The application of three-dimensional printing in the management of a difficult airway due to Treacher Collins syndrome.

We describe the use of three-dimensional printing to create precise airway models for a patient with Treacher Collins syndrome who presented for bimaxillary temporomandibular joint prostheses, and for whom airway management was predicted to be difficult. The model was based on pre-operative cone beam computed tomography images and printed in the 3D Lab of Hospital Universitario La Paz. Transparent models allowed clear visualisation for simulation and iterative refinement of airway management techniques and aided in risk assessment and instrument sizing. This case report emphasises the utility of this approach in complex airway scenarios.

Fatigue Failure Load of Restored Premolars: Effect of Etching the Intaglio Surface of Ceramic Inlays With Hydrofluoric Acid at Different Concentrations.

The aim of this study was to evaluate the effect of etching, with different hydrofluoric acid concentrations at the intaglio surface of feldspathic ceramic inlays, on the fatigue failure load of restored premolars. A total of 60 upper premolars were embedded in plastic cylinders with acrylic resin (up to 3 mm below the cement-enamel junction) and prepared using a device specially designed for that purpose. Teeth were randomly assigned to three groups (n=20): HF1, HF5, and HF10 (etching with hydrofluoric acid for 60 seconds at concentrations of 1%, 5%, and 10%, respectively). Preparations were scanned and restorations were milled by a computer-aided design / computer-aided manufacturing system. The inner surfaces of the inlays were etched and received an application of a silane coupling agent; the dentin and enamel were treated appropriately for the luting system (RelyX ARC, 3M-ESPE). The restorations were cemented and the fatigue failure load (in N) was determined using the staircase method (10 Hz; 105 cycles in each step). The initial load (585.5 N) was applied on the slopes of the cusps (labial and palatal/lingual, simultaneously) through a cylinder attached to the test machine (Instron ElectroPuls E3000). The tested samples were analyzed under a stereomicroscope for failure analysis. Fatigue data were analyzed by one-way analysis of variance. There was no statistical difference among the fatigue failure loads (in N): HF1 (448.5±79.1), HF5 (360.7±55.4), and HF10 (409.5±121.1). Regarding the fracture mode, there was a predominance of interfacial fracture (50%), followed by cusp fracture (34.6%). It may be concluded that the etching with hydrofluoric acid at the tested concentrations (1%, 5%, and 10%) does not influence the fatigue failure load of feldspathic ceramic inlays cemented on premolars.

Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis.

Systemic sclerosis (SSc) is an autoimmune disease which may lead to malnutrition. Previous studies have defined it with different criteria. No thorough evaluations of sarcopenia in SSc are available. The aim of the present study was to assess the prevalence and the potential association of malnutrition and sarcopenia in a large cohort of SSc cases. A total of 141 SSc consecutive outpatients were enrolled. Body composition was analyzed by densitometry. Malnutrition was defined according to recently published ESPEN criteria, whereas sarcopenia was diagnosed in patients with reduced skeletal muscle index. Malnutrition was diagnosed in 9.2% of patients (95% CI, 4.4-14.0%). Malnourished patients had worse gastrointestinal symptoms according to UCLA SCTC GIT 2.0 questionnaire (p = 0.007), lower physical activity (p = 0.028), longer disease duration (p = 0.019), worse predicted DLCO/VA and FVC (p = 0.009, respectively), worse disease severity according to Medsger severity score (p < 0.001), lower hemoglobin (p = 0.023), and fat-free mass (p < 0.001) and were more often sarcopenic (p < 0.001). In multivariate analysis, only FVC (p = 0.006) and disease severity (p = 0.003), in particular for the lungs (p = 0.013), were confirmed to be worse in malnourished patients. Sarcopenia was diagnosed in 29\140 patients (20.7%; 95% CI, 14.0-27.4%); 11\29 were also malnourished. In multivariate analysis, sarcopenic patients had longer disease duration (p = 0.049), worse DLCO/VA (p = 0.002), and lung (p = 0.006) and skin (p = 0.014) involvement. In SSc, malnutrition defined with ESPEN criteria was found to be lower than previously reported. Sarcopenia was found to be somewhat common. Lung involvement was significantly associated with nutritional status and may not be explained only by muscle weakness.

Quality of life in an Italian cohort of people living with HIV in the era of combined antiretroviral therapy (Evidence from I.A.N.U.A. study-investigation on antiretroviral therapy).

The aims of this study were to assess the Health Related Quality of Life (HRQoL) of People Living with HIV/AIDS (PLWHA) who attend outpatient services in Genoa, Italy, and to evaluate the relationship between HRQoL and clinical factors, primarily: CD4+ cell count, viral load and HIV-Hepatitis C Virus (HCV) coinfection. A cross-sectional study was performed involving a sample of 943 consecutive patients. Firstly the EuroQol-Five Dimensions-Three Level (EQ-5D-3L) self-reported questionnaire was used to evaluate HRQoL, while socio-demographic information was collected using a separate self-administered questionnaire. Descriptive statistical analysis was then used to show the socio-demographic and clinical characteristics of the sample. Having characterized the sample, Pearson's correlation technique was used to assess the relationship between HRQoL and socio-demographic and clinical characteristics. Finally, multivariable linear regression was used to determine factors associated with HRQOL. The median EQ-Visual analogue scale (EQ-VAS) score was 75.4 (SD 18.4). We found statistically significant associations between the EQ-VAS score and age, coinfection with HCV+, education, other drugs taken over cART, hospitalization due to HIV and a CD4+ cell count <200 mm3 compared with CD4+ cell count >500 mm3. Factors independently associated with lower HRQoL were: older age, coinfection with HCV+, other drugs used in addition to cART, hospitalization due to HIV and CD4+ cell count <200 mm3 compared with CD4+ cell count >500 mm3.

Low-temperature degradation of Y-TZP ceramics: A systematic review and meta-analysis.

The aim of this study was to systematically review the literature to assess if low-temperature degradation (LTD) simulation in autoclave promotes deleterious impact on the mechanical properties and superficial characteristics of Y-TZP ceramics compared to the non-aged protocol. The MEDLINE via PubMed electronic database was searched with included peer-reviewed publications in English language and with no publication year limit. From 413 potentially eligible studies, 49 were selected for full-text analysis, 19 were included in the systematic review with 12 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analysis was performed using RevMan 5.1, with random effects model, at a significance level of p<0.05. Descriptive analysis of monoclinic phase content data showed that aging in autoclave promotes an increase in m-phase content (ranging from 0% up to 13.4% before and 2.13% up to 81.4% after aging) with intensity associated to the material susceptibility and to the aging parameters (time, pressure and temperature). Risk of bias analysis showed that only 1 study presented high risk, while the majority showed medium risk. Five meta-analyzes (factor: aging×control) were performed considering global and subgroups analyzes (pressure, time, temperature and m-phase % content) for flexural strength data. In the global analysis a significant difference (p<0.05) was observed between conditions, favoring non-aging group. Subgroup analysis revealed statistical difference (p<0.05) favoring non-aging, for aging time >20h. However, for shorter aging times (≤20h), there was no difference between groups. Pressure subgroup analysis presented a statistical difference (p<0.05) only when a pressure ≥2bar was employed, favoring non-aging group. Temperature subgroup analysis showed a statistical difference (p<0.05) only when temperature=134°C was used, favoring the non-aging group. M-phase % content analysis presented statistical difference (p<0.05) when more than 50% of m-phase content was observed, favoring non-aging group. High heterogeneity was found in some comparisons. Aging in autoclave promoted low-temperature degradation, impacting deleteriously on mechanical properties of Y-TZP ceramics. However, the effect of LTD depends on some methodological parameters indicating that aging time higher than 20h; pressure ≥2bar and temperature of 134°C are ideal parameters to promote LTD effects, and that those effect are only observed when more than 50% m-phase content is observed.

[Borderline personality disorder is easy to treat: are we ready to accept this good news?]. / Le trouble de la personnalité borderline est facile à traiter: sommes-nous prêts à relever le défi?

Recent research indicated that the outcome of borderline patients is better than previously reported. We assessed the impact of co-morbid personality disorders (PD) on response to treatment and 1-year outcome among 206 borderline patients assigned to crisis intervention program. An overwhelming majority (89%) of borderline patients without supplementary Axis 11 psychopathology exhibited good to very good treatment response at acute treatment discharge as well as good to very good global outcome at 1-year followup (85%). Borderline patients meeting criteria for paranoid, schizotypal, antisocial, narcissistic and dependant personality disorder showed, contrarily, significantly more treatment failures.

Combined intra-extra-articular technique for stabilisation of coxofemoral luxation. Preliminary results in two dogs.

OBJECTIVE: To report a new technique for repairing traumatic cranio-dorsal coxofemoral luxation in dogs. METHODS: Stabilisation of hip luxation was carried out in two dogs: a one-year-old male Border Collie and an eight-year-old female American Staffordshire Bull Terrier. A caudal approach was performed to expose the hip joint. Following this, a 2.5 mm hole was drilled through the acetabular wall at the original attachment of the round ligament, followed by a tunnel between the fovea capitis and the proximal third of the femur. Nylon tape was tied in a clove hitch knot around the femoral neck. The tape was placed as a bridge over the ischial spine to create an acetabular roof in order to increase articular stabilisation. RESULTS: Follow-up examinations were performed at 10, 40 and 90 days after surgery.The dogs did not show any signs of lameness, pain or reoccurrence of the luxation during any of the follow-up examinations. CLINICAL SIGNIFICANCE: This tape-technique enabled reinforcement of the acetabular roof which in turn increased the stability of the joint.

The importance of myocardial amino acids during ischemia and reperfusion in dilated left ventricle of patients with degenerative mitral valve disease.

Taurine, glutamine, glutamate, aspartate, and alanine are the most abundant intracellular free amino acids in human heart. The myocardial concentration of these amino acids changes during ischemia and reperfusion due to alterations in metabolic and ionic homeostasis. We hypothesized that dilated left ventricle secondary to mitral valve disease has different levels of amino acids compared to the right ventricle and that such differences determine the extent of amino acids' changes during ischemia and reperfusion. Myocardial concentration of amino acids was measured in biopsies collected from left and right ventricles before cardioplegic arrest (Custodiol HTK) and 10 min after reperfusion in patients undergoing mitral valve surgery. The dilated left ventricle had markedly higher (P < 0.05) concentrations (nmol/mg wet weight) of taurine (17.0 +/- 1.5 vs. 10.9 +/- 1.5), glutamine (20.5 +/- 2.4 vs. 12.1 +/- 1.2), and glutamate (18.3 +/- 2.2 vs. 11.4 +/- 1.5) when compared to right ventricle. There were no differences in the basal levels of alanine or aspartate. Upon reperfusion, a significant (P < 0.05) fall in taurine and glutamine was seen only in the left ventricle. These changes are likely to be due to transport (taurine) and/or metabolism (glutamine). There was a marked increase in the alanine to glutamate ratio in both ventricles indicative of ischemic stress which was confirmed by global release of lactate during reperfusion. This study shows that in contrast to the right ventricle, the dilated left ventricle had remodeled to accumulate amino acids which are used during ischemia and reperfusion. Whether these changes reflect differences in degree of cardioplegic protection between the two ventricles remain to be investigated.

New method for low molecular weight heparin quantification in tablets by suppressed conductivity detection and cryptand column.

Unfractioned Heparins (UFH) and Low Molecular Weight Heparins (LMWHs) are non-chromophoric, high charged sulphated molecules which are difficult to elute and detect with conventional liquid chromatography methods. Moreover, the detection of LMWHs at low concentration level, like in samples coming from dissolution test of tablets formulated with Heparins is problematic due to the weak response by UV or refractive index detection. According to the European Pharmacopoeia requirements, the assay of LMWHs is based on the anti-Xa activity and anti-IIa activity factors, which are biological parameters related to the antithrombotic activity of this compound family. The same assay method could also be applied to determine the dissolution rate of LMWHs contained in tablets, but it is time consuming and expensive test. The challenge was to develop a simpler and faster alternative method based on Ion Chromatography coupled with Suppressed Conductivity detection, but the particular polycharge interaction of LMWHs with anions exchanger makes the analyte with standard eluents and columns difficult to elute . The analytical problem could be solved by using a particular chromatographic phase with 2,2,2 cryptand sites which gives variable capacity in anion exchange depending on the used eluent. Such phase was very effective for the elution of strongly retained polyanions using simple inorganic eluent phase suitable for suppressed conductivity detection as well. The developed method allows the elution of a unique peak, which represents the whole polymeric distribution, and therefore it makes easy to quantify quickly and selectively the active ingredient in case of multiple analysis like when a dissolution test is required to characterize and discriminate between different tablets formulations. The method was tested and developed in Cosmo Pharmaceuticals QC labs and the validation results are reported in the present paper. Besides, a comparison between biological and chromatographic methods was carried out as well.

Rotation of the femoral trochlea for treatment of medial patellar luxation in a dog.

A crossbreed dog was presented with non-weight bearing on the right hindlimb and a semi-flexed stifle. Clinical examination and radiographic investigation showed a grade 3 medial patellar luxation, characterised by hypoplasia of the medial trochlear ridge. No other significant skeletal abnormalities were detected. A 180 degrees rotation of the femoral trochlea was the surgical technique chosen to treat the trochlear dysplasia, the aim being to move the normal lateral ridge to the medial side and thereby prevent patellar luxation. This technique was able to restore correct conformation of the femoral trochlea and preserve the integrity of the trochlear groove cartilage, thus potentially retarding the progression of degenerative joint disease. The dog recovered fully and postoperative radiographic examinations showed healing of the rotated trochlea with only mild signs of degenerative joint disease.

A rare case of adenoid cystic carcinoma of the nasopharynx manifesting as Horner's syndrome: discussion and review of the literature.

Adenoid cystic carcinoma is a malignant tumour involving the salivary glands, rarely developing in the nasopharynx. The biological behaviour of adenoid cystic carcinoma is characterized by slow growth rate, high tendency to local recurrence and metastatic spread. Its histological features are particularly important for prognostic prediction: solid pattern has the worst outcome. Initial presentation of nasopharyngeal adenoid cystic carcinoma with paresis of cranial nerves and Horner's syndrome is infrequent. The Authors present a case of a rare adenoid cystic carcinoma of the nasopharynx, at admission with Horner's syndrome, in a 66-year-old male. Magnetic resonance imaging showed an expansive submucosal lesion of the nasopharynx involving the para-pharyngeal space, tensor and levator veli palati muscles and the apex of petrous bone. Positron emission tomography excluded distant metastasis. Definitive histopathological examination revealed an adenoid cystic carcinoma with mixed cribriform and solid pattern. The patient was treated exclusively with radiotherapy (70 Gy) in 35 fractions with partial reduction of the neoplastic mass.

The Community Balance and Mobility Scale--a balance measure for individuals with traumatic brain injury.

OBJECTIVE: To provide evidence for the validity and reliability of a new outcome measure of balance, the Community Balance and Mobility Scale, developed for the ambulatory individual with traumatic brain injury. DESIGN: A validity and reliability study. SETTING: Acute care, in- and outpatient rehabilitation and day hospital settings. SUBJECTS: Two convenience samples (n=36, 32) of ambulatory patients with traumatic brain injury. MAIN MEASURES: The content and construct validity, test-retest, inter- and intra-rater reliability and internal consistency of the Community Balance and Mobility Scale. RESULTS: Content validity was demonstrated by the involvement of patients with traumatic brain injury (n=7) and clinicians (n=17) in the process of item generation and by physical therapists' ratings of item relevance. Further support is the correlation of the Community Balance and Mobility Scale scores with physical therapists' global balance ratings of the patient (r=0.62). Construct validity was supported by the ability of the measure to differentiate between patients along the continuum of care and also by comparisons with maximal walking velocity (r=0.64). Patients who scored greater than or less than 50 on the balance measure demonstrated significantly different Community Integration Questionnaire scores (P=0.004). The Community Balance and Mobility Scale demonstrated intraclass correlation coefficients (ICCs) of 0.977, 0.977, 0.975 and Cronbach's alpha of 0.96 for intra-, inter-, test-retest reliability and internal consistency, respectively. CONCLUSION: The Community Balance and Mobility Scale is a valid and reliable outcome measure for the ambulatory individual with traumatic brain injury.

Thermal analysis characterization of aortic tissues for cardiac valve bioprostheses.

Two multistep extractions were achieved on porcine aortic tissues to obtain acellular matrices used for cardiac bioprostheses. The evaluation of structural modifications and the possible damage of extracellular matrix fibrous proteins were investigated by means of thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). Protein-water interactions and degradation temperatures were determined by TGA. DSC was used to characterize protein thermal transitions (glass transition and denaturation), which provided information on the dynamic structure of the aortic tissue components. Sodium dodecyl sulfate (SDS) extraction had a destructuring effect, while Triton and cholate treatments did not affect the structural integrity of either elastin and collagen. A DSC comparison showed that SDS destabilizes the collagen triple helical domain and swells the elastin network.

Do immigrants working illegally reduce the natives' legal employment? Evidence from Italy.

PIP: This paper examines how immigrants working illegally in the shadow economy affect the legal employment of native and foreign workers in the official economy of Italy. The data set used was provided by the Central Statistical Office and includes information regarding the units of labor employed both in official production and in underground production; employment in the latter is subdivided into native workers and foreign workers. Estimates were then made as to how "legal employment" has reacted to changes in "illegal employment", with special reference to the effect of the foreign component of "illegal labor". The results of the cross sector-time series analysis of the demand for legal labor in the Italian economy from 1980 to 1995 showed that the increase of illegal units of labor produces a reduction in the use of legal labor, albeit a very limited one. An analysis by sectors shows that the competitive effects of illegal foreign workers is not homogeneous and is strongest in the agricultural sector while complementarity between the two categories of labor is evident in the nontradable services sector. When comparing the number of effects of illegal foreign and illegal native workers, illegal native workers are lower than the illegal foreign workers. Despite regularization in Italy and the lack of flexibility in the labor market, neither regular nor nonregular foreign workers have begun to openly displace native workers.^ieng

[Therapeutic and prophylactic role of mesalazine (5-ASA) in symptomatic diverticular disease of the large intestine. 4 year follow-up results]. / Ruolo terapeutico e profilattico della mesalazina (5-ASA) nella malattia diverticolare sintomatica del crasso. Risultati a 4 anni di follow-up.

In order to evaluate the efficacy and tolerability of mesalazine (5-ASA) in the prophylaxis of symptomatic relapses, of major complications and of microhemorrhagic phenomena in diverticular disease of the large intestine (MDC), prospective clinical study was conducted on patients with light-moderate symptomatic MDC under treatment with sulbactam-ampicillin 1.5 g/12 h i.m. and rifaximine 400 mg/12 h per os for 7 days. Follow-up period of 5 years with seriated checkups and laboratory and instrumentation controls. End points are represented by the relapse on inflammation and/or by the occurrence of major complications. On enrollment, 166 patients were randomized to receive mesalazine (Pentacol tablets--SOFAR S.p.A.) 400 mg b.i.d. per os for 8 weeks (81 patients; group M) or no supplementary treatment (85 patients; group C). After 4 years of follow-up, 44 patients dropped out of the study (9 because of major complications, 3 for massive hemorrhage, and 32 drop outs). Symptomatic relapses occurred in 51 patients (12 M; 39 C), while minor diverticular hemorrhages occurred in 43 patients (12 M; 31 C), with an estimated probability of remaining free respectively from symptomatic relapse (p=0.00005) and from microhemorrhagic phenomena (p=0.001) decisively in favor of the group treated with mesalazine. The duration of abdominal pain due to diverticolitis was also shorter in patients of group M (p=0.0002), while the incidence of major complications and side effects was comparable in the two groups. In conclusion, supplementary treatment with mesalazine in patients affected with MDC--at a follow-up limited to 48 months--proved to be well tolerated and effective in reducing the frequency of symptomatic relapses and microhemorrhagic phenomena and in reducing the duration of abdominal pain.

Should right-sided fibroelastomas be operated upon?

There is general agreement that left-sided elastomas must be removed to avoid systemic complications. Right-sided localization is less risky and surgical treatment is not agreed upon. We report a case of surgical resected fibroelastoma of the tricuspid valve and discuss the indications to surgery by reviewing the literature on the few reported cases. We feel that, if surgery is timely, the tumor can be resected, thus preserving the native valve. This provides an opportunity to prevent possible right-sided complications due to increasing tumor size and embolization.

Aortic dissection in puerperium: a case report.

An acute type A aortic dissection, complicated by massive aortic regurgitation, was diagnosed in the case of a 32-year-old woman, thirty-three days post partum. Emergency operation (Cabrol II) was performed with an uneventful postoperative course. We draw attention to this high risk event, which is particularly apt to involve women within a short time after an otherwise uneventful pregnancy.

Primary repair of coarctation of the thoracic aorta by patch graft aortoplasty. A three-decade experience and follow-up in 60 patients.

OBJECTIVES: The present report is a critical review on primary repair of aortic coarctation by patch aortoplasty on the basis of over 30 years surgical experience. METHODS: Since 1962, 60 patients (mean age 9.4 +/- 4.8 years, range 2-25 years), affected by aortic coarctation, underwent patch aortoplasty repair. During the operation protective guidelines were adopted: additional external Dacron was placed around the repaired site in cases of friable host tissue, the aortic ridge was not excised to leave the posterior aortic wall intact, and the patent ductus arteriosus or ligamentum arteriosum was transected and sutured. Prophylactic measures of neurologic sequelae were: dual pressure monitoring, sequential aortic clamping, surgical shunt or left heart bypass associated with moderate hypothermia when the distal aortic pressure was less than 50 mmHg. RESULTS: No early deaths occurred. The overall survival rate was 92.77 +/- 4.04% at 31 years from surgery. Three late deaths occurred. Pressure gradients across the patch ranged between 9 and 20 mmHg. Late aneurysm occurred in one patient (1.3%), 2 years after bacterial endocarditis had developed on a biscuspid aortic valve. CONCLUSIONS: Patch aortoplasty is an effective and safe surgical procedure for primary repair of isthmic aortic coarctation when other surgical techniques cannot be performed.