Validation of a patient-specific system for mandible-first bimaxillary surgery: ramus and implant positioning precision assessment and guide design comparison

In orthognathic surgery, the use of patient-specific osteosynthesis devices is a novel approach used to transfer the virtual surgical plan to the patient. The aim of this study is to analyse the quality of mandibular anatomy reproduction using a mandible-first mandibular-PSI guided procedure on 22 patients. Three different positioning guide designs were compared in terms of osteosynthesis plate positioning and mandibular anatomical outcome. PSIs and positioning guides were designed according to virtual surgical plan and 3D printed using biocompatible materials. A CBCT scan was performed 1 month after surgery and postoperative mandibular models were segmented for comparison against the surgical plan. A precision comparison was carried out among the three groups. Correlations between obtained rami and plates discrepancies and between planned rami displacements and obtained rami discrepancies were calculated. Intraoperatively, all PSIs were successfully applied. The procedure was found to be accurate in planned mandibular anatomy reproduction. Different guide designs did not differ in mandibular outcome precision. Plate positional discrepancies influenced the corresponding ramus position, mainly in roll angle and vertical translation. Ramus planned displacement was found to be a further potential source of inaccuracy, possibly due to osteosynthesis surface interference

PARAMETRIZING THE GENIOPLASTY: A BIOMECHANICAL VIRTUAL STUDY ON SOFT TISSUE BEHAVIOUR

Purpose: Sliding genioplasty is used to surgically correct a retruded or misaligned chin: in this procedure, an osteotomy is performed and the bony segment is repositioned. In this study we investigate the effect of surgical parameters (bony segment movement, osteotomy design) on postop soft tissue changes in a patient cohort. Methods: Seven patients were retrospectively recruited. Cone beam computed tomography data were obtained and soft tissue and bone shape reconstructions were performed. 3D models were created and surgical cuts were replicated according to postop scans. Each model was imported in ANSYS 2019R1 (Ansys Inc, USA) for simulation: the effect of variation in osteotomy plane as well as extent of bony segment movement were assessed by means of design of experiment: surgical parameters were varied in a surgically acceptable range and the soft tissue predictions were evaluated as displacement output of five craniometric landmarks. Results: Simulation results show the overall changes of the lower third of the face are sensitive to changes in horizontal and vertical displacement of the bony segment as well as segment rotation. No significant changes in the soft tissue response were to attribute to the osteotomy design. Conclusions: Our results are consistent with experimental findings reported in the literature: when planning genioplasty in orthognathic surgery, particular focus on the segment movement (horizontal translation, vertical translation and rotation), rather than on the design of the osteotomy itself, should be considered

Labile plasma iron and echocardiographic parameters are associated to cardiac events in beta-thalassemic patients

Background and aim: Notwithstanding the improvement in therapies, patients affected by thalassemia major (TM) and intermedia (TI) are still at high risk of cardiac complications. This study aimed at evaluating the incidence and predictive factors for developing cardiac events in adult β-TM and TI patients. Population andmethods: Data on diagnosis and clinical historywere collected retrospectively; prospective data on new-onset cardiac failure and arrhythmias, echocardiographic parameters, biochemical variables including non-transferrin-bound iron (NTBI) and labile plasma iron (LPI), magnetic resonance imaging (MRI) T2* measurement of hepatic and cardiac iron deposits, and iron chelation therapy were recorded during a 6 year follow-up. Results: Thirty-seven patients, 29 TM and 8 TI, were included. At baseline, 8 TM patients and 1 TI patient had previously experienced a cardiac event (mainly heart failure). All patients were on chelation therapy and only 3 TM patients had mild-to-severe cardiac siderosis. During follow-up, 11 patients (29.7%) experienced a new cardiac event. The occurrence of cardiac events was correlated to high LPI levels (OR 12.0, 95% CI 1.56-92.3, p 0.017), low mean pre-transfusion hemoglobin (OR 0.21, 95% C.I. 0.051-0.761, p 0.21), and echocardiographic parameters suggestive of myocardial hypertrophy. Multivariate analysis disclosed high LPI and left ventricle mass index (LVMI) as independent variables significantly associated with cardiac events. Cardiac iron deposits measured by MRI T2* failed to predict cardiac events. Conclusion: LPI, Hb levels, and echocardiographic parameters assessing cardiac remodeling are associated to cardiac events in adult TM and TI patients. LPI might represent both a prognostic marker and a potential target for novel treatment strategies. Further studies are warranted to confirm our findings on larger population

Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian a 40-69 year-old cohort in general practice

Scopo. La frazione lipoproteica denominata “colesterolo non-HDL” viene raccomandata come un indice di rischio coronarico (RC) associata alla dislipidemia combinata ed è stata trovata un utile fattore predittivo del rischio coronarico nei pazienti diabetici. Abbiamo studiato l’associazione tra i fattori di RC noti, incluso la colesterolo non-HDL ed una “condizione di RC elevato”, cioè un “RC a 5-anni >15%” in medicina generale. Metodi. Abbiamo studiato 4085 individui di età 40-69 anni, 489 diabetici e 3596 non-diabetici, appartenenti ad una coorte opportunistica. Sono state utilizzate le statistiche descrittive, e la regressione logistica multivariata aggiustata per età e sesso per i confronti tra i 2 gruppi. Risultati. Circa il 12% dei participanti era diabetico. I confronti aggiustati per età e sesso hanno mostrato che tutte le variabili erano significativamente peggiori nei diabetici rispetto ai non-diabetici (eccetto fumo, colesterolo totale e rapporto colesterolo totale/HDL). I diabetici avevano un “RC medio a 5-anni” più alto dei non-diabetici (18.8±11.9% vs 7.5±6.9%, P15%” (55.4% vs 11.1%, P<0.01). Nei diabetici, le variabili associate ad una “condizione di RC elevato” sono: fumo, pressione arteriosa sistolica (PAS) e colesterolemia non-HDL; nei non-diabetici: fumo, PAS, colesterolemia non-HDL e HDL (inversamente). Conclusioni. Il colesterolo non-HDL – oltre a fumo e PAS – è un forte predittore di una “condizione di RC elevato” sia negli individui diabetici che non-diabetici

PSEUDOTUMORE INFIAMMATORIO DEL MEDIASTINO. DESCRIZIONE DI UN CASO.

Il granuloma plasmacellulare o pseudotumore infiamma- torio è una rara lesione proliferativa benigna, con eziologia incerta, che si localizza prevalentemente nel parenchima polmonare ed epatico. Sono stati riportati nella letteratura casi di granuloma plasmacellulare con invasione mediasti- nica [l, 5] e la localizzazione primitiva nel mediastino è estremamente rara [1]. Riportiamo un caso di pseudotumore infiammatorio con esclusiva localizzazione mediastinica, studiato con radiolo- gia tradizionale, TC ed RM e verificato istologicamente

Sleep-related erections and testosterone levels in men

In order to identify a possible threshold for a serum testosterone level below which sleep-related erections are impaired and to compare this threshold with the normal laboratory range of testosterone serum levels, we studied hypogonadal and eugonadal subject

Sexual behavior in a man with aromatase deficiency: role of estrogen on male sexuality

The evaluation of sexual behavior in a man with aromatase deficiency explains the role of estrogen on male sexualit

Piastrinopenia Neonatale di tipo alloimmune: una pulce nell'orecchio

No abstrac

Lymphotropic herpes virus (EBV, HHV-6, HHV-8) DNA sequences in HIV negative Castleman's disease

Aim—To evaluate the possible involvement of lymphotropic herpes viruses in Castleman's disease. Methods—Archival formalin fixed, paraffin wax embedded biopsy specimens from 16 HIV negative patients (11 with localised and five of multicentric disease) were studied. Epstein-Barr virus (EBV), human herpes virus-6 (HHV-6) and human herpes virus-8 (HHV-8) DNA was detected using PCR. PCR was also used to characterise the EBV genomes and the clonal status of the lesions. Results—EBV sequences were identified in nine (56%) cases. The main EBV genotype detected was type 1. Two (12%) cases were positive for both HHV-6 and EBV sequences. HHV-8 sequences were detected in one case of localised Castleman's disease, the sequence of which differed from that of the HHV-8 prototype. No clonal immunoglobulin gene rearrangements were found. Conclusions—EBV DNA was detected in a substantial proportion of cases, suggesting that it may have a role in the pathogenesis of Castleman's disease, unlike HHV-6 which was detected rarely. This is the first report of HHV-8 specific sequences in the localised from of the disease