Validating nasogastric tube placement with pH testing: A randomized controlled trial protocol.

Background: Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However, confirming the placement through chest radiography, besides delaying the initiation of nutritional therapy, exposes patients to radiation. The pH test of gastric aspirate provides a quicker check for NGT placement, but its reliability is compromised by challenges related to aspirating gastric secretions. Study objective: The main objective of this study is to assess the high-performance placement of NGTs for nutritional purposes, optimizing the evaluation of correct insertion through pH testing using an electronic pH meter. Additionally, the study aims to evaluate patient tolerance to the intervention. Materials and methods: This single-center RCT will include 150 EN candidate patients divided into three groups. Each group will use distinct NGTs, evaluating placement through pH testing and chest radiography for safety. Tolerance, complications related to NGT placement, and costs will be assessed, with data collected anonymously through a secure electronic database. Ethical considerations: authorization no. 3624, Territorial Ethical Committee Lombardy 5, October 20, 2023. Implications and perspectives: This protocol introduces innovative technologies, such as advanced NGTs and an electronic pH meter, aiming to optimize enteral nutrition management. This RCT focuses on replacing X-rays as the primary method for verifying NGT placement, thereby reducing costs, time, and patient exposure to radiation. Data analysis may provide insights into managing patients on pH-altering medication. Implementing innovative technologies has the potential to reduce errors and improve economic efficiency and process sustainability.

Divergence between CBCT and Optical Scans for Soft Tissue Analysis and Cephalometry in Facial Imaging: A cross-sectional study on healthy adults.

BACKGROUND: Facial soft tissue analysis is becoming increasingly emphasized in orthodontic diagnosis and treatment planning. While traditional cephalometry primarily focuses on hard tissues, recent non-invasive imaging techniques offer the potential to comprehensively evaluate three-dimensional (3D) facial soft tissues. The aim of the study was to establish the geometrical 3D and cephalometric divergence between Cone Beam Computed Tomography (CBCT) derived images and scanned soft tissues. Crucial for enhancing orthodontic diagnosis, minimizing patient exposure to ionizing radiation and providing facial cephalometric parameters. MATERIAL AND METHODS: A cross-sectional study was conducted from January 2020 to May 2023. CBCT and 3D facial scans were obtained simultaneously using a specialized imaging system. Reproducible landmark points were selected for both cephalometric and soft tissue analysis. Angular and linear measurements were recorded, and correlations between CT and facial scans were statistically assessed. RESULTS: Comparisons between 10 CBCT-derived and 10 facial scan-based soft tissue representations resulted into 1.8mm mean root median square (RMS). Angular measurements, such as ANB, right gonial angle, and left gonial angle, exhibited a 0.9° of difference with their respective soft tissue variables. In contrast, linear measurements of total anterior facial height showed a lower correlation coefficient, equal to 0.51. The correlation between soft tissues and underlying hard tissues was more pronounced for gonial angles. CONCLUSION: Facial soft tissue analysis using either 3D facial scans or CBCT-derived offers similar results for orthodontic diagnosis and treatment planning. These findings support the use of non-invasive diagnostic tools in orthodontics, although further investigations are needed to comprehensively understand the complexity of hard and soft tissue relationships.

Socket Preservation Using Dentin Mixed with Xenograft Materials: A Pilot Study.

BACKGROUND: The use of human dentin matrix could serve as an alternative to autologous, allogenic, and xenogeneic bone grafts due to its osteoinductive characteristics. The limitations of its use is tooth availability and that it is often necessary to mix it with a biomaterial. AIM: The aim of this study was to analyze a mix of two different graft materials with different reabsorption ranges when the dentin graft material was not sufficient for full socket preservation. METHODS: Seven socket preservation surgeries were carried out employing a mixed graft material containing 50% dentin and 50% xenograft. After four months of recovery, the implants were positioned. At the time of the prosthesis placement and implant surgery, bone samples were collected. RESULTS: The histologic analysis revealed no inflammatory or infective reaction against the seven biopsies. The histomorphometric graft analysis revealed an amount of New Bone of 29.03 ± 6.57% after 4 months and 34.11 ± 5.02% after 8 months. CONCLUSIONS: The two graft materials had a different volume reabsorption rate: 71% after 4 months and 90% after 8 months for dentin, and 6% after 4 months and 26% after 8 months for the xenograft. The space created by the dentin reabsorption increased the quantity of new bone.

MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19) pandemic. Besides virus intrinsic characteristics, the host genetic makeup is predicted to account for the extreme clinical heterogeneity of the disease, which is characterized, among other manifestations, by a derangement of hemostasis associated with thromboembolic events. To date, large-scale studies confirmed that genetic predisposition plays a role in COVID-19 severity, pinpointing several susceptibility genes, often characterized by immunologic functions. With these premises, we performed an association study of common variants in 32 hemostatic genes with COVID-19 severity. We investigated 49,845 single-nucleotide polymorphism in a cohort of 332 Italian severe COVID-19 patients and 1668 controls from the general population. The study was conducted engaging a class of students attending the second year of the MEDTEC school (a six-year program, held in collaboration between Humanitas University and the Politecnico of Milan, allowing students to gain an MD in Medicine and a Bachelor's Degree in Biomedical Engineering). Thanks to their willingness to participate in the fight against the pandemic, we evidenced several suggestive hits (p < 0.001), involving the PROC, MTHFR, MTR, ADAMTS13, and THBS2 genes (top signal in PROC: chr2:127192625:G:A, OR = 2.23, 95%CI = 1.50-3.34, p = 8.77 × 10-5). The top signals in PROC, MTHFR, MTR, ADAMTS13 were instrumental for the construction of a polygenic risk score, whose distribution was significantly different between cases and controls (p = 1.62 × 10-8 for difference in median levels). Finally, a meta-analysis performed using data from the Regeneron database confirmed the contribution of the MTHFR variant chr1:11753033:G:A to the predisposition to severe COVID-19 (pooled OR = 1.21, 95%CI = 1.09-1.33, p = 4.34 × 10-14 in the weighted analysis).