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Τετάρτη 14 Δεκεμβρίου 2022

Virtual Planning and 3D Printing in the Management of Acute Orbital Fractures and Post-Traumatic Deformities

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Semin Plast Surg 2022; 36: 149-157
DOI: 10.1055/s-0042-1754387

Virtual surgical planning (VSP) and three-dimensional (3D) printing have advanced surgical reconstruction of orbital defects. Individualized 3D models of patients' orbital bony and soft tissues provide the surgeon with corrected orbital volume based on normalized anatomy, precise location of critical structures, and when needed a better visualization of the defect or altered anatomy that are paramount in preoperat ive planning. The use of 3D models preoperatively allows surgeons to improve the accuracy and safety of reconstruction, reduces intraoperative time, and most importantly lowers the rate of common postoperative complications, including over- or undercontouring of plates, orbital implant malposition, enophthalmos, and hypoglobus. As 3D printers and materials become more accessible and cheaper, the utility of printing patient-specific implants becomes more feasible. This article summarizes the traditional surgical management of orbital fractures and reviews advances in VSP and 3D printing in this field. It also discusses the use of in-house (point-of-care) VSP and 3D printing to further advance care of acute orbital trauma and posttraumatic deformities.
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Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 1 0001, USA

Article in Thieme eJournals:
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Maximal exposure of the parapharyngeal internal carotid artery via transnasal and transoral corridors

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Abstract

Background

The parapharyngeal internal carotid artery (pICA) could be surgically exposed through the transnasal and transoral corridors. However, their potential degree of exposure has not been established sufficiently. This study aims to elucidate the maximal exposure of the pICA via the transnasal and transoral corridors.

Methods

An endonasal transpterygoid nasopharyngectomy for exposure of the pICA was performed on eight cadaveric specimens (16 sides), while a transoral approach for exposure of the pICA was performed on six additional specimens (12 sides). In addition, the CT angiography of 60 consecutive patients (120 sides) was analyzed to establish the potential maximal exposure of the pICA through each corridor.

Results

The hard palate becomes a restricting factor for the inferior exposure of the pICA via the transnasal approach, whereas the entire pICA segment could be adequately displayed through the transoral corridor. The maximal exposed length of the pICA for a transnasal and transoral approach was 3.08 ± 0.30 cm and 6.56 ± 0.57 cm, respectively. This difference was statistically significant (p < 0.001).

Conclusion

An endonasal exposure of the pICA seems limited to its superior aspect, whereas the transoral corridor could provide adequate exposure of the entire length of pICA.

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A systematic review of measurement methods used to estimate fluid and beverage intake in free‐living working age adults

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Abstract

Background

Beverage intake in employees is important to quantify due to the potential of dehydration to increase the risk of errors and reduced work performance. This systematic review aimed to 1) characterise existing fluid intake measurement tools used in the workplace setting or amongst free-living, healthy adults of working age and 2) report the current validation status of available assessment tools for use in a UK setting.

Methods

Three electronic databases were searched for publications measuring beverage intake using a defined tool or method. Additional studies were identified by hand from trial registers, grey literature, and reference lists. Eligibility was determined using pre-defined inclusion/exclusion criteria. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology framework. Narrative synthesis was performed.

Results

The review identified 105 studies. The most frequently re ported beverage assessment methods were total diet diaries/records (n=22), fluid specific diaries/records (n=18), food and fluid frequency questionnaires (n=17), beverage specific frequency questionnaires (n=23) and diet recalls (n=11). General dietary measurement tools (measuring beverages as part of total diet) were used in 60 studies, and 45 studies used a beverage specific tool. This review identified 18 distinct dietary assessment tools, of which six were fluid/beverage specific. Twelve tools published relative validity for a beverage related variable and seven tools for total daily fluid intake (from whole diet or from beverages only).

Conclusions

Several fluid intake assessment tools were identified; however, few have been fully evaluated for total beverage intake, and none in a UK working population.

This article is protected by copyright. All rights reserved.

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Determinants of dietary diversity among children 6‐23 months

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Abstract

Background

The Prenatal, perinatal, postnatal and nutritional support study (A3PN), was a four-year initiative aimed to reduce maternal mortality in Haiti. A cross-sectional study was developed to collect baseline data for evaluation purposes of the A3PN. The current study aims to determine the factors contributing to dietary diversity (DD) in Haitian children aged 6 to 23 months.

Methods

A cross-sectional study during two seasons (the lean season and the harvest season) was carried out in Haiti to assess the DD of children and their mothers using non-quantitative 24-hour recalls. Indicators of DD were Minimum Dietary Diversity for Children (MDD-C) and Minimum Dietary Diversity for Women (MDD-W). Mid-Upper Arm Circumference (MUAC) was measured in women and children and food security was assessed using the Household Hunger Scale (HHS). Focus groups were also conducted to gain a better understanding of quantitative findings.

Results

Only 7.3% of t he children included in this study met the MDD-C. Factors associated with MDD-C were the season (OR: 0.141 [0.039-0.513]), land ownership or rental (OR: 4.603 [1.233-17.188]), maternal education (OR: 0.092 [0.011-0.749]), the mother's responsibility for the main or secondary source of income for the household (OR: 2.883 [1.030-8.069]), and her DD (OR: 5.690 [1.916-16.892]). Focus groups revealed the existence of various food restrictions.

Conclusion

The results indicated that the low prevalence of MDD-C in three regions of study in Haiti is indicative of a serious public health concern that might be further aggravated by local food taboos. They also suggest that to fight against hunger it is necessary to focus on women's well-being.

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Therapeutic effects and the impact of statins in the prevention of ulcerative colitis in preclinical models: A systematic review

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Abstract

Ulcerative colitis (UC) is a chronic inflammatory condition of the large intestines. Although great advances have been made in the management of the disease with the introduction of immunomodulators and biological agents, the treatment of UC is still a challenge. So far, there are no definitive therapies for this condition. Statins are potent inhibitors of cholesterol biosynthesis, possess beneficial effects on primary and secondary prevention of coronary heart disease and have high tolerability and safety. Furthermore, they may have potential roles in UC management due to their possible anti-inflammatory, immunomodulatory, and antioxidant activities. This systematic review aimed to gather information about the potential benefits of statins for managing UC, reducing inflammation and disease remission in animal models. A systematic search was performed in PubMed/MEDLINE, Scopus, Web of Science, and Virtual Health Library. The data were summarized in tables and critically analyzed. After the database search, 21 relevant studies were identified as eligible for this review. Preclinical studies using several colitis-induction protocols and various statins have shown numerous beneficial effects of these drugs on reducing disease activity, inflammatory profile, oxidative stress, and general clinical parameters of animals with UC. These studies revealed the potential of statins against the pathogenesis of UC. However, there are still important gaps regarding the molecular mechanisms of action of statins, leading to some contradictory results. Thus, more research on the molecular level to determine the roles of statins in colitis should be carried out to elucidate their mechanisms of action.

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Risk Factors and Outcomes of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study of USRDS Data

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ABSTRACT
Background
Kidney transplant recipients are at increased risk for invasive aspergillosis (IA), a disease with poor outcomes and substantial economic burden. We aimed to determine risk factors for posttransplant IA by using a national database and to assess the association of IA with mortality and allograft failure.
Methods
Using the United States Renal Data System database, we performed a retrospective case-control study of patients who underwent kidney transplant from 1998 through 2017. To evaluate risk factors for IA, we performed conditional logistic regression analysis by comparing characteristics between IA-infected patients and their matched uninfected controls. We performed Cox regression analysis to evaluate the effects of IA on mortality and death-censored allograft failure.
Results
We matched 359 patients with IA to 1,436 uninfected controls (1:4). IA was diagnosed at a median of 22.5 months (IQR, 5.4-85.2 mo nths) after kidney transplant. Risk factors for IA were Black/African American race, duration of pretransplant hemodialysis, higher Elixhauser Comorbidity Index score, weight loss, chronic pulmonary disease, need for early posttransplant hemodialysis, and a history of cytomegalovirus infection. Receiving an allograft from a living donor was protective against IA. IA was a strong independent predictor of 1-year mortality (adjusted hazard ratio, 5.02 [95% CI, 3.58-7.04], P < .001). Additionally, IA was associated with 1-year allograft failure (adjusted hazard ratio, 3.37 [95% CI, 1.96-5.77], P < .001).
Conclusions
Our findings emphasize the importance of timely transplant to mitigate the risk of posttransplant IA. An individualized approach to disease prevention is essential to decrease mortality and allograft failure.
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Epidemiology of human parainfluenza virus type 3 (HPIV-3) and respiratory syncytial virus (RSV) infections in the time of COVID-19: findings from a household cohort

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Abstract
Background
During the COVID-19 pandemic, human parainfluenza type 3 (HPIV-3) and respiratory syncytial virus (RSV) circulation increased as non-pharmaceutical interventions were relaxed. Using data from 175 households (n = 690 members) followed between November 2020–October 2021, we characterizedHPIV-3 and RSV burden in children aged 0-4 years and infection patterns in their households.
Methods
Households with ≥1 child aged 0-4 years were enrolled and members collected weekly nasal swabs (NS) and additional swabs with COVID-like illness onset. We tested all NS from symptomatic episodes in children aged 0-4 years for HPIV-3, RSV, and SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR). Among children with HPIV-3 or RSV infection, we tested all contemporaneous NS collected from household members. We compared incidence rates (IRs) of symptomatic infection with each virus among children aged 0-4 years dur ing epidemic periods, identified household primary infections as the earliest detected infection, and examined community exposures associated with primary infection.
Results
Overall, 41/175 (23.4%) households had individuals with HPIV-3 (n = 45) or RSV (n = 46) infections. Among children aged 0-4 years, IRs of symptomatic infection/1,000 person-weeks were 8.7[6.0, 12.2] for HPIV-3, 7.6[4.8, 11.4] for RSV, and 1.9[1.0, 3.5] for SARS-CoV-2. 35/36 primary HPIV-3 or RSV infections occurred in children aged 0-4 years. Children with childcare/preschool attendance had higher odds of primary infection (OR = 10.81, 95% CI: 3.14-37.23).
Conclusion
Among children aged 0-4 years in this cohort, IRs of symptomatic HPIV-3 and RSV infection were four-fold higher than for SARS-CoV-2 during epidemic periods. HPIV-3 and RSV were almost exclusively introduced into households by infants and preschool children.
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Physiopathology of peri‐implant diseases

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Abstract

Background

Peri-implant health is characterized by the absence of clinical signs of soft tissue inflammation. Peri-implant diseases are initiated by the presence of bacterial biofilms and share a similar etiology as that involved in the onset of periodontal diseases.

Purpose

To summarize available evidence on the physiopathology of peri-implant diseases with emphasis on similarities and differences with periodontal diseases.

Materials and Methods

Evidence on the biologic mechanisms involved in the pathogenesis of peri-implant mucositis and peri-implantitis were explored in the recent scientific literature.

Results

Findings of studies in animals and in humans indicate that experimental peri-implant mucositis leads to a larger inflammatory connective tissue infiltrate and to a higher frequency of bleeding sites around implants compared with teeth. Tissue destruction at experimental peri-implantitis sites is more pronounced compared with that at experimental periodontitis sites. Although human periodontitis and peri-implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a physiopathologic point of view.

Conclusions

Diagnosis of peri-implant health requires a clinical examination to confirm absence of peri-implant soft tissue inflammation. In order to make a correct diagnosis and select the appropriate therapeutic steps to manage peri-implant diseases, knowledge of their pathogenetic mechanisms is required.

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Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

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Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

We describe the results of exome sequencing for genetic diagnosis of hearing loss among a clinically heterogeneous cohort of 218 pediatric patients. We found a higher diagnostic rate for unilateral hearing loss than previously reported as well as a significant number of syndromic forms of hearing loss. Based on these results, we advocate for expanded access to genetic testing for phenotypically diverse hearing loss patients.


Objectives

Genetic testing is the standard-of-care for diagnostic evaluation of bilateral, symmetric, sensorineural hearing loss (HL). We sought to determine the efficacy of a comprehensive genetic testing method, exome sequencing (ES), in a heterogeneous pediatric patient population with bilateral symmetric, bilateral asymmetric, and unilateral HL.

Methods

Trio-based ES was performed for pediatric patients with confirmed HL including those with symmetric, asymmetric, and unilateral HL.

Results

ES was completed for 218 probands. A genetic cause was identified for 31.2% of probands (n = 68). The diagnostic rate was 40.7% for bilateral HL, 23.1% for asymmetric HL, and 18.3% for unilateral HL, with syndromic diagnoses made in 20.8%, 33.3%, and 54.5% of cases in each group, respectively. Secondary or incidental findings were identified in 10 families (5.52%).

Conclusion

ES is an effective method for genetic diagnosis for HL including phenotypically diverse patients and allows the identification of secondary findings, discovery of deafness-causing genes, and the potential for efficient data re-analysis.

Level of Evidence

Level IV Laryngoscope, 2022

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Induced Paresis for Awake Laryngoscopy Procedures

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Induced Paresis for Awake Laryngoscopy Procedures

This article describes an anesthetic technique that induces temporary adductor vocal fold paresis and dense sensory loss of the posterior glottis. This method allows for improved precision of treatment and patient tolerance during awake office-based laryngeal surgery.


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