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

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

Long-term voice monitoring with smartphone applications and contact microphone

In recent years, the growing interest in the recognition of voice disorders as occupational diseases has required screening methods adaptable to the clinical requirements, capable to extend the collection of baseline data. In this framework, the use of smartphones has gained increasing interest, thanks to advancements in digital technology, which made them suitable for recording and analyzingacoustic signals. Two smartphone applications, based on the Voice Care® technology, have been developed for long-term monitoring of voice activity when combined with a cheap contact microphone embedded in a collar. The applications have been tested in laboratory and used for the monitoring of teachers at kindergarten, primary school, and university. Vocal Holter App allows the selection of short and long term monitoring mode, and three different clusters of vocal parameters related to intensity, intonation, and load, respectively. Most of the results are based on the distributions of occurrences of vocal parameters. A headlight informs the person under monitoring of pathologic voice. Vocal Holter Rec allows data recording and to perform a personalized analysis based on updated parameters. The equipment allows downloading and saving data on a dedicated web site for further processing, comparisons over time, or sharing with physicians or rehabilitators

Criteri metodologici di valutazione e valori guida per il rumore: una proposta per gli ambienti scolastici che considera l’apprendimento degli allievi e lo sforzo vocale degli insegnanti

Introduzione: il Sottogruppo coordinato da AIA con la collaborazione di AIDII e SIMLII si po-ne l’obiettivo di affrontare le tematiche poco note attinenti il disturbo da rumore nei luoghi di vita e di lavoro. Il primo lavoro del Sottogruppo riguarda gli ambienti scolastici. In questi ambienti, condizioni acustiche inadeguate, quali l’elevato rumore di fondo e l’eccessiva riverberazione, producono perdita di concentrazione e affaticamento nei docenti e discenti (1), riducono l’intelligibilità della parola compromettendo l’apprendimento degli allievi (2), determinano negli insegnanti un elevato sforzo vocale i cui effetti si manifestano come sintomi di una vera e propria malattia professionale (3). Obiettivi: nel lavoro si riportano i metodi di misurazione e di calcolo dei parametri acustici fondamentali per la valutazione dell’adeguatezza degli ambienti scolastici (livello del rumore di fondo, rapporto segnale-rumore, tempo di riverberazione, chiarezza, speech transmission index, livello di sforzo vocale), nonché i valori guida riferiti a detti parametri e indicazioni sulla ristrutturazione-progettazione acustica delle scuole. Metodi: l’intelligibilità del parlato è una precondizione essenziale in un ambiente destinato all’apprendimento; si valuta tramite alcuni dei parametri sopra indicati, misurabili e oggetto di norma. È possibile inoltre ricorrere a prove soggettive che consistono in test d’ascolto con materiale vocale registrato da svolgersi in campo o in laboratorio simulando condizioni acustiche ambientali differenti. Il livello di sforzo vocale è valutato tramite monitoraggio dell’attività vocale degli insegnanti per l’intera giornata lavorativa, mediante un dispositivo (Voice Care) costituito da un microfono a contatto da fissare in corrispondenza della fossetta giugulare e da un data logger. Da osservare che il monitoraggio dell’attività vocale può costituire uno strumento di prevenzione d’insorgenza di patologie della voce. Nell’ambito dello studio sono stati rilevati i requisiti acustici di circa cinquanta aule, sono stati eseguiti test d’ascolto su circa ottocento bambini e ragazzi, è stato monitorato lo sforzo vocale di alcune decine di insegnanti. Risultati e discussione: i valori guida sono stati ripresi dalla legislazione straniera e dalla letteratura scientifica e sono stati verificati e validati sperimentalmente al fine di giungere a una proposta integrata nazionale. In Italia la normativa sugli ambienti scolastici risale al 1975: oltre a non essere applicata, essa soffre del fatto di definire requisiti acustici meno stringenti di altri Paesi dove tali requisiti sono aggiornati con il progredire della ricerca. L’AIA sta operando affinché i valori guida proposti siano adottati in sede legislativa al fine di migliorare l’apprendimento e la salute nelle scuole

Pseudoaneurysm overlying an osteochondroma: a noteworthy complication

Pseuodaneurysms are an extremely rare complication of osteochondromas. We describe a case of traumatic pseudoaneurysm of the brachial artery presenting as a soft tissue mass in a patient who was treated for an osteochondroma 3 years earlier. This case demonstrates that radiographic follow-up of large osteochondromas is mandatory and that, in patients with soft tissue masses and a history of osteochondroma, pseudoaneurysms should be included in the differential diagnosis