses on 10 Italian Regions and the time span of observation is 7 years (from 2014 to 2020). Data collection and analysis adopts mixed methods in order to have a more in-depth picture of the contextual factors, mechanisms and outcomes. It includes a desk research of the literature and documentary analysis; semi-structured interviews; a theory driven evaluation of 12 programmes identified at the regional level; and a Consensus Conference to discuss and validate the results with an Expert Panel Group. Conclusions: The paper firstly describes the main policies developed in Italy in the last seven years; secondly, it discusses six main trends and clusters them into three strategies: demand management strategies; strategies to improve the management of comorbid and frail patients; and strategies to improve the coordination between levels of care and the patient journey; thirdly, it discusses eight trends and evolutionary trajectories which are now emerging

Chapter La rappresentazione del territorio peri-urbano tra city modelling, rilievo e fotografia

The 43rd UID conference, held in Genova, takes up the theme of ‘Dialogues’ as practice and debate on many fundamental topics in our social life, especially in these complex and not yet resolved times. The city of Genova offers the opportunity to ponder on the value of comparison and on the possibilities for the community, naturally focused on the aspects that concern us, as professors, researchers, disseminators of knowledge, or on all the possibile meanings of the discipline of representation and its dialogue with ‘others’, which we have broadly catalogued in three macro areas: History, Semiotics, Science / Technology. Therefore, “dialogue” as a profitable exchange based on a common language, without which it is impossible to comprehend and understand one another; and the graphic sign that connotes the conference is the precise transcription of this concept: the title ‘translated’ into signs, derived from the visual alphabet designed for the visual identity of the UID since 2017. There are many topics which refer to three macro sessions: - Witnessing (signs and history) - Communicating (signs and semiotics) - Experimenting (signs and sciences) Thanks to the different points of view, an exceptional resource of our disciplinary area, we want to try to outline the prevailing theoretical-operational synergies, the collaborative lines of an instrumental nature, the recent updates of the repertoires of images that attest and nourish the relations among representation, history, semiotics, sciences

Unmasking the Web of Deceit: Uncovering Coordinated Activity to Expose Information Operations on Twitter

Social media platforms, particularly Twitter, have become pivotal arenas for influence campaigns, often orchestrated by state-sponsored information operations (IOs). This paper delves into the detection of key players driving IOs by employing similarity graphs constructed from behavioral pattern data. We unveil that well-known, yet underutilized network properties can help accurately identify coordinated IO drivers. Drawing from a comprehensive dataset of 49 million tweets from six countries, which includes multiple verified IOs, our study reveals that traditional network filtering techniques do not consistently pinpoint IO drivers across campaigns. We first propose a framework based on node pruning that emerges superior, particularly when combining multiple behavioral indicators across different networks. Then, we introduce a supervised machine learning model that harnesses a vector representation of the fused similarity network. This model, which boasts a precision exceeding 0.95, adeptly classifies IO drivers on a global scale and reliably forecasts their temporal engagements. Our findings are crucial in the fight against deceptive influence campaigns on social media, helping us better understand and detect them.Comment: Accepted at the 2024 ACM Web Conferenc

Endoscopic resection of a duodenal web in an 11-month-old infant with multiple malformations

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Multimodal treatment for local recurrent malignant gliomas: resurgery and/or reirradiation followed by chemotherapy

The therapeutic management of recurrent malignant gliomas (MGs) is not determined. Therefore, the efficacy of a multimodal approach and a combination systemic therapy was investigated. A retrospective analysis of 26 MGs patients at first relapse treated with multimodal therapy (chemotherapy plus surgery and/or reirradiation) or chemotherapy alone was performed. Second-line chemotherapy consisted of fotemustine (FTM) in combination with bevacizumab (BEV) (cFTM/BEV) or followed by third-line BEV (sFTM/BEV). Subgroup analyses were performed. Multimodal therapy provided a higher overall response rate (ORR) (73 vs. 47%), disease control rate (DCR) (82 vs. 67%), median progression-free survival (mPFS) (11 vs. 7 months; P=0.08) and median overall survival (mOS) (13 vs. 8 months; P=0.04) compared with chemotherapy. Concomitant FTM/BEV resulted in higher ORR (84 vs. 36%), DCR (92 vs. 57%), mPFS (10 vs. 5 months; P=0.22) and mOS (11 vs. 5.2 months; P=0.15) compared with sFTM/BEV. Methylated patients did not experience additional survival benefits with multimodality treatment but had higher mPFS (10 vs 7.1 months; P=0.33) and mOS (11 vs. 8 months; P=0.33) with cFTM/BEV. Unmethylated patients experienced the greatest survival benefit with the multimodal approach (mPFS: 10 vs. 5 months; mOS 11 vs 6 months; both P=0.02) and cFTM/BEV (mPFS: 5 vs. 2 months; mOS 6 vs. 3.2 months; both P=0.01). In conclusion, in recurrent MGs, multimodal therapy and cFTM/BEV provide survival and response benefits. Methylated patients benefit from a cFTM/BEV but not from a multimodal approach. Notably, unmethylated patients had the highest survival benefit with the two strategies

The transition of patients with rare diseases between providers: the patient journey from the patient perspective

Background: Rare diseases are a group of more than 6000 disorders that on the whole may affect 30 million European Union citizens. Most rare diseases are of genetic origin, are often chronic and life-threatening. Patients living with rare diseases typically receive care from many providers and move frequently within health care settings, so high-quality transitional care is especially important for them, as well as for their family caregivers. Poor communications, incomplete transfer of information, inadequate education of health professionals, limited access to expertise services, and the absence of a single point person to ensure continuity of care all contribute to gaps in care during transitions. The research project focuses on four rare Lysosomal storage disease - LSDs (Pompe disease, Anderson-Fabry disease, Gaucher disease and Mucopolysaccharidosis type 1) featured by the availability of treatments that allow for a good quality of life for patients and aims to gather information on the real patient journey and on the health and social services used in order to analyse and identify the key conditions for improving the care management of rare and ultra-rare diseases (RD). Methods: We conducted a national survey, distributed to patients and caregivers from the 1st of June 2016 to the 7th of August 2016. Data were gathered through questionnaires disseminated online (through the patient associations' websites, Facebook pages and other online networks) or administered directly to patients through the patients' associations, to maintain the privacy and anonymity. The questionnaire consisted of 70 questions related to history and pattern of referrals to specialist, time to diagnosis, core medical tests, disciplines and specialists, time and type of treatment. The questionnaire was developed based on 16 in-depth interviews to patients sampled to cover the 4 LSDs, different ages and residence at the national level and further tested through the support of patients' associations. Data were analysed by descriptive and analytical statistics. Results: Of the survey participants, 177 patients provided evaluable data. The sample covered the national territory, was mainly composed of adult patients (average 40 age), who were diagnosed with rare LSDs 13 years ago. According to the survey patients living with rare LSD diseases visited an average of 2.4 centres before receiving an accurate diagnosis and the mean length of time from symptom onset to accurate diagnosis was around 7.3 years, however, there was a significant relationship between mean length of time for diagnosis and age (P >0.001), the mean length of time was reduced to 1.5 years for young patients (under 20 age), while was around 12 years for the older ones (over 65 age), indicating therefore the clear improvement in the diagnostic phase and in the access to reference centres. The analysis revealed the variability in tackling rarity and complexity, the wide number and specialization of professionals involved and the difficulty to provide integrated care pathways (ICPs) due to the lack of scalability and standardisation of care processes. Conclusion: The combination of rarity, complexity and lack of effective treatment creates huge obstacles to the provision of holistic care and in many cases significant medical, psychological and social needs remain unmet. Rare and ultra-rare disease challenge the most traditional care management models, indeed, people with a RD often need follow up care and support from different categories of health professionals, often from several different medical specialities, as well as by social workers and other social and local service providers which requires a level of coordination not easy to organise in most health care systems

Managing chronic conditions: lessons learned from a comparative evaluation of chronic care programs in Italy

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