Efficacy of three-dimensional visualization in mobile apps for patient education regarding orthognathic surgery

'Sur-face' is an interactive mobile app illustrating different orthognathic surgeries and their potential complications. This study aimed to evaluate the efficacy of Sur-face by comparing two methods of delivering patient information on orthognathic surgeries and their related potential complications: a mobile app with interactive three-dimensional (3D) animations and a voice recording containing verbal instructions only. For each method, the participants' acquired knowledge was assessed using a custom-designed questionnaire. Participants in the 'app' group performed significantly better (P<0.0034) than those in the 'voice' group and retained more knowledge, suggesting that interactive visualizations play a key role in improving understanding of the orthognathic surgical procedure and its associated complications. This study emphasizes the impact of 3D visualizations in delivering information regarding orthognathic surgery and highlights the advantage of delivering validated patient information through mobile apps.

Early changes in longitudinal deformation indices in young asymptomatic patients with type 1 diabetes mellitus: assessment by speckle-tracking echocardiography

BACKGROUND

We explored early changes in regional left ventricular systolic and diastolic function assessed by speckle-tracking echocardiography (STE) in young asymptomatic patients with type 1 diabetes mellitus (DM), compared with healthy controls.

METHODS

We enrolled 30 normotensive asymptomatic patients with type 1 DM, age ≤40 years, DM duration >5 years, and left ventricular ejection fraction ≥50%; and thirty matched controls. They underwent conventional echocardiography, and tissue Doppler imaging (TDI). Myocardial deformation indices were measured by STE. We measured global longitudinal systolic strain, global longitudinal systolic strain rate, and global longitudinal early diastolic strain rate, as an average of 18 myocardial segments.

RESULTS

The mean age was 27.7±4.5 years, (41.7% males). The mean duration of diabetes was 14.3±5.8 years. The 2-D ejection fraction was lower in diabetic patients versus controls (P=0.03). The trans-mitral A peak was higher, and isovolumetric relaxation time longer in diabetics (P<0.05 for both). Both lateral and septal É values were lower, and E/É ratio higher in diabetics (P<0.05 for all). The global longitudinal systolic strain and strain rate were decreased in diabetics (-17.7±2.5% versus -21.2±1.7%, and -1.1±0.2 versus -1.3±0.2 s-1, P<0.001 and P=0.003, respectively). The global longitudinal early diastolic strain rate was comparable to controls (1.5±0.4 versus 1.6±0.3 s-1, respectively, P=0.33).

CONCLUSIONS

In asymptomatic patients with type 1 DM, global longitudinal systolic function measured by STE was impaired versus controls; diastolic function was impaired by conventional echocardiography and TDI.

Effects of Atrial Fibrillation Cardioversion after Percutaneous Mitral Balloon Valvuloplasty on Echocardiographic Left and Right Atrial Functions

Amongst patients with mitral stenosis (MS), the most common complication is AF.Our study aimed at evaluating the effect of AF cardioversion after Percutaneous Mitral Balloon Valvuloplasty (PMBV) on echocardiographic atrial functions. The study included 34 patients with MS and AF, presenting to Ain-shams University hospitals, who underwent successful PMBV then randomized into 2 different groups according to AF management strategy. Group-I patients (n=16) received DC cardioversion after amiodarone infusion (within 24 hours post-PMBV) in addition to anticoagulation. Group-II patients (n= 18) were kept on the rate control strategy for AF and anticoagulation. Atrial functions were evaluated by echocardiography before and 48-72 hours after PMBV. Both groups were homogenous regarding demographic, clinical and echocardiographic data before PMBV. Both groups showed significant improvement in MVA (Group-I: 0.953 ± 0.144cm2 to 2.26 ± 0.463cm2, p=0.000, Group-II: 0.942 ± 0.171cm2 to 1.95 ± 0.40cm2 , p=0.0000), left atrial emptying fraction (Group-I:16.11 ± 6.93% to 26.16 ± 5.51%, p=0.000 , Group-II: 18.49 ± 5.47% to 26.12 ± 7.68%, p=0.002), left atrial function index (Group-I: 4.48 ± 2.32 to 6.84 ± 3.35, p=0.001 , Group-II: 3.34 ± 1.42 to 7.80 ± 4.17, p=0.006) as well as estimated systolic pulmonary artery pressure (Group-I: 49.06 ± 13.86 to 38.25 ± 7.29, p=0.01 , Group-II: 53.44 ± 14.52 to 39.88 ± 10.67, p=0.003). For group-I patients, reduction in left atrial end-diastolic volume was significant (120.84 ± 32.82 mL to 95.31 ± 19.27mL, p=0.012) and TAPSE showed significant improvement (17.57± 4.96 to 21.08 ± 2.52,p=0.018). When percentage improvement in variables was compared between both groups, none of the indices used to evaluate atrial functions showed any significant difference between both groups. Atrial functions improve post-PMBV. No additional improvement in atrial functions occurs after cardioversion in patients who have already undergone PMBV, at least within 72-hours.

[Landmark-based statistical procrustes analysis in the examination of breast shape and symmetry]

AIM

The aim of this presentation is the explanation of a mathematical analysis of a landmark-based procrustes calculation. The various components of breast symmetry and their impact on breast reconstruction have been examined.

METHOD

In an objective breast shape analysis asymmetries are quantified as a measure of the difference between a 3D landmark configuration of a breast and its mirror image. 10 landmarks, 4 on each side and 2 for a definition of the midline were defined. For each landmark the 3D coordinates were calculated statistically with the help of the software Programme R. Over a midline from the jugulum to the manubrium sterni, a mirror image of the breast was constructed. The data for the breast to be reconstructed and the non-operated breast from 44 patients were investigated. The statistical differences of the Procrustes analysis were used for an asymmetry score and the proportions of the individual components were calculated. These included size, location and orientation of the breast as well as the individual inherent morphological surface form data of the breast.

RESULTS

All 44 patients exhibited breast asymmetries and the mean asymmetry score amounted to 0.52. A calculation of the proportions of the individual components making up the asymmetry score revealed that morphological surface data made the largest contribution to the asymmetry score, closely followed by location, i. e., positioning of the breast on the thoracic wall. In contrast, the size of the breast and its orientation were of lesser relevance.

CONCLUSION

When considering breast symmetry in plastic surgery, the form plays a more important role than the size as objectively calculated by the statistical procrustes analysis. Almost equally important as the form is the positioning of the breast on the thoracic wall which contributes significantly more to total breast symmetry than axial displacements.

[Obstructive sleep apnea syndrome in the elderly]

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a common disease in the general population. However, original works on the SAHS in the elderly are few and their results are discordant. Studies show an increased prevalence of OSAHS with age, and despite this high prevalence, it remains under-diagnosed due to lack of knowledge of geriatric features of this disease and the frequency of comorbidities that may worsen as a result of nocturnal breathing problems but can also mask the symptoms necessary for positive diagnosis. The functional symptoms are dominated by neurological signs such as daytime hypersomnia and cognitive impairment often reported by those around the patient. The treatment is based mainly on continuous positive airway pressure which tolerance in elderly patients suffering from sleep apnea is similar to that of younger patients. Mandibular implants can be discussed depending on the severity of the condition. Surgical treatment is not indicated because of the increased frequency of complications.

[Determinants of quality of life in chronic obstructive pulmonary disease]

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease with pulmonary starting point. The use of spirometry alone is certainly not the best way to reflect the impact of disease on quality of life for patients.

PATIENTS AND METHODS

Prospective study concerning 70 patients treated for COPD. Quality of life was assessed using the French version of the Saint-George questionnaire.

RESULTS

Our population was predominantly male (97%) with a mean age of 63 years. All patients were smokers with an average of 46 pack-years. The total score of the Saint-Georges respiratory questionnaire was 50.7%. The mean scores of different fields were 68% for the field activities, 49% for impact and 26% for the item of symptoms. The multidimensional BODE index was correlated with the quality of life and its various fields were more powerfully than the forced expiratory volume per second, the number of exacerbations, the six-minute walking test and dyspnea score.

CONCLUSION

It is important to integrate the multidimensional classification indices in assessing the severity of the disease because only these indices can reflect the systemic aspect of the disease.

[Pseudotumor phenotype of sarcoidosis: about two cases]

INTRODUCTION

Sarcoidosis is a multisystem benign granulomatous disease of unknown etiology. It can sometimes cause diagnostic confusion by presenting in the form of a pseudotumor, thus constituting a trap for the unwary.

COMMENTS

The authors report two cases of pseudotumor sarcoidosis. In the first, the pseudotumor occurred in the context of multisystem disease in a 48-year-old man. The response to treatment with systemic corticosteroids was complicated by the development of disseminated tuberculosis, which was rapidly fatal. The second case, by contrast, was about a 58-year-old woman and the disease was self-limiting, resolving spontaneously in less than 3 months.

CONCLUSION

Through these two cases, the authors focus on the particularities of the pseudotumor manifestation of pulmonary sarcoidosis. The diagnosis is often difficult. The mismatch between the clinical picture and the extent of radiological lesions should, however, suggest the diagnosis. Histological evidence is needed to eliminate other etiologies including malignant tumors. The condition usually resolves either spontaneously or after treatment with systemic corticosteroids. However, relapses are possible, including on discontinuation of corticosteroid therapy.

The accuracy of three-dimensional prediction planning for the surgical correction of facial deformities using Maxilim

The motivation for orthognathic surgery is to improve facial appearance and quality of life. This study aimed to validate a three-dimensional (3D) orthognathic planning programme (Maxilim) for predicting soft tissue changes following Le Fort I advancements. Cone beam computed tomography (CBCT) scans were taken before surgery (T(1)) and at 6-12 months after surgery (T(2)) for 13 patients. For each patient the 3D hard tissue changes between T(1) and T(2) were determined by CBCT superimposition on the cranial vault. Using Maxilim, each patient's skeletal movements were used to generate a 3D soft tissue prediction. The actual soft tissue mesh at T(2) was compared to the predicted mesh. The face was divided into areas: nose, right and left nares, right and left paranasal regions, upper and lower lip, and chin. The absolute distance between meshes for each region was calculated. A one-sample t-test showed the distances between the meshes for all of the areas were within 3 mm (P<0.05), except for the upper lip which was greater than 3 mm (P=0.577). Using Maxilim, 3D soft tissue predictions for Le Fort I advancements were clinically satisfactory in the regions assessed, but associated with marked errors around the region of the upper lip.