The Evolution of the Cephalometric Superimposition Techniques from the Beginning to the Digital Era: A Brief Descriptive Review

Superimposition of craniofacial structures from radiographic examination has been always used for assessing changes in the maxilla-mandibular complexes, especially for the evaluation of potential changes occurring during growth as well as after orthodontic treatment and/or maxillofacial surgery. However, the availability of cone beam computed tomography (CBCT) and the recent advancement in 3D imaging have allowed the development of specific techniques for the registration and superimposition of virtual three-dimensional anatomical structures, improving the diagnosis and treatment plan strategies. In the present paper, it will be discussed the evolution of superimposition techniques from the beginning (2D) to the newest 3D approach, describing the most used methods and their main advantages and disadvantages, focusing primarily on accuracy and reproducibility of each technique.

Comparable clinical and functional outcomes after anterior cruciate ligament reconstruction over and under 40 years of age

PURPOSE

The aim of the present meta-analysis was to update the literature on the outcomes and complications of ACL reconstruction in patients aged 40 years and older. It has been hypothesized that patients older than 40 years of age may have comparable clinical outcomes to those of younger patients.

METHODS

A systematic review of articles from 1996 to 2018 was completed using Pubmed, Medline, Cochrane Reviews, and Google Scholar databases using the keyword terms "anterior cruciate ligament reconstruction" and "middle-aged OR elderly OR over 40 OR age factors." Functional and clinical outcomes (International Knee Documentation Committee, Lysholm and Tegner score and KT-1000 arthrometer), complication and graft failure rate were evaluated.

RESULTS

Eleven articles met inclusion criteria. In total, 306 middle-aged patients and 566 younger patients were included in this study. The mean age of patients > 40 was 49 ± 7 (range 40-75) years with a mean follow-up of 25 ± 9 months (range 12-68). The mean age of younger patients was 26 ± 2.7 (range 15-39) years with a mean post-operative follow-up of 26.7 ± 11.5 months (range 3-64). The results were slightly higher (but no significantly different) towards the younger group in terms of objective IKDC (P = n.s.), Lysholm (P = n.s.) and Tegner (P = n.s.) scores and knee laxity assessment (P = n.s.). Complication rate (P = n.s.) and graft failure (P = n.s.) were low even in this cohort.

CONCLUSIONS

The present meta-analysis shows that patients older than 40 years achieve comparable clinical outcomes to those of younger patients following primary ACL reconstruction. This evidence may push the surgeons toward a more aggressive approach in this specific cohort of patients.

LEVEL OF EVIDENCE

III.

ToF-SIMS Depth Profiling of PS-b-PMMA Block Copolymers Using Arn+, C60++, and Cs+ Sputtering Ions

Time-of-flight secondary ion mass spectrometry (ToF-SIMS) is a high performance tool for molecular depth profiling of polymer films, in particular when they are structured in microphases. However, a major issue is the degradation of polymer materials under ion irradiation in reactions such as cross-linking, chain breaking, or reorganization processes of polymers which have been demonstrated for materials such as polystyrene (PS) and poly(methyl methacrylate) (PMMA). This work aims at comparing ToF-SIMS molecular depth profiling of structured polymers (polystyrene (PS)-b-polymethyl methacrylate (PMMA) block copolymers (BCP)) using either ultralow energy cesium or the more recently introduced C₆₀⁺⁺ (under NO dosing and with sample cooling) and argon cluster ion beams (using Ar₁₅₀₀⁺ ions at 5 keV). The latter improved the quality of the depth profiles, especially the argon cluster ion beam, as it is characterized by a greater homogeneity for the sputter yields of PS and PMMA. No significant artifacts were observed, and this was confirmed by the comparison of depth profiles obtained from films with variable thickness, annealing time, and morphology (cylindrical blocks vs spherical blocks). Comparison to a theoretical model (hexagonal centered pattern) ensured that the ToF-SIMS depth profiles described the real morphology and may thus be a relevant characterization tool to verify the morphology of the films as a function of the deposition parameters.

Nitric oxide assisted C60 secondary ion mass spectrometry for molecular depth profiling of polyelectrolyte multilayers

RATIONALE

Secondary ion mass spectrometry (SIMS) with polyatomic primary ions provides a successful tool for molecular depth profiling of polymer systems, relevant in many technological applications. Widespread C60 sources, however, cause in some polymers extensive damage with loss of molecular information along depth. We study a method, based on the use of a radical scavenger, for inhibiting ion-beam-induced reactions causing sample damage.

METHODS

Layered polystyrene sulfonate and polyacrylic acid based polyelectrolyte films, behaving differently towards C60 beam-induced damage, were selected and prepared as model systems. They were depth profiled by means of time-of-flight (TOF)-SIMS in dual beam mode, using fullerene ions for sputtering. Nitric oxide was introduced into the analysis chamber as a radical scavenger. The effect of sample cooling combined with NO-dosing on the quality of depth profiles was explored.

RESULTS

NO-dosing during C60-SIMS depth profiling of >1 micrometer-thick multilayered polyelectrolytes allows detection, along depth, of characteristic fragments from systems otherwise damaged by C60 bombardment, and increases sputtering yield by more than one order of magnitude. By contrast, NO has little influence on those layers that are well profiled with C60 alone. Such leveling effect, more pronounced at low temperature, leads to a dramatic improvement of profile quality, with a clear definition of interfaces.

CONCLUSIONS

NO-dosing provides a tool for extending the applicability, in SIMS depth profiling, of the widely spread fullerene ion sources. In view of the acceptable erosion rates on inorganics, obtainable with C60, the method could be of relevance also in connection with the 3D-imaging of hybrid polymer/inorganic systems.

Chelating Surfaces for Native State Proteins Patterning: The Human Serum Albumin Case

The paper reports a new "soft" surface functionalization strategy, based on a highly selective ion metal chelation process. The proposed stepwise methodology implies at first the construction of a monolayer of terpyridine-based thiol (Tpy), whose highly packed structuring has been followed in situ by using quartz crystal microbalance (QCM-D) measurements, showing that the monolayers consist of about 2.7 × 10(14) Tpy/cm(2). Then, the tridentate sites of the each Tpy moiety are employed to partially chelate divalent metal ions, providing an effective platform to anchoring proteins by completing the metal ion coordination with an available site on the protein of interest. We report the case study of the application of the process to the HSA immobilization onto various surfaces, including Tpy-Fe(II) and Tpy-Cu(II) complexes, as well as hydrophilic bare gold substrates and hydrophobic self-assembled Tpy-based monolayers. It is shown that the chelation interaction between Tpy-Cu(II) complexes and HSA produces the highest and most robust HSA immobilization, with an adsorbed mass at the steady state of ∼800 ng/cm(2), with respect to an average adsorption of ∼350 ng/cm(2) for the other surfaces. Furthermore, Cu(II)-chelated surfaces seem to promote a sort of protein "soft" landing, preventing the ubiquitous surface-induced major unfolding and transmitting an orientation information to the protein, owing to the highly specific symmetry coordination of the Tpy-Cu(II)-protein complex. Indeed, the interaction with a specific monoclonal antiboby (anti-HSA) indicated the lack of a significant protein denaturation, while a massive reorientation/denaturation process was found for all the remaining surfaces, including the Tpy-Fe(II) complex. Finally, the metal-ion-dependent HSA immobilization selectivity has been exploited to obtain micropatterned surfaces, based on the strikingly different strength of interaction and stability observed for Fe(II) and Cu(II) complexes.

Modeling the dispersion of viable and total Escherichia coli cells in the artificial semi-enclosed bathing area of Santa Marinella (Latium, Italy)

Coastal areas are strongly affected by episodes of fecal contamination due to polluted water inflows from inadequately treated sewages. The present study aims to investigate the dispersion of Escherichia coli in the artificial semi-enclosed bathing area of Santa Marinella (Latium, Italy) through in situ samplings carried out in summer 2012 and the application of a dynamic model. Collected samples were analyzed by the Culture-Based technique and the Fluorescent Antibody method in order to estimate both the viable culturable cells and the total E. coli population, respectively. The in situ datasets were used to test the proposed modeling approach and simulate the behavior of bacteria as particles subjected, or not, to decay. Next, the flushing time and the computation of the Microbiological Potential Risk Area allowed the evaluation of the contribution of physical and biological processes to coliform dispersion and the related potential risk for bathers.

Nanoscale electrical investigation of layer-by-layer grown molecular wires

Nanoscopic metal-molecule-metal junctions consisting of Fe-bis(terpyridine)-based ordered nanostructures are grown in layer-by-layer fashion on a solid support. Hopping is demonstrated as the main charge-transport mechanism both experimentally and theoretically.

Assessment of the ecological status of transitional waters in Sicily (Italy): first characterisation and classification according to a multiparametric approach

A 1-year cycle of observations was performed in four Sicilian transitional water systems (Oliveri-Tindari, Cape Peloro, Vendicari and Marsala) to characterise their ecological status. A panel of variables among which trophic and microbial (enzyme activities, abundance of hetetrophic bacteria and of bacterial pollution indicators) parameters, were selected. Particulate organic carbon (POC) and nitrogen (PON) and chlorophyll-a (Chl-a) contents defined the trophic state, while microbial hydrolysis rates and abundance gave insights on microbial community efficiency in organic matter transformation and on allochthonous inputs. To classify the trophic state of examined waters, the synthetic trophic state index (TRIX) was calculated. Microbial hydrolysis rates correlated positively with POC and Chl-a, which increased along the eutrophication gradient. The significant relationships among TRIX, trophic and microbial parameters suggested the use of leucine aminopeptidase, alkaline phosphatase and POC as suitable parameters to implement the Water Framework Directive when assessing the ecological status of transitional water systems.

Memory disturbances in migraine with and without aura: a strategy problem?

Cognitive defects in migraine have been reported by several authors. These findings however, are controversial. In this study we carried out an investigation on 14 patients with migraine with aura and 16 with migraine without aura according to the International Headache Society criteria. They were submitted to a comprehensive battery of neuropsychological tests. The patients were compared with a control group not significantly different as to age, sex and education. Migraine subjects showed impaired neuropsychological performances only on some cognitive tests. Both groups of patients did worse than the control group on visuo-spatial memory tasks, while only migraineurs without aura showed significantly impaired verbal memory performances. The memory defects, both on visuo-spatial and on verbal cognitive tasks, could depend on an impaired recall mechanism. These memory difficulties seem related to strategically and organizationally defective aspects of learning.

Thymic hormones, cancer and behavioural adaptive responses

The effects of thymic hormones are not restricted within the immune system but are rather pleiotropic. Through neuropeptides the neuroendocrine system participates in the regulation of homeostasis as well as in the control of stress response and behavioural outputs. Thymic hormones increase spontaneous behaviour, inhibit anxiety-like responses and improve resistance to stress in tumour-bearing mice. In addition, thymic hormones modulate secretion of pituitary adrenocorticotrophin (ACTH) and beta-endorphin in both primates and rodents. In turn, both ACTH and beta-endorphin influence stress response and behaviour. Besides their neuroendocrine effects, thymic hormones have radioprotective effects either when administered alone or when associated with other radioprotective agents. Thymic hormones are possibly able to reduce postirradiation tissue damage in the bone marrow and in the central nervous system. Finally, evidence suggests a potentiating effect of thymic hormones when associated with current anticancer drugs. From the data reviewed it seems reasonable to conclude that the combination of thymic hormones with cancer therapy is associated with improvement of behaviour and well-being status, protection of tissues from detrimental effects of cancer treatment, and possibly also with potentiation of the antiproliferative effects of other drugs. Thus, thymic hormones could be envisioned as a valuable adjunct to actual cancer therapy.

Norms for the Mini-Mental State Examination in a healthy population

BACKGROUND

Although the Mini-Mental State Examination (MMSE) is widely used in clinical practice, few norms exist for healthy populations covering a broad range of ages.

OBJECTIVE

To obtain MMSE norms specific for age, gender, and education in healthy adults.

METHODS

From the population registers of seven communities across Italy, we selected a proportionate random sample of residents age 20 to 79 years to evaluate their health status with respect to conditions affecting cognitive performance. This sample yielded 908 persons who were deemed to be without cognitive impairment and who were then given the MMSE. We calculated fifth percentile norms and presented them as step functions. We then validated the norms as a screening tool for dementia in persons age 65 to 79 years. The validation was based on unpublished data from a separate study and involved estimates of sensitivity and specificity.

RESULTS

The norms declined with advancing age, especially for less educated women. Given any age and sex, the norms were higher for individuals with higher educational levels. In screening for dementia, the norms had a sensitivity of 85% and a specificity of 89%.

CONCLUSIONS

When using MMSE scores, it is important to account for age, gender, and education, especially in populations where the educational level is low. Expressing MMSE norms as step functions provides an easy-to-use tool for neurologists and other clinicians.

Quantitative cytochemistry of human leukocyte elastase compared with plasma elastase and acute phase proteins in inflammatory diseases

Plasma levels of human leukocyte elastase, a serine proteinase stored in the azurophilic granules of polymorphonuclear granulocytes, increase in the early stages of several inflammatory diseases. We studied the intracellular enzyme activity by cytochemical quantitative image analysis and the amount of elastase released in plasma by an automatic immunoactivation immunoassay method in 66 patients with inflammatory diseases and in a control group. The patients were divided into two groups with infective disease (severe and moderate) and one group with non-infective inflammation. Intracellular activity and plasmatic levels of elastase were also compared with other inflammatory markers, i.e. erythrocyte sedimentation rate, C-reactive protein, alpha 1-antitrypsin, haptoglobin, alpha 1-acid glycoprotein and fibrinogen. Our studies suggest that plasma and leukocyte elastase are correlated both with etiology and with the severity of the inflammation.

Aging and memory: corrections for age, sex and education for three widely used memory tests

The associate learning subtest from the Wechsler Memory Scale; Benton's Visual Retention test and a Controlled Word Association Task (FAS) were administered to a random sample of normal, healthy individuals whose age ranged from 20 to 79 years, recruited within the Italian peninsula. The neuropsychological examination took place on a mobile unit and the tests were given by the same team of neuropsychologists to reduce variability among examiners. The Research Project was known as Progetto Memoria. Corrections to the scores of these tests were calculated for age, sex, and education. These corrected values will allow clinicians to screen for memory impairment with greater precision among normally aging individuals, thus improving differential diagnosis between physiologic and pathologic deterioration of cognitive functions.

Raven's colored progressive matrices: a normative study of a random sample of healthy adults

Raven's Colored Progressive Matrices Test (RCPM) was administered to 894 normal healthy adults who were randomly selected in six Italian cities and in the Republic of San Marino. Gender, age, and education significantly influenced overall test performance, and performance on different RCPM subsets. Findings from this large random sample provide demographic corrections to test scores for use in clinical practice.

[Ischemic hepatitis. Description of 4 cases and review of the literature]

We studied four patients who presented a striking elevation of blood transaminases suggesting acute hepatitis. The post mortem histological examination of the liver revealed centrolobular necrosis that is commonly diagnosed as ischaemic hepatitis. The liver necrosis arose from heart failure which was worsened by an acute anaemia in one patient and by a severe hypoxemia, due to respiratory failure, in another. In three subjects there was evidence of disseminated intravascular coagulation that may be responsible for aggravating the condition of liver hypoxia. The authors also review the literature on the various aspects of ischaemic hepatitis.

[Description of a case of rheumatoid pleuropneumopathy with primary onset]

A case of pleuropulmonary manifestation as the first symptom of rheumatoid arthritis is reported; articular involvement followed at a later stage. Pleuropulmonary localisation of rheumatoid arthritis is varied and infrequent; it is seldom the first manifestation of illness. This case was particular because isolated pleuropulmonary symptom appeared in a subject negative rheumatoid factor. The patient improved after initial NSAIDS treatment, followed by corticosteroids and NSAIDS together, leading to the resolution of clinical and x-ray symptoms.

Preliminary analysis of effects of "normal" aging on different memory processes and abilities

Visual recognition-memory span, name-face association, and verbal memory with selective reminding were tested in two groups of 24 normal healthy volunteers (above and below age 50 yr.). The preliminary study suggests differential effects of aging on specific memory components and warrants careful exploration.

Ecological memory assessment in normal aging. A preliminary report on an Italian population

Forty-eight healthy volunteers were administered a computerized battery of "ecological" memory tests simulating real life everyday tasks and actions such as recalling people's names or telephone numbers. The group was dichotomized according to recent criteria proposed by a NIMH study group. Younger individuals (below 50 years of age) always showed better performances than those over 50. Although the learning curves were significantly lower for the older subgroup, the forgetting rate did not differ, suggesting that most of the memory complaints of the elderly might be attributable to the initial encoding phase of the memorizing activity rather than to a retrieval problem. It seems that easy distractability and inefficient strategic elaboration of incoming information are also, at least in part, responsible for the memory problems associated with normal aging. This article reports preliminary findings of a normative and representative Italian population sample.

Manual behavior, lateralization of manual skills and cognitive performance of preschool children

Direction and degree of manual specialization (functional asymmetry between the hands) on a pegboard task, and fine motor ability (total number of pegs inserted) of both hands were correlated with verbal and visuospatial performances for 47 preschool children. No significant differences were found between right-, and left-, and mixed-handers even though the best motor skills were shown by the 6 mixed-handed subjects, who also had the highest scores on cognitive tasks. Verbal and visuospatial performances were not correlated with degree or direction of manual specialization. They were instead correlated with the level of motor ability of both hands. Motor maturation should be viewed, then, as a process that implies a richer motor performance of both hands and could be interpreted as a more specific diagnostic parameter than the traditional indices of handedness in cognitive fields.

[Chemical and cytologic tests in the differential diagnosis of ascites]

The value of chemical (protein, LDH, glucose, total and differential cell count) and cytological examination of the ascitic fluid in the differential diagnosis of peritoneal ascites was assessed in a prospective study of 98 patients. The ascites caused by hepatic metastases and primary carcinoma were of the transudative type and could not be distinguished from the type caused by cirrhosis on the basis of the parameters examined. In contrast the ascites caused by peritoneal carcinosis was exudative presenting a highly significant (p less than 0.001 for all parameters) difference from the three preceding groups. However there was no clear-cut distinction between the groups: in fact cirrhosis patients may present exudative ascites (8% in the present series, 12-19% in the literature). There was a substantial decrease in ascitic fluid glucose (less than 60 mg/dl) only in peritonitis and its measurement is therefore of secondary importance. In contrast with reports by other authors the ratio between LDH and protein concentrations in the effusion and the serum was found to be insignificant. The cytological examination revealed a significantly higher total cell count in bacterial peritonitis with a prevalence of polymorphonuclear cells and in peritoneal carcinoma where mononuclear cells predominate. Finally cytology revealed malignant tumour cells in the ascitic fluid and neoplastic peritoneal effusions in 28% of the patients examined.

[Advantages and limitations of chemicomorphological study of pleural fluid]

A chemical-physical and morphological examination of 109 pleural samples taken from 66 patients showed that the most reliable laboratory tests for discriminating between an exudate and transudate were specific gravity, total effusion protein content and the effusion/serum protein ratio, while LDH and cell number seem less important. In the differential diagnosis of pleuritis, pleural fluid amylase assays are important only if certain well-defined diseases are suspected (particularly pancreatitis). In this case the assay is irreplaceable. Glucose assay may be carried out for a wider range of complaints although a review of the literature shows it to be always below 30 mg, particularly in cases of rheumatoid arthritis. A cytological examination offers a pathognomonic guide in the case of tumours and as a back-up to other checks for many other complaints.

Influence of different paths on spatial memory performance in the Block-Tapping Test

In a group of 83 normal adults, spatial memory performance in the Block-Tapping Test depended not only on path length but also on digit sequence, which, for a given path length, generates different spatial configurations. Sequences of homogeneous difficulty are proposed for defining the spatial span.

Visual neglect in Parkinson's disease

Recent studies have documented the presence of neglect in patients with subcortical lesions. In this study, we gave 31 patients with Parkinson's disease (14 bilateral, seven right sided and ten left sided) a visual cancellation test. Visual neglect was found only in the bilateral and left-sided parkinsonian patients. These data support the hypothesis that subcortical structures are involved in attentional mechanisms and indicate the dominance of the right hemisphere for these mechanisms.

[Case studies of the histological characterization of primary tumors of the testis]

One hundred-ninety nine cases of testicular tumours, of which 189 (94,9%) germ cell tumours, have been studied by histological methods. Seminoma with its two subtypes (anaplastic and spermatocytic) is the most frequent tumour (110 cases i.e. 55,2%), followed by embryonal carcinoma (30 cases: 15,3%), teratocarcinoma (25 cases: 13,2%), teratoma (12 cases: 6,3%) and choriocarcinoma (5 cases: 2,6%). Tumours showing more than one histologic pattern are frequent. The distinctive histologic features have studied, with emphasis of those useful for diagnostic and prognostic purposes. The ages mostly involved by various tumours are stressed. The rarest tumours are briefly described. Histologic data suggest that germinal tumours are originated by the same primordial germ cell which is able to develop various degrees of differentiation. Histologic and histogenetic features of limphomas and tumours of specialized gonadal stroma are also discussed.

[1 year of automatic management of an analytical laboratory using a part-time computer]

This paper is a report on a one year-automatic management of the Clinical Lab. of the Hospital of Gallarate (Italy) by means of a "part-time" computerization system. Technologies and procedures used for in-patients and out-patients are analysed: by this kind of management many advantages are obtained but some partly unremovable drawbacks, are identified which are mainly caused by the current management of clinical Departments.