Maxillary segments have the potential for growth during presurgical orthopedic treatment in the early neonatal period. The cleft segment delimitation on digital dental casts and area measurements by the 3D stereophotogrammetric system revealed an accurate (true and precise) method for evaluating the stone casts of newborn patients with UCLP.
Background: Nonsurgical management of symptomatic hip osteoarthritis needs real-world evidence. We evaluated the effectiveness and tolerability of US-guided intra-articular treatment of two hyaluronic acids (HAs) commercially available in Italy and investigated predictors of response.
Methods: Outpatient records including three cohorts: 122 subjects treated with medium (1,500–3,200 kDa; Hyalubrix®) molecular weight (MW) or high (hylan G-F20; Synvisc®) MW HAs and 20 controls taking NSAIDs/analgesics on demand were retrospectively analyzed. Pain VAS score, WOMAC, NSAID/analgesic consumption, and causes of suspension were available at 1, 6, 12, and 24 months after first administration. As selection bias usually affects observational retrospective studies, a quasi-randomization process was attained by performing propensity score approach.
Results: Propensity score adjustment successfully allowed comparisons among balanced groups of treatments. VAS and WOMAC considerably decreased over time in treated groups independently of the radiological grade (p<0.001). On the other hand, the control group showed only a slight and rather uneven variation in VAS. Mean score changes were comparable in both HA cohorts from the earliest stages (ΔVAS(HA1,500–3,200kDa)T1vsT0 = −20%; ΔVAS(hylan G-F20)T1vsT0 = −23%/ΔWOMAC(HA1,500–3,200kDa)T1vsT0 = −17%; ΔWOMAC(hylan G-F20)T1vsT0 = −19%), reaching a further substantial reduction after 12 months (ΔVAS(HA1,500–3,200kDa)T12vsT0 = −52%; ΔVAS(hylan G-F20)T12vsT0 = −53%/ΔWOMAC(HA1,500–3,200kDa)T12vsT0 = −45%; and ΔWOMAC(hylan G-F20)T12vsT0 = −47%). Almost 11% (=13/122) of ineffectiveness and few moderate local side effects 3% (=4/122) were detected.
Conclusions: Viscosupplementation in a real-life setting seems to provide a sound alternative in pain management in comparison to oral NSAIDs/analgesics, guaranteeing a reduced intake of pain killer medications. Analgesic effectiveness, functional recovery, and reduced joint stiffness extend and improve over 12 and 24 months, suggesting that repeated administrations achieve an additive effect.
Cleft lip and/or palate (CL/P) are the most common craniofacial abnormalities. CL/P therapy involves also orthopedic and surgical treatments. In particular, the orthopedic treatment can help to align the cleft segments and facilitate surgery. Traditionally, facial and palatal structures have been analyzed by 2D methods, omitting information of volume bone defects. A pre-surgical volume estimation can be useful to determine the anatomical boundaries of the alveolar bone defect; subsequently, volume assessments can appreciate the outcome of secondary alveolar bone grafting. In the present study, we developed a 3D stereophotogrammetric technique for volume estimation of the dental arches of children with CL/P. The method was employed to assess the 3D changes occurring in the maxillary arch of unilateral CLP (UCLP) patients with the use of plates before the first year of life. We collected 96 palatal casts of 32 neonatal patients with UCLP. Palatal casts were obtained before orthopedic treatment, before cheiloplasty, and after cheiloplasty. Half patients were treated with an active plate, half with a passive one. Casts were marked with a set of landmarks, digitized using a stereophotogrammetric system, and then analyzed. Volumes of the greater and the minor alveolar segments were separately assessed, and compared with a 3-w repeated measures ANOVA. Method accuracy was assessed using objects of known size, while repeatability was evaluated using Student's t test and technical error of measurements. Volume estimates were accurate, without systematic errors; random errors were lower than 5% of the total variance. Significant effects of alveolar segment and time were observed (p<0.0001). Instead, no differences were found for the kind of plate. In conclusion, stereophotogrammetric systems can be a valid instrument to estimate palatal volumes of patients with CL/P during treatment, that can be followed up in a safe, rapid and non-invasive way.
VBG increases the peak of CCK secretion and shortens the time to reach it. These changes could contribute to the satiety effects of gastric restrictive operations.
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