Standard and low-dose cone beam computer tomography protocol for orthognatodontic diagnosis: a comparative evaluation.

Considering the diagnostic capability offered by cone-beam computed tomography (CBCT), nowadays orthodontists often use this exam for treatment planning, especially in cases of impacted teeth, maxillary ipoplasia, orthognathic surgery etc. The aim of this study was to compare the radiation doses related to a conventional CBCT setting and that of a low dose protocol, usable in orthodontic practice. The absorbed organ doses were measured using an anthropomorphic phantom loaded with thermo-luminescent dosimeters related to sensitive organs (brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, lymph nodes). The device used was a MyRay Hyperion X9-11x5. The standard setting of the apparatus was 90 Kv, 36 mAs, CTDI/Vol 4.09 mGy, instead the low dose one was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. Equivalent and effective doses have been calculated; the measurement of the effective doses was based on the ICRP recommendations. For the assessment of image quality, five readers, independent and experienced orthodontists, were asked to state if the images were sufficient enough to perform an orthodontic diagnosis. The lowest organ dose (5.01 microSv) was received by the esophagus during low dose CBCT acquisition. The highest mean organ dose instead (1227.67 microSv) was received by the salivary glands during conventional setting CBCT acquisition. Image quality has been considered sufficient for orthodontic diagnostic needs for both CBCT protocols. CBCT low dose setting should be preferred over the standard one in orthodontic practice, because it provides a significant lower radiation dose to the patients ensuring a good image quality. However, further studies are necessary to evaluate the opportunity of CBCT exams in orthodontic treatment planning.

International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure.

BACKGROUND: No consensus exists on the optimal settings of mechanical ventilation during veno-venous extracorporeal membrane oxygenation (ECMO). Our aim was to describe how mechanical ventilation and related interventions are managed by adult ECMO centres. METHODS: A cross-sectional, multi-centre, international survey of 173 adult respiratory ECMO centres. The survey was generated through an iterative process and assessed for clarity, content and face validity. RESULTS: One hundred thirty-three centres responded (76.8%). Pressure control was the most commonly used mechanical ventilation mode (64.4%). Although the median PEEP was 10 cmH2O, 22.6% set PEEP <10 cmH2O and 15.5% used 15-20 cmH2O. In 63% of centres PEEP was fixed and not titrated. Recruitment maneuvres, were never used in 34.1% of centres, or used daily in 13.2%. Centres reported using either a "lung rest" (45.7%), or an "open lung" strategy (44.2%). Only 24.8% used chest CT to guide mechanical ventilation. Adjunctive treatments were never or occasionally used. Only 10% of centres extubated patients on ECMO, mainly in more experienced centres. 71.3% of centres performed tracheostomy on ECMO, with large variability in timing (most frequent on days 6-10). Only 27.1% of ECMO centres had a protocol for mechanical ventilation on ECMO. CONCLUSION: We found large variability in ventilatory practices during ECMO. The clinicians' training background and the centres' experience had no influence on the approach to ventilation. This survey shows that well conducted studies are necessary to determine the best practice of mechanical ventilation during ECMO and its impact on patient outcome.

Development of a novel set of Gateway-compatible vectors for live imaging in insect cells.

Insect genomics is a growing area of research. To exploit fully the genomic data that are being generated, high-throughput systems for the functional characterization of insect proteins and their interactomes are required. In this work, a Gateway-compatible vector set for expression of fluorescent fusion proteins in insect cells was developed. The vector set was designed to express a protein of interest fused to any of four different fluorescent proteins [green fluorescent protein (GFP), cyan fluorescent protein (CFP), yellow fluorescent protein (YFP) and mCherry] by either the C-terminal or the N-terminal ends. Additionally, a collection of organelle-specific fluorescent markers was assembled for colocalization with fluorescent recombinant proteins of interest. Moreover, the vector set was proven to be suitable for simultaneously detecting up to three proteins by multiple labelling. The use of the vector set was exemplified by defining the subcellular distribution of Mal de Río Cuarto virus (MRCV) outer coat protein P10 and by analysing the in vivo self-interaction of the MRCV viroplasm matrix protein P9-1 in Förster resonance energy transfer (FRET) experiments. In conclusion, we have developed a valuable tool for high-throughput studies of protein subcellular localization that will aid in the elucidation of the function of newly described insect and virus proteins.

[Evaluation of psychological characteristics in the preoperative phase of patients with mental retardation]. / Valutazione delle caratteristiche psicologiche nella fase prechirurgica dei pazienti con Ritardo Mentale.

OBJECTIVES: To make easier the psychological evaluation of patients affected by Mental Retardation and scheduled for general anesthesia. DESIGN: A form prepared by the Psychological Service of the IRCCS "Oasi Maria SS" in collaboration with the Service of Anesthesia was evaluated prospectively. The form is addressed to relatives and psychologists; the interviewed person is firstly asked for a short description of patient's personality and for any suggestion useful to patient's management; secondly it is requested to assign a score from 1 (never present) to 5 (always present) to 44 items concerning adaptive capacities (divided into body scheme, spoken language, receptive language, mimic-gestural language, temporal orientation, memory), emotional and social fields (including sensibility, dependence, and social behaviors), problematic and stereotyped behaviors. SETTING: A medical and psychological Institute aimed at the study of Mental Retardation. PATIENTS: Twenty-five patients affected by Mental Retardation and scheduled for general and dental surgery. RESULTS: The form supplied a great deal of information and suggestions for patient management. Subjects that did not cooperative with the anesthetist presented lower scores about the ability to use mimic-gestural language (p < 0.05) and higher scores about the presence of anxiety or fear caused by the sight of syringes or blood (p < 0.05) and about behaviors of flight, isolation, or aggression caused by fear (p < 0.05). By contrast, patients presenting mild or moderate degrees of Mental Retardation differentiated from patients with serious degree of Mental Retardation about body scheme (p < 0.001), spoken language (p < 0.05), receptive language (p < 0.001), temporal orientation (p < 0.001) and memory (p < 0.001). CONCLUSIONS: The form was very useful to plan patient management. These data suggest that the lack of cooperation by some patients affected by Mental Retardation is related to fear, anxiety, and incapacity to communicate rather than to the degree of Mental Retardation.