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Background Despite the limited number of articles dedicated to its use, augmented reality (AR) is an emerging technology that has shown to have increasing applications in multiple different medical sectors. These include, but are not limited to, the Maxillo-facial and Dentistry disciplines of medicine. In these medical specialties, the focus of AR technology is to achieve a more visible surgical field during an operation. Currently, this goal is brought about by an accurate display of either static or dynamic diagnostic images via the use of a visor or specific glasses. The objective of this study is to evaluate the feasibility of using a virtual display for dynamic navigation via AR. The secondary outcome is to evaluate if the use of this technology could affect the accuracy of dynamic navigation. Case presentation Two patients, both needing implant rehabilitation in the upper premolar area, were treated with flapless surgery. Prior to the procedure itself, the position of the implant was virtually planned and placed for each of the patients using their previous scans. This placement preparation contributed to a dynamic navigation system that was displayed on AR glasses. This, in turn, allowed for the use of a computer-aided/image-guided procedure to occur. Dedicated software for surface superimposition was then used to match the planned position of the implant and the real one obtained from the postoperative scan. Accuracies, using this procedure were evaluated by way of measuring the deviation between real and planned positions of the implants. For both surgeries it was possible to proceed using the AR technology as planned. The deviations for the first implant were 0.53 mm at the entry point and 0.50 mm at the apical point and for the second implant were 0.46 mm at the entry point and 0.48 mm at the apical point. The angular deviations were respectively 3.05° and 2.19°. Conclusions From the results of this pilot study, it seems that AR can be useful in dental implantology for displaying dynamic navigation systems. While this technology did not seem to noticeably affect the accuracy of the procedure, specific software applications should further optimize the results.

The present paper was aimed at reporting the state of the art about lithium disilicate ceramics. The physical, mechanical, and optical properties of this material were reviewed as well as the manufacturing processes, the results of in vitro and in vivo investigations related to survival and success rates over time, and hints for the clinical indications in the light of the latest literature data. Due to excellent optical properties, high mechanical resistance, restorative versatility, and different manufacturing techniques, lithium disilicate can be considered to date one of the most promising dental materials in Digital Dentistry.

Background and objectives: Macrophage Migration Inhibitory Factor (MIF) and D-Dopachrome Tautomerase (DDT) are two pleiotropic and primarily, but not exclusively, proinflammatory cytokines belonging to the MIF family of cytokines that have recently been shown to be implicated in the pathogenesis of progressive forms of human progressive Multiple Sclerosis (MS) and the experimental model counterpart in rodents. Materials and Methods: We have presently evaluated a transcriptomic analysis of the expression of MIF, DDT, their receptors CD74 and CD44, and MIF co-receptors CXCR2, CXCR4, and CXCR7 in peripheral blood of patients with Clinically Isolated Syndrome (CIS), with rapid progression to clinical defined MS. Results: Our analysis reveals that MIF, DDT, and CD44 are overexpressed in CD4+ T cells from patients with CIS, as compared to healthy controls. Accordingly, a significant overlap was observed between the genes overexpressed in CD4+ T cells from patients with CIS and the genes belonging to the MIF regulatory network. This upregulated expression appeared to be unique for CD4+ T cells, as other immune cells including CD8+ T cells, B cells, and monocytes from these patients exhibited expression levels of these molecules that were superimposable to those observed in healthy controls. Conclusions: Overall, our data suggest that the overexpression MIF cytokine family signature may occur in CD4+ T cells from patients with CIS, and that this phenomenon may be implicated in the pathogenesis of the disease, offering the possibility to represent both a diagnostic marker and a therapeutic target.

The ground-based solar telescope THEMIS performed several observations of Mercury’s sodium exosphere in years 2011–2013, when the MESSENGER spacecraft was orbiting around the planet. Typical two-peak exospheric patterns were frequently identified. In previous studies, some specific cases of THEMIS Na two-peak observations were characterized and related to IMF conditions, during specific extreme cases, in the occasion of CME arrival. The present study aims to perform a statistical analysis of Na two-peak emissions in nominal IMF conditions at Mercury, as measured by MESSEGER. The comparison between parameters of Na two-peak exospheric patterns (relative distances and intensities) versus the IMF intensity and Z-component is analysed, demonstrating, in average conditions, the existance of a direct relationship between Na peaks distance/intensity and IMF intensity. Moreover, only when IMF is very low, the shear angle seems to detrmine the occurrence of dayside reconnection when IMF-Z is negative (similarly to the Earth’s case), whereas at higher IMF, it seems that reconnection may occur independently from shear angle. This study supports the idea that particle precipitation is a significant driver of the shaping of Na exosphere morphology, and that only when IMF intensity is particularly low, the dayside magnetospheric structure appears to be more similar to the Earth’s configuration. These results allow to better understand the way the planet reacts to IMF conditions, thus providing interesting clues for the incoming BepiColombo measurement objectives.

Vector-borne parasites might be transmitted through transfusion, notably Plasmodium spp. and Trypanosoma cruzi. Prevention strategies include blood donor screening, deferral, and blood unit treatment by pathogen inactivation methods. At the end of 2015, in line with European guidelines, Italian legislation introduced a questionnaire to identify donors at risk and their screening by serological methods. In early 2016, the Laboratory of Parasitology at Pisa University Hospital started the serological analysis of donors at risk, referring to Transfusion Services located in northwestern Tuscany. The aim of the present study was to describe the prevalence of seropositive donors observed during 8 years of screening. Donors at risk of transmitting malaria were screened by ELISA (Enzyme Linked Immunosorbent Assay). The DRG ELISA kit was employed until 2020, when it was substituted by the Euroimmun ELISA kit based on the results of a comparative evaluation of available commercial kits. Seropositive donors were offered the possibility of Plasmodium DNA testing by Loop-Mediated AMPlification (LAMP) to exclude current infection. Donors at risk of transmitting Chagas disease were screened by ICT employing recombinant antigen until 2021, when it was substituted by ELISA employing lysate antigen because of its higher accuracy. Seropositive donors were further tested by CLIA, and WB was performed in case of discordant results, according to WHO guidelines for diagnosis of chronic Chagas disease. A total of 3754 donors were tested for anti-Plasmodium antibodies, revealing a 6.8% (95% CI = 6.1–7.7%) seroprevalence. Seropositivity was higher among donors from Sub-Saharan Africa (42.9%; 95% CI = 36.1–49.9%) and Southeast Asia (10.6%; 95% CI = 6.7–16.4%). A lower seropositivity was observed when employing Euroimmun ELISA (4.8; 95% CI = 3.8–5.9%) than DRG ELISA (8.2%; 95% CI = 7.1–9.3%). Seropositivity dropped to 3.6% (95% CI = 2.4–5.6) in 2020, likely because of travel restrictions during the COVID-19 pandemic. None of the tested seropositive donors (n = 20) tested positive for Plasmodium DNA LAMP testing. A high proportion of seroreversion was observed after one year of testing. Among 4285 donors tested for anti-T. cruzi antibodies seroprevalence was 0.7% (95% CI = 0.5–1.1%), a higher value than what was observed in a recent national survey. All seropositive donors were born in Europe or Latin America. Seropositivity was apparently lower with ELISA (0.5%, 95% CI = 0.2–1.2%) than ICT (0.8%, 95% CI = 0.6–1.2%), possibly due to ELISA’s higher specificity, although the difference is not significant. No confirmed cases of chronic Chagas disease were identified. The study emphasizes the importance of defining the serological test employed for screening and the need to confirm seropositive results with further testing. The high seroreversion observed in the study suggests repeating seropositive donor screening after a year to minimize deferral and blood unit loss.

Evidence for macroscopic life in the Paleoproterozoic Era comes from1.8 billion-year-old (Ga) compression fossils [Han TM, Runnegar B (1992) Science 257:232–235; Knoll et al. (2006) Philos Trans R Soc Lond B 361:1023–1038], Stirling biota [Bengtson S et al. (2007) Paleobiology 33:351–381], and large colonial organisms exhibiting signs of coordinated growth from the 2.1-Ga Francevillian series, Gabon. Here we report on pyritized string-shaped structures from the Francevillian Basin. Combined microscopic, microtomographic, geochemical, and sedimentologic analyses provide evidence for biogenicity, and syngenicity and suggest that the structures underwent fossilization during early diagenesis close to the sediment–water interface. The string-shaped structures are up to 6 mm across and extend up to 170 mm through the strata. Morphological and 3D tomographic reconstructions suggest that the producer may have been a multicellular or syncytial organism able to migrate laterally and vertically to reach food resources. A possible modern analog is the aggregation of amoeboid cells into a migratory slug phase in cellular slime molds at times of starvation. This unique ecologic window established in an oxygenated, shallow-marine environment represents an exceptional record of the biosphere following the crucial changes that occurred in the atmosphere and ocean in the aftermath of the great oxidation event (GOE).

BackgroundRPD (Robotic pancreatoduodenectomy) was first performed by P. C. Giulianotti in 2001 (Arch Surg 138(7):777–784, 2003). Since then, the complexity and lack of technique standardization has slowed down its widespread utilization. RPD has been increasingly adopted worldwide and in few centres is the preferred apporached approach by certain surgeons. Some large retrospective series are available and data seem to indicate that RPD is safe/feasible, and a valid alternative to the classic open Whipple. Our group has recently described a standardized 17 steps approach to RPD (Giulianotti et al. Surg Endosc 32(10): 4329–4336, 2018). Herin, we present an educational step-by-step surgical video with short technical/operative description to visually exemplify the RPD 17 steps technique.MethodsThe current project has been approved by our local Institutional Review Board (IRB). We edited a step-by-step video guidance of our RPD standardized technique. The data/video images were collected from a retrospective analysis of a prospectively collected database (IRB approved). The narration and the images describe hands-on operative “tips and tricks” to facilitate the learning/teaching/evaluation process.ResultsEach of the 17 surgical steps is visually represented and explained to help the in-depth understanding of the relevant surgical anatomy and the specific operative technique.ConclusionsEducational videos descriptions like the one herein presented are a valid learning/teaching tool to implement standardized surgical approaches. Standardization is a crucial component of the learning curve. This approach can create more objective and reproducible data which might be more reliably assessed/compared across institutions and by different surgeons. Promising results are arising from several centers about RPD. However, RPD as gold standard-approach is still a matter of debate. Randomized-controlled studies (RCT) are required to better validate the precise role of RPD.

BackgroundMinimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp (Surg Endosc 8:408–410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity. Since it was first performed by P. C. Giulianotti in 2001, Robotic PD (RPD) has been gaining ground among surgeons. MIPD is included as a surgical option in the latest NCCN Guidelines. However, lack of surgical standardization, however, has limited the reproducibility of MIPD and made the acquisition of the technique by other surgeons difficult. We provide an accurate description of our standardized step-by-step RDP technique.MethodsWe took advantage of our 15-year long experience and > 150 cases performed to provide a step-by-step guidance of our RPD standardized technique. The description includes practical “tips and tricks” to facilitate the learning curve and assist with the teaching/evaluation process.Results17 surgical steps were identified as key components of the RPD procedure. The steps reflect the subdivision of the RPD into several parts which help to understand a strategy that takes into accounts specific anatomical landmarks and the demands of the robotic platform.ConclusionsStandardization is a key element of the learning curve of RPD. It can potentially provide consistent, reproducible results that can be more easily evaluated. Despite promising results, full acceptance of RPD as the ‘gold standard’ is still work in progress. Randomized-controlled trials with the application of a standardized technique are necessary to better define the role of RPD.

Atopic dermatitis (AD) is a pathological skin condition with complex aetiological mechanisms that are difficult to fully understand. Scientific evidence suggests that of all the causes, the impairment of the skin barrier and cutaneous dysbiosis together with immunological dysfunction can be considered as the two main factors involved in this pathological skin condition. The loss of the skin barrier function is often linked to dysbiosis and immunological dysfunction, with an imbalance in the ratio between the pathogen Staphylococcus aureus and/or other microorganisms residing in the skin. The bibliographic research was conducted on PubMed, using the following keywords: ‘atopic dermatitis’, ‘bacterial therapy’, ‘drug delivery system’ and ‘alternative therapy’. The main studies concerning microbial therapy, such as the use of bacteria and/or part thereof with microbiota transplantation, and drug delivery systems to recover skin barrier function have been summarized. The studies examined show great potential in the development of effective therapeutic strategies for AD and AD-like symptoms. Despite this promise, however, future investigative efforts should focus both on the replication of some of these studies on a larger scale, with clinical and demographic characteristics that reflect the general AD population, and on the process of standardisation, in order to produce reliable data.

Cardiofaciocutaneous (CFC) syndrome is one of the rarest RASopathies characterized by multiple congenital ectodermal, cardiac and craniofacial abnormalities with a mild to severe ocular, gastrointestinal and neurological involvement. It is an autosomal dominant syndrome, with complete penetrance, caused by heterozygous pathogenic variants in the genes BRAF, MAP2K1/MEK1, MAP2K2/MEK2, KRAS or, rarely, YWHAZ, all part of the RAS-MAPK pathway. This pathway is a signal transduction cascade that plays a crucial role in normal cellular processes such as cell growth, proliferation, differentiation, survival, metabolism and migration. CFC syndrome overlaps with Noonan syndrome, Costello syndrome, neurofibromatosis type 1 and Legius syndrome, therefore making the diagnosis challenging. Neurological involvement in CFC is more severe than in other RASopathies. Phenotypic variability in CFC patients is related to the specific gene affected, without a recognized genotype–phenotype correlation for distinct pathogenic variants. Currently, there is no specific treatment for CFC syndrome. Encouraging zebrafish model system studies suggested that, in the future, MEK inhibitors could be a suitable treatment of progressive phenotypes of CFC in children. A multidisciplinary care is necessary for appropriate medical management.